Radiological significance of high-resolution computed tomography for elderly pulmonary tuberculosis patients – an analysis with culture test

Abstract

Purpose: Pulmonary tuberculosis (PTB) is one of the major health problems in the elderly population, causing significant morbidity and mortality. The aim of this study is to evaluate the significance of the high-resolution computed tomography (HRCT) modality for the diagnosis of PTB, in comparison to culture test. Material and methods: Thoracic HRCT images of the study population, comprising 124 patients clinically suspected for PTB with smear and culture reports, were analysed for sensitivity and specificity of the HRCT test. Features of active PTB were centrilobular nodules, 'tree-in-bud' pattern densities, macro-nodules, consolidations, cavitary lesions, ground-glass opacities, and miliary nodules. Results: Among the study population, 108 cases presented HRCT features of active PTB and the remaining cases were negative but had presented a few features mimicking PTB. As inferred from positive culture test results, 106 cases had active PTB, the remaining cases were culture negative for PTB. False-positive (FP) or 'type I error' cases, and false-negative (FN) or 'type II error' cases were ascertained by Bayes' theorem. Sensitivity (true positive rate) and specificity (true negative rate) of HRCT test were 0.8125 and 0.8571, respectively. Conclusions: For proper diagnosis the predictive capability, as two values of 'a posteriori probability' , was computed; the mean value of 'a posteriori probability' for HRCT was 0.6358. When its culture test was positive, the HRCT test was 69.56-92.85% efficient in ascertaining positive results with a sample; on the other hand, when its culture test was negative it was 66.66-100% efficient for a negative result. Thus, the HRCT test is considerably dependable.

Impaired pulmonary function and associated factors in the elderly with tuberculosis on admission

“…Therefore, in the elderly with pulmonary TB, chest computed tomography features include parenchymal density, cavitary lung lesions, ground glass opacities, and miliary nodules [21]. In addition, more segments distributed with lesions have been found in the elderly with pulmonary TB compared to those with community-acquired pneumonia [22].…”

Miliary pattern, a classic pulmonary finding of tuberculosis disease

“…Clinical suspicion and radiological findings are very important for an early diagnosis and a correct treatment. It is important to evaluate HIV status among other conditions of immunosuppression including age, uncontrolled diabetes, chemotherapy, organ transplant, and corticosteroid therapy [2] , [10] , [11] , [12] . To confirm the diagnosis a microbiological isolation is necessary.…”

“…Tuberculosis (TB) is a an important health concern [1] , [2] that affects more than 1.7 billion people worldwide [3] . Pulmonary affectation is presented in most cases of M. tuberculosis primary infection and tuberculosis disease.…”

Clinical significance of CA-125 in elderly patients with active pulmonary tuberculosis

“…Furthermore, the chest imaging findings in the elderly may not be typical of PTB in terms of the location and pattern of the lesions, and the sensitivity of bacteriological examination is low and variable. [13][14][15] Notably, it is also difficult for elderly PTB patients to produce high-quality respiratory specimens for bacteriological detection. Previous studies have stated that, in the elderly, the sensitivity of tuberculin skin test )TST( in diagnosing latent TB infection )LTBI( is lower, and there are more indeterminate results for IGRA in diagnosing LTBI.…”

“…Previous studies have stated that, in the elderly, the sensitivity of tuberculin skin test )TST( in diagnosing latent TB infection )LTBI( is lower, and there are more indeterminate results for IGRA in diagnosing LTBI. [13][14][15][16] In addition, the positivity rate of IGRA in the diagnosis of TB is lower in older adults than in young people, and the sensitivity decreases with age. 17,18 In the present study, we assessed the clinical value of serum CA-125 levels in elderly PTB patients )≥60 years old(.…”