Abnormalities suggestive of latent tuberculosis infection on chest radiography; how specific are they? (original) (raw)
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Open Forum Infectious Diseases, 2019
Objective Current guidelines recommend screening for latent tuberculosis infection (LTBI) with a tuberculin skin test (TST) or interferon gamma release assay (IGRA), or both. Many also recommend chest radiography (CXR), although its added value is uncertain. This systematic review assessed the prevalence of abnormalities suggestive of LTBI on CXR (LTBI-CXR lesions) and evaluated the strength of the association. Method We searched 4 databases up to September 2017 and systematically reviewed cross-sectional and cohort studies reporting LTBI-CXR lesions in individuals with a positive TST or IGRA, or both, result. Prevalence estimates were pooled using random effects models and odds ratios (ORs) were used to calculate risk estimates. Results In the 26 included studies, the pooled proportion of individuals with LTBI having LTBI-CXR lesions was 0.15 (95% confidence interval [CI], 0.12–0.18]. In 16 studies that reported on individuals with LTBI and uninfected controls, LTBI-CXR lesions wer...
The Prevalence of Active Tuberculosis Among Patients With Fibrotic Lesion in Chest CT-Scan
Jundishapur Journal of Microbiology, 2013
Background: Since tuberculosis (TB) is a major public health problem that is a leading cause of mortality and morbidity among infectious diseases worldwide, early diagnosis and treatment are important to control an effective tuberculosis (TB) and also the increasing number of patients with atypical manifestations of active TB. It suggests more evaluation for active TB in fibrotic lesion in CT scan. Objectives: We evaluated patients with each respiratory complaints and apical fibrocalcification in chest CT scan to detect active TB. Patients and Methods: This study was an observational cross sectional study and was carried out from July 2010 to September 2011 in our teaching hospital. Patients with apical fibrocalcification or fibrocystic lesion in lung CT scan (regardless of the size), without history of TB or other diseases which can cause these lesions were enrolled, then sputum analysis was performed, and in case the result was negative, we did bronchoalveolar lavage for them. Results: We gathered 40 patients out of which 15 patients were women. The average age was calculated at 64 ± 8 years old. In total 6 patients had positive results. Conclusions: According to our observations fibrocalcified lesions should be evaluated for detecting M. tuberculosis particularly in the endemic regions.
How radiology can help pulmonary tuberculosis diagnosis: analysis of 49 patients
Radiologia Medica, 2019
Purpose To identify the most frequent radiological findings of pulmonary tuberculosis using CT of the chest, to determine those with the highest degree of correlation, and, if possible, to identify the most suggestive radiological findings for acidfast bacilli (AFB) positive disease. Materials and methods The radiological and clinical data of 49 patients submitted to CT during diagnosis were retrospectively analysed. The association between findings was assessed using Fisher's exact test, while correlation at CT scan was evaluated with the Spearman analysis. Results Bronchiectasis/bronchioloectasis (89.8%), nodule(s) (81.6%), tree-in-bud (TIB), and consolidation (79.6% each) figured among the most common parenchymal findings. Lymphadenopathy (26.5%) was the most common nodal finding. TIB and cavity showed the highest correlation (r = 0.577), followed by TIB and bronchi(olo)ectasis (r = 0.498), TIB and consolidation (r = 0.497), nodule(s), and ground glass opacity (r = 0.488). High correlation was found in only the seven most frequent parenchymal findings. Consolidation, TIB, and cavity were useful to predict the AFB stain positivity. Conclusions Our series confirms the extreme heterogeneity of pulmonary tuberculosis. It also proves there are couple of findings which can drive us to the right diagnosis. While a triad of findings predicts AFB positivity, we have not found any predictive sign of AFB negativity; consequently, all patients with suspected imaging and clinical findings for TB should be isolated.
Evaluation of Chest X-ray and Thoracic Computed Tomography in Patients with Suspected Tuberculosis
The Indian Journal of Pediatrics, 2015
Objective To investigate if there is any correlation between positive findings detected by posterior-anterior (PA) chest radiograph and thoracic computerized tomography (CT) in cases with suspected lung tuberculosis (TB) due to positive tuberculin skin test (TST) results. Methods This is a retrospective evaluation of the medical files of patients who visited the Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine from 2006, through 2011 as outpatients and had positive TST (>15 mm) results. Results A total of 326 patients were included in the study; 45.7 % (n = 149) were girls, and the mean age was 9.0 ± 4.1 y (range: 1-17 y). In total, 14.4 % (n = 47) had TB findings, all of which were in the form of hilar lymphadenopathy. Among the 47 cases with TB findings in PA chest X-ray, 45 (95.7 %) also had findings in thoracic CT. Only 2 (4.3 %) patients had normal thoracic CT results although their PA chest X-ray results were positive. Conclusions Evaluation for pulmonary TB in children with positive isolated TSTs should be made primarily with PA chest X-ray. A routine thoracic CT scan is not necessary for asymptomatic patients with only hilar lymphadenopathy findings in PA chest radiographs.
European Journal of Radiology, 2005
The relationship between tuberculosis and mankind has been known for many centuries, with the disease being one of the major causes of illness and death. During the early 1980s, there was a widespread belief that the disease was being controlled, but by the mid-1980s, the number of cases increased. This change in the epidemiological picture has several causes, of which the AIDS epidemic, the progression of poverty in developing countries, the increase in the number of elderly people with an altered immune status and the emergence of multidrug-resistant tuberculosis are the most important. Mainly due to this epidemiological change, the radiological patterns of the disease are also being altered, with the classical distinction between primary and postprimary disease fading and atypical presentations in groups with an altered immune response being increasingly reported. Therefore, the radiologist must be able not only to recognize the classical features of primary and postprimary tuberculosis but also to be familiar with the atypical patterns found in immuno-compromised and elderly patients, since an early diagnosis is generally associated with a greater therapeutic efficacy. Radiologists are, in this way, presented with a new challenge at the beginning of this millennium.
Detection of Pulmonary Tuberculosis in Patients With a Normal Chest Radiograph
Chest, 1999
Objectives: To describe the early symptoms of pulmonary tuberculosis (TB) when the chest radiograph (CXR) is normal. Setting: Centralized, provincial TB control program. Subjects: Twenty-five patients with culture-positive pulmonary TB and a normal CXR were identified from a review of 518 consecutive patients with culture-positive pulmonary TB in the province of Saskatchewan from January 1, 1988 to March 31, 1997. Patients with abnormal CXRs at the time of diagnosis were excluded from the analysis. Results: Twenty-three of the 25 patients (92%) were symptomatic at the time of diagnosis, with cough/sputum (76%) being reported most commonly. Eleven patients were identified because of contact tracing from cases of infectious pulmonary TB, while the other 14 patients were identified because of an investigation of symptoms. Twenty-four patients (96%) exhibited one or more symptoms of cough for > 1 month, fever for > 1 week, or skin-test conversion after contact with infectious TB. The sputum smear of only one patient was positive. Two patients were pregnant at the time of diagnosis, one patient was HIV-positive, and one patient demonstrated isoniazidresistant organisms on sensitivity testing. Five patients were diagnosed as having primary TB associated with Mantoux skin-test conversion. The incidence of culture-positive pulmonary TB with a normal chest radiograph was < 1% in the period from 1988 to 1989 and steadily increased to 10% in the period from 1996 to 1997. Conclusions: Culture-positive pulmonary TB with a normal CXR is not uncommon, and the incidence of this presentation is increasing. Patients with this presentation of TB are typically symptomatic and/or are detected by contact tracing to infectious cases of pulmonary TB. The results suggest that patients presenting with a cough for > 1 month, with a fever for > 1 week, or with documented skin-test conversion < 2 years after known exposure to infectious TB should have sputum submitted for a Mycobacterium tuberculosis smear and culture despite a normal CXR.
High resolution computed tomography and chest x-ray findings in patient with pulmonary tuberculosis
Journal of Chitwan Medical College, 2019
Background: Pulmonary Tuberculosis (PTB) is a major public health problem in Nepal. Diagnosis of pulmonary tuberculosis is done by bacteriological confirmation of respiratory specimen however Negative smear needs clinical and radiological evaluation for the diagnosis in suspected patient. This study focuses on radiological findings in both Pulmonary bacteriologically confirmed (PBC) and pulmonary clinically diagnosed (PCD) Tuberculosis. Methods: This observational study was conducted at Chitwan Medical College between Feb 2019 to July 2019. 45 Patient diagnosed with PTB were enrolled. Chest X-ray (CXR) and High Resolution Computed Tomography (HRCT) chest reports were analysed for the presence of findings that suggest active infection like cavity, consolidation, tree in bud, etc in PBC and PCD. Results: A total of 45 PTB patients with mean age: 54.60 ± 19 years were included. 53.3 % were PBC and 46.7 % were PCD tuberculosis, CXR findings in PBC and PCD tuberculosis was nodular inf...
Radiological manifestations of pulmonary tuberculosis
European Journal of Radiology, 2004
Pulmonary tuberculosis (TB) is a common worldwide lung infection. The radiological features show considerable variation, but in most cases they are characteristic enough to suggest the diagnosis. Classically, tuberculosis is divided into primary, common in childhood, and postprimary, usually presenting in adults. The most characteristic radiological feature in primary tuberculosis is lymphadenopathy. On enhanced CT, hilar and mediastinal nodes with a central hypodense area suggest the diagnosis. Cavitation is the hallmark of postprimary tuberculosis and appears in around half of patients. Patchy, poorly defined consolidation in the apical and posterior segments of the upper lobes, and in the superior segment of the lower lobe is also commonly observed.
Chest radiological features among patients with smear positive pulmonary tuberculosis
Caspian journal of internal medicine, 2013
Chest x-ray has an important role in the diagnosis of tuberculosis (TB). The aim of this study was to determine the radiological changes in patients with smear positive pulmonary tuberculosis. In this study, 325 patients with smear positive pulmonary TB was enrolled. The affected lobe or lobes of the left or right lung were recorded. The types of involvement were categorized based on patchy consolidation, cavitation, collapse consolidation and bronchopneumonia. The data were collected and analyzed. From the 325 patients, 116 (35.7%) were males and 209 (64.3%) were females. The most frequent involved site was the left upper lobe in 175 (53.8%) followed by the right upper lobe in 134 (41.2%) cases. The most frequent radiographic finding was bronchopneumonia in 242 (74.4%) cases. Patchy consolidation was detected in 99 (30.4%) patients. Cavitary lesion and pleural effusion were observed in 68 (20.9%) and 35 (10.7%) patients, respectively. The results show that pulmonary upper lobes wer...