The Validity of Medical History, Classic Symptoms, and Chest Radiographs in Predicting Pulmonary Tuberculosis

Tattevin, Pierre; Casalino, Enrique; Fleury, Laurent; Egmann, G.; Ruel, Michel; Bouvet, E.

doi:10.1378/chest.115.5.1248

Cited by 94 publications

(85 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although CXR is neither sufficiently sensitive nor specific for diagnosis of TB, strong radiographic associations with microbiological diagnoses exist [27] and, when combined with other available clinical and laboratory information, CXR information may influence early empiric initiation of therapy, with or without additional confirmatory testing. When interpreting CXRs, radiologists working in areas with a high prevalence of HIV-related TB should consider the way HIV status and degree of immunosuppression change the radiographic presentation, and clinicians ordering CXRs should provide radiologists with clinical and immunological information to facilitate more accurate diagnosis for TB.…”

Section: Discussionmentioning

confidence: 99%

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Kisembo¹,

Boon²,

Davis³

et al. 2012

BJR

View full text Add to dashboard Cite

Objective: We describe chest radiograph (CXR) findings in a population with a high prevalence of human immunodeficiency virus (HIV) and tuberculosis (TB) in order to identify radiological features associated with TB; to compare CXR features between HIV-seronegative and HIV-seropositive patients with TB; and to correlate CXR findings with CD4 T-cell count. Methods: Consecutive adult patients admitted to a national referral hospital with a cough of duration of 2 weeks or longer underwent diagnostic evaluation for TB and other pneumonias, including sputum examination and mycobacterial culture, bronchoscopy and CXR. Two radiologists blindly reviewed CXRs using a standardised interpretation form. Results: Smear or culture-positive TB was diagnosed in 214 of 403 (53%) patients. Median CD4+ T-cell count was 50 cells mm -3 [interquartile range (IQR) 14-150]. TB patients were less likely than non-TB patients to have a normal CXR (12% vs 20%, p50.04), and more likely than non-TB patients to have a diffuse pattern of opacities (75% vs 60%, p50.003), reticulonodular opacities (45% vs 12%, p,0.001), nodules (14% vs 6%, p50.008) or cavities (18% vs 7%, p50.001). HIV-seronegative TB patients more often had consolidation (70% vs 42%, p50.007) and cavities (48% vs 13%, p,0.001) than HIV-seropositive TB patients. TB patients with a CD4+ T-cell count of #50 cells mm -3 less often had consolidation (33% vs 54%, p50.006) and more often had hilar lymphadenopathy (30% vs 16%, p50.03) compared with patients with CD4 51-200 cells mm -3 . Conclusion: Although different CXR patterns can be seen in TB and non-TB pneumonias there is considerable overlap in features, especially among HIVseropositive and severely immunosuppressed patients. Providing clinical and immunological information to the radiologist might improve the accuracy of radiographic diagnosis of TB.

show abstract

Section: Discussionmentioning

confidence: 99%

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Kisembo¹,

Boon²,

Davis³

et al. 2012

BJR

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…Radiographs were scored as typical of TB when there was a nodular, alveolar or interstitial infiltrate or cavitations predominantly affecting the supraclavicular zones or upper zones of the lung, cavitations in the apical segment of the lower lobe or a miliary pattern. In the absence of these signs, chest radiographs were scored as atypical [9].…”

Section: Methodsmentioning

confidence: 99%

Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis

Tueller

Chhajed²,

Buitrago-Téllez³

et al. 2005

Eur Respir J

View full text Add to dashboard Cite

At present, further investigations are needed in patients with suspected pulmonary tuberculosis (TB) and either negative sputum smear or without sputum. The aim of the present study was to analyse the yield of bronchoalveolar lavage fluid (BALF) smear and PCR in patients with confirmed pulmonary TB.Patients with a positive culture for Mycobacterium tuberculosis complex in sputum or BALF were analysed over 5 yrs.In total, 90 out of 230 (39%) patients with culture-positive pulmonary TB had a positive sputum smear, and 120 patients underwent bronchoscopy. BALF smear was positive in 56 (47%), BALF PCR in 93 (78%) patients, and BALF smear and/or PCR was positive in 83%. In total, 71 patients who underwent bronchoscopy and had complete clinical records were further analysed. BALF (smear or Mycobacterium tuberculosis complex-PCR) allowed a rapid diagnosis in 10 (59%) out of 17 patients who had a negative sputum smear, and 49 (91%) out of 54 patients without sputum production. Of these 71 patients, 12 (17%) were only culture positive. Rapid diagnosis of pulmonary TB by smear and/or PCR was made in 190 out of 210 patients (90%) in sputum or BALF.In conclusion, combined use of bronchoalveolar lavage fluid smear and Mycobacterium tuberculosis complex-PCR has a good diagnostic yield in patients with sputum smear-negative tuberculosis or without sputum production.

show abstract

The Validity of Medical History, Classic Symptoms, and Chest Radiographs in Predicting Pulmonary Tuberculosis

Cited by 94 publications

References 24 publications

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

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

Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis

Contact Info

Product

Resources

About