Detection of Pulmonary Tuberculosis in Patients With a Normal Chest Radiograph (original) (raw)
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Diagnostic yield of sputum, induced sputum and bronchoscopy after radiological TB screening
Rationale: To assess feasibility and yield of diagnostic procedures after active case finding for tuberculosis with radiologic screening at the three main entry points for asylum seekers to Switzerland. Method: Prospective multicenter study on the value of symptoms, spontaneous and induced sputum, and bronchoscopy for the confirmation of tuberculosis in radiologically selected cases. Results: Among 101 asylum seekers examined, spontaneous sputum was collected "on the spot" in 83 and yielded 7 (54%) of 13 smearpositive and 13 (39%) of 33 culture-positive cases. Morning sputum, collected in 84, yielded 8 (62%) and 16 (49%), and the two spontaneous sputa combined 9 (69%) and 20 (61%), respectively. Two additional induced sputa, collected in 91 persons, yielded no additional smear-positive, but yielded seven culture-positive cases (yield, 82%). Bronchoscopy, performed in 87 of 92 sputum smearnegative cases, yielded four additional smear-positive and six culture-positive cases. Culture confirmation was independently and significantly predicted by obtaining a specimen using bronchoscopy (adjusted odds ratio, 11.0; 95% confidence interval, 1.9-62) and a prior decision to treat (adjusted odds ratio, 3.0; confidence interval, 1.1-8.1). Conclusion: Radiographic anomalies compatible with tuberculosis found during screening are a poor guide to initiation of treatment. Respiratory and systemic symptoms correlated weakly with culture confirmation of tuberculosis. All radiologically selected cases must be examined with on-the-spot and early-morning sputum, regardless of symptoms. If both specimens are smear negative, the yield is increased by bronchoscopy and, to a lesser extent, by two samples of induced sputum. The examination of any single specimen has a low yield of 36 to 63% and is insufficient to exclude active tuberculosis.
Criteria for diagnosis in pulmonary tuberculosis
JPMA. The Journal of the Pakistan Medical Association, 1990
In a retrospective study, case records of 1061 patients treated with antituberculosis drugs were examined to assess the criteria for diagnosis in each case. Seventy six percent had sputum examined for A.F.B. and 45% had mantoux test done. Five hundred and eighty one (55%) were diagnosed on radiology alone, while 262 (25%) had positive sputum for A.F.B. Only 50 (5%) of cases had positive Mantoux in addition to positive sputum and radiological changes. Practical significance of this practice is discussed.
Unexpected Pulmonary Involvement in Extrapulmonary Tuberculosis Patients
CHEST Journal, 2008
Background: This study aimed to assess the utility of sputum examinations and chest radiographs (CXRs) in patients with extrapulmonary tuberculosis (XPTB) to detect pulmonary involvement of tuberculosis (TB). Methods: We studied 72 XPTB patients who were managed through the TB Program, King County, WA, from January 2003 through November 2004. Results: The two most common sites of XPTB were the lymph nodes (36 [50%]) and pleura (12 [17%]). Thirty-five of 72 XPTB patients (49%) had abnormal CXR findings. Sputum was not obtained from 15 patients despite sputum induction. Of the 57 patients from whom sputum was collected, 30 (53%) had abnormal CXR findings, 5 (9%) had sputum smears that were positive for acid-fast bacilli, and 12 (21%) had sputum cultures that were positive for Mycobacterium tuberculosis. Weight loss was significantly associated with positive sputum culture findings in a multivariate analysis (odds ratio, 4.3; 95% confidence interval, 1.01 to 18.72; p ؍ 0.049). There was no significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings and those with normal CXR findings (7 of 30 patients [23%] vs 5 of 27 patients [19%], respectively; p ؍ 0.656). Of 24 HIV-negative XPTB patients with normal CXR findings, 2 patients (8%) had positive sputum culture findings. Conclusions: CXR results did not reliably differentiate XPTB patients with and without positive sputum culture findings. Some XPTB patients had positive sputum culture results despite normal CXR findings and negative HIV status. Weight loss in XPTB patients was associated with positive sputum culture results. Sputum examinations in XPTB patients, regardless of the CXR results, may identify potentially infectious cases of TB. (CHEST 2008; 134:589 -594)
International Journal of Applied Dental Sciences
This research covered 100 patients. According to the Revised National Tuberculosis Control Program (RNTCP) guidelines published in the Technical and Operational Guidelines for Tuberculosis Control in India 2016, children aged 6 months to 18 years who present with constitutional symptoms such as persistent fever >2 weeks without a known cause and/or unremitting cough for >2 weeks and/or weight loss of 5% in three months or no weight gain in the previous three months along with any one of the following findings, i.e., his The radiology department performed a chest X-ray and reported findings indicative of tuberculosis, such as hilar and paratracheal lymphadenopathy, parenchymal lesions, and cavitatory lesions. Results: The study covered 100 juvenile patients with an average age of 12.044.96 years. In the research, 58 percent of the individuals were older than 11 years old. The study had a female predominance. Only 44 (44%) male patients participated in the trial, compared to 56 (56%) female patients. The most prevalent complaint was fever (84 percent), followed by cough (76 percent). Other major symptoms at the start of the disease were weight loss (88 percent), lack of appetite (86 percent), and shortness of breath (16 percent). Haemoptysis, chest discomfort, and shortness of breath were less common. Out of 100 participants, 22% tested positive for Mycobacterium tuberculosis, whereas the remaining 78 percent tested negative by both ZN staining and CBNAAT. The proportion of CBNAAT positive patients with cavitation on chest X-ray was 63 percent, which was substantially higher than the national average (p-0.0018). Conclusion: We determined that females were more likely than males to be infected with tuberculosis. The study also discovered that patients with clinical findings indicative of pulmonary Koch's do not necessarily have positive sputum CBNAAT. Sputum positivity was shown to be substantially related to a cavitatory lesion on a chest X-ray.
How many sputum specimens are necessary to diagnose pulmonary tuberculosis
American Journal of Infection Control, 2005
The definitive diagnosis of pulmonary tuberculosis (PTB) relies on identifying or culturing Mycobacterium tuberculosis from respiratory specimens. National guidelines have recommended obtaining 3 sputum specimens from patients with suspected tuberculosis, but there has been little data on the number of specimens actually needed to support a diagnosis. We retrospectively reviewed all patients diagnosed with PTB at a public inner-city hospital and assessed the sensitivity of the acid-fast bacilli (AFB) smear and the number of smears needed to establish the diagnosis. Between January 1, 1997 and October 1, 2000, 425 patients were diagnosed with culture-proven PTB. Acid-fast bacilli (AFB) smears and cultures were performed on 951 respiratory specimens from 425 patients. The overall sensitivity of a positive AFB smear increased from 67% with 1 sputum collected to 71% and 72%, respectively, with the second and third specimens. The sensitivity of smears from 239 HIV-negative patients was 75%, 79%, and 80% with 1, 2, and 3 smears, respectively, collected compared with 57%, 61%, and 62%, respectively, for 142 HIV-positive patients. In summary, 2 respiratory specimens proved adequate in establishing a diagnosis of tuberculosis, and the third specimen added little additional diagnostic value.
Jornal Brasileiro de Pneumologia, 2009
To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. Methods: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. Results: Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. Conclusions: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.
Chest X Ray findings in New Sputum Positive Pulmonary Tuberculosis
IOSR Journals, 2019
Background: Tuberculosis remains a worldwide public health problem. The guidelines of RNTCP suggest sputum as the initial diagnostic test for Tuberculosis. If sputum test is positive in patients who are receiving Anti tubercular therapy (ATT), without undergoing chest X-Ray. The sequel of tuberculosis of Lung can have a chronic affect on patients. Aim: The aim of this study was to determine whether new sputum positive pulmonary tuberculosis (PTB) patients must undergo chest X-Ray as a part of the initial diagnosis and treatment of PTB. Materials and Methods: 100 patients who attended our OPD with cough and sputum for two weeks with and without HIV infection underwent sputum AFB. The diagnosis of PTB was made on the basis of clinical history, physical examination, Ziehl-Neelsen microscopy (AFB stain) on two sputum samples. Chest X-Ray was done for the sputum positive patients. The findings were recorded for each radiograph. Results: Among the 70 sputum positive patients, 55 (78.57%) were male, 15 (21.42%) were female. Out of 70 patients with Tuberculosis 67 have Chest radiograph appearances in this group the cavitation, miliary pattern, t statistical trend towards less pleural effusion as well as hilar lymphadenopathy. Conclusion: Our observations suggest that normal finding in CXR is an exception and implementing chest x-ray as an additional test in new sputum positive patients will be helpful in extent of damage of lungs and the future complications that results if patient is not compliant ATT in the Indian setting
Prevalence of tuberculosis in TB suspects with short duration of cough
Transactions of the Royal Society of Tropical Medicine and Hygiene
The prevalence of pulmonary tuberculosis (PTB) in patients with short duration of cough was determined. Ninety-eight adult out-patients (60 men, 38 women; mean age 32 years) at Queen Elizabeth Central Hospital, Blantyre, Malawi, who had cough for 1-3 weeks which was unresponsive to a course of antibiotics, were successfully screened by microscopy and culture of 2 or 3 sputum specimens and chest radiography; 34 (35%) had PTB. Ten patients were sputum smear-positive and 24 were smear-negative and culture-positive. There was no difference in age, gender or clinical features of general illness, respiratory disease and HIV-related disease between patients with PTB and those with no evidence of PTB. Nine patients (26%) with microbiologically confirmed tuberculosis (TB) had chest radiograph abnormalities consistent with TB, compared with 5 (8%) of patients with no microbiological evidence of TB. Certain classes of patients with a short history of cough would benefit from PTB screening stra...