Smear-positive pulmonary tuberculosis and risk factors in non-HIV patients at a tertiary care hospital in Larkana
DOI:
https://doi.org/10.55629/pakjpathol.v37i3.1037Abstract
Objective: To determine the frequency of smear-positive pulmonary tuberculosis and identify its associated risk factors among non-HIV patients at a tertiary care hospital in Larkana.
Material and Methods: This cross-sectional study was conducted at the Department of Pulmonology, SMBBMU, Larkana, 15th December 2025 till 15th June 2026. A total of 176 HIV-negative patients aged 18 to 60 years with presumptive pulmonary tuberculosis were enrolled by consecutive sampling. Demographic, clinical, behavioural and radiological variables were noted, and two sputum samples were tested for AFB. Chi-square, Fisher’s exact and logistic regression were used to assess associations through SPSS-26.0
Results: Among 176 HIV-negative presumptive PTB patients, 31 (17.6%) were smear-positive by direct sputum smear microscopy. The mean age was 36.8 ± 11.1 years, and males constituted 60.8% of participants. Smoking (aOR 7.97; p<0.001), TB contact (aOR 4.99; p<0.001), and previous TB history (aOR 4.84; p=0.003) were independent predictors of smear positivity. Cavitation and consolidation were significantly more frequent among smear-positive patients.
Conclusion: Smear-positive pulmonary tuberculosis affected nearly one in six HIV-negative presumptive patients. In addition to diabetes, alcohol use and low BMI, exposure-related factors, especially smoking, and modifiable factors (contact with TB a case and previous TB) were independently associated with positivity. These findings convey the burden in that locality and the characteristics of the patients most likely to be smear-positive.
Keywords: Acid-fast, Microscopy, Risk factors, Smoking, Sputum, Tuberculosis, Pulmonary.
References
Tobin EH, Tristram D. Tuberculosis overview. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. Updated 2024 Dec 22 [cited 2026 Jul 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441916/
Jain R, Gupta G, Mitra DK, Guleria R. Diagnosis of extrapulmonary tuberculosis: an update on novel diagnostic approaches. Respir Med. 2024; 225: 107601. DOI: https://doi.org/10.1016/j.rmed.2024.107601
Hemalatha VS, Thaliath ZX, Somson HT. Comparison of pulmonary tuberculosis and extra pulmonary tuberculosis in a tertiary care setting. Int J Acad Med Pharm. 2023; 5(1): 225-8. Available from: https://academicmed.org/Uploads/ Volume5Issue1/47.-9.-JAMP_Arpitha-225-228.pdf
Li X, Li Y, Guo L, Chen Y, Wang G, Zhang H. Tuberculosis incidence, deaths and disability-adjusted life years in children and adolescence, 1990-2021: Results from the Global Burden of Disease Study 2021. PLoS One. 2025; 20(3): e0317880. DOI: https://doi.org/10.1371/journal.pone.0317880
Shang W, Cao G, Jing W, Liu J, Liang W, Liu M. Global burden of tuberculosis in adolescents and young adults: 1990-2019. Pediatrics. 2024; 153(4): e2023063910. DOI: https://doi.org/10.1542/peds.2023-063910
World Health Organization. Global tuberculosis report 2024. Geneva: World Health Organization; 2024. Available from: https://iris.who.int/server/ api/core/bitstreams/7292c91e-ffb0-4cef-ac39-0200f06961ea/content
Ullah H, Ahmed H, Salman A, Iqbal R, Hussaini SJ, Malikzai A. The rising tide of tuberculosis in Pakistan: factors, impact, and multi-faceted approaches for prevention and control. Health Sci Rep. 2024; 7(10): e70130.
DOI: https://doi.org/10.1002/hsr2.70130
Teibo TK, Andrade RL, Rosa RJ, de Abreu PD, Olayemi OA, Alves YM, et al. Barriers that interfere with access to tuberculosis diagnosis and treatment across countries globally: A systematic review. ACS Infect Dis. 2024; 10(8): 2600-14. DOI: https://doi.org/10.1021/acsinfecdis.4c00466
Bartolomeu-Goncalves G, Souza JM, Fernandes BT, Spoladori LF, Correia GF, Castro IM, et al. Tuberculosis diagnosis: current, ongoing, and future approaches. Diseases. 2024;12(9): 202. DOI: https://doi.org/10.3390/diseases12090202
Chopra KK, Singh S. Tuberculosis: newer diagnostic tests: Applications and limitations. Indian J Tuberc. 2020; 67(4): S86-90. DOI: https://doi.org/10.1016/j.ijtb.2020.09.025
Mantefardo B, Sisay G, Awlachew E. Assessment of smear-positive pulmonary tuberculosis and associated factors among patients visiting health facilities of Gedeo Zone, Southern Ethiopia: A cross-sectional study. Tuberc Res Treat. 2023; 2023: 2502314. DOI: https://doi.org/10.1155/2023/2502314
Tang D, He J. Risk factors for sputum-smear positive in active tuberculosis patients. Eur Respir J. 2024; 64(Suppl 68): PA4179. DOI: https://doi.org/10.1016/j.micpath.2026.108319
Hameed S, Zuberi FF, Hussain S, Ali SK. Risk factors for mortality among inpatients with smear positive pulmonary tuberculosis. Pak J Med Sci. 2019; 35(5): 1361-5. DOI: https://doi.org/10.12669/pjms.35.5.919
Park J, Yoon JH, Ki HK, Han K, Kim H. Lifestyle changes and risk of tuberculosis in patients with type 2 diabetes mellitus: a nationwide cohort study. Front Endocrinol (Lausanne). 2022; 13: 1009493. DOI: https://doi.org/10.3389/fendo.2022.1009493
Antonio-Arques V, Franch-Nadal J, Moreno-Martinez A, Real J, Orcau A, Mauricio D, et al. Subjects with diabetes mellitus are at increased risk for developing tuberculosis: A cohort study in an inner-city district of Barcelona (Spain). Front Public Health. 2022; 10: 789952. DOI: https://doi.org/10.3389/fpubh.2022.789952
Sinshaw W, Kebede A, Bitew A, Tesfaye E, Tadesse M, Mehamed Z, et al. Prevalence of tuberculosis, multidrug resistant tuberculosis and associated risk factors among smear negative presumptive pulmonary tuberculosis patients in Addis Ababa, Ethiopia. BMC Infect Dis. 2019;19(1):641. DOI: https://doi.org/10.1186/s12879-019-4241-7
Amin W, Gadallah M, Salah A, Rady M. Prevalence of Rifampicin resistance tuberculosis among presumptive tuberculosis patients in Egypt-2021: A national health facility-based survey. BMC Infect Dis. 2024;24(1):210. DOI: https://doi.org/10.1186/s12879-023-08807-7
Sorsa A, Kaso M. Diagnostic performance of GeneXpert in tuberculosis-HIV co-infected patients at Asella Teaching and Referral Hospital, Southeastern Ethiopia: A cross sectional study. PLoS One. 2021; 16(1): e0242205. DOI: https://doi.org/10.1371/journal.pone.0242205
Martinez L, Cords O, Horsburgh CR, Andrews JR, et al. The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis. Lancet. 2020; 395(10228): 973-84. DOI: https://doi.org/10.1371/journal.pone.0242205
Siddalingaiah N, Chawla K, Nagaraja SB, Hazra D. Risk factors for the development of tuberculosis among the pediatric population: a systematic review and meta-analysis. Eur J Pediatr. 2023; 182(7): 3007-19.
DOI: https://doi.org/10.1007/s00431-023-04988-0
Pourali F, Khademloo M, Abedi S, Roozbeh F, Barzegari S, Moosazadeh M. Relationship between smoking and tuberculosis recurrence: a systematic review and meta-analysis. Indian J Tuberc. 2023; 70(4): 475-82. DOI: https://doi.org/10.1016/j.ijtb.2023.04.010
Tan J, Shi X, Pi Y, Xiang M, Li T. Nutritional scores predict the prognosis of patients with pulmonary tuberculosis. Front Nutr. 2024; 11: 1454207. DOI: https://doi.org/10.3389/fnut.2024.1454207
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