Diagnostic Accuracy of Chest Radiography for the Diagnosis of Tuberculosis (TB) and Its Role in the Detection of Latent TB Infection: a Systematic Review

Piccazzo, Riccardo; Paparo, Francesco; Garlaschi, Giacomo

doi:10.3899/jrheum.140100

Cited by 68 publications

(54 citation statements)

References 83 publications

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“…In the small group of UMRs assessed here, no cases of active tuberculosis were identified by chest x-ray, which is a standard screening tool for active pulmonary tuberculosis for migrants coming to Germany. Although some authors describe that the sensitivity of gamma-interferon release assays is higher than that of chest x-ray for the diagnosis of active pulmonary tuberculosis in sputum-negative patients [24], a recent literature review indicated that chest x-rays have acceptable to good sensitivity for the diagnosis of pulmonary tuberculosis [25]. Further, the positive predictive value of gamma-interferon release assays for the diagnosis of active tuberculosis is low for patients from high-endemicity settings because positive results can also be expected in cases of latent or cured tuberculosis [24].…”

Section: Discussionmentioning

confidence: 99%

Microbiological screenings for infection control in unaccompanied minor refugees: the German Armed Forces Medical Service’s experience

et al. 2017

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BackgroundThe German Military Medical Service contributed to the medical screening of unaccompanied minor refugees (UMRs) coming to Germany in 2014 and 2015. In this study, a broad range of diagnostic procedures was applied to identify microorganisms with clinical or public health significance. Previously, those tests had only been used to screen soldiers returning from tropical deployments. This instance is the first time the approach has been studied in a humanitarian context.MethodsThe offered screenings included blood cell counts, hepatitis B serology and microscopy of the stool to look for protozoa and worm eggs as well as PCR from stool samples targeting pathogenic bacteria, protozoa and helminths. If individuals refused certain assessments, their decision to do so was accepted. A total of 219 apparently healthy male UMRs coming from Afghanistan, Egypt, Somalia, Eritrea, Syria, Ghana, Guinea, Iran, Algeria, Iraq, Benin, Gambia, Libya, Morocco, Pakistan, and Palestine were assessed. All UMRs who were examined at the study department were included in the assessment.ResultsWe detected decreasing frequencies of pathogens that included diarrhoea-associated bacteria [Campylobacter (C.) jejuni, enteropathogenic Escherichia (E.) coli (EPEC), enterotoxic E. coli (ETEC), enteroaggregative E. coli (EAEC), enteroinvasive E. coli (EIEC)/Shigella spp.), Giardia (G.) duodenalis, helminths (comprising Schistosoma spp., Hymenolepis (H.) nana, Strongyloides (S.) stercoralis] as well as hepatitis B virus. Pathogenic microorganisms dominated the samples by far. While G. duodenalis was detected in 11.4% of the assessed UMRs, the incidence of newly identified cases in the German population was 4.5 cases per 100,000 inhabitants.ConclusionsWe conclude that the applied in-house PCR screening systems, which have proven to be useful for screening military returnees from tropical deployments, can also be used for health assessment of immigrants from the respective sites. Apparently healthy UMRs may be enterically colonized with a broad variety of pathogenic and apathogenic microorganisms. Increased colonization rates, as shown for G. duodenalis, can pose a hygiene problem in centralized homes for asylum seekers.

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Section: Discussionmentioning

confidence: 99%

Microbiological screenings for infection control in unaccompanied minor refugees: the German Armed Forces Medical Service’s experience

et al. 2017

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“…The use of chest radiography (CXR) for the diagnosis of pulmonary TB (PTB) dates back over a century 3 . However, the utility of CXR is limited by modest specificity, high hardware costs, and poor inter-rater reliability [4][5][6] . In addition, many high burden countries, including India, suffer from a lack of qualified radiologists to interpret CXR 7 .…”

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confidence: 99%

Deep learning, computer-aided radiography reading for tuberculosis: a diagnostic accuracy study from a tertiary hospital in India

Nash

Kadavigere

Andrade

et al. 2020

Sci Rep

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In general, chest radiographs (CXR) have high sensitivity and moderate specificity for active pulmonary tuberculosis (ptB) screening when interpreted by human readers. However, they are challenging to scale due to hardware costs and the dearth of professionals available to interpret cXR in low-resource, high ptB burden settings. Recently, several computer-aided detection (cAD) programs have been developed to facilitate automated cXR interpretation. We conducted a retrospective case-control study to assess the diagnostic accuracy of a cAD software (qXR, Qure.ai, Mumbai, india) using microbiologically-confirmed PTB as the reference standard. To assess overall accuracy of qXR, receiver operating characteristic (Roc) analysis was used to determine the area under the curve (AUc), along with 95% confidence intervals (CI). Kappa coefficients, and associated 95% CI, were used to investigate inter-rater reliability of the radiologists for detection of specific chest abnormalities. In total, 317 cases and 612 controls were included in the analysis. The AUC for qXR for the detection of microbiologicallyconfirmed PTB was 0.81 (95% CI: 0.78, 0.84). Using the threshold that maximized sensitivity and specificity of qXR simultaneously, the software achieved a sensitivity and specificity of 71% (95% CI: 66%, 76%) and 80% (95% CI: 77%, 83%), respectively. The sensitivity and specificity of radiologists for the detection of microbiologically-confirmed PTB was 56% (95% CI: 50%, 62%) and 80% (95% CI: 77%, 83%), respectively. For detection of key PTB-related abnormalities 'pleural effusion' and 'cavity', qXR achieved an AUC of 0.94 (95% CI: 0.92, 0.96) and 0.84 (95% CI: 0.82, 0.87), respectively. For the other abnormalities, the AUC ranged from 0.75 (95% CI: 0.70, 0.80) to 0.94 (95% CI: 0.91, 0.96). The controls had a high prevalence of other lung diseases which can cause radiological manifestations similar to PTB (e.g., 26% had pneumonia, 15% had lung malignancy, etc.). In a tertiary hospital in india, qXR demonstrated moderate sensitivity and specificity for the detection of PTB. There is likely a larger role for cAD software as a triage test for ptB at the primary care level in settings where access to radiologists in limited. Larger prospective studies that can better assess heterogeneity in important subgroups are needed.

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“…An anteroposterior chest X-ray is one of the most important tests to be performed in a patient having TB or suspected TB. Chest X-ray findings include parenchymal infiltrates, hilar adenopathy, cavitation, nodules and pleural effusion [14]. Infiltrates or consolidations and cavities are often seen at the lung upper lobes, with or without mediastinal or hilar lymphadenopathy.…”

Section: Chest X-raymentioning

confidence: 99%

Conventional and Molecular Diagnosis of Drug-Sensitive and Drug-Resistant Pulmonary Tuberculosis

Martínez-Martínez¹,

GuadalupeMartínez-Rodríguez²,

Said‐Fernández³

2018

Mycobacterium - Research and Development

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Tuberculosis is a transmissible disease, which is primarily caused by the bacteria Mycobacterium tuberculosis and by other Mycobacterium species, forming the Mycobacterium tuberculosis complex. Until the end of the 20th Century, most cases of pulmonary tuberculosis were considered curable. Nevertheless, the rising of tuberculosis resistant to firstand second-line anti-tuberculous drugs is threatening the world's tuberculosis control programs. Due to this fact, the World Health Organization and other public health institutions recommended applying the conventional methods, affordable by low-incoming countries, to diagnose tuberculosis and to develop faster and more sensitive and specific methods to identify M. tuberculosis and determine their condition of anti-tuberculous drug resistance or drug sensitivity. In this chapter, we mention the most used conventional and molecular methods designed to identify M. tuberculosis and to determine their drug sensitivity or drug resistance. We also briefly describe the fundamentals of methods and its advantages and limitations.

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Diagnostic Accuracy of Chest Radiography for the Diagnosis of Tuberculosis (TB) and Its Role in the Detection of Latent TB Infection: a Systematic Review

Cited by 68 publications

References 83 publications

Microbiological screenings for infection control in unaccompanied minor refugees: the German Armed Forces Medical Service’s experience

Microbiological screenings for infection control in unaccompanied minor refugees: the German Armed Forces Medical Service’s experience

Deep learning, computer-aided radiography reading for tuberculosis: a diagnostic accuracy study from a tertiary hospital in India

Conventional and Molecular Diagnosis of Drug-Sensitive and Drug-Resistant Pulmonary Tuberculosis

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