Background The clinical and prognostic implications of asymptomatic tuberculosis remain poorly understood. Methods We conducted a multicentre prospective cohort study to evaluate the association between asymptomatic tuberculosis and treatment outcomes. Individuals with rifampicin-susceptible pulmonary tuberculosis were enrolled from the Cohort Study of Pulmonary Tuberculosis. Asymptomatic tuberculosis was defined as the absence of any tuberculosis-related symptoms at diagnosis. The primary outcome was a favourable outcome, defined as treatment success without recurrence. Multivariable logistic regression models were used to assess associations between asymptomatic tuberculosis and favourable outcomes. Cox proportional hazards model was applied to evaluate effect of asymptomatic tuberculosis on failure to complete treatment within one year. Stratified analyses by symptom status and mode of detection were performed to examine stratum-specific effects. Results Of 1071 individuals with pulmonary tuberculosis, 32.7% were asymptomatic. Compared to symptomatic patients, asymptomatic individuals were younger, less likely to be underweight, and more often diagnosed through population health screening rather than clinical presentation or opportunistic testing. Asymptomatic tuberculosis was associated with higher likelihood of favourable outcome in multivariable models (adjusted odds ratioaOR, 1.50; 95% confidence interval CI, 1.04–2.20) and a reduced risk of failing to complete treatment within one year in survival analyses (adjusted hazard ratio, 0.66; 95% CI, 0.45–0.95). Asymptomatic tuberculosis detected through health screening had the most favourable outcomes (aOR, 2.41; 95% CI, 1.34–4.66). Conclusion Asymptomatic tuberculosis was significantly associated with treatment success without recurrence, and particularly in patients identified through health screening. Our results support symptom-agnostic screening in tuberculosis control programs.
Park et al. (2025) studied this question.