Active case finding of tuberculosis (TB) in an emergency room in a region with high prevalence of TB in Brazil

PLoS One. 2014 Sep 11;9(9):e107576. doi: 10.1371/journal.pone.0107576. eCollection 2014.


Setting: Public hospital emergency room (ER) in Porto Alegre, Brazil, a setting with high prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) infection.

Objective: To determine the prevalence of PTB, using a symptom based active case finding (ACF) strategy in the ER of a public hospital in an area with high prevalence of TB and HIV, as well as variables associated with pulmonary TB diagnosis.

Methods: Cross sectional study. All patients ≥ 18 years seeking care at the ER were screened for respiratory symptoms and those with cough ≥ 2 weeks were invited to provide a chest radiograph and two unsupervised samples of sputum for acid-fast bacilli smear and culture.

Results: Among 31,267 admissions, 6,273 (20.1%) reported respiratory symptoms; 197 reported cough ≥ 2 weeks, of which pulmonary TB was diagnosed in 30. In multivariate analysis, the variables associated with a pulmonary tuberculosis diagnosis were: age (OR 0.94, 95% CI: 0.92-0.97; p<0.0001), sputum production (OR 0.18, 95% CI 0.06-0.56; p = 0.003), and radiographic findings typical of TB (OR 12.11, 95% CI 4.45-32.93; p<0.0001).

Conclusions: This study identified a high prevalence of pulmonary TB among patients who sought care at the emergency department of a tertiary hospital, emphasizing the importance of regular screening of all comers for active TB in this setting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Brazil / epidemiology
  • Cross-Sectional Studies
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Tertiary Care Centers
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / epidemiology*

Grants and funding

This work was supported by the Fundo de Incentivo à Pesquisa – Hospital de Clínicas de Porto Alegre (FIPE-HCPA). Marcus B. Conde is supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; 300414/2010-2) and Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ; E26/101491/2010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.