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Elsingergy MM, Naidoo J, Baker G, Zar HJ, Lucas S, Andronikou S. Comparison of chest radiograph findings in ambulatory and hospitalized children with pulmonary tuberculosis. Pediatr Radiol 2023; 53:1765-1772. [PMID: 37423915 DOI: 10.1007/s00247-023-05707-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The diagnosis of childhood tuberculosis (TB) is, in many instances, solely reliant on chest radiographs (CXRs), as they are often the only diagnostic tool available, especially in TB-endemic areas. Accuracy and reliability of CXRs for detecting TB lymphadenopathy may vary between groups depending on severity of presentation and presence of parenchymal disease, which may obscure visualization. OBJECTIVE To compare CXR findings in ambulatory versus hospitalized children with laboratory confirmed pulmonary TB versus other lower respiratory tract infections (LRTI) and test inter-rater agreement for these findings. MATERIALS AND METHODS Retrospective review, by two pediatric radiologists, of CXRs performed on children < 12 years old referred for evaluation of LRTI with clinical suspicion of pulmonary TB in inpatient and outpatient settings. Each radiologist commented on imaging findings of parenchymal changes, lymphadenopathy, airway compression and pleural effusion. Frequency of imaging findings was compared between patients based on location and diagnosis and inter-rater agreement was determined. Accuracy of radiographic diagnosis was compared to laboratory testing which served as the gold standard. RESULTS The number of enrolled patients was 181 (54% males); 69 (38%) were ambulatory and 112 (62%) were hospitalized. Of those enrolled, 87 (48%) were confirmed to have pulmonary TB, while 94 (52%) were other LRTI controls. Lymphadenopathy and airway compression were more common in TB patients than other LRTI controls, regardless of patient location. Parenchymal changes and pleural effusion were more common in hospitalized than ambulatory patients, regardless of patient diagnosis. Agreement for parenchymal changes was higher in the hospitalized group (kappa [κ] = 0.75), while agreement for lymphadenopathy (κ = 0.65) and airway compression (κ = 0.68) was higher in the ambulatory group. The specificity of CXRs for TB diagnosis (> 75%) was higher than the sensitivity (< 50%) for both ambulatory and hospitalized groups. CONCLUSION Higher frequency of parenchymal changes among hospitalized children may conceal specific imaging findings of TB such as lymphadenopathy, contributing to the poor reliability of CXRs. Despite this, the high specificity of CXRs shown in our results is encouraging for continued use of radiographs for TB diagnosis in both settings.
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Affiliation(s)
- Mohamed M Elsingergy
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Jaishree Naidoo
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Gregory Baker
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, and SA-MRC Unit On Child & Adolescent Health University of Cape Town, Cape Town, South Africa
| | - Susan Lucas
- Department of Radiology, University of Witwatersrand, Johannesburg, South Africa
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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2
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Muacevic A, Adler JR, Kumar S, Shayowitz DJ. Hospital Practices for Respiratory Isolation for Patients With Suspected Tuberculosis and Potential Application of Prediction Models. Cureus 2022; 14:e32294. [PMID: 36627984 PMCID: PMC9822524 DOI: 10.7759/cureus.32294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Hospitalized persons with suspected pulmonary tuberculosis (PTB) are placed in airborne isolation to prevent nosocomial infection, as recommended by the Centers for Disease Control and Prevention (CDC). There is significant evidence that clinicians overuse this resource due to an abundance of caution when confronted with a patient with possible PTB. Many researchers have developed predictive tools based on clinical and radiographic data to assist clinicians in deciding which patients to place in respiratory isolation. We assessed the isolation practices for an urban hospital serving a large immigrant population and then retrospectively applied seven previously derived prediction models of isolation of PTB to our population. Our current clinical practice results in 76% of patients with PTB being placed in isolation on admission. However, 208 patients without PTB were placed in isolation unnecessarily for a total of 584 days. Four models had sensitivities greater than 90%, and two models had sensitivities of 100%. The use of these models would have potentially saved more than 150 days of patient isolation per year.
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3
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Tengku Khalid TNF, Wan Mohammad WMZ, Ab Samat R, Nik Husain NR. Predictors of tuberculosis disease in smokers: a case-control study in northeastern Malaysia. PeerJ 2022; 10:e13984. [PMID: 36093335 PMCID: PMC9462367 DOI: 10.7717/peerj.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/10/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Tuberculosis (TB) is a leading infectious disease. However, many TB cases remain undetected and only present symptoms at a late stage of the infection. Therefore, targeted TB screening in high-risk populations, including smokers, is crucial. This study aimed to determine the predictors of TB disease among the smoker population in northeast Malaysia from 2019 to 2020. Methods A case-control study was conducted involving smokers aged 18 years and older from health clinics in Bachok Kelantan, Malaysia. Data were collected via face-to-face interviews or telephone calls from 159 participants, randomly selected from outpatient TB records. Simple and multiple logistic regression, using R software, were used to identify the determinants of TB. Results Most participants were male (59.1%) and had a secondary education (56.0%). Active smokers constituted 35.2% of the group, and the mean (SD) duration of exposure to smoking was 23.9 (16.47) and 18.4 (12.84) years for the case and control groups, respectively. Being an ex-smoker (adjusted odds ratio (AOR) 6.17; 95% CI [1.55-28.32]; p = 0.013), weight loss (AOR 13.45; 95% CI [4.58-44.46]; p < 0.005), night sweats (AOR 63.84; 95% CI [8.99-1392.75]; p < 0.005) and duration of symptoms (AOR 1.02; 95% CI [1.01-1.04]; p = 0.022) were shown to be significant predictors for TB disease. Conclusion Four predictors of TB disease in the population of smokers were recognised in this study and should be prioritised for early TB screening and diagnosis. This may help increase TB detection, initiate prompt treatment and reduce complications among the group at risk for TB.
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Affiliation(s)
- Tengku Noor Farhana Tengku Khalid
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Razan Ab Samat
- Bachok District Health Office, Bachok, Kelantan, Malaysia
| | - Nik Rosmawati Nik Husain
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
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4
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Development and Validation of the Tuberculosis Risk Score for Smokers (TBRSS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126959. [PMID: 35742208 PMCID: PMC9223179 DOI: 10.3390/ijerph19126959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
Tuberculosis (TB) remains a significant public health issue worldwide. However, the effectiveness of TB screening programmes among smokers is still questionable. There is a need for a simple, reliable, and validated screening system for this risk population. This study aimed to develop and validate the tuberculosis risk score for smokers (TBRSS) in Kelantan, Malaysia. A case–control study was conducted on 159 patients (smokers with and without TB) between January and July 2020. Simple and multiple logistic regressions were applied to determine the variables to be included in the risk score. The cut-off points to determine a score indicating low or high risk for TB disease were obtained based on the receiver operating characteristics curve. Content validation was carried out through interviews with eight experts to measure each variable′s relevancy. The face validation was conducted among 20 health clinic staff. Seven variables were selected for inclusion in the risk score. The chosen cut-off point was 16 (out of 43), with 91% and 78% sensitivity and specificity, respectively. The scale-level content validity index was 0.83, while the face validity index scores for each element ranged between 0.85 and 1.00. The TBRSS can be considered a validated screening tool for use in screening TB disease risk among smokers, which potentially may lead to an increased detection of TB disease in the community.
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5
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Komiya K, Yamasue M, Goto A, Nakamura Y, Hiramatsu K, Kadota JI, Kato S. High-resolution computed tomography features associated with differentiation of tuberculosis among elderly patients with community-acquired pneumonia: a multi-institutional propensity-score matched study. Sci Rep 2022; 12:7466. [PMID: 35523934 PMCID: PMC9076820 DOI: 10.1038/s41598-022-11625-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
While high-resolution computed tomography (HRCT) is increasingly performed, its role in diagnosing pulmonary tuberculosis (TB) among elderly patients with community-acquired pneumonia (CAP) has not been fully elucidated. This study aimed to determine HRCT features that can differentiate pulmonary TB from non-TB CAP in elderly patients. This study included consecutive elderly patients (age > 65 years) admitted to two teaching hospitals for pulmonary TB or non-TB pneumonia who met the CAP criteria of the American Thoracic Society/Infectious Diseases Society of America guidelines. After propensity score matching for clinical background between patients with pulmonary TB and those with non-TB CAP, their HRCT features were compared. This study included 151 patients with pulmonary TB and 238 patients with non-TB CAP. The presence of centrilobular nodules, air bronchograms, and cavities and the absence of ground-glass opacities and bronchial wall thickening were significantly associated with pulmonary TB. The negative predictive values of centrilobular nodules, air bronchograms, and cavities for pulmonary TB were moderate (70.6%, 67.9%, and 63.0%, respectively), whereas the positive predictive value of cavities was high (96.6%). In elderly patients, although some HRCT features could differentiate pulmonary TB from non-TB CAP, no useful findings could rule out pulmonary TB with certainty.
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Affiliation(s)
- Kosaku Komiya
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Akihiko Goto
- Department of Respiratory Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, 879-7761, Japan
| | - Yuta Nakamura
- Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, 874-0840, Japan
| | - Kazufumi Hiramatsu
- Department of Medical Safety Management, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.,Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Seiya Kato
- Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, 204-8533, Japan
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6
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Chen J, Wu L, Lv Y, Liu T, Guo W, Song J, Hu X, Li J. Screening of Long Non-coding RNAs Biomarkers for the Diagnosis of Tuberculosis and Preliminary Construction of a Clinical Diagnosis Model. Front Microbiol 2022; 13:774663. [PMID: 35308365 PMCID: PMC8928272 DOI: 10.3389/fmicb.2022.774663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background Pathogenic testing for tuberculosis (TB) is not yet sufficient for early and differential clinical diagnosis; thus, we investigated the potential of screening long non-coding RNAs (lncRNAs) from human hosts and using machine learning (ML) algorithms combined with electronic health record (EHR) metrics to construct a diagnostic model. Methods A total of 2,759 subjects were included in this study, including 12 in the primary screening cohort [7 TB patients and 5 healthy controls (HCs)] and 2,747 in the selection cohort (798 TB patients, 299 patients with non-TB lung disease, and 1,650 HCs). An Affymetrix HTA2.0 array and qRT-PCR were applied to screen new specific lncRNA markers for TB in individual nucleated cells from host peripheral blood. A ML algorithm was established to combine the patients’ EHR information and lncRNA data via logistic regression models and nomogram visualization to differentiate PTB from suspected patients of the selection cohort. Results Two differentially expressed lncRNAs (TCONS_00001838 and n406498) were identified (p < 0.001) in the selection cohort. The optimal model was the “LncRNA + EHR” model, which included the above two lncRNAs and eight EHR parameters (age, hemoglobin, lymphocyte count, gamma interferon release test, weight loss, night sweats, polymorphic changes, and calcified foci on imaging). The best model was visualized by a nomogram and validated, and the accuracy of the “LncRNA + EHR” model was 0.79 (0.75–0.82), with a sensitivity of 0.81 (0.78–0.86), a specificity of 0.73 (0.64–0.79), and an area under the ROC curve (AUC) of 0.86. Furthermore, the nomogram showed good compliance in predicting the risk of TB and a higher net benefit than the “EHR” model for threshold probabilities of 0.2–1. Conclusion LncRNAs TCONS_00001838 and n406498 have the potential to become new molecular markers for PTB, and the nomogram of “LncRNA + EHR” model is expected to be effective for the early clinical diagnosis of TB.
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Affiliation(s)
- Juli Chen
- Laboratory Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Lijuan Wu
- Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yanghua Lv
- Laboratory Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Tangyuheng Liu
- Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weihua Guo
- Laboratory Medicine, Panzhihua Central Hospital, Panzhihua, China
| | - Jiajia Song
- Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuejiao Hu
- Laboratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Xuejiao Hu,
| | - Jing Li
- Laboratory Medicine, Panzhihua Central Hospital, Panzhihua, China
- Jing Li,
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7
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Tavaziva G, Harris M, Abidi SK, Geric C, Breuninger M, Dheda K, Esmail A, Muyoyeta M, Reither K, Majidulla A, Khan AJ, Campbell JR, David PM, Denkinger C, Miller C, Nathavitharana R, Pai M, Benedetti A, Khan FA. Chest X-ray analysis with deep learning-based software as a triage test for pulmonary tuberculosis: an individual patient data meta-analysis of diagnostic accuracy. Clin Infect Dis 2021; 74:1390-1400. [PMID: 34286831 PMCID: PMC9049274 DOI: 10.1093/cid/ciab639] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Automated radiologic analysis using computer-aided detection software (CAD) could facilitate chest X-ray (CXR) use in tuberculosis diagnosis. There is little to no evidence on the accuracy of commercially-available deep learning-based CAD in different populations, including patients with smear-negative tuberculosis and people living with HIV (PLWH). METHODS We collected CXRs and individual patient data (IPD) from studies evaluating CAD in patients self-referring for tuberculosis symptoms with culture or nucleic acid amplification testing as the reference. We re-analyzed CXRs with three CAD (CAD4TB version (v) 6, Lunit v3.1.0.0, and qXR v2). We estimated sensitivity and specificity within each study and pooled using IPD meta-analysis. We used multivariable meta-regression to identify characteristics modifying accuracy. RESULTS We included CXRs and IPD of 3727/3967 participants from 4/7 eligible studies. 17% (621/3727) were PLWH. 17% (645/3727) had microbiologically-confirmed tuberculosis. Despite using the same threshold score for classifying CXR in every study, sensitivity and specificity varied from study to study. The software had similar unadjusted accuracy (at 90% pooled sensitivity, pooled specificities were: CAD4TBv6, 56.9% [95%CI:51.7-61.9]; Lunit, 54.1% [44.6-63.3]; qXRv2, 60.5% [51.7-68.6]). Adjusted absolute differences in pooled sensitivity between PLWH and HIV-uninfected participants was: CAD4TBv6, -13.4% [-21.1, -6.9]; Lunit, +2.2% [-3.6, +6.3]; qXRv2: -13.4% [-21.5, -6.6]); between smear-negative and smear-positive tuberculosis was: CAD4TBv6, -12.3% [-19.5, -6.1]; Lunit, -17.2% [-24.6, -10.5]; qXRv2, -16.6% [-24.4, -9.9]. Accuracy was similar to human readers. CONCLUSIONS For CAD CXR analysis to be implemented as a high-sensitivity tuberculosis rule-out test, users will need threshold scores identified from their own patient populations, and stratified by HIV- and smear-status.
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Affiliation(s)
- Gamuchirai Tavaziva
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Miriam Harris
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Syed K Abidi
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Coralie Geric
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada.,Departments of Medicine & Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - Marianne Breuninger
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Keertan Dheda
- Centre for Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa.,Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Monde Muyoyeta
- Zambart, Lusaka, Zambia.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Arman Majidulla
- Interactive Research & Development (IRD) Pakistan, Karachi, Pakistan
| | | | - Jonathon R Campbell
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada.,Departments of Medicine & Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - Pierre-Marie David
- Département des Médicaments et Santé des Populations, Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Claudia Denkinger
- Division of Tropical Medicine, Center of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ruvandhi Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Madhukar Pai
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada.,Departments of Medicine & Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - Andrea Benedetti
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada.,Departments of Medicine & Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
| | - Faiz Ahmad Khan
- McGill International TB Centre, Research Institute of the McGill University Health Centre, Montreal, Canada.,Departments of Medicine & Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
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8
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Burger C, Holness JL, Smit DP, Griffith-Richards S, Koegelenberg CFN, Ellmann A. The Role of 18F-FDG PET/CT in Suspected Intraocular Sarcoidosis and Tuberculosis. Ocul Immunol Inflamm 2019; 29:530-536. [PMID: 31743044 DOI: 10.1080/09273948.2019.1685109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To determine the utility of fluorine-18 fluorodeoxyglucose Positron Emission Tomography Computed Tomography (FDG PET/CT) in patients with suspected ocular sarcoidosis (OS) or intraocular tuberculosis (IOTB) in a resource-constrained, TB endemic area.Methods: Independent review of the FDG PET/CTs, Computed Tomography (CT) scans and chest radiographs (CXRs) of patients with suspected OS or IOTB and inconclusive conventional workup.Results: Twenty-nine PET/CTs and CXRs were reviewed, with 38% of PET/CTs and CTs demonstrating evidence of TB or sarcoidosis, compared to 21% of CXRs. The sensitivity, specificity, positive and negative predictive values for PET/CT and CT were similar - 85.7%, 95.5%, 85.7% and 95.5% for OS, and 33.3%, 100%, 100% and 68% for IOTB respectively and for CXR, 57.1%, 100%, 100% and 88% for OS, and 16.7%, 100%, 100% and 63% for IOTB.Conclusion: PET/CT added no significant additional benefit over Chest CT in patients with suspected OS or IOTB.
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Affiliation(s)
- C Burger
- Divisions of Nuclear Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - J L Holness
- Divisions of Nuclear Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - D P Smit
- Ophthalmology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - S Griffith-Richards
- Radiodiagnosis, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - C F N Koegelenberg
- Pulmonology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - A Ellmann
- Divisions of Nuclear Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
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9
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Melendez J, Hogeweg L, Sánchez CI, Philipsen RHHM, Aldridge RW, Hayward AC, Abubakar I, van Ginneken B, Story A. Accuracy of an automated system for tuberculosis detection on chest radiographs in high-risk screening. Int J Tuberc Lung Dis 2019; 22:567-571. [PMID: 29663963 PMCID: PMC5905390 DOI: 10.5588/ijtld.17.0492] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Tuberculosis (TB) screening programmes can be optimised by reducing the number of chest radiographs (CXRs) requiring interpretation by human experts. OBJECTIVE: To evaluate the performance of computerised detection software in triaging CXRs in a high-throughput digital mobile TB screening programme. DESIGN: A retrospective evaluation of the software was performed on a database of 38 961 postero-anterior CXRs from unique individuals seen between 2005 and 2010, 87 of whom were diagnosed with TB. The software generated a TB likelihood score for each CXR. This score was compared with a reference standard for notified active pulmonary TB using receiver operating characteristic (ROC) curve and localisation ROC (LROC) curve analyses. RESULTS: On ROC curve analysis, software specificity was 55.71% (95%CI 55.21–56.20) and negative predictive value was 99.98% (95%CI 99.95–99.99), at a sensitivity of 95%. The area under the ROC curve was 0.90 (95%CI 0.86–0.93). Results of the LROC curve analysis were similar. CONCLUSION: The software could identify more than half of the normal images in a TB screening setting while maintaining high sensitivity, and may therefore be used for triage.
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Affiliation(s)
- J Melendez
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, Thirona, Nijmegen, The Netherlands
| | - L Hogeweg
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C I Sánchez
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R H H M Philipsen
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands; Thirona, Nijmegen, The Netherlands
| | - R W Aldridge
- Department of Infectious Disease Informatics, Institute of Health Informatics, University College London, London, UK
| | - A C Hayward
- Department of Infectious Disease Informatics, Institute of Health Informatics, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, UK
| | - I Abubakar
- Institute for Global Health, University College London, UK
| | - B van Ginneken
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands; Thirona, Nijmegen, The Netherlands
| | - A Story
- Department of Infectious Disease Informatics, Institute of Health Informatics, University College London, London, UK
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10
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Rastoder E, Shaker SB, Naqibullah M, Wille MMW, Lund M, Wilcke JT, Seersholm N, Jensen SG. Chest x-ray findings in tuberculosis patients identified by passive and active case finding: A retrospective study. J Clin Tuberc Other Mycobact Dis 2019; 14:26-30. [PMID: 31720415 PMCID: PMC6830123 DOI: 10.1016/j.jctube.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Chest x-ray is central in screening and diagnosis of tuberculosis. However, sputum culture remains gold standard for diagnosis. Aim To establish the rate of normal chest x-rays in tuberculosis patients found by spot sputum culture screening, and compare them to a group identified through passive case finding. Method Chest x-rays from 39 culture-positive patients, identified by spot sputum culture screening in Copenhagen from 2012 to 2014, were included in the study (spot sputum culture group(SSC)). 39 normal chest x-rays from persons screened by mobile x-ray, and 39 chest x-rays from tuberculosis-patients identified through passive case finding(PCF) were anonymised and randomised. Two respiratory physicians and two radiologists assessed the chest x-rays. Results The normal chest x-ray rate was higher in the non-tuberculosis control group (median = 32 (82.1%), range = 74.4% – 100%), compared to the SSC group (median = 7 (17.9%), range = 10.3% – 33.3%), and the PCF controls (median = 3(7.7%), range = 2.6% – 15.4%). In the SSC group 14 (35.9%) were categorized as normal by at least one study participant. Conclusion A substantial minority of patients diagnosed with tuberculosis by spot sputum culture screening, and through passive case finding would not have been identified with chest x-ray alone, highlighting that a normal chest x-ray does not exclude pulmonary tuberculosis.
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Affiliation(s)
- Ema Rastoder
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Matiullah Naqibullah
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | | | - Mette Lund
- Department of Radiology, Hillerød Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Jon Torgny Wilcke
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Niels Seersholm
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Sidse Graff Jensen
- Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark
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11
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Te Riele JB, Buser V, Calligaro G, Esmail A, Theron G, Lesosky M, Dheda K. Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis. Int J Infect Dis 2018; 79:65-71. [PMID: 30395979 DOI: 10.1016/j.ijid.2018.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Data about the relationship between chest radiographs and sputum bacillary load, with treatment outcomes, in patients with extensively drug-resistant tuberculosis (XDR-TB) from HIV/TB endemic settings are limited. METHODS Available chest radiographs from 97 South African XDR-TB patients, at the time of diagnosis, were evaluated by two independent readers using a validated scoring system. Chest radiograph findings were correlated with baseline sputum bacillary load (smear-grade and culture time-to-positive in MGIT), and prospectively ascertained clinical outcomes (culture conversion and all-cause mortality). RESULTS Radiographic bilateral lung disease was present in 75/97 (77%). In the multivariate analysis only a higher total radiographic score (95% CI) was associated with higher likelihood of death [1.16 (1.05-1.28) p=0.003], and failure to culture convert [0.85 (0.74-0.97) p=0.02]. However, when restricting analyses to HIV-infected patients, disease extent, cavitation, and total radiographic scores were not associated with mortality or culture-conversion. Finally, cavitary, disease extent, and total radiographic scores all positively correlated with bacterial load (culture time-to-positive). CONCLUSIONS In endemic settings, XDR-TB radiological disease extent scores are associated with adverse clinical outcomes, including mortality, in HIV uninfected persons. These data may have implications for clinical and programmatic decision-making and for evaluation of new regimens in clinical trials.
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Affiliation(s)
- J B Te Riele
- Department of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - V Buser
- Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa.
| | - G Calligaro
- Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa.
| | - A Esmail
- Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa.
| | - G Theron
- Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa.
| | - M Lesosky
- Department of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - K Dheda
- Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa.
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12
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Ko Y, Lee HY, Park YB, Hong SJ, Shin JH, Choi SJ, Kim C, Park SY, Jeong JY. Correlation of microbiological yield with radiographic activity on chest computed tomography in cases of suspected pulmonary tuberculosis. PLoS One 2018; 13:e0201748. [PMID: 30091997 PMCID: PMC6084932 DOI: 10.1371/journal.pone.0201748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/20/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Little is known about the correlation between microbiological yield and radiographic activity, on chest computed tomography (CT), in suspected pulmonary tuberculosis (PTB) cases, despite CT being widely used, clinically. METHODS We used multicenter retrospective data, obtained from medical records, focusing on the diagnostic performance for definite PTB. We categorized patients into four groups, by radiographic activity: definitely active, probably active, indeterminate activity, and probably inactive. RESULTS Of the 650 patients included, 316 had culture-confirmed PTB; 190 (29.2%), 323 (49.7%), 70 (10.8%), and 67 (10.3%) were classified into the definitely active, probably active, indeterminate activity, and probably inactive groups, respectively. The corresponding observed culture rates for CT radiographic activity were 61.6%, 60.7%, 4.3% and 0%, respectively. When not only culture rates but TB-PCR and histological results were taken into consideration as definite PTB, it showed 66.6%, 67.2%, 14.3%, and 0% of each CT radiographic activity, respectively. Regarding the diagnostic performance for definite PTB, radiographic activity displayed high sensitivity (97.1%, 95% confidence interval (CI), 94.6-98.5) and negative predictive values (92.7%, 95% CI, 86.6-96.2), considered definitely and probably active PTB. Apart from PTB, other etiologies, according to radiographic activity, were predominantly respiratory infections such as bacterial pneumonia and non-tuberculous mycobacterial infection. CONCLUSIONS Radiographic activity showed good diagnostic performance, and can be used easily in clinical practice. However, clinicians should consider other possibilities, because radiologic images do not confirm microbiological PTB.
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Affiliation(s)
- Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Ho Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jeong Hwan Shin
- Department Laboratory Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seok Jin Choi
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - So Young Park
- Department of Pulmonary and Critical Care Medicine, Chung Nam National University Medical Center, Daejeon, Republic of Korea
| | - Jin Young Jeong
- Hallym Research Institute of Clinical Epidemiology, Chuncheon, Republic of Korea
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13
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Murthy SE, Chatterjee F, Crook A, Dawson R, Mendel C, Murphy ME, Murray SR, Nunn AJ, Phillips PPJ, Singh KP, McHugh TD, Gillespie SH. Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis. BMC Med 2018; 16:73. [PMID: 29779492 PMCID: PMC5961483 DOI: 10.1186/s12916-018-1053-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 04/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis. METHODS Pre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al., N Engl J Med 371:1577-87, 2014) were retrospectively reviewed. Two clinicians blinded to clinical details using the Ralph scoring system performed separate readings. An independent reader reviewed discrepant results for quality assessment and cavity presence. Cavitation presence was plotted against time to positivity (TTP) of sputum liquid cultures (MGIT 960). The Wilcoxon rank sum test was performed to calculate the difference in average TTP for these groups. The average lung field affected was compared to log 10 TTP by linear regression. Baseline markers of disease severity and patient characteristics were added in univariable regression analysis against radiological severity and a multivariable regression model was created to explore their relationship. RESULTS For 1354 participants, the median TTP was 117 h (4.88 days), being 26 h longer (95% CI 16-30, p < 0.001) in patients without cavitation compared to those with cavitation. The median percentage of lung-field affected was 18.1% (IQR 11.3-28.8%). For every 10-fold increase in TTP, the area of lung field affected decreased by 11.4%. Multivariable models showed that serum albumin decreased significantly as the percentage of lung field area increased in both those with and without cavitation. In addition, BMI and logged TTP had a small but significant effect in those with cavitation and the number of severe TB symptoms in the non-cavitation group also had a small effect, whilst other factors found to be significant on univariable analysis lost this effect in the model. CONCLUSIONS The radiological severity of disease on chest x-ray prior to treatment in smear positive pulmonary TB patients is weakly associated with the bacterial burden. When compared against other variables at diagnosis, this effect is lost in those without cavitation. Radiological severity does reflect the overall disease severity in smear positive pulmonary TB, but we suggest that clinicians should be cautious in over-interpreting the significance of radiological disease extent at diagnosis.
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Affiliation(s)
- S E Murthy
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - F Chatterjee
- Department of Radiology, Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK
| | - A Crook
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - R Dawson
- University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - C Mendel
- Global Alliance for Tuberculosis Drug Development, New York, NY, 10005, USA
| | - M E Murphy
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - S R Murray
- Global Alliance for Tuberculosis Drug Development, New York, NY, 10005, USA
| | - A J Nunn
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - P P J Phillips
- Medical Research Council UK Clinical Trials Unit at University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Kasha P Singh
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - T D McHugh
- UCL Centre for Clinical Microbiology, Department of Infection, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - S H Gillespie
- Medical and Biological Sciences, School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK.
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14
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False-Positive Xpert MTB/RIF Results in Retested Patients with Previous Tuberculosis: Frequency, Profile, and Prospective Clinical Outcomes. J Clin Microbiol 2018; 56:JCM.01696-17. [PMID: 29305538 DOI: 10.1128/jcm.01696-17] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/14/2017] [Indexed: 11/20/2022] Open
Abstract
Globally, Xpert MTB/RIF (Xpert) is the most widely used PCR test for the diagnosis of tuberculosis (TB). Positive results in previously treated patients, which are due to old DNA or active disease, are a diagnostic dilemma. We prospectively retested sputum from 238 patients, irrespective of current symptoms, who were previously diagnosed to be Xpert positive and treated successfully. Patients who retested as Xpert positive and culture negative were exhaustively investigated (repeat culture, chest radiography, bronchoscopy with bronchoalveolar lavage, long-term clinical follow-up). We evaluated whether the duration since previous treatment completion, mycobacterial burden (the Xpert cycle threshold [CT ] value), and reclassification of Xpert-positive results with a very low semiquantitation level to Xpert-negative results reduced the rate of false positivity. A total of 229/238 (96%) of patients were culture negative. Sixteen of 229 (7%) were Xpert positive a median of 11 months (interquartile range, 5 to 19 months) after treatment completion. The specificity was 93% (95% confidence interval [CI], 89 to 96%). Nine of 15 (40%) Xpert-positive, culture-negative patients reverted to Xpert negative after 2 to 3 months (1 patient declined further participation). Patients with false-positive Xpert results had a lower mycobacterial burden than patients with true-positive Xpert results (CT , 28.7 [95% CI, 27.2 to 30.4] versus 17.6 [95% CI, 16.9 to 18.2]; P < 0.001), an increased likelihood of a chest radiograph not compatible with active TB (5/15 patients versus 0/5 patients; P = 0.026), and less-viscous sputum (15/16 patients versus 2/5 patients whose sputum was graded as mucoid or less; P = 0.038). All patients who initially retested as Xpert positive and culture negative ("Xpert false positive") were clinically well without treatment after follow-up. The duration since the previous treatment poorly predicted false-positive results (a duration of ≤2 years identified only 66% of patients with false-positive results). Reclassifying Xpert-positive results with a very low semiquantitation level to Xpert negative improved the specificity (+3% [95% CI, +2 to +5%]) but reduced the sensitivity (-10% [95% CI, -4 to -15%]). Patients with previous TB retested with Xpert can have false-positive results and thus not require treatment. These data inform clinical practice by highlighting the challenges in interpreting Xpert-positive results, underscore the need for culture, and have implications for next-generation ultrasensitive tests.
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15
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Ebana H, Mizobuchi T, Kurihara M, Kobayashi E, Haga T, Okamoto S, Takahashi K, Seyama K. Novel clinical scoring system to identify patients with pneumothorax with suspicion for Birt-Hogg-Dubé syndrome. Respirology 2017; 23:414-418. [PMID: 28960698 DOI: 10.1111/resp.13191] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/09/2017] [Accepted: 08/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary disease that presents with multiple lung cysts and pneumothorax (PTX). Although some reports propose that findings from chest computed tomography enable one to distinguish BHDS from primary spontaneous pneumothorax (PSP), it is still unclear whether clinical features are useful for identifying patients with suspicion of BHDS from those with PTX. METHODS We retrospectively reviewed the medical records of patients with PTX who underwent video-assisted thoracoscopic surgery at Nissan Tamagawa Hospital from January 2012 to December 2015. RESULTS We identified a total of 1141 patients with PTX, including 54 with BHDS and 517 with PSP. Among them, logistic regression analysis segregated five features that were significantly associated with BHDS: familial history of PTX, past history of bilateral PTX, age at the first episode of PTX (≥25 years old (y.o.)), body mass index (≥18.5) and gender (female). We assigned scores of 3, 3, 2, 2 and 1 to the five features, respectively, to establish a system with a calculated score from 0 to 11. The cut-off value of a calculated score ≥ 4 yielded the highest sensitivity of 93% and specificity of 86%. Receiver operating characteristic (ROC) analysis showed the area under the curve reflecting an accuracy of this diagnostic test as 0.953. CONCLUSION BHDS has several clinical features distinct from PSP. Our scoring system consists of only five clinical variables that are easily evaluated and efficiently separate BHDS patients from those who have PTX without relying on an imaging study. Further prospective study is needed to confirm our findings.
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Affiliation(s)
- Hiroki Ebana
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Teruaki Mizobuchi
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Etsuko Kobayashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Takahiro Haga
- The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Shoichi Okamoto
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.,The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
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16
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Ahmad Khan F, Pande T, Tessema B, Song R, Benedetti A, Pai M, Lönnroth K, Denkinger CM. Computer-aided reading of tuberculosis chest radiography: moving the research agenda forward to inform policy. Eur Respir J 2017; 50:50/1/1700953. [PMID: 28705949 DOI: 10.1183/13993003.00953-2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Faiz Ahmad Khan
- McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada .,Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Tripti Pande
- McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada
| | - Belay Tessema
- FIND, Geneva, Switzerland.,Dept of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rinn Song
- FIND, Geneva, Switzerland.,Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA.,Dept of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrea Benedetti
- McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Depts of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Madhukar Pai
- McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada.,Depts of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Knut Lönnroth
- Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Global TB Programme, WHO, Geneva, Switzerland
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17
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Aston SJ. Pneumonia in the developing world: Characteristic features and approach to management. Respirology 2017; 22:1276-1287. [PMID: 28681972 DOI: 10.1111/resp.13112] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/22/2023]
Abstract
Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in adults worldwide, but its epidemiology varies markedly by region. Whilst in high-income countries, the predominant burden of CAP is in the elderly and those with chronic cardiovascular and pulmonary co-morbidity, CAP patients in low-income settings are often of working age and, in sub-Saharan Africa, frequently HIV-positive. Although region-specific aetiological data are limited, they are sufficient to highlight major trends: in high-burden settings, tuberculosis (TB) is a common cause of acute CAP; Gram-negative pathogens such as Klebsiella pneumoniae are regionally important; and HIV-associated opportunistic infections are common but difficult to diagnose. These differences in epidemiology and aetiological profile suggest that modified approaches to diagnosis, severity assessment and empirical antimicrobial therapy of CAP are necessary, but tailored individualized management approaches are constrained by limitations in the availability of radiological and laboratory diagnostic services, as well as medical expertise. The widespread introduction of the Xpert MTB/RIF platform represents a major advance for TB diagnosis, but innovations in rapid diagnostics for other opportunistic pathogens are urgently needed. Severity assessment tools (e.g. CURB65) that are used to guide early management decisions in CAP have not been widely validated in low-income settings and locally adapted tools are required. The optimal approach to initial antimicrobial therapy choices such as the need to provide early empirical cover for atypical bacteria and TB remain poorly defined. Improvements in supportive care such as correcting hypoxaemia and intravenous fluid management represent opportunities for substantial reductions in mortality.
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Affiliation(s)
- Stephen J Aston
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
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18
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Cudahy PGT, Dawson R, Allwood BW, Maartens G, Wilson D. Diagnostic Outcomes After Chest Radiograph Interpretation in Patients With Suspected Tuberculosis and Negative Sputum Smears in a High-Burden Human Immunodeficiency Virus and Tuberculosis Setting. Open Forum Infect Dis 2017; 4:ofx123. [PMID: 28721354 PMCID: PMC5508775 DOI: 10.1093/ofid/ofx123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/16/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evaluation of patients with suspected tuberculosis and negative sputum smears for acid-fast bacilli (AFB) is challenging, especially in high human immunodeficiency virus coinfection settings where sputum smears have lower sensitivity for detecting AFB. METHODS We examined the utility of chest radiographs for detecting smear-negative pulmonary tuberculosis. Three hundred sixty sputum smear-negative patients who were referred from primary care clinics in the KwaZulu-Natal province of South Africa were evaluated. Chest radiographs were read by experienced pulmonologists using a previously validated Chest X-Ray Reading and Recording System (CRRS). RESULTS Agreement between observers using CRRS was high at 91% with a Cohen's kappa of 0.64 (95% confidence interval [CI] = 0.52-0.76). Against a reference standard of sputum culture, sensitivity was 93% (95% CI = 86%-97%), whereas specificity was 14% (95% CI = 10%-19%). Performance against clinical diagnosis (following World Health Organization guidelines) was similar with sensitivity of 92% (95% CI = 88%-95%) and specificity of 20% (95% CI = 13%-28%). CONCLUSION The low specificity of CRRS in this setting indicates poor diagnostic utility for detecting pulmonary tuberculosis.
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Affiliation(s)
- Patrick G T Cudahy
- Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Rodney Dawson
- Department of Medicine, University of Cape Town Lung Institute and Division of Pulmonology, Groote Schuur Hospital, Cape Town
| | - Brian W Allwood
- Department of Medicine, University of Cape Town Lung Institute and Division of Pulmonology, Groote Schuur Hospital, Cape Town
- Department of Medicine, Division of Pulmonology, Stellenbosch University/Tygerberg Academic Hospital, Stellenbosch
| | - Gary Maartens
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, and
| | - Douglas Wilson
- Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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19
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Henostroza G, Harris JB, Kancheya N, Nhandu V, Besa S, Musopole R, Krüüner A, Chileshe C, Dunn IJ, Reid SE. Chest radiograph reading and recording system: evaluation in frontline clinicians in Zambia. BMC Infect Dis 2016; 16:136. [PMID: 27005684 PMCID: PMC4804604 DOI: 10.1186/s12879-016-1460-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/10/2016] [Indexed: 02/04/2023] Open
Abstract
Background In Zambia the vast majority of chest radiographs (CXR) are read by clinical officers who have limited training and varied interpretation experience, meaning lower inter-rater reliability and limiting the usefulness of CXR as a diagnostic tool. In 2010–11, the Zambian Prison Service and Ministry of Health established TB and HIV screening programs in six prisons; screening included digital radiography for all participants. Using front-line clinicians we evaluated sensitivity, specificity and inter-rater agreement for digital CXR interpretation using the Chest Radiograph Reading and Recording System (CRRS). Methods Digital radiographs were selected from HIV-infected and uninfected inmates who participated in a TB and HIV screening program at two Zambian prisons. Two medical officers (MOs) and two clinical officers (COs) independently interpreted all CXRs. We calculated sensitivity and specificity of CXR interpretations compared to culture as the gold standard and evaluated inter-rater reliability using percent agreement and kappa coefficients. Results 571 CXRs were included in analyses. Sensitivity of the interpretation “any abnormality” ranged from 50–70 % depending on the reader and the patients’ HIV status. In general, MO’s had higher specificities than COs. Kappa coefficients for the ratings of “abnormalities consistent with TB” and “any abnormality” showed good agreement between MOs on HIV-uninfected CXRs and moderate agreement on HIV-infected CXRs whereas the COs demonstrated fair agreement in both categories, regardless of HIV status. Conclusions Sensitivity, specificity and inter-rater agreement varied substantially between readers with different experience and training, however the medical officers who underwent formal CRRS training had more consistent interpretations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1460-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- German Henostroza
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA. .,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
| | - Jennifer B Harris
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Nzali Kancheya
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Stable Besa
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Robert Musopole
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Annika Krüüner
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.,Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chisela Chileshe
- Prisons Health Services, Ministry of Home Affairs, Lusaka, Zambia
| | - Ian J Dunn
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,Department of Medicine, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
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20
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A Novel Reading Scheme for Assessing the Extent of Radiographic Abnormalities and Its Association with Disease Severity in Sputum Smear-Positive Tuberculosis: An Observational Study in Hyderabad/India. PLoS One 2015; 10:e0138070. [PMID: 26381644 PMCID: PMC4575099 DOI: 10.1371/journal.pone.0138070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background Existing reading schemes for chest X-ray (CXR) used to grade the extent of disease severity at diagnosis in patients with pulmonary tuberculosis (PTB) are often based on numerical scores that summate specific radiographic features. However, since PTB is known to exhibit a wide heterogeneity in pathology, certain features might be differentially associated with clinical parameters of disease severity. Objective We aimed to grade disease severity in PTB patients at diagnosis and after completion of DOTS treatment by developing a reading scheme based on five different radiographic manifestations and analyze their association with the clinical parameters of systemic involvement and infectivity. Methods 141 HIV-negative adults with newly diagnosed sputum smear-positive PTB were enrolled in a prospective observational study in Hyderabad, India. The presence and extent on CXRs of five radiographic manifestations, i.e., lung involvement, alveolar infiltration, cavitation, lymphadenopathy and pleural effusion, were classified using the new reading scheme by using a four-quadrant approach. We evaluated the inter-reader reliability of each manifestation, and its association with BMI and sputum smear positivity at diagnosis. The presence and extent of these radiographic manifestations were further compared with CXRs on completion of DOTS treatment. Results At diagnosis, an average lung area of 51.7% +/- 23.3% was affected by radiographic abnormalities. 94% of the patients had alveolar infiltrates, with 89.4% located in the upper quadrants, suggesting post primary PTB and in 34.8% of patients cavities were found. We further showed that the extent of affected lung area was a negative predictor of BMI (β value -0.035, p 0.019). No significant association of BMI with any of the other CXR features was found. The extent of alveolar infiltrates, along with the presence of cavitation, were strongly associated with sputum smear positivity. The microbiological cure rate in our cohort after 6 months of DOTS treatment was 95%. The extent of the affected lung area in these patients decreased from 56.0% +/- 21.5% to 31.0 +/- 20% and a decrease was also observed in the extent of alveolar infiltrates from 98.4% to 25.8% in at least one quadrant, presence of cavities from 34.8% to 1.6%, lymphadenopathy from 46.8% to 16.1%, and pleural effusion from 19.4% to 6.5%. Conclusions We established a new assessment scheme for grading disease severity in PTB by specifically considering five radiographic manifestations which were differently associated with the BMI and sputum smear positivity, changed to a different extent after 6 months of treatment and exhibited an excellent agreement between radiologists. Our results suggest that this reading scheme might contribute to the estimation of disease severity with respect to differences in disease pathology. Further studies are needed to determine a correlation with short and long-term pulmonary function impairment and whether there would be any benefit in lengthening or modulating therapy based on this CXR severity assessment.
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Liu J, Sun Z, Xie R, Gao M, Li C. Special computer-aided computed tomography (CT) volume measurement and comparison method for pulmonary tuberculosis (TB). Int J Clin Exp Med 2015; 8:15117-15126. [PMID: 26628995 PMCID: PMC4658884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/07/2015] [Indexed: 06/05/2023]
Abstract
The computed tomography (CT) manifestations in pulmonary tuberculosis (PTB) patients are complex and could not be quantitatively evaluated. We aimed to establish a new method to objectively measure the lung injury level in PTB by thoracic CT and make quantitative comparisons. In the retrospective study, a total of 360 adults were selected and divided into four groups according to their CT manifestations and medical history: Normal group, PTB group, PTB with diabetes mellitus (DM) group and Death caused by PTB group. Five additional patients who had continuous CT scans were chosen for preliminary longitudinal analysis. We established a new computer-aided CT volume measurement and comparison method for PTB patients (CACTV-PTB) which measured lung volume (LV) and thoracic volume (TV). RLT was calculated as the ratio of LV to TV and comparisons were performed among different groups. Standardized RLT (SRLT) was used in the longitudinal analysis among different patients. In the Normal group, LV and TV were positively correlated in linear regression (Ŷ=-0.5+0.46X, R(2)=0.796, P<0.01). RLT values were significantly different among four groups (Normal: 0.40±0.05, PTB: 0.37±0.08, PTB+DM: 0.34±0.06, Death: 0.23±0.04). The curves of SRLT value from different patients shared a same start point and could be compared directly. Utilizing the novel objective method CACTV-PTB makes it possible to compare the severity and dynamic change among different PTB patients. Our early experience also suggested that the lung injury is severer in the PTB+DM group than in the PTB group.
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Affiliation(s)
- Jingming Liu
- Beijing Key Laboratory of Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute No. 97 Ma Chang, Tongzhou District, 101149 Beijing, China
| | - Zhaogang Sun
- Beijing Key Laboratory of Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute No. 97 Ma Chang, Tongzhou District, 101149 Beijing, China
| | - Ruming Xie
- Beijing Key Laboratory of Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute No. 97 Ma Chang, Tongzhou District, 101149 Beijing, China
| | - Mengqiu Gao
- Beijing Key Laboratory of Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute No. 97 Ma Chang, Tongzhou District, 101149 Beijing, China
| | - Chuanyou Li
- Beijing Key Laboratory of Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute No. 97 Ma Chang, Tongzhou District, 101149 Beijing, China
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Hashemian SM, Tabarsi P, Karam MB, Kahkouee S, Marjani M, Jamaati H, Shekarchi N, Mohajerani SA, Velayati AA. Radiologic manifestations of pulmonary tuberculosis in patients of intensive care units. Int J Mycobacteriol 2015; 4:233-8. [PMID: 27649871 DOI: 10.1016/j.ijmyco.2015.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/02/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a serpent disease with various pulmonary manifestations, and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity, particularly in intensive care units (ICU). Therefore, it is imperative that intensivists understand the typical distribution, patterns, and imaging manifestations of TB. AIM To describe different manifestations of pulmonary TB in patients in the ICU. METHODS In a retrospective study, all patients with a clinical and a laboratory-confirmed diagnosis of TB who were admitted to the ICU were entered in the study. All patients had a confirmatory laboratory diagnosis of TB including positive smears. The patterns of parenchymal lesions, involved segments and presence of cavity, bronchiectasis and bronchogenic spread of the lesions with computed tomography (CT) and chest/X-ray (CXR) were recorded and analyzed. RESULTS Data of 146 patients with TB were entered in the study. The most common finding in CT was acute respiratory distress syndrome (ARDS)-like radiologic manifestations (17.1%), followed by parenchymal nodular infiltration (13.6%) and cavitation (10.9%), consolidation (10.2%), interstitial involvement (9.5%), calcified parenchymal mass (8.3%), ground-glass opacities (7.5%), and pleural effusion or thickening (6.9%). Radiologic evidence of lymphadenopathy was seen in up to 43% of adults. Miliary TB was observed in 2.3% of patients, mostly in those older than 60years of age. ARDS-like (64.5%) manifestations on CT and miliary TB (85.5%) had the highest mortality rates among other pulmonary manifestations. CONCLUSION ARDS, interstitial involvement, and Parenchymal nodular infiltration are the most common manifestations of pulmonary TB. Various features of TB in ICU patients could be misleading for intensivists.
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Affiliation(s)
- Seyed MohammadReza Hashemian
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
| | - Payam Tabarsi
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Mehrdad Bakhshayesh Karam
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Shahram Kahkouee
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Nazila Shekarchi
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Seyed Amir Mohajerani
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Ali Akbar Velayati
- Mycobacteriology Research Center Virology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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García-Basteiro AL, López-Varela E, Augusto OJ, Gondo K, Muñoz J, Sacarlal J, Marais B, Alonso PL, Ribó JL. Radiological findings in young children investigated for tuberculosis in Mozambique. PLoS One 2015; 10:e0127323. [PMID: 26020541 PMCID: PMC4447385 DOI: 10.1371/journal.pone.0127323] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/13/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Chest radiography remains a critical tool for diagnosing intrathoracic tuberculosis (TB) in young children who are unable to expectorate. We describe the radiological findings in children under 3 years of age investigated for TB in the district of Manhiça, southern Mozambique, an area with a high prevalence of TB and HIV. Methods Digital antero-posterior and lateral projections were performed and reviewed by two independent readers, using a standardized template. Readers included a local pediatrician and a pediatric radiologist blinded to all clinical information. International consensus case definitions for intra-thoracic TB in children were applied. Results A total of 766 children were evaluated of whom 43 (5.6%) had TB. The most frequent lesion found in TB cases was air space consolidation (65.1%), followed by suggestive hilar lymphadenopathy (17.1%) and pleural effusion (7.0%). Air space consolidation was significantly more common in TB cases than in non-TB cases (odds ratio 8.9; 95% CI: 1.6-50.5), as were hilar lymphadenopathy (OR 17.2; 95% CI: 5.7-52.1). The only case with miliary infiltrates and 3 with pleural effusions occurred in HIV-infected children. Conclusion Frequent air space consolidation complicates radiological distinction between TB and bacterial pneumonia in young children, underscoring the need for epidemiological contextualization and consideration of all relevant signs and symptoms.
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Affiliation(s)
- Alberto L. García-Basteiro
- Centro de Investigação em Saude de Manhiça (CISM). Rua 12, Cambeve CP 1929 Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Rossello, 132, 08036, Barcelona, Spain
| | - Elisa López-Varela
- Centro de Investigação em Saude de Manhiça (CISM). Rua 12, Cambeve CP 1929 Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Rossello, 132, 08036, Barcelona, Spain
- * E-mail:
| | - Orvalho Joaquim Augusto
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Rossello, 132, 08036, Barcelona, Spain
| | - Kizito Gondo
- Centro de Investigação em Saude de Manhiça (CISM). Rua 12, Cambeve CP 1929 Maputo, Mozambique
| | - José Muñoz
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Rossello, 132, 08036, Barcelona, Spain
| | - Jahit Sacarlal
- Centro de Investigação em Saude de Manhiça (CISM). Rua 12, Cambeve CP 1929 Maputo, Mozambique
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI) and The Children’s Hospital at Westmead, The University of Sydney, Australia. Westmead NSW 2145 Australia
| | - Pedro L. Alonso
- Centro de Investigação em Saude de Manhiça (CISM). Rua 12, Cambeve CP 1929 Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Rossello, 132, 08036, Barcelona, Spain
| | - José L. Ribó
- Radiology Department, Hospital San Juan de Dios. Passeig Sant Joan de Déu, 2. 08950 Esplugues de Llobregat, Barcelona, Spain
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Nayate AP, Dubroff JG, Schmitt JE, Nasrallah I, Kishore R, Mankoff D, Pryma DA. Use of Standardized Uptake Value Ratios Decreases Interreader Variability of [18F] Florbetapir PET Brain Scan Interpretation. AJNR Am J Neuroradiol 2015; 36:1237-44. [PMID: 25767185 DOI: 10.3174/ajnr.a4281] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 01/12/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Fluorine-18 florbetapir is a recently developed β-amyloid plaque positron-emission tomography imaging agent with high sensitivity, specificity, and accuracy in the detection of moderate-to-frequent cerebral cortical β-amyloid plaque. However, the FDA has expressed concerns about the consistency of interpretation of [(18)F] florbetapir PET brain scans. We hypothesized that incorporating automated cerebral-to-whole-cerebellar standardized uptake value ratios into [(18)F] florbetapir PET brain scan interpretation would reduce this interreader variability. MATERIALS AND METHODS This randomized, blinded-reader study used previously acquired [(18)F] florbetapir scans from 30 anonymized patients who were enrolled in the Alzheimer's Disease Neuroimaging Initiative 2. In 4 separate, blinded-reading sessions, 5 readers classified 30 cases as positive or negative for significant β-amyloid deposition either qualitatively alone or qualitatively with additional adjunct software that determined standardized uptake value ratios. A κ coefficient was used to calculate interreader agreement with and without the use of standardized uptake value ratios. RESULTS There was complete interreader agreement on 20/30 cases of [(18)F] florbetapir PET brain scans by using qualitative interpretation and on 27/30 scans interpreted with the adjunct use of standardized uptake value ratios. The κ coefficient for the studies read with standardized uptake value ratios (0.92) was significantly higher compared with the qualitatively read studies (0.69, P = .006). CONCLUSIONS Use of standardized uptake value ratios improves interreader agreement in the interpretation of [(18)F] florbetapir images.
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Affiliation(s)
- A P Nayate
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J G Dubroff
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J E Schmitt
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - I Nasrallah
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R Kishore
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D Mankoff
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D A Pryma
- From the Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Maduskar P, Hogeweg L, de Jong PA, Peters-Bax L, Dawson R, Ayles H, Sánchez CI, van Ginneken B. Cavity contour segmentation in chest radiographs using supervised learning and dynamic programming. Med Phys 2015; 41:071912. [PMID: 24989390 DOI: 10.1118/1.4881096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Efficacy of tuberculosis (TB) treatment is often monitored using chest radiography. Monitoring size of cavities in pulmonary tuberculosis is important as the size predicts severity of the disease and its persistence under therapy predicts relapse. The authors present a method for automatic cavity segmentation in chest radiographs. METHODS A two stage method is proposed to segment the cavity borders, given a user defined seed point close to the center of the cavity. First, a supervised learning approach is employed to train a pixel classifier using texture and radial features to identify the border pixels of the cavity. A likelihood value of belonging to the cavity border is assigned to each pixel by the classifier. The authors experimented with four different classifiers:k-nearest neighbor (kNN), linear discriminant analysis (LDA), GentleBoost (GB), and random forest (RF). Next, the constructed likelihood map was used as an input cost image in the polar transformed image space for dynamic programming to trace the optimal maximum cost path. This constructed path corresponds to the segmented cavity contour in image space. RESULTS The method was evaluated on 100 chest radiographs (CXRs) containing 126 cavities. The reference segmentation was manually delineated by an experienced chest radiologist. An independent observer (a chest radiologist) also delineated all cavities to estimate interobserver variability. Jaccard overlap measure Ω was computed between the reference segmentation and the automatic segmentation; and between the reference segmentation and the independent observer's segmentation for all cavities. A median overlap Ω of 0.81 (0.76 ± 0.16), and 0.85 (0.82 ± 0.11) was achieved between the reference segmentation and the automatic segmentation, and between the segmentations by the two radiologists, respectively. The best reported mean contour distance and Hausdorff distance between the reference and the automatic segmentation were, respectively, 2.48 ± 2.19 and 8.32 ± 5.66 mm, whereas these distances were 1.66 ± 1.29 and 5.75 ± 4.88 mm between the segmentations by the reference reader and the independent observer, respectively. The automatic segmentations were also visually assessed by two trained CXR readers as "excellent," "adequate," or "insufficient." The readers had good agreement in assessing the cavity outlines and 84% of the segmentations were rated as "excellent" or "adequate" by both readers. CONCLUSIONS The proposed cavity segmentation technique produced results with a good degree of overlap with manual expert segmentations. The evaluation measures demonstrated that the results approached the results of the experienced chest radiologists, in terms of overlap measure and contour distance measures. Automatic cavity segmentation can be employed in TB clinics for treatment monitoring, especially in resource limited settings where radiologists are not available.
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Affiliation(s)
- Pragnya Maduskar
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Laurens Hogeweg
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, 3584 CX, The Netherlands
| | - Liesbeth Peters-Bax
- Department of Radiology, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Rodney Dawson
- University of Cape Town Lung Institute, Cape Town 7700, South Africa
| | - Helen Ayles
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Clara I Sánchez
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
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Adams S, Ehrlich R, Baatjies R, van Zyl-Smit RN, Said-Hartley Q, Dawson R, Dheda K. Incidence of occupational latent tuberculosis infection in South African healthcare workers. Eur Respir J 2015; 45:1364-73. [PMID: 25700382 DOI: 10.1183/09031936.00138414] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/09/2014] [Indexed: 11/05/2022]
Abstract
The test-specific incidence of latent tuberculosis infection (LTBI) in healthcare workers from sub-Saharan Africa is unknown. 505 healthcare workers from South Africa were screened at baseline, and after 12 months, with a questionnaire, the tuberculin skin test (TST), and two T-cell assays (T-SPOT.TB and QuantiFERON-TB Gold-In-Tube). Test-specific conversion rates were calculated. The prevalence of presumed LTBI at baseline was 84, 69 and 62% using the TST, QuantiFERON-TB Gold-In-Tube and T-SPOT.TB, respectively. The annual test-specific conversion rate, depending on the cut-off point used, was as follows: TST 38%; QuantiFERON-TB Gold-In-Tube 13-22%; and T-SPOT.TB 18-22%. Annual reversion rates were 4, 7 and 16%, respectively. The annual TST conversion rate was significantly higher than that derived from published local community-based data (IRR 3.53, 95% CI 1.81-6.88). Factors associated with conversion (any test) included healthcare sector of employment, counselling of tuberculosis patients, and a baseline positive TST (for T-SPOT.TB). The annual rate of tuberculosis infection in South African healthcare workers was very high, irrespective of the testing method used, and may be explained by occupational exposure, as the rate was considerably higher than non-healthcare workers from the same community. Collectively, these data support the need for implementation of tuberculosis-specific infection control measures in Africa.
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Affiliation(s)
- Shahieda Adams
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rodney Ehrlich
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Roslynn Baatjies
- Dept of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Rodney Dawson
- Centre for TB Research Innovation, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa
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Aliyu G, El-Kamary SS, Abimiku A, Hungerford L, Obasanya J, Blattner W. Cost-effectiveness of point-of-care digital chest-x-ray in HIV patients with pulmonary mycobacterial infections in Nigeria. BMC Infect Dis 2014; 14:675. [PMID: 25495355 PMCID: PMC4269933 DOI: 10.1186/s12879-014-0675-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/01/2014] [Indexed: 11/27/2022] Open
Abstract
Background Chest-x-ray is routinely used in the diagnosis of smear negative tuberculosis (TB). This study assesses the incremental cost per true positive test of a point-of-care digital chest-x-ray, in the diagnosis of pulmonary mycobacterial infections among HIV patients with presumed tuberculosis undetected by smear microscopy. Methods Consecutive patients with clinical suspicion of pulmonary tuberculosis were serially tested for Human immunodeficiency virus (HIV), their sputum examined for Acid Fast Bacilli then cultured in broth and solid media. Cultures characterized as tuberculous (M.tb) and non-tuberculous (NTM) mycobacteria by Hain assays were used as gold standards. A chest-x-ray was classified as: (1) consistent for TB, (2) not consistent for TB and (3) no pathology. Results Of the 1391 suspected cases enrolled, complete data were available for 952 (68%): 753/952 (79%) had negative smear tests while 150/753 (20%) had cultures positive for TB. Of those, 82/150 (55%) had chest-x-ray signs consistent with TB and 29/82 (35%) were positive for HIV. Within the co-infected, 9/29 (31%) had NTM infections. Among all suspects, the cost per positive case detected using smear microscopy test was $52.84; the overall incremental cost per positive case using chest-x-ray in smear negatives was $23.42, and in smear negative, HIV positive patients the cost was $15.77. Conclusion Point-of-care chest-x-ray is a cost-effective diagnostic tool for smear negative HIV positive patients with pulmonary mycobacterial infection. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0675-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gambo Aliyu
- Health and Human Services, Federal Capital Territory, Abuja, Nigeria.
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Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility. Interdiscip Perspect Infect Dis 2014; 2014:291841. [PMID: 25197271 PMCID: PMC4150539 DOI: 10.1155/2014/291841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 11/28/2022] Open
Abstract
The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a medical officer (M.O), and four clinical officers (C.Os) with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard (n = 8). A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; k = 0.14 (95% CI: 0.10–0.18) and on lymphadenopathy moderate k = 0.26 (95% CI: 0.18–0.36). M.O [75% (95% CI: 34.9%–96.8%)] and C.Os [63% (95% CI: 24.5%–91.5%)] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features.
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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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Haga T, Kataoka H, Ebana H, Otsuji M, Seyama K, Tatsumi K, Kurihara M. Thoracic endometriosis-related pneumothorax distinguished from primary spontaneous pneumothorax in females. Lung 2014; 192:583-7. [PMID: 24831784 DOI: 10.1007/s00408-014-9598-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Thoracic endometriosis-related pneumothorax (TERP) is a secondary condition specific for females, but in a clinical setting, TERP often is difficult to distinguish from primary spontaneous pneumothorax (PSP) based on a relationship between the dates of pneumothorax and menstruation. The purpose of this study was to clarify the clinical features of TERP compared with PSP. METHODS We retrospectively reviewed the clinical and histopathological files of female patients with pneumothorax who underwent video-assisted thoracoscopic surgery in the Pneumothorax Research Center during the 6-year period from January 2005 to December 2010. We analyzed the clinical differences between TERP and PSP. RESULTS The study included a total of 393 female patients with spontaneous pneumothorax, of whom 92 (23.4 %) were diagnosed as having TERP and 33.6 % (132/393) as having PSP. We identified four factors (right-sided pneumothorax, history of pelvic endometriosis, age ≥31 years, and no smoking history) that were statistically significant for predicting TERP and assigned 6, 5, 4, and 3 points, respectively, to establish a scoring system with a calculated score from 0 to 18. The cutoff values of a calculated score ≥12 yielded the highest positive predictive value (86 %; 95 % confidence interval (CI) 81.5-90.5 %) for TERP and negative predictive value (95.2 %; 95 % CI 92.3-98 %) for PSP. CONCLUSIONS TERP has several distinct clinical features from PSP. Our scoring system consists of only four clinical variables that are easily obtainable and enables us to suspect TERP in female patients with pneumothorax.
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Affiliation(s)
- Takahiro Haga
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095, Japan
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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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