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Yoon SH, Goo JM, Yim JJ, Yoshiyama T, Flynn JL. CT and 18F-FDG PET abnormalities in contacts with recent tuberculosis infections but negative chest X-ray. Insights Imaging 2022; 13:112. [PMID: 35796839 PMCID: PMC9261169 DOI: 10.1186/s13244-022-01255-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/19/2022] [Indexed: 12/05/2022] Open
Abstract
Close contacts of individuals with pulmonary tuberculosis are at risk for tuberculosis infection and the development of active tuberculosis. In current contact investigations, immunologic tests (the tuberculin skin test and interferon-gamma release assay) and chest X-ray examinations are used to dichotomize contacts with Mycobacterium tuberculosis infections into those with active (X-ray abnormalities) versus latent tuberculosis (normal radiographs). This article is a critical review of computed tomographic (CT) and 18-fluorodeoxyglucose positron emission tomographic (PET) findings of incipient tuberculosis without X-ray abnormalities based on a systematic literature review of twenty-five publications. The CT and 18-fluorodeoxyglucose PET studies revealed minimal pauci-nodular infiltrations in the lung parenchyma and mediastinal lymph nodes abnormalities with metabolic uptake in approximately one-third of asymptomatic close contacts with negative chest radiographic and bacteriological/molecular results for active tuberculosis. Tuberculosis with minimal changes challenge the validity of simply dichotomizing cases of recent M. tuberculosis infections in contacts depending on the presence of X-ray abnormalities as the recent infections may spontaneously regress, remain stagnant, or progress to active tuberculosis in human and nonhuman primate studies. Whether contacts with tuberculosis with minimal changes are interpreted as having active tuberculosis or latent tuberculosis has clinical implications in terms of specific benefits and harms under the current contact management. Advanced imaging tools may help further stratify contacts intensely exposed to M. tuberculosis on a continuous spectrum from latent tuberculosis to incipient, subclinical and active tuberculosis. Identifying incipient tuberculosis would provide an opportunity for earlier and tailored treatment before active tuberculosis is established.
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Affiliation(s)
- Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Takashi Yoshiyama
- Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan, Kiyose, Japan
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics and the Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Risk Factors for Delayed Isolation of Patients with Active Pulmonary Tuberculosis in an Acute-care Hospital. Sci Rep 2019; 9:4849. [PMID: 30890727 PMCID: PMC6424955 DOI: 10.1038/s41598-019-41086-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/27/2019] [Indexed: 01/15/2023] Open
Abstract
The objective of the current study was to determine the factors associated with delayed isolation of pulmonary tuberculosis (TB). In this retrospective study, data of patients newly diagnosed with pulmonary TB from January 2015 through December 2017 at a referral hospital were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of admission. We analyzed the clinical, microbiological, and radiological factors associated with delayed isolation of pulmonary TB. A total of 134 patients with positive sputum acid-fast bacilli (AFB) cultures were analyzed, of which 44 (33%) were isolated within 3 days after admission. In multivariate logistic regression analysis, older age (p = 0.01), admission to departments other than Infectious Disease or Pulmonology (p = 0.005), and presence of malignancy (p = 0.02) were associated with delayed isolation. Patients with a radiologic diagnosis of active pulmonary TB were likely to be isolated early (p = 0.01). Better awareness of pulmonary TB among attending practitioners in hospital settings is required. Delay in isolation is associated with older age, malignancy, hospitalization to departments other than Infectious Disease or Pulmonology, and non-confident radiologic diagnosis of active pulmonary TB.
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He W, Chen BD, Lv Y, Zhou Z, Xu JP, Lv PX, Zhou XH, Ning FG, Li CH, Wang DP, Zheng J. Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital. Infect Dis Poverty 2017; 6:68. [PMID: 28335802 PMCID: PMC5364637 DOI: 10.1186/s40249-017-0274-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 03/05/2017] [Indexed: 01/15/2023] Open
Abstract
Background According to the World Health Organization, China is one of 22 countries with serious tuberculosis (TB) infections and one of the 27 countries with serious multidrug-resistant TB strains. Despite the decline of tuberculosis in the overall population, healthcare workers (HCWs) are still at a high risk of infection. Compared with high-income countries, the TB prevalence among HCWs is higher in low- and middle-income countries. Low-dose computed tomography (LDCT) is becoming more popular due to its superior sensitivity and lower radiation dose. However, there have been no reports about active pulmonary tuberculosis (PTB) among HCWs as assessed with LDCT. The purposes of this study were to examine PTB statuses in HCWs in hospitals specializing in TB treatment and explore the significance of the application of LDCT to these workers. Methods This study retrospectively analysed the physical examination data of healthcare workers in the Beijing Chest Hospital from September 2012 to December 2015. Low-dose lung CT examinations were performed in all cases. The comparisons between active and inactive PTB according to the CT findings were made using the Pearson chi-square test or the Fisher’s exact test. Comparisons between the incidences of active PTB in high-risk areas and non-high-risk areas were performed using the Pearson chi-square test. Analyses of active PTB were performed according to different ages, numbers of years on the job, and the risks of the working areas. Active PTB as diagnosed by the LDCT examinations alone was compared with the final comprehensive diagnoses, and the sensitivity and positive predictive value were calculated. Results A total of 1 012 participants were included in this study. During the 4-year period of medical examinations, active PTB was found in 19 cases, and inactive PTB was found in 109 cases. The prevalence of active PTB in the participants was 1.24%, 0.67%, 0.81%, and 0.53% for years 2012 to 2015. The corresponding incidences of active PTB among the tuberculosis hospital participants were 0.86%, 0.41%, 0.54%, and 0.26%. Most HCWs with active TB (78.9%, 15/19) worked in the high-risk areas of the hospital. There was a significant difference in the incidences of active PTB between the HCWs who worked in the high-risk and non-high-risk areas (odds ratio [OR], 14.415; 95% confidence interval (CI): 4.733 – 43.896). Comparisons of the CT signs between the active and inactive groups via chi-square tests revealed that the tree-in-bud, cavity, fibrous shadow, and calcification signs exhibited significant differences (P = 0.000, 0.021, 0.001, and 0.024, respectively). Tree-in-bud and cavity opacities suggest active pulmonary tuberculosis, whereas fibrous shadow and calcification opacities are the main features of inactive pulmonary tuberculosis. Comparison with the final comprehensive diagnoses revealed that the sensitivity and positive predictive value of the diagnoses of active PTB based on LDCT alone were 100% and 86.4%, respectively. Conclusions Healthcare workers in tuberculosis hospitals are a high-risk group for active PTB. Yearly LDCT examinations of such high-risk groups are feasible and necessary. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0274-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wei He
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Bu-Dong Chen
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
| | - Yan Lv
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Zhen Zhou
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Jin-Ping Xu
- The school hospital, Beijing Science and Technology University, Beijing, 100083, China
| | - Ping-Xin Lv
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Xin-Hua Zhou
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Feng-Gang Ning
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Cheng-Hai Li
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Dong-Po Wang
- Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, Saint Louis, MO, 63110, USA.
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Baxter S, Goyder E, Chambers D, Johnson M, Preston L, Booth A. Interventions to improve contact tracing for tuberculosis in specific groups and in wider populations: an evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe tracing and screening of people who have had contact with an active case of tuberculosis (TB) is an important element of TB control strategies.ObjectivesThis study aimed to carry out a review of evidence regarding TB contact tracing, with a particular emphasis on research that was applicable to TB contact tracing in specific population groups in the UK.DesignAn evidence synthesis of literature of any study design on TB contact tracing in developed countries was carried out.SettingAny setting.PopulationIndividuals found to have active TB disease, and people who have come into contact with them.InterventionsContact-tracing investigations.Main outcome measuresAny outcome related to TB infection, contact investigations and/or the views of staff, people with TB disease, or their contacts.Data sourcesSearches for research published 1995 onwards were undertaken in the following databases: MEDLINE via Ovid SP, EMBASE via Ovid SP, EconLit via Ovid SP, PsycINFO via Ovid SP, Social Policy and Practice via Ovid SP, Cumulative Index to Nursing and Allied Health Literature via EBSCOhost, Science and Social Science Citation Indices via Web of Science and The Cochrane Library via Wiley Online Library.Review methodsThe study comprised a review of TB contact tracing in specific population groups and a review in wider populations. A narrative synthesis was completed and a logic model was developed from the literature.ResultsThere were 112 articles in the review: 23 related to specific populations and 89 related to wider populations. The literature was of limited quality, with much general description of investigations. We identified only two (uncontrolled) studies that could be considered evaluative. Although the limitations of the evidence should be recognised, the review suggested the following: the value of a location-based approach, working with local communities and the media, partnership working, using molecular epidemiological testing, ensuring adequate systems and addressing fear of stigma. The literature on investigations for specific populations has much concordance with that reporting findings from wider population groups. The recognised limitations of conventional investigation methods may, however, be exacerbated in specific populations.LimitationsThe English-language inclusion criterion may have limited the breadth of countries represented. A meta-analysis was not possible owing to the nature of the literature. Relevant studies may have been missed by our searches, which used terminology relating to contact tracing rather than to active case finding or screening.ConclusionsThe review identified a sizeable volume of literature relating to contact investigations. However, it is currently predominantly descriptive, with little evaluative work underpinning investigations in either specific or wider populations. Our findings are, therefore, based on limited evidence. Further research is required if robust conclusions are to be made.Future workResearch should further explore the development of measures that can be used to compare the effectiveness of different contact investigations, in studies using evaluative designs.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Kowada A. Cost effectiveness of interferon-gamma release assay for tuberculosis screening using three months of rifapentine and isoniazid among long-term expatriates from low to high incidence countries. Travel Med Infect Dis 2016; 14:489-498. [DOI: 10.1016/j.tmaid.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/10/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
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Yeh JJ, Chen SCC, Chen CR, Yeh TC, Lin HK, Hong JB, Wu BT, Wu MT. A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients. Eur Radiol 2014; 24:2372-84. [PMID: 24972956 DOI: 10.1007/s00330-014-3279-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/23/2014] [Accepted: 06/06/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to use high-resolution computed tomography (HRCT) imaging to predict the presence of smear-positive active pulmonary tuberculosis (PTB) in elderly (at least 65 years of age) and non-elderly patients (18-65 years of age). METHODS Patients with active pulmonary infections seen from November 2010 through December 2011 received HRCT chest imaging, sputum smears for acid-fast bacilli and sputum cultures for Mycobacterium tuberculosis. Smear-positive PTB was defined as at least one positive sputum smear and a positive culture for M. tuberculosis. Multivariate logistic regression analyses were performed to determine the HRCT predictors of smear-positive active PTB, and a prediction score was developed on the basis of receiver operating characteristic curve analysis. RESULTS Of 1,255 patients included, 139 were diagnosed with smear-positive active PTB. According to ROC curve analysis, the sensitivity, specificity, positive predictive value, negative predictive value, false positive rates and false negative rates were 98.6 %, 95.8 %, 78.5 %, 99.8 %, 4.2 % and 1.4 %, respectively, for diagnosing smear-positive active PTB in elderly patients, and 100.0 %, 96.9 %, 76.5 %, 100.0 %, 3.1 % and 0.0 %, respectively, for non-elderly patients. CONCLUSIONS HRCT can assist in the early diagnosis of the most infectious active PTB, thereby preventing transmission and minimizing unnecessary immediate respiratory isolation. KEY POINTS • HRCT can assist in the early diagnosis of the infectious active PTB • HRCT imaging is useful to predict the presence of smear-positive active PTB • Predictions from the HRCT imaging are valid even before sputum smear or culture results.
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Affiliation(s)
- Jun-Jun Yeh
- Section of Thoracic Imaging, Department of Chest Medicine and Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China,
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Awerbuch E, Benavides M, Gershengorn HB. The Impact of Computed Tomography of the Chest on the Management of Patients in a Medical Intensive Care Unit. J Intensive Care Med 2014; 30:505-11. [PMID: 24948509 DOI: 10.1177/0885066614540122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/24/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE To understand whether chest computed tomographies (CTs) have utility in a medical intensive care unit (MICU) population as previously noted in nonmedical critically ill patients. PATIENTS AND METHODS We conducted a retrospective cohort study of patients receiving chest CTs in the MICU at an urban, academic institution. Indications for, findings on, and care changes made after chest CT were obtained. We identified patient characteristics associated with having a care change clearly related to the CT using multivariate regression. RESULTS We evaluated 134 patients; 64 (47.8%) had a chest CT with intravenous contrast. Common findings included pulmonary consolidation (46.3%), nonconsolidative pulmonary parenchymal disease (29.1%), and pleural effusion (35.1%). Of the chest CTs, 23.9% were followed by changes in management clearly related to the study. Use of intravenous contrast was associated with increased odds of having a care change (adjusted odds ratio [95% confidence interval [CI] versus noncontrast study: 3.14 [1.18-8.37], P = .022) and having the CT performed 1 or 2 days after ICU admission versus on the day of ICU admission was associated with lower odds of a care change (odds ratio [95% CI]: 0.29 [0.09-0.99], P = .048). CONCLUSION Less than one-quarter of chest CTs in the MICU result in management. Intravenous contrast-enhanced CTs and CTs done on the day of ICU admission have increased odds of utility.
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Affiliation(s)
- Elizabeth Awerbuch
- Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Hayley B Gershengorn
- Department of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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Yeh JJ, Neoh CA, Chen CR, Chou CYT, Wu MT. A high resolution computer tomography scoring system to predict culture-positive pulmonary tuberculosis in the emergency department. PLoS One 2014; 9:e93847. [PMID: 24727951 PMCID: PMC3984117 DOI: 10.1371/journal.pone.0093847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/08/2014] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the use of high-resolution computed tomography (HRCT) to predict the presence of culture-positive pulmonary tuberculosis (PTB) in adult patients with pulmonary lesions in the emergency department (ED). The study included a derivation phase and validation phase with a total of 8,245 patients with pulmonary disease. There were 132 patients with culture-positive PTB in the derivation phase and 147 patients with culture-positive PTB in the validation phase. Imaging evaluation of pulmonary lesions included morphology and segmental distribution. The post-test probability ratios between both phases in three prevalence areas were analyzed. In the derivation phase, a multivariate analysis model identified cavitation, consolidation, and clusters/nodules in right or left upper lobe (except anterior segment) and consolidation of the superior segment of the right or left lower lobe as independent positive factors for culture-positive PTB, while consolidation of the right or left lower lobe (except superior segment) were independent negative factors. An ideal cutoff point based on the receiver operating characteristic (ROC) curve analysis was obtained at a score of 1. The sensitivity, specificity, positivity predictive value, and negative predictive value from derivation phase were 98.5% (130/132), 99.7% (3997/4008), 92.2% (130/141), and 99.9% (3997/3999). Based on the predicted positive likelihood ratio value of 328.33 in derivation phase, the post-test probability was observed to be 91.5% in the derivation phase, 92.5% in the validation phase, 94.5% in a high TB prevalence area, 91.0% in a moderate prevalence area, and 76.8% in moderate-to-low prevalence area. Our model using HRCT, which is feasible to perform in the ED, can promptly diagnose culture-positive PTB in moderate and moderate-to-low prevalence areas.
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Affiliation(s)
- Jun -Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Meiho University, Pingtung, Taiwan
- Pingtung Christian Hospital, Pingtung, Taiwan
- * E-mail: (J-JY); (M-TW)
| | | | - Cheng-Ren Chen
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | | | - Ming-Ting Wu
- Section of Thoracic and Circulation Imaging, Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- * E-mail: (J-JY); (M-TW)
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Fujikawa A, Fujii T, Mimura S, Takahashi R, Sakai M, Suzuki S, Kyoto Y, Uwabe Y, Maeda S, Mori T. Tuberculosis contact investigation using interferon-gamma release assay with chest x-ray and computed tomography. PLoS One 2014; 9:e85612. [PMID: 24454900 PMCID: PMC3891819 DOI: 10.1371/journal.pone.0085612] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/06/2013] [Indexed: 11/19/2022] Open
Abstract
Between September 2009 and January 2010, 6 members of the Japanese Eastern Army, who had completed the same training program, were diagnosed with active tuberculosis (TB) on different occasions. The Ministry of Defense conducted a contact investigation of all members who had come into contact with the infected members. The purpose of this study was to verify the efficacy of the TB screening protocol used in this investigation. A total of 884 subjects underwent interferon-gamma release assay (IGRA) and chest X-ray. The 132 subjects who were IGRA positive or with X-ray findings suggestive of TB subsequently underwent chest computer tomography (CT). Chest CT was performed for 132 subjects. Based on CT findings, 24 (2.7%) subjects were classified into the active TB group, 107 (12.1%) into the latent tuberculosis infection (LTBI) group, and 753 (85.2%) into the non-TB group. The first 2 groups underwent anti-TB therapy, and all 3 groups were followed for 2 years after treatment. Although one subject in the active TB group experienced relapse during the follow-up period, no patient in the LTBI or non-TB groups developed TB. IGRA and chest X-ray, followed by chest CT for those IGRA positive or with suspicious X-ray findings, appears to be an effective means of TB contact screening and infection prevention.
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Affiliation(s)
- Akira Fujikawa
- Department of Medical Education and Research, Japan Self-Defense Forces Central Hospital, Ikejiri, Setagaya, Tokyo, Japan
- Department of Radiology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
- * E-mail: (AF); (TF)
| | - Tatsuya Fujii
- Department of Internal Medicine, Kawakita General Hospital, Asagaya-kita, Suginami, Tokyo, Japan
- * E-mail: (AF); (TF)
| | - Satoshi Mimura
- Division of Respiratory Medicine, Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Ryota Takahashi
- Division of Infectious disease, Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Masao Sakai
- Division of Respiratory Medicine, Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Shinya Suzuki
- Department of Medical Education and Research, Japan Self-Defense Forces Central Hospital, Ikejiri, Setagaya, Tokyo, Japan
- Division of Respiratory Medicine, Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Yukishige Kyoto
- Department of Radiology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Yasuhide Uwabe
- Department of Internal Medicine, Japan Ground Self-Defense Force Fukuoka Hospital, Kokura-Higashi, Kasuga, Fukuoka, Japan
| | - Shinji Maeda
- Molecular Epidemiology Division, Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis Japan, Matsuyama, Kiyose, Tokyo, Japan
| | - Toru Mori
- Japan Anti-Tuberculosis Association (JATA), Research Institute of Tuberculosis Japan, Matsuyama, Kiyose, Tokyo, Japan
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