Longitudinal symptom transitions predict incident tuberculosis risk among persons deprived of liberty in Brazil
Jung, E.; Bampi, J. V. B.; da Silva, A. M.; Liu, Y. E.; Tsuha, D. H.; Salindri, A. D.; Santos, A. d. S.; de Oliveira, R. D.; Croda, J.; Andrews, J. R.
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Tuberculosis (TB) screening often relies on cross-sectional symptom assessment. To determine the added value of longitudinal symptom monitoring, we conducted a prospective cohort study among 2,282 incarcerated men in Brazil. Every four months, participants were assessed for symptoms and incident TB (Xpert or culture positive). Compared to remaining asymptomatic, developing symptoms was associated with higher TB risk (aRR 2.31; 95% CI 1.55-3.43), strongest among those with prior radiographic abnormalities (aRR 2.49; 95% CI 1.56-3.97), while remaining symptomatic was not associated (aRR 1.27; 95% CI 0.72-2.24). Longitudinal symptom monitoring may enhance TB screening in high-risk settings, particularly in complement with radiography. GENERAL SUMMARYIn an active case-finding program for TB, developing new symptoms was associated with over double the TB risk, while persistent symptoms were not. Monitoring symptom changes longitudinally, especially combined with chest radiography, may improve TB case detection in high-risk settings.
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