The Roles of HRCT and Clinical Parameters in Assessing Activity of Suspected Smear Negative Pulmonary Tuberculosis

Tozkoparan, Ergün; Deniz, Ömer; Çiftçi, Faruk; Bozkanat, Erkan; Biçak, Mesut; Mutlu, Hakan; Örs, Fatih; Bilgiç, Hayati; Demirci, Necmettin

doi:10.1016/j.arcmed.2004.12.010

Cited by 37 publications

(37 citation statements)

References 13 publications

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“…The diagnosis of TB and the decision to start treatment against sputum smear-negative TB is usually dependent on clinical features, but 20% of PTB patients are completely asymptomatic whereas 42–86% of PTB patients may be symptomatic. Sputum smear-negative PTB patients are especially likely to show no or mild respiratory symptoms and systemic manifestations [5]. …”

Section: Introductionmentioning

confidence: 99%

Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis

et al. 2012

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BackgroundThis study was aimed to investigate the diagnostic value of fiberoptic bronchoscopy (FOB) with chest high-resolution computed tomography (HRCT) for the rapid diagnosis of active pulmonary tuberculosis (PTB) in patients suspected of PTB but found to have a negative sputum acid-fast bacilli (AFB) smear.MethodsWe evaluated the diagnostic accuracy of results from FOB and HRCT in 126 patients at Gangnam Severance Hospital (Seoul, Korea) who were suspected of having PTB.ResultsOf 126 patients who had negative sputum AFB smears but were suspected of having PTB, 54 patients were confirmed as having active PTB. Hemoptysis was negatively correlated with active PTB. Tree-in-bud appearance on HRCT was significantly associated with active PTB. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FOB alone was 75.9%, 97.2%, 95.3%, and 84.3%, respectively, for the rapid diagnosis of active PTB. The combination of FOB and HRCT improved the sensitivity to 96.3% and the NPV to 96.2%.ConclusionsFOB is a useful tool in the rapid diagnosis of active PTB with a high sensitivity, specificity, PPV and NPV in sputum smear-negative PTB-suspected patients. HRCT improves the sensitivity of FOB when used in combination with FOB in sputum smear-negative patients suspected of having PTB.

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Section: Introductionmentioning

confidence: 99%

Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis

et al. 2012

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“…By evaluating radiological findings and localizations in these patients, it has been suggested that HRCT can be used for guessing patients with high risk of SNPT (33). The most common radiological findings detected on HRCT in SNPT patients are centrilobular nodules (73%), nodules (71%), and consolidation (54%) (34).…”

Section: Radiologymentioning

confidence: 99%

Smear-Negative Pulmonary Tuberculosis

Çalışkan¹,

Kaya²

2015

Eurasian J Pulmonol

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Tuberculosis (TB) is the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus. There are almost 2.5 million new smear-positive pulmonary TB cases and 1.9 million new smear-negative pulmonary TB cases in the world in 2012 according to the World Health Organization (WHO) Global Tuberculosis Report 2013. Smear negativity in pulmonary TB is a common clinical problem. Clinicians have difficulty in diagnosing smear-negative pulmonary TB without bacteriological confirmation. It is very important to decide whether or not to treat a patient with smear negative pulmonary TB when the culture results are pending or negative. New diagnostic methods are required for the diagnosis of smear-negative pulmonary TB. In addition to the development of new microbiological and serological diagnostic tests, clinical prediction scoring systems and algorithms including clinical and radiological findings of smear-negative pulmonary TB patients in our country, should be established to facilitate the diagnosis of smear-negative pulmonary TB.

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“…High-resolution computed tomography (HRCT) provides information on the extent and distribution of PTB [7,8] and can help distinguish active from inactive disease [9]. However, because of the smaller mycobacterium burden present in smear-negative disease, such patients have clinical and radiological findings different from those with smear-positive TB [10,11].…”

Section: Introductionmentioning

confidence: 99%

HRCT and Whole-Blood Interferon-γ Assay for the Rapid Diagnosis of Smear-Negative Pulmonary Tuberculosis

Lee

Shin²,

Kim³

et al. 2010

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Background: Early diagnosis of active pulmonary tuberculosis (PTB) is critical for TB control, and difficult in patients with smear-negative sputum. Objective: We wanted to evaluate the usefulness of clinical findings, high-resolution computed tomography (HRCT), interferon-γ-releasing assay (IGRA) and polymerase chain reaction (PCR) of sputum in the diagnosis of smear-negative PTB. Methods: From June 2006 to September 2008, 178 patients with suspected PTB on the basis of clinical and radiological findings visited our institute. After excluding smear-positive cases (n = 77) and cases with an inconclusive diagnosis (n = 17), we studied 84 patients. Their clinical records, HRCT, sputum TB-PCR assay and IGRA results were retrospectively evaluated. A QuantiFeron-TB Gold (QFT-G; Cellestis Ltd., Carnegie, Vic., Australia) assay was used for the IGRA. Results: Active PTB was diagnosed in 40 (48%) of 84 patients; lack of sputum and young age were significantly associated with an increased risk of PTB. The sensitivities of sputum PCR assay, IGRA, and HRCT were 43.2, 84.4 and 80.0%, respectively, and the specificities were 97.7, 82.9 and 70.5%, respectively. Among the 38 patients suspected of having PTB based on HRCT, 24 patients showed positive results on the IGRA, and 23 of these were diagnosed with active PTB. Among the 35 patients suggested not to have TB based on HRCT, 25 showed negative results on the IGRA, and 23 (92%) of these were diagnosed as not to have TB. Conclusion: The combined results of HRCT and the IGRA could help decision-making for early initiation of treatment in smear-negative patients.

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The Roles of HRCT and Clinical Parameters in Assessing Activity of Suspected Smear Negative Pulmonary Tuberculosis

Cited by 37 publications

References 13 publications

Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis

Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis

Smear-Negative Pulmonary Tuberculosis

HRCT and Whole-Blood Interferon-γ Assay for the Rapid Diagnosis of Smear-Negative Pulmonary Tuberculosis

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