Extra-pulmonary and smear-negative forms of tuberculosis are associated with treatment delay and hospitalisation

SETTING: Adult patients with tuberculosis (TB) recruited at the chest clinic of the University Teaching Hospital in Lusaka, Zambia, from 2003 to 2004. OBJECTIVE: To identify factors associated with delayed treatment or hospitalisation. DESIGN: A cross-sectional survey of newly identified adult patients with TB. RESULTS: A total of 223 patients were included in the analysis. Patients with smear-negative disease were 2.6 times more likely to be hospitalised than those with smear-positive disease (95%CI 1.28-5.30), while patients with extra-pulmonary disease were 3.42 times more likely to be hospitalised than those with pulmonary disease (95%CI 1.75-6.66). Patients with smear-negative disease were 2.81 times more likely to have experienced overall delay than those with smear-positive disease (95%CI 1.20-6.66). DISCUSSION: This analysis has demonstrated that patients with extra-pulmonary or smear-negative disease are significantly more likely to be hospitalised. Patients with smear-negative disease arc also more likely to have experienced treatment delay. These data reinforce the urgent need for more robust diagnostic tests, particularly for smear-negative and extra-pulmonary disease. As these forms of disease are more likely to be associated with the human immunodeficiency virus (HIV), the data support earlier diagnosis and treatment of HIV infection.