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Madhani, F., R. A. Maniar, A. Burfat, M. Ahmed, S. Farooq, A. Sabir, A. K. Domki, et al. "Automated chest radiography and mass systematic screening for tuberculosis." International Journal of Tuberculosis and Lung Disease 24, no. 7 (July 1, 2020): 665–73. http://dx.doi.org/10.5588/ijtld.19.0501.
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BACKGROUND: Systematic screening for TB using automated chest radiography (ACR) with computer-aided detection software (CAD4TB) has been implemented at scale in Karachi, Pakistan. Despite evidence supporting the use of ACR as a pre-screen prior to Xpert® MTB/RIF diagnostic testing in presumptive TB patients, there has been no data published on its use in mass screening in real-world settings.METHOD: Screening was undertaken using mobile digital X-ray vehicles at hospital facilities and community camps. Chest X-rays were offered to individuals aged ≥15 years, regardless of symptoms. Those with a CAD4TB score of ≥70 were offered Xpert testing. The association between Xpert positivity and CAD4TB scores was examined using data collected between 1 January and 30 June 2018 using a custom-built data collection tool.RESULTS: Of the 127 062 individuals screened, 97.2% had a valid CAD4TB score; 11 184 (9.1%) individuals had a CAD4TB score ≥70. Prevalence of Xpert positivity rose from 0.7% in the <50 category to 23.5% in the >90 category. The strong linear association between CAD4TB score and Xpert positivity was found in both community and hospital settings.CONCLUSION: The strong association between CAD4TB scores and Xpert positivity provide evidence that an ACR-based pre-screening performs well when implemented at scale in a high-burden setting.
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Rohith, R., and S. P. Syed Ibrahim. "Screening of chest X-Rays for Tuberculosis using Deep Convolutional Neural Network." International Journal of Recent Technology and Engineering 9, no. 5 (January 30, 2021): 254–58. http://dx.doi.org/10.35940/ijrte.c4460.019521.
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Tuberculosis is a life-threatening disease that mainly affects underdeveloped as well as developing nations. While lethal it is often resistive to antibiotics and the safest way to treat a patient is to detect the disease's presence as soon as possible. Various techniques have been developed to diagnose tuberculosis and radiography of the chest is one of such methods that works well for over a decade.. Though an effective method still the success depends on the medical officer who examines the chest X-rays. Thus ,this paper proposes an approach for detecting X-ray abnormalities using deep learning. The systems output is assessed on two open Montgomery and Shenz en chest X-ray datasets and accuracy of 84 percent is achieved.
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Timire, C., C. Sandy, M. Ngwenya, N. Woznitza, A. M. V. Kumar, K. C. Takarinda, T. Sengai, and A. D. Harries. "Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable?" Public Health Action 9, no. 3 (September 1, 2019): 96–101. http://dx.doi.org/10.5588/pha.19.0003.
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Setting: Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation.Objectives: To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB.Design: This was a cross-sectional study using programme data.Results: A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64–78). Around 29% (95%CI 23–36) of the patients were potentially over-treated during Tas4TB.Conclusion: Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.
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Ricky Septafianty, Anita Widyoningroem, M. Yamin S. S, Rosy Setiawati, and Soedarsono. "Comparison of Chest X-Ray Findings Between Primary and Secondary Multidrug Resistant Pulmonary Tuberculosis." Bioscientia Medicina : Journal of Biomedicine and Translational Research 5, no. 4 (June 10, 2021): 855–62. http://dx.doi.org/10.32539/bsm.v5i4.356.
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Introduction: Radiological imaging has a key role in multidrug-resistant (MDR) pulmonary tuberculosis (TB) screening and diagnosis. However, new cases of MDR pulmonary TB are often overlooked; therefore, its transmission might continue before its diagnosis. The most widely used and affordable radiological modality is a chest radiograph. This study aims to describe the characteristics of primary and secondary MDR pulmonary TB chest x-ray findings for differential diagnosis.
Methods: This study was an analytic observational study with a retrospective design. Researchers evaluated medical record data of primary and secondary MDR pulmonary TB patients who underwent chest x-ray examinations. The patient's chest x-rays were then evaluated. Evaluated variables were lung, pleural, and mediastinal abnormalities and severity category.
Results: The most common chest x-ray finding in primary MDR pulmonary TB was consolidation (96.2%), which was mostly unilateral (52.0%), accompanied by cavities (71.2%), most of which were multiple (83.8%) with a moderate category of severity. The most common chest x-ray finding in secondary MDR pulmonary TB was consolidation (100%), which was mostly bilateral (60.4%), accompanied by cavities (80.2%), most of which were multiple (90.1%) with severe category of severity. Pleural thickening (47.5%) was also found.
Conclusion: There was a significant difference between primary and secondary MDR pulmonary TB in terms of mild severity category, and pleural thickening. Mild severity category is mostly found in primary MDR-TB and pleural thickening is mostly found in secondary TB.
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Mungai, Brenda Nyambura, Elizabeth Joekes, Enos Masini, Angela Obasi, Veronica Manduku, Beatrice Mugi, Jane Ong’angò, et al. "‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey." Thorax 76, no. 6 (January 27, 2021): 607–14. http://dx.doi.org/10.1136/thoraxjnl-2020-216123.
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BackgroundThe prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.MethodsWe reviewed a random sample of 1140 adult (≥15 years) CXRs classified as ‘abnormal, suggestive of TB’ or ‘abnormal other’ during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).
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Barber, Casey, Eyal Oren, Yi-Ning Cheng, Madeline Slater, and Susannah Graves. "1364. Pretreatment Chest X-ray Stability Duration and Tuberculosis Disease in San Diego County, 2012–2017." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S494. http://dx.doi.org/10.1093/ofid/ofz360.1228.
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Abstract Background Repeated chest X-rays serve as an essential screening tool to identify and describe new or stable (i.e., unchanged) lung abnormalities suggestive of pulmonary tuberculosis (TB) disease. The time for which a patient’s chest X-ray has not demonstrated appreciable change prior to treatment, or pretreatment chest X-ray stability duration, has been considered clinically useful in distinguishing inactive from active disease at four or 6 months. This relationship, however, has not been previously quantified. Methods This study relied on retrospective medical record review to assess the relationship of documented pretreatment chest X-ray stability duration thresholds relative to four and 6 months with a future clinical or culture-confirmed (Class 3) diagnosis of pulmonary TB disease. Multivariable logistic regression quantified this association among 146 patients who were evaluated and started on treatment for pulmonary TB disease in the San Diego County tuberculosis clinic between May 2012 and March 2017. Results After adjusting for age and Class B1 TB, Pulmonary status, a CXR stability duration of 4 months or more was not significantly associated with a Class 3 pulmonary TB diagnosis (adjusted odds ratio [AOR], 0.830; 95% confidence interval [CI], 0.198–3.48). Results were similar for the 6-month cut-point after adjusting for age and Class B1 Pulmonary status (AOR, 0.970; 95% CI, 0.304–3.10). Compared with less than 4 months, CXR stability durations of four to 6 months (AOR, 0.778; 95% CI, 0.156–3.89) and greater than 6 months (AOR, 0.875; 95% CI, 0.187–4.10) were also not significantly associated with a Class 3 TB diagnosis after adjusting for covariates. Conclusion Repeated chest X-rays remain a valuable tool for clinicians identifying and describing new or unchanged lung abnormalities suggestive of pulmonary TB disease. This study found no statistically significant association between pretreatment chest X-ray stability duration and subsequent TB disease diagnosis, with a wide range of estimates compatible with the data, suggesting the stability duration cut points relative to four and 6 months may not be as informative as previously understood. Disclosures All authors: No reported disclosures.
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Kowada, A., G. A. Deshpande, O. Takahashi, T. Shimbo, and T. Fukui. "Cost-effectiveness analysis of interferon-γ release assays versus chest X-ray for annual tuberculosis screening of healthcare workers." Journal of Hospital Infection 78, no. 2 (June 2011): 152–54. http://dx.doi.org/10.1016/j.jhin.2011.01.026.
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Zohora, Fatema Tuz, and K. C. Santosh. "Foreign Circular Element Detection in Chest X-Rays for Effective Automated Pulmonary Abnormality Screening." International Journal of Computer Vision and Image Processing 7, no. 2 (April 2017): 36–49. http://dx.doi.org/10.4018/ijcvip.2017040103.
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In automated chest X-ray screening (to detect pulmonary abnormality: Tuberculosis (TB), for instance), the presence of foreign element such as buttons and medical devices hinders its performance. In this paper, using digital chest radiographs, the authors present a new technique to detect circular foreign element, within the lung regions. They first compute edge map by using several different edge detection algorithms, which is followed by morphological operations for potential candidate selection. These candidates are then confirmed by using circular Hough transform (CHT). In their test, the authors have achieved precision, recall, and F1 score of 96%, 90%, and 92%, respectively with lung segmentation. Compared to state-of-the-art work, their technique excels performance in terms of both detection accuracy and computational time.
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Sah, Vijay Kumar, Arun Giri, and Niraj Niraula. "Prevalence and Clinico- Laboratory Profile of Tuberculosis in Children in Nobel Medical College, Biratnagar." Journal of Nepalgunj Medical College 17, no. 1 (August 22, 2019): 47–49. http://dx.doi.org/10.3126/jngmc.v17i1.25317.
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Introduction: Tuberculosis infection is very common, and it continues to be the major public health problem in Nepal. Published data about the epidemiology of TB in children is scarce in Nepal, though it is considered one of the most common causes of childhood morbidity in the country.
Aims and objectives: To calculate the prevalence of tuberculosis in children aged 0-15 years and to study their clinico-laboratory profile.
Methodology: This is a hospital based study conducted in Nobel Medical College Teaching Hospital, Biratnagar over a period of one year. We analyzed 289 children aged 0-15 years suspected of having tuberculosis on clinical grounds and subjected to further screening tests.
Results: Majority of the children were males and most of the children were 5-15 years of age. 15 of the cases were diagnosed as tuberculosis out of which one case was bacteriologically confirmed pulmonary tuberculosis and be 5.2 %. Fever and cough were the most common clinical presentations and mantoux test and chest X-ray were most suggestive in majority of the cases.
Conclusions: This study supports the use of history and thorough clinical examination and high index of clinical suspicion for diagnosis of childhood tuberculosis.
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Kimura, Tatsuo, Shinya Fukumoto, Hideki Fujii, Akemi Nakano, Yuji Nadatani, Yukie Tauchi, Tomohiro Suzumura, Koichi Ogawa, Tomoya Kawaguchi, and Norifumi Kawada. "Annual lung cancer screening by chest X ray to avoid further examinations." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19124-e19124. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19124.
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e19124 Background: Chest X ray (CXR) has been the most common screen procedure for detection of lung cancer. However, if patients had old inflammatory shadows such as tuberculosis, calcification and fibrotic changes, it would become increasingly difficult to detect the lung cancer. In that case, a comparative review of the CXR to the previous one helps the detection of new shadows. We examined whether the repeat participants (pts) who received the medical checkup annually, may have a profit for the lung cancer detection screening. Methods: Our clinic “MedCity21” is a university outpatient clinic to undergo a complete medical checkup in private health screening program. The pts with abnormalities detected in CXR were announced by call request and invited to our specialty clinic for chest CT scan as further examination. We examined the varieties of abnormal shadows by CXR and CT scans, and compared the differences between the repeat and the first-time pts using the chi-square tests, in 2018 and 2019 respectively. Results: In 2018, a total of 12540 with repeat / first-time pts of 6898/5642 pts (55/45%) were enrolled. The CXR abnormalities requiring further examinations were a total of 335 (2.6%) with those of 138/188 pts (p < 0.01). After the call requests, a total of 239 (71.3%) with those of 109/130 pts in 2018 received chest CT scan in our specialty clinic. In 2019, a total of 13690 pts with those of 7748/5942 (56.6/43.4%) were enrolled. The CXR abnormalities requiring further examinations were a total of 323 (2.4%) with those of 137/186 pts (p < 0.01). After the call requests, a total of 224 (69.3%) pts with those of 104/120 pts received chest CT scan in our specialty clinic. The varieties of abnormal shadows by CT scans showed that 8.3/20.8% (p < 0.01) in 2018 and 11.5/21.7% (p = 0.04) in 2019 of old inflammatory shadows, 11.0/6.9% (p = 0.27) in 2018 and 14.4/1.7% (p < 0.01) in 2019 of acute inflammatory shadows, respectively. The nodule was detected in 11.9/11.5% in 2018 and 8.7/10.8% in 2019 with no significant differences. Lung cancer was detected in 3/3 pts in 2018, and 1/3 pts in 2019. Conclusions: The repeat pts in each year, had significantly lower rate of CXR abnormalities detection, and had lower rate of the detection of old inflammatory changes as significant. In private health screening program, the repeat pts may have higher profits for the avoidance of further examination for lung cancer detection than the first-time pts.
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Dewan, Gourab. "Two Sample Sputum Microscopy and Revised Tuberculosis Case Definition by WHO: Bangladesh Perspective." Journal of Universal College of Medical Sciences 2, no. 4 (February 5, 2015): 1–6. http://dx.doi.org/10.3126/jucms.v2i4.12034.
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INTRODUCTION: Three samples of sputum (Spot-Morning-Spot) used for screening patients with suspected pulmonary tuberculosis in Bangladesh. At least two positive samples required for case definition. Cases with single positive smear require additional chest x-ray or culture. The study was done to evaluate utility of two sputum samples for case detection and whether adoption of new case definition (requiring single positive sample) recommended by World Health Organization adds advantage over current case definition for diagnosing smear positive pulmonary tuberculosis. MATERIAL AND METHODS: Retrospective analysis of sputum positive pulmonary tuberculosis cases taken from two separate hospitals in southeast Bangladesh. Frequency, pattern and increment of smear positivity noted in each samples. Smear positive cases reevaluated using proposed case definition and compared with current national definition. RESULTS: Sputum positivity for first, second and third samples was 71.6%, 99.0% and 97.3% respectively (n=408). Incremental new case detection rate was 71.6%. 28.1% and 0.2% in same order. Morning sputum had the highest sensitivity for case detection (99.0%). Incremental new case detection from third sample was negligible and using current case definition of sputum positive tuberculosis in three samples left some inconclusive cases requiring further x- ray or culture for diagnosis pending decision further. Adoption of new case definition reduces number of inconclusive cases and diagnostic delay. CONCLUSION: Two sputum samples adequate for screening of tuberculosis suspects. Adopting new case definition will reduce number of cases left inconclusive with microscopy alone (using current case definition). This will strengthen role of microscopy in tuberculosis detection in low resource setting.DOI: http://dx.doi.org/10.3126/jucms.v2i4.12034 Journal of Universal College of Medical Sciences (2014) Vol.02 No.04 Issue 08Page: 1-6
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Worodria, William, Marguerite Massinga-Loembe, Harriet Mayanja-Kizza, Jane Namaganda, Andrew Kambugu, Yukari C. Manabe, Luc Kestens, and Robert Colebunders. "Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART." Clinical and Developmental Immunology 2011 (2011): 1–9. http://dx.doi.org/10.1155/2011/758350.
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Commencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI) consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4%) patients were diagnosed with TB during followup. Eight (3.8%) patients had ART-associated TB (incidence rate of 4.3 per 100 person years); of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years). A body mass index of less than 18.5 kg/m2BMI (HR 5.85 95% CI 1.24–27.46,P=.025) and a C-reactive protein greater than 5 mg/L (HR 8.23 95% CI 1.36–38.33,P=.020) were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray), the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence.
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Shukla, S., N. Acharya, S. Acharya, DP Rajput, and S. Vagha. "Fictitious pseudo Meig’s syndrome: A medical emergency." Journal of College of Medical Sciences-Nepal 7, no. 1 (March 3, 2012): 57–64. http://dx.doi.org/10.3126/jcmsn.v7i1.5975.
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The present case scenario deals with an acute on chronic symptomatology, and collapsed state of the patient with poor vitals on admission in casualty. Clinical work up pointing to an elevated serum CA 125 levels and USG pelvis suggesting peritoneal adhesions with cystic to firm mass in left ovary and minimal free fluid in abdomen and cul de sac, X Ray chest suggesting right sided Pleural effusion. It was after careful evaluation of the case, with past and present history along with signs, symptommatology and intraoperative findings that differentials like Chronic granulomatous lesions, endometriosis, Neoplastic lesions with metastasis and Meig’s syndrome or Pseudo Meig’s were evaluated. Finally, a diagnosis of genital tuberculosis with enodmetriosis was confirmed on histopathological evaluation. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5975 JCMSN 2011; 7(1): 57-64
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Almufty, Hind Bahzad, Ibtesam Salih Abdulrahman, and Muayad Aghali Merza. "Latent Tuberculosis Infection among Healthcare Workers in Duhok Province: From Screening to Prophylactic Treatment." Tropical Medicine and Infectious Disease 4, no. 2 (May 23, 2019): 85. http://dx.doi.org/10.3390/tropicalmed4020085.
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Healthcare workers (HCWs) are at increased risk of infection with Mycobacterium tuberculosis (Mtb) and, hence, of developing tuberculosis (TB) disease. The aims of this study are to identify the prevalence and determinants of latent TB infection (LTBI) among HCWs in Duhok Province. This is a cross-sectional prospective study conducted during April–July 2018 in different health care facilities of Duhok province. HCWs at multiple levels were selected by a non-systematic random sampling method. Information on demographic and associated risk factors of LTBI were collected by using a standardized questionnaire. Thereafter, all HCWs underwent QuantiFERON Gold Plus (QFT-Plus) assay. HCWs with indeterminate QFT-Plus underwent a Tuberculin Skin Test. HCWs with positive results were further evaluated by smear microscopy investigation and chest X-ray examination. Three hundred ninety-five HCWs were enrolled; 49 (12%) tested positive for LTBI. The mean age of the HCWs was 33.4 ± 9.25 with a female predominance (51.1%). According to the univariate analysis, LTBI was significantly higher among HCWs with the following: age groups ≥ 30 years, alcohol intake, ≥ 11 years of employment, high risk stratification workplaces, and medical doctors. In the multivariate analysis, the age group of 30–39 years (OR = 0.288, 95% CI: 0.105–0.794, p value = 0.016) was the only risk factor associated with LTBI. Further medical investigations did not reveal active TB cases among HCWs with LTBI. With regards to prophylactic treatment, 31 (63.3%) LTBI HCWs accepted the treatment, whereas 18 (36.7%) declined the chemoprophylaxis. Of these 31 HCWs on chemoprophylaxis, 12 (38.7%) received isoniazid (INH) for six months, 17 (54.8%) received INH in combination with rifampicin (RMP) for three months, and two (6.5%) received alternative therapy because of anti-TB drug intolerance. In conclusions, although Iraq is a relatively high TB burden country, the prevalence of LTBI among Duhok HCWs is relatively low. It is important to screen HCWs in Duhok for LTBI, particularly medical doctors, young adults, alcoholics, and those whom had a long duration of employment in high-risk workplaces. The acceptance rate of HCWs with LTBI to chemoprophylaxis was low. Therefore, ensuring medical efforts to educate the healthcare staff particularly, non-professionals are a priority to encourage chemoprophylaxis acceptance.
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Colombatti, Raffaella. "Feasibility and effectiveness of tuberculosis active case-finding among children living with tuberculosis relatives: a cross sectional study in Guinea-Bissau ”." Mediterranean Journal of Hematology and Infectious Diseases 9, no. 1 (October 15, 2017): e2017059. http://dx.doi.org/10.4084/mjhid.2017.059.
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Background and Objectives: The World Health Organization End tuberculosis (TB) Strategy, approved in 2014, aims at a 90% reduction in TB deaths and an 80% reduction in TB incidence rate by 2030. One of the suggested interventions is the systematic screening of people with suspected TB, belonging to specific risk groups. The Hospital Raoul Follereau (HRF) in Bissau, Guinea-Bissau, is the National Reference Hospital for Tuberculosis and Lung Disease of the country. We performed an active case-finding program among pediatric age family members and cohabitants of admitted adult TB patients, from January to December 2013.Methods: Newly admitted adult patients with a diagnosis of TB were invited to bring their family members or cohabitants in childhood age for clinical evaluation in a dedicated outpatient setting within the hospital compound. All the children brought to our attention underwent medical examination and chest x-ray. In children with clinical and/or radiologic finding consistent with pulmonary TB a sputum-smear was requested.Results: All admitted adult patients accepted to bring their children cohabitants. In total, 287 children were examined in 2013. Forty-four patients (15%) were diagnosed with TB. The number needed to screen (NNS) to detect one case of TB was 7. 35 patients (80%) had pulmonary TB; 2 of them were sputum smear-positive. No adjunctive personnel cost was necessary for the intervention.Conclusions: children with TB represent a large proportion of the pool of undetected TB. A simple TB active case-finding program targeted to high risk groups like children households of severely ill admitted patients with TB can successfully be implemented in a country with limited resources.
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Jones, Margaret. "Policy Innovation and Policy Pathways: Tuberculosis Control in Sri Lanka, 1948–1990." Medical History 60, no. 4 (September 15, 2016): 514–33. http://dx.doi.org/10.1017/mdh.2016.58.
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This paper, based on World Health Organization and Sri Lankan sources, examines the attempts to control tuberculosis in Sri Lanka from independence in 1948. It focuses particularly on the attempt in 1966 to implement a World Health Organization model of community-orientated tuberculosis control that sought to establish a horizontally structured programme through the integration of control into the general health services. The objective was to create a cost- effective method of control that relied on a simple bacteriological test for case finding and for treatment at the nearest health facility that would take case detection and treatment to the rural periphery where specialist services were lacking. In the late 1940s and early 1950s, Sri Lanka had already established a specialist control programme composed of chest clinics, mass X-ray, inpatient and domiciliary treatment, and social assistance for sufferers. This programme had both reduced mortality and enhanced awareness of the disease. This paper exposes the obstacles presented in trying to impose the World Health Organization’s internationally devised model onto the existing structure of tuberculosis control already operating in Sri Lanka. One significant hindrance to the WHO approach was lack of resources but, equally important, was the existing medical culture that militated against its acceptance.
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Kimura, Tatsuo, Shinya Fukumoto, Hiroyasu Morikawa, Akemi Nakano, Koji Otani, Yukie Tauchi, Risa Uemura, et al. "Annual lung cancer screening by chest x-ray results in higher profits for the exclusion of lung cancer." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e23050-e23050. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e23050.
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e23050 Background: Chest X ray (CXR) has been the most common screen procedure for detection of lung cancer. However, if patients had old inflammatory shadows such as tuberculosis, calcification and fibrotic changes, it would become increasingly difficult to detect the lung cancer. In that case, the previous CXR helps the detection of new shadows. We examine whether the repeat participants (pts) who received the medical checkup annually, may improve the rate of lung cancer detection. Methods: Our clinic “MedCity21” was a university outpatient clinic to undergo a complete medical checkup in private health screening program. The pts with abnormalities detected in CXR were announced by call request and invited to our specialty clinic for chest CT scan as further examination. We examined the varieties of abnormal shadows by CXR and CT scans in recent 3 years. Furthermore, we compared the differences between the repeat and the first-time pts using the chi-square tests. Results: In 2016, 2017 and 2018, a total of 10020, 11925 and 12540 pts were enrolled, respectively. The CXR abnormalities for further examinations were detected in 282 (2.8%), 344 (2.9%) and 335 (2.6%) pts, respectively. After the call requests, 203 (72.0%), 239 (69.4%) and 239 (71.3%) pts received chest CT scan in our clinic. In 2016 and 2017, 7 and 9 pts were diagnosed as lung cancer within 12 months follow-up. In 2018, 6 pts were diagnosed as lung cancer, and another 4 pts were now observed. The numbers of lung cancer detections by CXR per 100,000 people were 70.0, 75.5 and ≥47.8, respectively. The repeat / first time pts in 2018 were 6898/5642 pts (55/45%), and 142/193 pts (2.1/3.4%) had CXR abnormalities (p < 0.01), respectively. The varieties of abnormal shadows by CT scans showed that 8.3/20.8% of old inflammatory shadows (p < 0.01), 11.9/20.7% of nodule or GGO (p = 0.47), 12.8/12.3% of Mycobacterial infections or suspected (p = 0.46), and 11.0/6.9% of acute bacterial infections (p = 0.98). Lung cancer was detected in 3/3 pts (p = 0.86), respectively. Conclusions: The repeat pts had significantly lower rate of CXR abnormalities detection, and the first time pts had higher rate of error detection old inflammatory changes as significant. In private health screening program, the repeat pts may have higher profits for the exclusion of lung cancer than the first time pts.
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Peetluk, Lauren S., Felipe M. Ridolfi, Peter F. Rebeiro, Dandan Liu, Valeria C. Rolla, and Timothy R. Sterling. "Systematic review of prediction models for pulmonary tuberculosis treatment outcomes in adults." BMJ Open 11, no. 3 (March 2021): e044687. http://dx.doi.org/10.1136/bmjopen-2020-044687.
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ObjectiveTo systematically review and critically evaluate prediction models developed to predict tuberculosis (TB) treatment outcomes among adults with pulmonary TB.DesignSystematic review.Data sourcesPubMed, Embase, Web of Science and Google Scholar were searched for studies published from 1 January 1995 to 9 January 2020.Study selection and data extractionStudies that developed a model to predict pulmonary TB treatment outcomes were included. Study screening, data extraction and quality assessment were conducted independently by two reviewers. Study quality was evaluated using the Prediction model Risk Of Bias Assessment Tool. Data were synthesised with narrative review and in tables and figures.Results14 739 articles were identified, 536 underwent full-text review and 33 studies presenting 37 prediction models were included. Model outcomes included death (n=16, 43%), treatment failure (n=6, 16%), default (n=6, 16%) or a composite outcome (n=9, 25%). Most models (n=30, 81%) measured discrimination (median c-statistic=0.75; IQR: 0.68–0.84), and 17 (46%) reported calibration, often the Hosmer-Lemeshow test (n=13). Nineteen (51%) models were internally validated, and six (16%) were externally validated. Eighteen (54%) studies mentioned missing data, and of those, half (n=9) used complete case analysis. The most common predictors included age, sex, extrapulmonary TB, body mass index, chest X-ray results, previous TB and HIV. Risk of bias varied across studies, but all studies had high risk of bias in their analysis.ConclusionsTB outcome prediction models are heterogeneous with disparate outcome definitions, predictors and methodology. We do not recommend applying any in clinical settings without external validation, and encourage future researchers adhere to guidelines for developing and reporting of prediction models.Trial registrationThe study was registered on the international prospective register of systematic reviews PROSPERO (CRD42020155782)
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Shafiq, Syed. "Clinical, Imaging, and Endoscopic Profile of Patients with Abdominal Tuberculosis." Journal of Digestive Endoscopy 10, no. 02 (April 2019): 112–17. http://dx.doi.org/10.1055/s-0039-1693272.
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Abstract Aims: The aim is to study the clinical, imaging, and endoscopic profile of patients with abdominal tuberculosis (TB) in a tertiary care center. Subjects and Methods: This was a prospective observational study conducted at Meenakshi Medical College Hospital, Kancheepuram, over a 3-year period, from March 2011 to February 2014. A total of 76 patients were diagnosed with abdominal TB based on their clinical, pathological, endoscopic, and radiological features. A meticulous history and physical examination with complete blood count, human immunodeficiency virus (HIV) status, chest X-ray, ultrasound abdomen, upper endoscopy, and colonoscopy was performed. Barium study, ascitic fluid analysis, and contrast-enhanced computed tomography of the abdomen and pelvis with peritoneal biopsies where need be were also obtained. All the patients received antituberculosis treatment (ATT) under close surveillance and monitoring. Results: The total number of patients enrolled in our study was 76 with age ranging from 18 to 75 years; 40 were male and 36 were female. There was a significant overlap of symptoms, and most of the patients presented with a multitude of complaints. Abdominal pain was the most common complaint noted in 70 patients, followed by loss of appetite and weight loss in 52, fever in 48, constipation in 28, abdominal distention in 14, and diarrhea in 6 patients. Two patients presented with acute intestinal obstruction requiring emergency surgical intervention. Fever was the most common finding followed by anemia, ascites, abdominal tenderness, and a palpable abdominal mass. A history of pulmonary Koch's was elicited in 28 patients, and 17 had defaulted on treatment. All the patients enrolled in our study received ATT although six were lost to follow-up. Conclusions: Abdominal TB can present with a myriad of signs and symptoms, and early diagnosis and treatment are the keys for an effective cure and for reducing the morbidity and mortality from this chronic granulomatous disease.
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Kamyshanskaya, I. G., V. M. Cheremisin, A. V. Vodovatov, and A. N. Boriskina. "Results of the clinical evaluation of the low-dose protocols of the digital linear tomography of the chest." Radiatsionnaya Gygiena = Radiation Hygiene 13, no. 1 (March 31, 2020): 47–59. http://dx.doi.org/10.21514/1998-426x-2020-13-1-47-59.
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High levels of tuberculosis morbidity in the Russian Federation lead to the extensive use of X-ray diagnostics for the tuberculosis screening and assessment of the effectiveness of treatment. Digital radiography and computed tomography are traditionally used for the diagnostics of tuberculosis. These methods are associated with significant drawbacks: low specificity for radiography, high costs per examination, significant patient doses, and limited availability for computed tomography. As an additional method for the assessment of the effectiveness of the tuberculosis treatment it is possible to use linear tomography performed on the digital X-ray units. The aim of the current study was to evaluate the possibility of utilization of the digital linear tomography for the control of the effectiveness of tuberculosis treatment in a dedicated antitubercular medical facility. The study was divided in two stages. The first stage was aimed at the assessment of the diagnostic image quality of the digital linear tomograms obtained using the previously developed low-dose imaging protocols. Image quality assessment was performed using an anthropomorphic chest phantom and dedicated imitators of the lung lesions. Image quality was assessed by the experts (radiologists) based on the developed image quality criteria. Results of the first stage of the study indicate that all low-dose protocols allow obtaining images with at least acceptable image quality. Hence it was possible to propose low-dose protocols for clinical evaluations. The second stage of the study was performed as a prospective cohort survey aimed at the evaluation of the structure of X-ray examinations, patient doses and clinical image quality of the digital linear tomograms in antitubercular early treatment center. The cohort survey included two patient samples, uniform by age and gender composition, anthropometric characteristics and structure of diagnosis. One of the samples was imaged using standard (vendor) digital linear protocols, other – using the proposed low-dose protocols. Dose data collection (measurement of dose-area product and subsequent calculation of effective dose) and expert image quality assessment was performed for each patient. The results of the second stage of the study indicate that the use of the low-dose protocols allow reducing the patient effective doses per examination up to a factor of 6–8 (0.56 – 5.9 mSv for standard protocols; 0.2 – 1.15 mSv for low-dose protocols) due to the reduction in tube current-time product (126 mean mAs and 11 mean mAs, respectively). The dose reduction is accompanied by the reduction in the image quality of the linear tomograms (from “excellent” or “good” for standard protocols to “acceptable” for low-dose protocols). However, that dose not hinder the conclusion decision and identification of pathologies. Results of the study indicate that digital linear tomography can be used for the evaluation of the dynamics of the pathological process in the lungs with the previously defined localization of the pathology. The presented low-dose protocols were implemented into radiological practice of the antitubercular early treatment center. Currently, the proposed low-dose protocols are under evaluation for the large-scale study on the base of general practice hospitals
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Nguyen, Ngoc Thi Bich, Huy Le Ngoc, Nhung Viet Nguyen, Luong Van Dinh, Hung Van Nguyen, Huyen Thi Nguyen, and David W. Denning. "Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study." Journal of Fungi 7, no. 7 (June 30, 2021): 532. http://dx.doi.org/10.3390/jof7070532.
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This study provides a brief view of chronic pulmonary aspergillosis (CPA) in the post-tuberculosis treatment community in Vietnam, a high burden tuberculosis (TB) country. In three months in late 2019, 70 post-TB patients managed at Vietnam National Lung Hospital were enrolled. Of these, 38 (54.3%) had CPA. The male/female ratio was 3/1 (28 males and ten females). CPA patients had a mean age of 59 ± 2.3 years (95%CI 54.4–63.6). The mean Body mass index (BMI) was 19.0 ± 0.5 (18.0–20.0) and 16 of 38 (42.1%) patients had concurrent diseases, the most common of which were chronic obstructive pulmonary disease (COPD) and diabetes. Twenty-six patients (68.4%) developed hemoptysis, 21 (55.3%) breathlessness, and weight loss was seen in 30 (78.9%). Anaemia was seen in 15 (39.5%) and 27 of 38 (71.1%) patients had an elevated C-reactive protein (CRP). The most common radiological findings were multiple cavities (52.6%) and pleural thickening (42.7%), followed by aspergilloma (29.0%) and non-specific infiltrates. There were five of 38 patients (13.2%) with a cavity containing a fungal ball on the chest X-ray, but when the high resolution computed tomography (HRCT) was examined, the number of patients with fungal balls rose to 11 (28.9%). Overall, 34 of 38 (89.5%) cases had an elevated Aspergillus IgG with an optical density ≥ 1, and in 2 cases, it was 0.9–1.0 (5%), borderline positive. In nine patients (23.7%) Aspergillus fumigatus was cultured from sputum. CPA is an under-recognised problem in Vietnam and other high burden TB countries, requiring a different diagnostic approach and treatment and careful management. HRCT and Aspergillus IgG serum test are recommended as initial diagnostic tools for CPA diagnosis.
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Horton, Lucy E., Susannah Graves, Kathleen Fischer, Gina Fleming-Magit, Camila Romero, Christine Thorne, Eric McDonald, et al. "1618. Public Health at the United States/Mexico Border: Evaluation of the County of San Diego Health and Human Services Agency’s Health Screening Assessment of Asylum-Seeking Families at the San Diego Rapid Response Network Shelter." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S590. http://dx.doi.org/10.1093/ofid/ofz360.1482.
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Abstract Background Many families arrive at the United States–Mexico border seeking asylum. Jewish Family Service and the San Diego Rapid Response Network operate a shelter in San Diego that provides shelter, food, clothing, legal services and travel coordination for asylum-seeking families. Two local federally qualified health centers provide on-site urgent care. Methods In late December 2018, the County of San Diego expanded public health efforts by conducting health screenings of guests upon entry to the shelter with the goal of identifying health issues requiring urgent or emergent evaluation and preventing the spread of communicable disease. University of California San Diego Health physicians contracted by the County of San Diego Health and Human Services Agency (HHSA) nurses and ancillary staff provide daily on-site services to all shelter entrants including: health screening for diseases of public health significance, treatment and/or referral of urgent conditions, and medical clearance for shelter entry or medical isolation as needed. Official tracking of screening outcomes from January 2 to April 24, 2019 were collected using standardized surveys and analyzed for program evaluation and surveillance purposes. Results During that time a total of 9,124 asylum-seekers were screened, averaging 81 guests daily, identifying: 42 influenza-like illness, 645 lice, 330 scabies, 8 varicella, and 0 hepatitis A cases. Chest radiography for suspected tuberculosis was performed for 29 guests. Only one chest x-ray was abnormal. Sputum specimens for acid-fast stain (n = 3) and nucleic acid testing (n = 2) were all negative and no tuberculosis cases were diagnosed. Emergency department referrals were made for <1% of guests (n = 90) for conditions including pregnancy complications, asthma, dysentery, hemoptysis and fractures. No deaths or outbreaks of communicable disease occurred. Conclusion Coordination among local partner agencies resulted in early identification of communicable and acute health conditions prior to shelter entry allowing evaluation, treatment and off-site isolation, and minimizing stress on the emergency medical services system. This approach provides a successful model for health screening of asylum-seeking families arriving at the United States–Mexico border. Disclosures All authors: No reported disclosures.
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Olsen, S.-R., R. Long, GJ Tyrrell, and D. Kunimoto. "Induced Sputum for the Diagnosis of Pulmonary Tuberculosis: Is It Useful in Clinical Practice?" Canadian Respiratory Journal 17, no. 4 (2010): e81-e84. http://dx.doi.org/10.1155/2010/426185.
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BACKGROUND: Diagnosing pulmonary tuberculosis (PTB) is challenging in patients who are unable to spontaneously expectorate. Published evidence suggests that induced sputum (IS) is the least invasive and most cost-effective method of diagnosis, and should be used before fibre-optic bronchoscopy (FOB).METHODS: The medical records of 337 adults treated for PTB in northern Alberta between 1997 and 2007 were reviewed to determine whether local practice patterns reflect the evidence. Microbiological data were collected from the Provincial Laboratory for Public Health. Demographic information was collected from the patients’ charts.RESULTS: A total of 8.5% (26 of 307) of PTB patients had IS collected, whereas 35.8% (110 of 307) underwent FOB. Among FOB patients, 56.4% (62 of 110) had no sputum sent before the procedure and 29% (18 of 62) of these patients were smear positive. Only five patients referred for FOB had IS sent previously. There were no demographic factors predictive of IS use, whereas being an inpatient at a teaching facility or having a nodule or mass on chest x-ray was predictive of FOB referral. Because so few IS samples were available, not all patients had spontaneously expectorated sputum, IS and FOB tests performed; thus, the calculated yields were not comparable with one another.CONCLUSIONS: Despite published evidence recommending IS collection before FOB referral in suspected PTB patients, clinicians in our health region appeared to prefer early FOB over IS by a large margin. This practice pattern is less cost effective and exposes patients and health care workers to greater risk. Further research is needed to identify the reasons for the underuse of sputum induction.
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Vassilopoulos, Dimitrios, Stamatoula Tsikrika, Chrisoula Hatzara, Varvara Podia, Anna Kandili, Nikolaos Stamoulis, and Emilia Hadziyannis. "Comparison of Two Gamma Interferon Release Assays and Tuberculin Skin Testing for Tuberculosis Screening in a Cohort of Patients with Rheumatic Diseases Starting Anti-Tumor Necrosis Factor Therapy." Clinical and Vaccine Immunology 18, no. 12 (October 12, 2011): 2102–8. http://dx.doi.org/10.1128/cvi.05299-11.
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ABSTRACTGamma interferon release assays (IGRAs) are increasingly used for latentMycobacterium tuberculosisinfection (LTBI) screening in patients with rheumatic diseases starting anti-tumor necrosis factor (anti-TNF) therapies. We compared the performances of two IGRAs, an enzyme-linked immunospot release assay (T-SPOT.TB) and an enzyme-linked immunosorbent assay (QuantiFERON-TB Gold In Tube [QFT-GIT]), to that of tuberculin skin testing (TST) for LTBI screening of 157 consecutive rheumatic patients starting anti-TNF therapies. Among 155 patients with valid results, 58 (37%) were positive by TST, 39 (25%) by T-SPOT.TB assay, and 32 (21%) by QFT-GIT assay. IGRAs were associated more strongly with at least one risk factor for tuberculosis (TB) than TST. Risk factors for a positive assay included chest X-ray findings of old TB (TST), advanced age (both IGRAs), origin from a country with a high TB prevalence, and a positive TST (T-SPOT.TB assay). Steroid use was negatively associated with a positive QFT-GIT assay. The agreement rate between IGRAs was 81% (kappa rate = 0.47), which was much higher than that observed between an IGRA and TST. If positivity by either TST or an IGRA was required for LTBI diagnosis, then the rate of LTBI would have been 46 to 47%, while if an IGRA was performed only for TST-positive patients, the respective rate would have been 11 to 17%. In conclusion, IGRAs appear to correlate better with TB risk than TST and should be included in TB screening of patients starting anti-TNF therapies. In view of the high risk of TB in these patients, a combination of one IGRA and TST is probably more appropriate for LTBI diagnosis.
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Nanovic, Zorica, Biserka Kaeva Jovkovska, Gorica Breskovska, and Milena Petrovska. "Key Issues in the Management of Multi-Drug Resistant Tuberculosis: A Case Report." Open Access Macedonian Journal of Medical Sciences 6, no. 7 (July 14, 2018): 1282–88. http://dx.doi.org/10.3889/oamjms.2018.290.
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BACKGROUND: Global tuberculosis (TB) epidemic is being driven to an increasing extent by the emergence and spread of drug-resistant strains of Mycobacterium tuberculosis complex (MTBC). We present a case of primary multidrug-resistant tuberculosis (MDR-TB), highlighting Macedonian MDR-TB management issues.CASE REPORT: A 39-year old previously healthy Caucasian male, with no previous history of TB or close contact to TB, was admitted in referral TB-hospital due to respiratory bleeding. Chest X-ray revealed opacity with cavernous lesions in the right upper lobe. Sputum samples showed no presence of acid-fast bacilli (AFB) on fluorescence microscopy, but molecular tests (real-time PCR-based assay and multiplex PCR-based reverse hybridisation Line Probe Assay) confirmed the presence of MTBC, also revealing rifampicin and isoniazid resistance and absence of resistance to second-line anti-tubercular drugs. The strain was considered multidrug-resistant, lately confirmed by conventional methods in liquid and solid culture. Following the protocol of the World Health Organization, we started the longer treatment of MDR-TB comprised of at least five effective anti-tubercular drugs. Due to patient’s extreme non-adherence, we had to delay and modify the regimen (i.e. omitting parenteral aminoglycoside) and to discharge him from the hospital a month after directly observed therapy (DOT) in negative pressure room. As there is no legal remedy in our country regarding involuntary isolation, our patient continued the regimen under ambulatory control of referral TB-hospital. Ignoring the risk of additional acquisition of drug resistance and prolonged exposure of the community to MDR-TB strain - for which he was repeatedly advised - he decided to cease the therapy six months after beginning.CONCLUSION: The benefit of molecular tests in the early diagnosis of TB and drug resistance is unequivocal for adequate treatment of resistant forms of TB. Whole genome sequencing ensures additional knowledge of circulating strains and their resistance patterns. These are essentials of effective TB control programs and can provide evidence to medical and legal authorities for more active policies of screening, involuntary confinement and compliance with therapy, and alternative modalities for successful treatment, as a part of infection control.
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SURYANA, KETUT, HAMONG SUHARSONO, and IDA BAGUS NGURAH RAI. "THE DIAGNOSTIC VALUE OF CONVENTIONAL TUBERCULOSIS DIAGNOSTIC PROCEDURE COMPARED WITH GENE X-PERT MTB/RIF: A CROSS-SECTIONAL STUDY." Asian Journal of Pharmaceutical and Clinical Research, June 5, 2020, 138–41. http://dx.doi.org/10.22159/ajpcr.2020.v13i8.37981.
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Objectives: The objectives of the study were to evaluate the diagnostic value of conventional tuberculosis (TB) diagnostic procedure compared with Gene X-pert Mycobacterium tuberculosis/rifampicin (MTB/RIF).
Methods: A cross-sectional study conducted from January to December 2018. The accuracy of conventional TB diagnostic procedure: TB screening, chest X-ray, and sputum Ziehl-Neelsen (ZN) staining was compared to Gene X-pert MTB/RIF using 2 × 2 table. p < 0.05 were taken as statistically significant. The collected data were processed using Statistical Package for the Social Science software version 26.0.
Results: A total of 117 participants suspected TB was found 44 (37.60%) confirmed TB. Among the suspected TB cases, 86 (73.50%) were male and 31 (26.50%) were female with the mean age of 43.86±16.47 years. The sensitivity and specificity of TB screening (prolonged cough) were 84.00% and 12.00%, respectively. Chest X-ray had the sensitivity and specificity (91.00%) and (10.00%). The sensitivity and specificity of sputum ZN were 57.00% and 99.00%.
Conclusions: Conventional TB diagnostic procedure has a high accuracy compared with Gene X-pert MTB/RIF. Therefore, it is still recommended as a TB diagnostic procedure routinely in era of Gene X-pert MTB/RIF, especially in Primary Health Care with limited settings.
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Moodley, Nishila, Kavindhran Velen, Amashnee Saimen, Noor Zakhura, Gavin Churchyard, and Salome Charalambous. "Digital chest radiography enhances screening efficiency for pulmonary tuberculosis in primary health clinics, South Africa." Clinical Infectious Diseases, July 27, 2021. http://dx.doi.org/10.1093/cid/ciab644.
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Abstract Background Optimized tuberculosis (TB) screening in high burden settings is essential for case finding. We evaluated digital chest x-ray with computer-aided detection (CAD) software (d-CXR) for identifying undiagnosed TB in three primary health clinics in South Africa. Methods The cross-sectional study consented adults who were sequentially screened for TB using the World Health Organization (WHO) four symptom questionnaire and d-CXR. Participants reporting ≥1 TB symptom and/or CAD score ≥60 (suggestive of TB) provided two spot sputum for Xpert MTB/RIF Ultra (Xpert Ultra) and liquid culture testing respectively. TB yield (proportion of screened tested positive) and number needed to test [NNT] (no of tests to identify one TB patient) were calculated. Risk factors for microbiologically confirmed or presumed (on radiological grounds) were determined. Results Among 3041 participants, 45% (1356/3,041) screened positive on either d-CXR or symptoms. TB yield was 2.3% (71/3041) using Xpert Ultra and 2.7% (82/3041) using Xpert Ultra plus culture. Modelled TB yield (identified by Xpert Ultra) by screening approach was: 1.9% (59/3041) for d-CXR alone, 2.0% (62/3041) for symptoms alone and 2.3% (71/3041) for both. The NNT was 9.7 for d-CXR, 17.8 for symptoms and 19.1 for d-CXR and/or symptom. Males, those with previous TB, untreated HIV or unknown HIV status, and acute illness were at higher risk of developing TB. Conclusion d-CXR screening identified a similar yield of undiagnosed TB compared to symptom-based screening, however required fewer diagnostic tests. Due to its objective nature, d-CXR screening may improve case detection in clinics.
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Frascella, Beatrice, Alexandra S. Richards, Bianca Sossen, Jon C. Emery, Anna Odone, Irwin Law, Ikushi Onozaki, Hanif Esmail, and Rein M. G. J. Houben. "Subclinical tuberculosis disease - a review and analysis of prevalence surveys to inform definitions, burden, associations and screening methodology." Clinical Infectious Diseases, September 16, 2020. http://dx.doi.org/10.1093/cid/ciaa1402.
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Abstract While it is known that a substantial proportion of individuals with tuberculosis disease (TB) present subclinically, usually defined as bacteriologically-confirmed but negative on symptom screening, considerable knowledge gaps remain. Our aim was to review data from TB prevalence population surveys and generate a consistent definition and framework for subclinical TB, thus enabling an estimate of the proportion of TB that is subclinical, explore associations with overall burden and programme indicators, and performance of screening strategies. We extracted data from all publicly available prevalence surveys conducted since 1990. Between 36.1–79.7% (median 50.4%) of prevalent bacteriologically-confirmed TB was subclinical. No association was found between prevalence of subclinical and all bacteriologically confirmed TB, patient diagnostic rate or country-level HIV prevalence (p-values, 0.32, 0.4, 0.34, respectively). Chest X-ray detected 89% (range 73–98%) of bacteriologically-confirmed TB disease, highlighting the potential of optimizing current TB case-finding policies.
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Alisjahbana, Bachti, Susan M. McAllister, Cesar Ugarte-Gil, Nicolae Mircea Panduru, Katharina Ronacher, Raspati C. Koesoemadinata, Carlos Zubiate, et al. "Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa." Transactions of The Royal Society of Tropical Medicine and Hygiene, October 28, 2020. http://dx.doi.org/10.1093/trstmh/traa100.
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Abstract Background Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. Results A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. Conclusions These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.
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Pal Singh, Surinder, Harjinder Singh, Komal Deep Kaur, Kailash Meena, Ashish Shukla, AjayPal Singh, Renu Bedi, Kamaldeep Singh, and Jyoti Jyoti. "THE IMPORTANCE OF CHEST-X-RAY (TIMIKA SCORE) TO PREDICT THE CLINICO-BACTERIOLOGICAL PROFILE OF PULMONARY TUBERCULOSIS PATIENTS." INDIAN JOURNAL OF APPLIED RESEARCH, May 1, 2021, 55–58. http://dx.doi.org/10.36106/ijar/8602284.
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Introduction: Chest x-ray (CXR) is the primary modality for diagnosis and severity assessment and monitoring the ATT response in pulmonary tuberculosis (PTB). The aim of our study was to determine the correlation between the radiographic involvement of disease on CXR based on Timika CXR score with the clinically and bacteriological specications at diagnosis and initiation of ATT in sputum smear-positive PTB patients. Material And Method: A cross-sectional study was conducted in the Department of Pulmonary Medicine, a tertiary care hospital, Punjab, from January to June 2020. Seventy new sputum smear-positive cases of PTB were included. At the time of diagnosis, the patient's baseline test, clinical signs and symptoms were evaluated using TB scores I, II, Karnofsky performance score (KPS), and body mass index (BMI). Two chest physicians, according to the Timika CXR score, evaluated the CXR of each patient Independently. Result: Cavitary lesion on CXR resulted in a signicantly higher Timika score associated with higher Mycobacterial load in sputum grading compared to non-cavitary disease. 55.17% of patients with CXR score ≥71 had statistically signicant higher baseline sputum grading compared to 9.76% of patients with CXR ≤ 71. Higher Timika CXR score ≥ 71 was signicantly associated with a longer mean duration of symptoms, lower BMI, higher TB score, lower KPS at baseline, higher ESR, low hemoglobin, low serum albumin. Discussion: The study shows that Timika CXR score signicantly correlates with radiographic involvement and extent of disease severity on CXR with the clinically and bacteriological prole of PTB patients, which a pulmonologist can use in a medical practice. A Higher CXR Timika score is associated with the patient's poor clinical condition and the severity of the disease. Cavitary lesion on CXR associated with higher sputum smear grading. It is observed that the Timika CXR score can be used to identify the PTB patients at risk of treatment failure for their more aggressive management.
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Ticlla, Monica R., Jerry Hella, Hellen Hiza, Mohamed Sasamalo, Francis Mhimbira, Liliana K. Rutaihwa, Sara Droz, et al. "The Sputum Microbiome in Pulmonary Tuberculosis and Its Association With Disease Manifestations: A Cross-Sectional Study." Frontiers in Microbiology 12 (August 20, 2021). http://dx.doi.org/10.3389/fmicb.2021.633396.
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Each day, approximately 27,000 people become ill with tuberculosis (TB), and 4,000 die from this disease. Pulmonary TB is the main clinical form of TB, and affects the lungs with a considerably heterogeneous manifestation among patients. Immunomodulation by an interplay of host-, environment-, and pathogen-associated factors partially explains such heterogeneity. Microbial communities residing in the host's airways have immunomodulatory effects, but it is unclear if the inter-individual variability of these microbial communities is associated with the heterogeneity of pulmonary TB. Here, we investigated this possibility by characterizing the microbial composition in the sputum of 334 TB patients from Tanzania, and by assessing its association with three aspects of disease manifestations: sputum mycobacterial load, severe clinical findings, and chest x-ray (CXR) findings. Compositional data analysis of taxonomic profiles based on 16S-rRNA gene amplicon sequencing and on whole metagenome shotgun sequencing, and graph-based inference of microbial associations revealed that the airway microbiome of TB patients was shaped by inverse relationships between Streptococcus and two anaerobes: Selenomonas and Fusobacterium. Specifically, the strength of these microbial associations was negatively correlated with Faith's phylogenetic diversity (PD) and with the accumulation of transient genera. Furthermore, low body mass index (BMI) determined the association between abnormal CXRs and community diversity and composition. These associations were mediated by increased abundance of Selenomonas and Fusobacterium, relative to the abundance of Streptococcus, in underweight patients with lung parenchymal infiltrates and in comparison to those with normal chest x-rays. And last, the detection of herpesviruses and anelloviruses in sputum microbial assemblage was linked to co-infection with HIV. Given the anaerobic metabolism of Selenomonas and Fusobacterium, and the hypoxic environment of lung infiltrates, our results suggest that in underweight TB patients, lung tissue remodeling toward anaerobic conditions favors the growth of Selenomonas and Fusobacterium at the expense of Streptococcus. These new insights into the interplay among particular members of the airway microbiome, BMI, and lung parenchymal lesions in TB patients, add a new dimension to the long-known association between low BMI and pulmonary TB. Our results also drive attention to the airways virome in the context of HIV-TB coinfection.
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Sidhu, Arslan A., and Anupama Nandagudi. "P32 Should we continue to test for latent tuberculosis infection in patients treated with biologics?" Rheumatology 59, Supplement_2 (April 1, 2020). http://dx.doi.org/10.1093/rheumatology/keaa111.031.
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Abstract Background Timely diagnosis of tuberculosis (TB) infection is important in patients receiving biologics. Current BSR guidelines on biologic safety in inflammatory arthritis (2018) advise to screen all patients for TB before starting treatment. Due to limitations of tuberculin skin test (TST), IFN-γ release assay (IGRA) is frequently used in addition to clinical examination, risk assessment and chest x-ray (CXR). There are no clear guidelines whether IGRA should be part of follow up assessments. The Royal College of Nursing suggest patients on biologics should have repeat CXR in 3 months after starting biologics and then annually. The American College of Rheumatology suggest an annual TST or IGRA for high-risk individuals receiving biologics. Centers for disease control and prevention guidelines allows to use TST and IGRA for surveillance in selected population. Methods We present two cases in which patients developed TB after starting biologics. Both patients had negative IGRA, normal CXR and low risk of developing TB on prebiologic screening. Results First patient was a 64-year-old female with rheumatoid arthritis diagnosed in 2001. She failed multiple conventional DMARDs and was started on Certolizumab in 2014. Prebiologic screen showed a negative IGRA (T Spot) and CXR was clear. She was a smoker and her mother had pulmonary TB when she was a child. After 4 years she presented with weight loss and cough. CXR showed 1.4 cm round opacity in right upper lobe. She underwent surgical resection and histology showed acid fast bacilli on ZN stain with superimposed aspergilloma. She was started on quadruple therapy and we switched Certolizumab to Etanercept due to its shorter half-life. Second patient was a 27-year-old man with ankylosing spondylitis diagnosed in 2015. He was a smoker and had no past medical history. He was started on Adalimumab in 2016. T Spot was negative and CXR was clear. There were no risk factors for TB. Two years later he presented with multiple tender subcutaneous nodules over thighs and lower abdomen. Skin biopsy after dermatology assessment showed superficial and deep perivascular inflammation with lymphocytes and small number of eosinophils. Differential were granulomatous infection or panniculitis due to injection site reaction. TB cultures came back negative but repeat T Spot was positive. He was treated as latent TB infection for 3 months and Adalimumab was restarted without any problems. Conclusion Current BSR guidelines advise to monitor patient clinically for any signs of TB while receiving biologics. We suggest that there is a need to review whether TST or IGRA should be done annually on high risk patients along with CXR. Disclosures A.A. Sidhu None. A. Nandagudi None.
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"Intralobar pulmonary sequestrations in adults." Journal of Clinical Review & Case Reports 2, no. 1 (May 25, 2017). http://dx.doi.org/10.33140/jcrc/02/01/00002.
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Intralobar sequestration accounts for 75% of pulmonary sequestrations. It is characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply. We conducted a retrospective medical records review of all patients evaluated and treated in our pulmonary department of military hospital of Tunisia with diagnosis of PS from January 2007 through December 2015. Among them, we report 5 cases of intralobar pulmonary sequestrations operated. There are three women and two men; the mean age is 27.6 years. The sequestration was intralobar in all cases. Clinical presentations were chest pain and productive cough in three cases. Chest X-ray showed left basal opacity in three cases, bilateral basal reticulonodular opacities in one case and round hydric opacity in the right lower lobe in one other case. Computed tomography was performed and revealed an aberrant systemic artery born from the lateral side of aorta supplying a left lower lobe sequestration in four cases and a right lower lobe mass in only one case. The confirmation was operative in all cases and histologic only in three cases. All patients were treated by lobectomy. Only one case presented with a pulmonary sequestration combined with tuberculosis and he was treated firstly by antituberculous chemotherapy. The results were excellent with a favorable clinical course and the mortality was nil.
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Sharma, Dhrubajyoti, Anju Gupta, Manojkumar Rohit, Deepti Suri, Amit Rawat, and Surjit Singh. "Abstract 145: Long Term Follow-up Of Children With Kawasaki Disease (KD) Treated With Infliximab (IFX) - Our Experience At Chandigarh, North India." Circulation 131, suppl_2 (April 28, 2015). http://dx.doi.org/10.1161/circ.131.suppl_2.145.
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Background: Tuberculosis (TB) is endemic in India. Flare-up of TB is a concern in children treated with IFX. Objective: To report long-term follow-up of children with KD treated with IFX. Patients and methods: Study design: Review of records of 17 children with KD who had received IFX. Median age was 1.5 years (range 2 months to 6 years) Study setting: Pediatric Rheumatology Clinic, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, North India. Study duration: January 2007 to July 2014. Patient group: Patients with diagnosis of KD and given IFX were included and analyzed. 15 of these patients had received intravenous immunoglobulin (2g/kg) as first line therapy. Dose of IFX was 5-7 mg/kg given intravenously. Screening tests for TB (chest X-ray, tuberculin test) were not carried out prior to IFX infusion. Duration of follow-up:6 -12 months in 6 patients;13-30 months in 5 patients;45-65 months in 5 patients and 80 months in 1 patient (mean follow-up 30.6 ± 24.4 months). Results: None of the patients had any significant adverse reactions during infusion of IFX. On follow-up none of these patients has developed TB or any other significant infection. Twelve (12)/17 patients showed coronary artery abnormalities (CAAs) (table). Post IFX, 66% (8 of 12) patients with KD showed improvement in CAAs on follow-up. Conclusion: In our experience use of IFX was not associated with flare-up of any significant bacterial infection (including TB) during follow-up. 8/12 patients with CAAs showed resolution.
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Bjartveit, Kjell. "Statens helseundersøkelser: Fra tuberkulosekamp til mangesidig epidemiologisk virksomhet." Norsk Epidemiologi 7, no. 2 (October 26, 2009). http://dx.doi.org/10.5324/nje.v7i2.397.
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<strong><span style="font-family: TimesNewRomanPS-BoldMT;"><font face="TimesNewRomanPS-BoldMT"><p align="left"> </p></font></span><p align="left"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">SAMMENDRAG</span></span></p></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">I 1940 ble skjermbildefotografering tatt i bruk i tuberkulosearbeidet. Statens skjermbildefotografering ble</p><p align="left">opprettet i 1943 for at dette helsetilbudet kunne nå frem til alle. Fra 1952 var virksomheten landsdekkende.</p><p align="left">Screeningen ble utført av team som besøkte alle kommuner med buss eller båt. Resultatene ble meddelt den lokale</p><p align="left">helsetjeneste, som tok seg av oppfølgingen.</p><p align="left">I 1962 ble Det sentrale tuberkuloseregister opprettet. Fra 1969 ble totalundersøkelsene gradvis avløst av selektive</p><p align="left">tuberkuloseundersøkelser. Risiko ble beregnet på grunnlag av resultater fra tidligere masseundersøkelser, og</p><p align="left">bare personer med relativt høy risiko ble innbudt.</p><p align="left">På 1950-60-tallet ble undersøkelsene utvidet med enkelte større epidemiologiske prosjekter. I 1970-80-årene</p><p align="left">ble det gjennomført omfattende kartlegginger av risikofaktorer for hjerte-karsykdom i tre fylker, og i 1985 startet</p><p align="left">det såkalte 40-åringsprogrammet, som fra 1993 er landsomfattende. Alle kommuner besøkes med tre års intervall.</p><p align="left">Ved hver runde innbys alle personer 40-42 år til undersøkelse mhp. kardiovaskulær risiko. Undersøkelsene er en</p><p align="left">totalpakke som omfatter overvåking, forskning, undervisning og forebygging ved masse- og høyrisikostrategi.</p><p align="left">I 1986 ble navnet endret til Statens helseundersøkelser. Institusjonen er i dag engasjert i mangesidig virksomhet</p><p align="left">innenfor forebygging og epidemiologi. Epidemiologisk forskning, rådgivning og helseopplysning spiller en</p><p align="left">sentral rolle. Opp gjennom årene er det samlet en unik datakilde som burde ha vært utnyttet mer inngående.</p><font face="TimesNewRomanPSMT" size="2"><font face="TimesNewRomanPSMT" size="2"><p align="left">Bjartveit K.</p></font></font></span><font face="TimesNewRomanPSMT" size="2"><p align="left"> </p></font></span><p align="left"><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">The National Health Screening Service: From fight against tuberculosis to many-sided<strong><font face="TimesNewRomanPS-BoldMT" size="2"><font face="TimesNewRomanPS-BoldMT" size="2"><p align="left">epidemiological activities.</p></font></font></strong></span><strong><font face="TimesNewRomanPS-BoldMT" size="2"><p align="left"> </p></font></strong></span></strong><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;">Nor J Epidemiol </span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">1997; </span></span><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">7 </span></span></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">(2): 157-174.</span></span></p><p align="left"> </p><strong><span style="font-family: TimesNewRomanPS-BoldMT;"><font face="TimesNewRomanPS-BoldMT"><p align="left">E</p></font></span><p align="left"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">NGLISH SUMMARY</span></span></p></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">From 1940 miniature chest X-ray screening was used in tuberculosis work. In 1943 the National Mass Radiography</p><p align="left">Service was established so that this health measure could be offered everyone. From 1952 onwards this</p><p align="left">service covered the entire country. The screening was carried out by teams visiting all municipalities by bus or</p><p align="left">boat. The results were sent to the local health services, which took care of follow up.</p><p align="left">In 1962 the Central Tuberculosis Register was set up. From 1969 onwards screening of the total population</p><p align="left">was gradually replaced by selective case-finding for tuberculosis. Risk was calculated on the basis of results from</p><p align="left">previous examinations, and only persons with relatively high risk were invited.</p><p align="left">In the 1950s and ‘60s some large epidemiological surveys were included in the screenings. In the 1970s and</p><p align="left">‘80s extensive surveys of risk factors for cardiovascular disease were carried out in three counties, and in 1985 the</p><p align="left">so-called age-40 programme started, which from 1993 is nation-wide. All municipalities are visited with an</p><p align="left">interval of three years. At each round, all persons aged 40-42 are invited to screening for cardiovascular disease</p><p align="left">risk. The examinations represent a total package, including surveillance, research, education, and prevention</p><p align="left">through mass and high risk strategy.</p><p align="left">In 1996 the institute’s name was changed to the National Health Screening Service, which today is involved in</p><p align="left">a many-sided activity within prevention and epidemiology. Epidemiological research, counselling and health</p><p align="left">education play a central role. Through the years a unique data source has been collected, which should have been</p><p>utilised more extensively.</p></span></span>
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Baldeweg, Friederike, Anna Nuttall, Dhilanthy Arul, and Anna Childerhouse. "P031 Whipple's disease: a multidisciplinary conundrum." Rheumatology 60, Supplement_1 (April 1, 2021). http://dx.doi.org/10.1093/rheumatology/keab247.028.
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Abstract Background/Aims A 45-year-old male patient presented in 2015 with a six-month history of relapsing and remitting polyarthralgia. Hand X-rays appeared normal. Serology showed mildly elevated inflammatory markers. Autoimmune profile including anti-CCP antibody, rheumatoid factor and ANA was negative. His initial diagnosis was palindromic rheumatism. He was under watchful waiting in rheumatology clinic having declined a trial of hydroxychloroquine, when in 2018 he developed severe epigastric pain. Over the subsequent 18 months he was noted to have dramatic weight loss, fatigue and drenching night sweats. Methods Investigations showed microcytic anaemia with elevated inflammatory markers (Hb 98 g/L, CRP 161 mg/L, ESR 68 mm/hr). Serum ACE, bone profile, thyroid function and urate levels were normal. Chest X-ray was unremarkable. HIV and hepatitis screening was negative. Endoscopy with jejunal biopsy was performed, with mild gastritis only on histopathology and normal D2 biopsies. He was found to be H pylori positive, and notably felt his B-symptoms much improved with triple antibiotic and PPI eradication therapy. CT abdomen demonstrated widespread mesenteric lymphadenopathy. Para-aortic lymph node biopsy showed non-necrotising granulomata suggestive of either sarcoidosis or an infective etiology such as tuberculosis (TB). Given the clinical picture, the patient was commenced on high dose oral prednisolone and methotrexate for suspected sarcoidosis. Results The patient made some clinical improvement, particularly with regards to arthralgia, however his B-symptoms returned with any reduction in steroid dose. Serology showed worsening anaemia with iron and folate deficiency, and increasing inflammatory markers. We therefore decided to perform a PET CT and refer to Haematology for consideration of a lymphoproliferative disease. PET CT demonstrated lymphadenopathy without avid uptake. A second lymph node biopsy was performed which showed florid histiocytic infiltration within which there were numerous PAS positive particles consistent with Whipple's disease. This was confirmed as tropheryma whipplei on PCR. Whipple's disease is a rare systemic infectious disease causing arthralgia, diarrhoea, abdominal pain and weight loss. Treatment consists of antibiotic therapy. On further questioning, the patient had grown up on a farm. There is a known association with Whipple's disease in the agricultural community as it is a soil-borne organism. Conclusion Our patient has made an excellent recovery. He remains under the care of our rheumatology team and the London School of Tropical Medicine and Hygiene. Treatment plan is 12 months of combined therapy with doxycycline and hydroxychloroquine. He underwent a lumbar puncture to rule out meningeal Whipple disease. We have also commenced sulfasalazine for persistent arthritis, which we feel could be a reactive phenomenon. Our key learning points from this case were to use a stepwise approach to diagnosis, involve relevant specialty teams and that it in complex cases it is useful to go back to the history. Disclosure F. Baldeweg: None. A. Nuttall: None. D. Arul: None. A. Childerhouse: None.