Evaluation of Clinical Parameters to Predict Mycobacterium tuberculosis in Inpatients

Wisnivesky, Juan P.; Kaplan, Jennifer A.; Henschke, Claudia I.; McGinn, Thomas; Crystal, Ronald G.

doi:10.1001/archinte.160.16.2471

Cited by 63 publications

(71 citation statements)

References 26 publications

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“…After full-text review, 174 articles were excluded for various reasons and 13 articles (all observational studies) were included in the systematic review ( fig. 1) [20][21][22][23][24][25][26][27][28][29][30][31][32].…”

Section: Resultsmentioning

confidence: 99%

“…Of the 13 included studies, 12 studies involved scoring systems that combined clinical and radiographic features [20][21][22][23][24][25][26][27][28][29][30][31] and one study involved validation of 13 clinical prediction rules for inpatient respiratory isolation [32]. This study was included as it retrospectively applied prediction rules from six studies identified by our systematic review to a group of eligible participants with symptoms suggestive of PTB.…”

Section: Included Studiesmentioning

confidence: 99%

“…This study also tested rules that were derived from seven other studies, which were excluded from our systematic review as they did not satisfy our reference standard [33,34] or did not use specific features visualised on the chest radiograph as part of the scoring system [35][36][37][38][39]. Seven studies included all patients with possible PTB [20][21][22][23][24][25]32], five studies included patients with possible PTB who were found to have negative sputum smears [26][27][28][29][30], and one study specifically excluded PLWH [31]. Nine studies were performed in high-income countries.…”

Section: Included Studiesmentioning

confidence: 99%

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Scoring systems using chest radiographic features for the diagnosis of pulmonary tuberculosis in adults: a systematic review

et al. 2012

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Chest radiography for the diagnosis of active pulmonary tuberculosis (PTB) is limited by poor specificity and reader inconsistency. Scoring systems have been employed successfully for improving the performance of chest radiography for various pulmonary diseases. We conducted a systematic review to assess the diagnostic accuracy and reproducibility of scoring systems for PTB.We searched multiple databases for studies that evaluated the accuracy and reproducibility of chest radiograph scoring systems for PTB. We summarised results for specific radiographic features and scoring systems associated with PTB. Where appropriate, we estimated pooled performance of similar studies using a random effects model. 13 studies were included in the review, nine of which were in low tuberculosis (TB) burden settings. No scoring system was based solely on radiographic findings. All studies used systems with various combinations of clinical and radiological features. 11 studies involved scoring systems that were used for making decisions concerning hospital respiratory isolation. None of the included studies reported data on intra-or inter-reporter reproducibility. Upper lobe infiltrates (pooled diagnostic OR 3.57, 95% CI 2.38-5.37, five studies) and cavities (diagnostic OR range 1.97-25.66, three studies) were significantly associated with PTB. Sensitivities of the scoring systems were high (median 96%, IQR 93-98%), but specificities were low (median 46%, IQR 35-50%).Chest radiograph scoring systems appear useful in ruling out PTB in hospitals, but their low specificity precludes ruling in PTB. There is a need to develop accurate scoring systems for people living with HIV and for outpatient settings, especially in high TB burden settings. @ERSpublications Chest radiograph scoring systems are useful for ruling out PTB in hospital, but low specificity precludes ruling in PTB

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Section: Resultsmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

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Scoring systems using chest radiographic features for the diagnosis of pulmonary tuberculosis in adults: a systematic review

et al. 2012

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“…We therefore used the more stringent definition that a strong TST response with an induration in the TST of ⩾14 mm equated to LTBI [27]. Using this definition, it was also found that a strong TST response (⩾14 mm) was associated with a significantly elevated risk for subsequent progress to TB among contacts, as described previously [28].…”

Section: Discussionmentioning

confidence: 99%

Biomarkers for risk of developing active tuberculosis in contacts of TB patients: a prospective cohort study

et al. 2015

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Identifying those Mycobacterium tuberculosis latent-infected individuals most at risk of developing active tuberculosis (TB) using routine clinical and laboratory tests remains a huge challenge in TB control efforts. We conducted a prospective longitudinal study of clinical and laboratory markers associated with the risk of developing active TB in contacts with latent M. tuberculosis infection.HIV-negative household contacts (n=296) of pulmonary TB patients underwent monitoring of clinical features, full blood cell counts, tuberculin skin text (TST) and chest radiography performed regularly during 18 months of follow-up. Paired statistical tests, a Kaplan-Meier analysis and Cox proportional hazard modelling were performed on variables between contacts progressing or not progressing to active TB.The appearance of TB disease symptoms in contacts was significantly associated with an elevated peripheral percentage of blood monocytes (adjusted hazard ratio (aHR) 6.25, 95% CI 1.63-23.95; p<0.01), a ⩾14 mm TST response (aHR 5.72, 95% CI 1.22-26.80; p=0.03) and an increased monocyte:lymphocyte ratio (aHR 4.97, 95% CI 1.3-18.99; p=0.03). Among contacts having TST ⩾14 mm, a strong association with risk of progression to TB was found with an elevated blood monocyte percentage (aHR 8.46, p<0.01).Elevated percentage of peripheral blood monocytes plus an elevated TST response are potential biomarkers for identifying contacts of TB patients at highest risk of developing active TB. @ERSpublications Tuberculin skin tests combined with monocyte count improve evaluation of disease progression risk among TB contacts

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“…For patients whose samples were Xpert-positive and culture-negative, medical records were examined for clinical diagnosis of TB [8,9]. Patients with radiological and/or histological signs suggesting TB were considered TB cases only if a clinical improvement after anti-TB treatment was recorded.…”

Section: Methodsmentioning

confidence: 99%

Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis

Tortoli¹,

et al. 2012

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Extrapulmonary tuberculosis (EPTB) accounts for more than 20% of tuberculosis (TB) cases. Xpert MTB/RIF (Xpert) (Cepheid, Sunnyvale, CA, USA) is a fully automated amplification system, for which excellent results in the diagnosis of pulmonary TB in highly endemic countries have been recently reported. We aimed to assess the performance of the Xpert system in diagnosing EPTB in a low incidence setting.We investigated with Xpert a large number of consecutive extrapulmonary clinical specimens (1,476, corresponding to 1,068 patients) including both paediatric (494) and adult samples.We found, in comparison with a reference standard consisting of combination of culture and clinical diagnosis of TB, an overall sensitivity and specificity of 81.3% and 99.8% for Xpert, while the sensitivity of microscopy was 48%. For biopsies, urines, pus and cerebrospinal fluids the sensitivity exceeded 85%, while it was slightly under 80% for gastric aspirates. It was, in contrast, lower than 50% for cavitary fluids. High sensitivity and specificity (86.9% and 99.7%, respectively) were also obtained for paediatric specimens.Although the role of culture remains central in the microbiological diagnosis of EPTB, the sensitivity of Xpert in rapidly diagnosing the disease makes it a much better choice compared to smear microscopy. The ability to rule out the disease still remains suboptimal.

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Evaluation of Clinical Parameters to Predict Mycobacterium tuberculosis in Inpatients

Abstract: Among inpatients with suspected active pulmonary TB, a prediction rule based on clinical and chest radiographic findings accurately identified patients requiring respiratory isolation.

Cited by 63 publications

References 26 publications

Scoring systems using chest radiographic features for the diagnosis of pulmonary tuberculosis in adults: a systematic review

Scoring systems using chest radiographic features for the diagnosis of pulmonary tuberculosis in adults: a systematic review

Biomarkers for risk of developing active tuberculosis in contacts of TB patients: a prospective cohort study

Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis

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