Improving the diagnosis and treatment of smear-negative pulmonary and extra-pulmonary tuberculosis among adults and adolescents
Recommendations for HIV-prevalent and resource-constrained settings
Rates of smear-negative pulmonary and extrapulmonary tuberculosis have been rising in countries with HIV epidemics. The mortality rate among HIV-infected tuberculosis patients is higher than that of noninfected tuberculosis patients, particularly for those with smear-negative pulmonary and extrapulmonary tuberculosis. Delayed diagnosis may be an important cause of excess mortality in people living with HIV who have smear-negative pulmonary and extrapulmonary tuberculosis. In the absence of rapid, simple, and accurate diagnostic tools for smear-negative pulmonary and extrapulmonary tuberculosis, diagnostic algorithms have been recommended. Earlier algorithms and recommendations have been developed through consensus and expert opinion, without a firm evidence base. These algorithms extend a patient’s evaluation over a period of time, during which HIV-infected patients may die from undiagnosed tuberculosis or from advanced HIV complications. The Stop TB Strategy now emphasizes the timely diagnosis and treatment of all cases of tuberculosis, including smearnegative pulmonary and extrapulmonary tuberculosis.