The role of chest radiography to diagnose active tuberculosis in symptomatic patients who have a negative Xpert MTB/RIF (Xpert) test result is unclear. This study aimed to assess the performance of chest radiography and the value of chest radiography findings for a prediction tool to identify cases of active pulmonary tuberculosis among symptomatic, Xpert-negative hospitalised patients. Xpert-negative patients hospitalised between January and July 2019 at Jimma University Medical Center in Ethiopia were assessed by mycobacterial culture and chest radiography. Chest radiography was interpreted by a clinician for clinical decision making and by a radiologist for research purposes. Using bacteriological confirmation as the reference standard, the performance of chest radiography to diagnose active tuberculosis was assessed by the area under the receiver operating characteristic curve (AUC); predictors of active tuberculosis were identified using bivariate and multivariate logistic regression analyses. Of 247 Xpert-negative patients, 38% and 40% were classified as suggestive of tuberculosis by clinician and radiologist, respectively. Of the 39 (15.8%) bacteriologically confirmed cases, 69% and 79% were classified as having chest radiography findings suggestive of tuberculosis by clinician or radiologist, respectively. While there was a strong association between bacteriologically confirmed tuberculosis and chest radiography classified by clinician as suggestive of tuberculosis (adjusted OR 2.7, 95% CI 1.2–6.6), chest radiography with signs typical of tuberculosis (adjusted OR 5.3, 95% CI 2.1–14.4) or compatible with tuberculosis (adjusted OR 5.1, 95% CI 1.3–20.0), the positive predictive value of the chest radiography was low (27% and 34% for classification by clinician and radiologist, respectively). The addition of chest radiography findings by clinician or radiologist to clinical characteristics did not improve the performance of the prediction tool, with similar risk classification distribution, AUCs and negative and positive prediction values. Despite the strong association between chest radiography findings and active tuberculosis among hospitalised Xpert negative individuals, chest radiography findings did not improve the performance of a risk prediction tool based solely on clinical symptoms. Countries with a high tuberculosis/HIV burden should urgently replace Xpert by the more sensitive Xpert Ultra assay to improve the diagnosis of active tuberculosis.

https://openres.ersjournals.com/content/erjor/7/1/00708-2020.full.pdf

The role of chest radiography in the diagnosis of bacteriologically confirmed pulmonary tuberculosis in hospitalised Xpert MTB/RIF-negative patients.

Interpretation of Chest X Ray (CXR) in relation to sputum smear microscopy can be useful in early diagnosis of pulmonary TB. The study aimed to compare the CXR findings in pulmonary TB cases with positive sputum microscopy and negative sputum microscopy. Patients with presumptive pulmonary TB were grouped into smear positive pulmonary TB and smear negative pulmonary TB groups based on CXR and sputum smear microscopy. CXR findings in the two groups were compared using chi square and students- t test. A total of 225 patients with presumptive pulmonary TB were evaluated. Of these, 174 subjects were included in the study: 129 (74.2%) in smear positive pulmonary TB group and 45(25.8%) in smear negative pulmonary TB group. Parenchymal involvement was the most common finding in both smear positive and smear negative groups seen in 118 (91.5%) and 42 (93.3%) subjects, respectively. The area of parenchymal involvement was significantly more in smear positive group as compared to smear negative group (p<0.001). Cavitation was more commonly associated with smear positive group (p=0.005) Nodal enlargement was significantly more common among smear negative subjects (p<.001). CXR could detect 25.8% smear negative pulmonary TB cases. Extensive parenchymal infiltration and cavitation were more commonly associated with smear positive patients whereas nodal involvement was significantly more common in smear negative patients.

/pdf/pulmonary-tuberculosis-an-observational-study-to-compare-fj4ohl57.pdf

Pulmonary tuberculosis: An observational study to compare radiographic abnormalities with reference to smear microscopy status

Improving the management of hospitalized presumptive Xpert MTB/RIF-negative tuberculosis cases in Ethiopia

Background: Tuberculosis (TB) is a mycobacterial infection mainly affecting the lungs. Early and correct diagnosis of sputum smear negative patients by chest radiography (CXR) is challenging since it depends on reader's ability to detect abnormal findings and to interpret it correctly. Objectives: To evaluate the validity and reliability of CXR the diagnosis of TB among smear negative pulmonary tuberculosis (PTB) Methods: An institutional based cross-sectional study was conducted at seven selected health facilities from October 2011 to September 2012 on 159 adults aged 18 years and above who were newly diagnosed smear negative for PTB patients diagnosed using Chest X-ray (CXR). Morning sputum was collected and cultured from each patient using Lowenstein Jensen media. All the CXRs were revised by senior radiologists in conjunction with the principal investigator.  Results: The mean (SD) age of patients involved in the study was 37.1(16.7), ranging from 18 to 87 years. Of the total 159 smear negative PTB patients, the most common CXR finding was consolidation (40.3%) followed by cavitations (23.9%) and nodular lesions (17.0%). Sputum culture results showed that, 47(29.6%) were culture positive, 103(64.7%) were culture negative and 9(5.6%) were contaminated. About 14% (22/159) of the study subjects were HIV positive. The sensitivity and specificity of CXR findings were 77.1% (37/48) and 36.9% (41/111), respectively. The positive and negative predictive values were 34.6% (37/107) and 78.8% (41/52), respectively. Conclusion: CXR can be used as supportive investigative modality to diagnose smear negative Pulmonary TB in conditions where TB culture is no more feasible.

Evaluating the validity and reliability of chest radiography in the diagnosis of tuberculosis among smear negative pulmonary tuberculosis patients.

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Evaluating the validity and reliability of chest radiography in the diagnosis of tuberculosis among smear negative pulmonary tuberculosis patients.