INT J TUBERC LUNG DIS 7(6):550–555 © 2003 IUATLD Symptoms in patients attending services for diagnosis of pulmonary tuberculosis in Sudan A. I. El-Sony,* † S. A. Mustafa, ‡ A. H. Khamis, §¶# S. Sobhi,* D. A. Enarson, † O. Z. Baraka,** G. Bjune †† * National Tuberculosis Programme, Khartoum, Khartoum, Sudan; † International Union Against Tuberculosis and Lung Disease (IUATLD), Paris, France; ‡ Epidemiological Laboratory, National Tuberculosis Programme, Khartoum, Khartoum, § Department of Medicine, Ahfad University for Women, Omdurman, Khartoum, ¶ University of Sudan for Science and Technology, Khartoum, Khartoum, # Bayan College for Science and Technology, Khartoum, Khartoum, **University of SUMMARY Khartoum, Department of Medicine, Khartoum, Khartoum, Sudan; †† University of Oslo, Oslo, Norway OBJECTIVE: To describe the variation in clinical fea- tures of individuals presenting to a health facility with chest symptoms according to their ultimate diagnosis. METHODS: Of 16 735 patients (52.6% males and 47.4% females) presenting at respiratory centres in seven states in Sudan, 5338 patients were identified with respiratory tract symptoms: 2917 (54.6%) men and 2421 (45.4%) women, with a mean age of 32 years. Those who had cough for more than 3 weeks that was not responsive to a course of antibiotics were screened by microscopy of two or three sputum specimens and chest radiography. RESULTS: A total of 504 (9.44%) were smear-positive, 259 (4.85%) were smear-negative, and 166 (3.11%) had extra-pulmonary tuberculosis, of whom 59 (1.11%) had pleural involvement; the remaining 4409 suspects (82.6%) were non-tuberculous. CONCLUSION: Tuberculosis patients had a constellation of presenting symptoms, with the principal symptom being cough for more than 3 weeks. The accompanying symptoms with greatest predicted significance were weight loss, tiredness and night sweats. KEY WORDS: tuberculosis; diagnosis; symptoms; Sudan THE GLOBAL EPIDEMIC of tuberculosis (TB) is increasing. The breakdown in health services, the spread of the human immunodeficiency virus and the acquired immune deficiency syndrome (HIV/AIDS) and the emergence of multidrug-resistant TB are con- tributing to the worsening impact of this disease. 1–3 One third of the world’s population is infected with tuberculosis, and around 8 million TB cases and some 2 million deaths occur annually. Most cases and deaths occur in developing countries. 4,5 Smear examination of sputum specimens obtained from patients presenting with respiratory symptoms suggestive of tuberculosis remains the cornerstone of diagnosis of tuberculosis in most locations with a high burden of tuberculosis. The sensitivity of sputum microscopy to identify all cases of tuberculosis, even in good centres, is only about 60%, 6–8 and patients whose smears are negative for acid-fast bacilli (AFB) represent a diagnostic dilemma. Sudan has a low prevalence of HIV among TB patients, of about 7.9%. The HIV prevalence in the country is 1.4% in northern Sudan and 5% in south- ern Sudan. The incidence of TB is thus not affected by the HIV epidemic. 9 The aim of this study was to describe the variation in clinical features of individuals presenting to a health facility with chest symptoms according to their ultimate diagnosis, in order to assist the clinician in diagnosing tuberculosis in settings where resources are limited. A representative sample of patients attending the respiratory disease centres was studied and those suspected of tuberculosis were offered sputum smear microscopy for AFB, radiographic and clinical exam- ination, according to the routine practice of the National Tuberculosis Programme (NTP). PATIENTS AND METHODS Persons between 15 and 49 years of age with respira- tory symptoms seen consecutively in the chest out- patient departments of hospitals and chest clinics at health centres and examined by the health personnel in Gezira, Bahr Al Jebel, Khartoum, Red Sea, Gadarif and Kassala States, including both internally displaced and settled populations, were prospectively enrolled in the study from March 1998 to March 1999. The health services where these patients were seen consti- tute the first level referral and were specialist services Correspondence to: Asma I El-Sony, National Tuberculosis Programme, Federal Ministry of Health, PO Box 193, PC-11 111, Khartoum, Khartoum, Sudan. Tel: (+249) 11-772 182. Fax: (+249) 11-774 412. e-mail: aelsony@hotmail.com Article submitted 9 July 2002. Final version accepted 3 December 2002. [A version in French of this article is available from the Editorial Office in Paris and from the IUATLD Website www.iuatld.org]