TY - JOUR

T1 - Chest x-ray findings in tuberculosis patients identified by passive and active case finding

T2 - A retrospective study

AU - Rastoder, Ema

AU - Shaker, Saher Burhan

AU - Naqibullah, Matiullah

AU - Wille, Mathilde Marie Winkler

AU - Lund, Mette

AU - Wilcke, Jon Torgny

AU - Seersholm, Niels

AU - Jensen, Sidse Graff

PY - 2019/2

Y1 - 2019/2

N2 - Background: Chest x-ray is central in screening and diagnosis of tuberculosis. However, sputum culture remains gold standard for diagnosis. Aim: To establish the rate of normal chest x-rays in tuberculosis patients found by spot sputum culture screening, and compare them to a group identified through passive case finding. Method: Chest x-rays from 39 culture-positive patients, identified by spot sputum culture screening in Copenhagen from 2012 to 2014, were included in the study (spot sputum culture group(SSC)). 39 normal chest x-rays from persons screened by mobile x-ray, and 39 chest x-rays from tuberculosis-patients identified through passive case finding(PCF) were anonymised and randomised. Two respiratory physicians and two radiologists assessed the chest x-rays. Results: The normal chest x-ray rate was higher in the non-tuberculosis control group (median = 32 (82.1%), range = 74.4% – 100%), compared to the SSC group (median = 7 (17.9%), range = 10.3% – 33.3%), and the PCF controls (median = 3(7.7%), range = 2.6% – 15.4%). In the SSC group 14 (35.9%) were categorized as normal by at least one study participant. Conclusion: A substantial minority of patients diagnosed with tuberculosis by spot sputum culture screening, and through passive case finding would not have been identified with chest x-ray alone, highlighting that a normal chest x-ray does not exclude pulmonary tuberculosis.

AB - Background: Chest x-ray is central in screening and diagnosis of tuberculosis. However, sputum culture remains gold standard for diagnosis. Aim: To establish the rate of normal chest x-rays in tuberculosis patients found by spot sputum culture screening, and compare them to a group identified through passive case finding. Method: Chest x-rays from 39 culture-positive patients, identified by spot sputum culture screening in Copenhagen from 2012 to 2014, were included in the study (spot sputum culture group(SSC)). 39 normal chest x-rays from persons screened by mobile x-ray, and 39 chest x-rays from tuberculosis-patients identified through passive case finding(PCF) were anonymised and randomised. Two respiratory physicians and two radiologists assessed the chest x-rays. Results: The normal chest x-ray rate was higher in the non-tuberculosis control group (median = 32 (82.1%), range = 74.4% – 100%), compared to the SSC group (median = 7 (17.9%), range = 10.3% – 33.3%), and the PCF controls (median = 3(7.7%), range = 2.6% – 15.4%). In the SSC group 14 (35.9%) were categorized as normal by at least one study participant. Conclusion: A substantial minority of patients diagnosed with tuberculosis by spot sputum culture screening, and through passive case finding would not have been identified with chest x-ray alone, highlighting that a normal chest x-ray does not exclude pulmonary tuberculosis.

KW - Active case finding

KW - Chest x-ray assessment

KW - Chest x-ray changes

KW - Normal chest x-ray

KW - Passive case finding

KW - Tuberculosis

U2 - 10.1016/j.jctube.2019.01.003

DO - 10.1016/j.jctube.2019.01.003

M3 - Journal article

C2 - 31720415

AN - SCOPUS:85059785827

VL - 14

SP - 26

EP - 30

JO - Journal of Clinical Tuberculosis and Other Mycobacterial Diseases

JF - Journal of Clinical Tuberculosis and Other Mycobacterial Diseases

SN - 2405-5794

ER -