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da Cunha DL, Rossetti ML, Nunes ET, Martins EBL, Ferreira ADM, Ribeiro SC. Relevance of the correlation between tomography findings and laboratory test results in the accuracy of the diagnosis of pulmonary tuberculosis. Radiol Bras 2024; 57:e20230079en. [PMID: 38993970 PMCID: PMC11235076 DOI: 10.1590/0100-3984.2023.0079-en] [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] [Received: 07/08/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 07/13/2024] Open
Abstract
Objective To evaluate the correlation between multidetector computed tomography (MDCT) findings and laboratory test results in patients with pulmonary tuberculosis (PTB). Materials and Methods A total of 57 patients were evaluated. Patients with suspected PTB were divided into groups according to the final diagnosis (confirmed or excluded), and the groups were compared in terms of sociodemographic variables, clinical symptoms, tomography findings, and laboratory test results. Results Among the patients with a confirmed diagnosis of PTB, small pulmonary nodules with a peribronchovascular distribution were significantly more common in the patients with a positive sputum smear microscopy result (47.4% vs. 8.3%; p = 0.046), as were a miliary pattern (36.8% vs. 0.0%; p = 0.026), septal thickening (84.2% vs. 41.7%; p = 0.021), and lymph node enlargement (52.6% vs. 8.3%; p = 0.020). Small pulmonary nodules with a centrilobular distribution were significantly more common among the culture-positive patients (75.0% vs. 35.7%; p = 0.045), as was a tree-in-bud pattern (91.7% vs. 42.9%; p = 0.014). A tree-in-bud pattern, one of the main tomography findings characteristic of PTB, had a sensitivity, specificity, positive predictive value, and negative predictive value of 71.0%, 73.1%, 75.9%, and 67.9%, respectively. Conclusion MDCT presented reliable predictive values for the main tomography findings in the diagnosis of PTB, being a safe tool for the diagnosis of PTB in patients with clinical suspicion of the disease. It also appears to be a suitable tool for the selection of patients who are candidates for more complex, invasive examinations from among those with high clinical suspicion of PTB and a negative sputum smear microscopy result.
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Affiliation(s)
- Daniel Lopes da Cunha
- Hospital Universitário da Universidade Federal do
Piauí (UFPI), Teresina, PI, Brazil
- Universidade Luterana do Brasil (Ulbra), Canoas, RS, Brazil
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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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The Accuracy of Emergency Physicians' Suspicions of Active Pulmonary Tuberculosis. J Clin Med 2021; 10:jcm10040860. [PMID: 33669722 PMCID: PMC7922231 DOI: 10.3390/jcm10040860] [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: 02/04/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate factors associated with recognition and delayed isolation of pulmonary tuberculosis (PTB). Background: Precise identification of PTB in the emergency department (ED) remains challenging. Methods: Retrospectively reviewed PTB suspects admitted via the ED were divided into three groups based on the acid-fast bacilli culture report and whether they were isolated initially in the ED or general ward. Factors related to recognition and delayed isolation were statistically compared. Results: Only 24.94% (100/401) of PTB suspects were truly active PTB and 33.77% (51/151) of active PTB were unrecognized in the ED. Weight loss (p = 0.022), absence of dyspnea (p = 0.021), and left upper lobe field (p = 0.024) lesions on chest radiographs were related to truly active PTB. Malignancy (p = 0.015), chronic kidney disease (p = 0.047), absence of a history of PTB (p = 0.013), and lack of right upper lung (p ≤ 0.001) and left upper lung (p = 0.020) lesions were associated with PTB being missed in the ED. Conclusions: Weight loss, absence of dyspnea, and left upper lobe field lesions on chest radiographs were related to truly active PTB. Malignancy, chronic kidney disease, absence of a history of PTB, and absence of right and/or left upper lung lesions on chest radiography were associated with isolation delay.
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Carlesi E, Orlandi M, Mencarini J, Bartalesi F, Lorini C, Bonaccorsi G, Macconi L, Selvi V, Bartoloni A, Colagrande S. How radiology can help pulmonary tuberculosis diagnosis: analysis of 49 patients. Radiol Med 2019; 124:838-845. [PMID: 31087215 DOI: 10.1007/s11547-019-01040-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/25/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To identify the most frequent radiological findings of pulmonary tuberculosis using CT of the chest, to determine those with the highest degree of correlation, and, if possible, to identify the most suggestive radiological findings for acid-fast bacilli (AFB) positive disease. MATERIALS AND METHODS The radiological and clinical data of 49 patients submitted to CT during diagnosis were retrospectively analysed. The association between findings was assessed using Fisher's exact test, while correlation at CT scan was evaluated with the Spearman analysis. RESULTS Bronchiectasis/bronchioloectasis (89.8%), nodule(s) (81.6%), tree-in-bud (TIB), and consolidation (79.6% each) figured among the most common parenchymal findings. Lymphadenopathy (26.5%) was the most common nodal finding. TIB and cavity showed the highest correlation (r = 0.577), followed by TIB and bronchi(olo)ectasis (r = 0.498), TIB and consolidation (r = 0.497), nodule(s), and ground glass opacity (r = 0.488). High correlation was found in only the seven most frequent parenchymal findings. Consolidation, TIB, and cavity were useful to predict the AFB stain positivity. CONCLUSIONS Our series confirms the extreme heterogeneity of pulmonary tuberculosis. It also proves there are couple of findings which can drive us to the right diagnosis. While a triad of findings predicts AFB positivity, we have not found any predictive sign of AFB negativity; consequently, all patients with suspected imaging and clinical findings for TB should be isolated.
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Affiliation(s)
- Edoardo Carlesi
- Department of Experimental and Clinical Biomedical Sciences Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Martina Orlandi
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy
| | - Jessica Mencarini
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy
| | - Chiara Lorini
- Department of Health Science, University of Florence, Viale G.B. Morgagni 48, 50134, Florence, Italy
| | - Guglielmo Bonaccorsi
- Department of Health Science, University of Florence, Viale G.B. Morgagni 48, 50134, Florence, Italy
| | - Letizia Macconi
- Department of Experimental and Clinical Biomedical Sciences Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Valeria Selvi
- Department of Experimental and Clinical Biomedical Sciences Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandro Bartoloni
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, 50134, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences Radiodiagnostic Unit n. 2, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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Risk Factors for Delayed Isolation of Patients with Active Pulmonary Tuberculosis in an Acute-care Hospital. Sci Rep 2019; 9:4849. [PMID: 30890727 PMCID: PMC6424955 DOI: 10.1038/s41598-019-41086-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/27/2019] [Indexed: 01/15/2023] Open
Abstract
The objective of the current study was to determine the factors associated with delayed isolation of pulmonary tuberculosis (TB). In this retrospective study, data of patients newly diagnosed with pulmonary TB from January 2015 through December 2017 at a referral hospital were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of admission. We analyzed the clinical, microbiological, and radiological factors associated with delayed isolation of pulmonary TB. A total of 134 patients with positive sputum acid-fast bacilli (AFB) cultures were analyzed, of which 44 (33%) were isolated within 3 days after admission. In multivariate logistic regression analysis, older age (p = 0.01), admission to departments other than Infectious Disease or Pulmonology (p = 0.005), and presence of malignancy (p = 0.02) were associated with delayed isolation. Patients with a radiologic diagnosis of active pulmonary TB were likely to be isolated early (p = 0.01). Better awareness of pulmonary TB among attending practitioners in hospital settings is required. Delay in isolation is associated with older age, malignancy, hospitalization to departments other than Infectious Disease or Pulmonology, and non-confident radiologic diagnosis of active pulmonary TB.
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Yeh JJ. Predictors of Initial Smear-Negative Active Pulmonary Tuberculosis with Acute Early Stage Lung Injury by High-Resolution Computed Tomography and Clinical Manifestations: An Auxiliary Model in Critical Patients. Sci Rep 2019; 9:4527. [PMID: 30872774 PMCID: PMC6418143 DOI: 10.1038/s41598-019-40799-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/21/2019] [Indexed: 12/13/2022] Open
Abstract
This study evaluated the diagnostic use of high-resolution computed tomography (HRCT), chest X-ray (CXR), and clinical manifestations (CM) to identify initial smear-negative (iSN) active pulmonary tuberculosis (aPTB) [iSN-aPTB] in patients with iSN-pulmonary diseases (PD) and acute lung injury (ALI). In the derivation cohort, the [iSN-PD] with ALI patients were divided into the [iSN-aPTB] (G1, n = 26) and [non-aPTB-PD] (G2, n = 233) groups. Lung morphology, number, and lobar (segmental) distribution were evaluated using CXR and HRCT. A multivariate analysis was performed to identify independent variables associated with G1, which were used to generate predictive score models for G1. The predictive model was validated in a separate population of patients (n = 372) with [iSN-PD] and (ALI). The validated model for [HRCT (CXR + Hypoalbuminemia)] had 93.5% (25.8%) sensitivity, 99.5% (89.4%) specificity, and a negative predictive value of 99.5% (93.0%). For [iSN-aPTB], the post-test probability in the derivation cohort (prevalence = 10%), validation cohort (prevalence = 8.3%), and the given prevalence (prevalence = 1%) was 88.7%, 94.4%, and 41.5%, respectively. The HRCT model effectively identified the [iSN-aPTB] subjects among the [iSN-PD] with ALI, regardless of CM. The [non-aPTB-PD] were also correctly classified by the HRCT and [CXR + Hypoalbuminemia] models.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Pulmonary Medicine, Section of Thoracic Imaging, and Family Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi, Taiwan.
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
- China Medical University, Taichung, Taiwan.
- Pingtung Christian Hospital, Pingtung, Taiwan.
- Heng Chun Christian Hospital, Pingtung, Taiwan.
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Chesov D, Botnaru V. Imaging for diagnosis and management of tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10021217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ravenel JG, Chung JH, Ackman JB, de Groot PM, Johnson GB, Jokerst C, Maldonado F, McComb BL, Steiner RM, Mohammed TL. ACR Appropriateness Criteria ® Imaging of Possible Tuberculosis. J Am Coll Radiol 2018; 14:S160-S165. [PMID: 28473072 DOI: 10.1016/j.jacr.2017.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022]
Abstract
Pulmonary tuberculosis remains a major cause of disease worldwide and an important public health hazard in the United States. The imaging evaluation depends to a large degree on clinical symptoms and whether active disease is suspected or a subject is at high risk for developing active disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - James G Ravenel
- Principal Author and Panel Chair, Medical University of South Carolina, Charleston, South Carolina.
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Robert M Steiner
- Columbia University Medical Center New York and Temple University Health System, Philadelphia, Pennsylvania
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
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Yeh JJ. Validation of a model for predicting smear-positive active pulmonary tuberculosis in patients with initial acid-fast bacilli smear-negative sputum. Eur Radiol 2017; 28:243-256. [PMID: 28710581 DOI: 10.1007/s00330-017-4959-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 06/18/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study was to develop a predictive model for final smear-positive (SP) active pulmonary tuberculosis (aPTB) in patients with initial negative acid fast bacilli (AFB) sputum smears (iSN-SP-aPTB) based on high-resolution computed tomography (HRCT). METHOD AND MATERIALS Eighty (126, 21) patients of iSN-SP-aPTB and 402 (459, 876) patients of non-initial positive acid fast bacilli (non-iSP) pulmonary disease without iSN-SP-aPTB were included in a derivation (validation, prospective) cohort. HRCT characteristics were analysed, and multivariable regression and receiver operating characteristic (ROC) curve analysis was performed to develop a score predictive of iSN-SP-aPTB. RESULTS The derivation cohort showed clusters of nodules/mass of the right upper lobe or left upper lobe were independent predictors of iSN-SP-aPTB, while bronchiectasis in the right middle lobe or left lingual lobe were negatively associated with iSN-SP-aPTB. A predictive score for iSN-SP-aPTB based on these findings was tested in the validation and prospective cohorts. With an ideal cut-off score = 1, the sensitivity, specificity, positive predictive value, and negative predictive value of the prediction model were 87.5% (90%, 90.5%), 99% (97.1%, 98.4%), 94.6% (81.3%, 57.5%), and 97.6% (97%, 99.8%) in the derivation (validation, prospective) cohorts, respectively. CONCLUSIONS The model may help identify iSN-SP-aPTB among patients with non-iSP pulmonary diseases. KEY POINTS • Smear-positive active pulmonary tuberculosis that is initial smear-negative (iSN-SP-aPTB) is infectious. • High-resolution computed tomography can identify iSN-SP-aPTB among non-iSP pulmonary diseases. • Clusters nodules/mass in right/left upper lobe are positively associated with iSN-SP-aPTB. • Bronchiectasis in right middle/left lingual lobe is negatively associated with iSN-SP-aPTB. • The model may have high post-test probability in identifying iSN-SP-aPTB.
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Affiliation(s)
- Jun -Jun Yeh
- Department of Chest Medicine, Section of Thoracic Imaging, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., Chiayi City, 600, Taiwan. .,Chia Nan University of Pharmacy and Science, Tainan, Taiwan. .,Meiho University, Pingtung, Taiwan. .,Pingtung Christian Hospital, Pingtung, Taiwan. .,Heng Chun Christian Hospital, Pingtung, Taiwan.
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Yeh JJ, Wang YC, Chen JH, Hsu WH. Effect of Systemic Lupus Erythematosus on the Risk of Incident Respiratory Failure: A National Cohort Study. PLoS One 2016; 11:e0163382. [PMID: 27654828 PMCID: PMC5031430 DOI: 10.1371/journal.pone.0163382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/06/2016] [Indexed: 02/06/2023] Open
Abstract
Purpose We conducted a nationwide cohort study to investigate the relationship between systemic lupus erythematosus (SLE) and the risk of incident respiratory failure. Methods From the National Health Insurance Research Database, we identified 11 533 patients newly diagnosed with SLE and 46 132 controls without SLE who were randomly selected through frequency-matching according to age, sex, and index year. Both cohorts were followed until the end of 2011 to measure the incidence of incident respiratory failure, which was compared between the 2 cohorts through a Cox proportional hazards regression analysis. Results The adjusted hazard ratio (aHR) of incident respiratory failure was 5.80 (95% confidence interval [CI] = 5.15–6.52) for the SLE cohort after we adjusted for sex, age, and comorbidities. Both men (aHR = 3.44, 95% CI = 2.67–4.43) and women (aHR = 6.79, 95% CI = 5.93–7.77) had a significantly higher rate of incident respiratory failure in the SLE cohort than in the non-SLE cohort. Both men and women aged <35 years (aHR = 31.2, 95% CI = 21.6–45.2), 35–65 years; (aHR = 6.19, 95% CI = 5.09–7.54) and ≥65 years (aHR = 2.35, 95% CI = 1.92–2.87) had a higher risk of incident respiratory failure in the SLE cohort. Moreover, the risk of incident respiratory failure was higher in the SLE cohort than the non-SLE cohort, for subjects with (aHR = 2.65, 95% CI = 2.22–3.15) or without (aHR = 9.08, 95% CI = 7.72–10.7) pre-existing comorbidities. In the SLE cohort, subjects with >24 outpatient visits and hospitalizations per year had a higher incident respiratory failure risk (aHR = 21.7, 95% CI = 18.0–26.1) compared with the non-SLE cohort. Conclusion Patients with SLE are associated with an increased risk of incident respiratory failure, regardless of their age, sex, and pre-existing comorbidities; especially medical services with higher frequency.
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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
| | - Yu-Chiao Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Jiunn-Horng Chen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Yeh JJ, Wang YC, Kao CH. Asthma-Chronic Obstructive Pulmonary Diseases Overlap Syndrome Increases the Risk of Incident Tuberculosis: A National Cohort Study. PLoS One 2016; 11:e0159012. [PMID: 27448309 PMCID: PMC4957791 DOI: 10.1371/journal.pone.0159012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/02/2016] [Indexed: 01/09/2023] Open
Abstract
Purpose The association between asthma–chronic obstructive pulmonary diseases (COPD) overlap syndrome (ACOS) and tuberculosis (TB) has yet to be studied. Methods The newly diagnosed TB patients (age > 20 y) treated from January 2000 to December 2008 were included (ACOS cohort, n = 10 751; non-ACOS cohort, n = 42 966). The non-ACOS cohort involved patients with confirmed absence of ACOS. We calculated incidence rate ratios (IRRs) for TB in the ACOS and non-ACOS cohorts by using poisson regression analysis. Cox proportional hazards regression models were used to determine the adjusted HR (aHR) for TB in the ACOS cohort compared with the non-ACOS cohort. Results The aHR for TB was 2.41 (95% confidence interval [CI], 2.19–2.66) in the ACOS cohort. The TB risk was significantly higher in the ACOS cohort than in the non-ACOS cohort when stratified by age, sex, comorbidities, and atopy. Within the ACOS cohort, the aHR was higher among patients receiving SABAs+SAMAs, LABAs+LAMAs, and ICSs (aHR [95% CI]: 3.06 [2.75–3.41], 3.68 [2.93–4.61], and 2.79 [1.25–6.22], respectively; all P < .05). Furthermore, patients with more than 15 outpatient visits and hospitalizations per year demonstrated the highest aHR (8.09; 95% CI, 6.85–9.56). Conclusions ACOS cohort potentially develop incident TB, regardless of the age,sex, comorbidities and atopy; even without receiving the inhalers.This risk is higher, especially in the ACOS cohort have a high frequency of medical services or receiving the inhalers such as SABAs+SAMAs, LABAs+LAMAs and ICSs.
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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
| | - Yu-Chiao Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Yeh JJ, Wang YC, Sung FC, Kao CH. Rheumatoid arthritis increases the risk of nontuberculosis mycobacterial disease and active pulmonary tuberculosis. PLoS One 2014; 9:e110922. [PMID: 25337995 PMCID: PMC4206451 DOI: 10.1371/journal.pone.0110922] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/23/2014] [Indexed: 01/01/2023] Open
Abstract
Background Few studies have examined the association of rheumatoid arthritis (RA) with nontuberculosis mycobacterium (NTM) disease and pulmonary tuberculosis (PTB). Methods We identified 29 131 patients with RA from the catastrophic illness registry who were diagnosed from 1998–2008; 116 524 patients without RA from inpatient data files were randomly frequency matched according to sex, age, and index year and used as a comparison group. Both groups were followed-up until the end of 2010 to measure the incidence of NTM disease and active PTB. We analyzed the risk of NTM disease and active PTB using the Cox proportional hazards regression models, controlling for sex, age, and Charlson comorbidity index (CCI). Results The incidence of NTM disease was 4.22 times greater in the RA group than in the non-RA group (1.91 vs 0.45 per 10,000 person-years). The incidence of PTB was 2.99 times greater in the RA group than in the non-RA group (25.3 vs 8.46 per 10,000 person-years). After adjusting for age, sex, and CCI, the adjusted hazard ratios (HRs) of NTM disease and active PTB for the RA group were 4.17 (95% CI = 2.61–6.65) and 2.87 (95% CI = 2.55–3.23), respectively, compared with the non-RA group. In the first 2 years of follow-up, the RA group yielded corresponding adjusted HRs of 4.98 and 3.39 compared with the non-RA group. The follow-up time-specific RA group to the non-RA group HR of both the NTM disease and active PTB varied. Conclusion This study can serve as a reference for clinical physicians to increase awareness regarding the detection of NTM disease and active PTB in RA patients among the any stage of the clinical course even without CCI.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Internal Medicine and Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Meiho University, Pingtung, Taiwan
| | - Yu-Chiao Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- College of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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