Chest x-ray findings in tuberculosis patients identified by passive and active case finding: A retrospective study

Ema Rastoder; Saher Burhan Shaker; Matiullah Naqibullah; Mathilde Marie Winkler Wille; Mette Lund; Jon Torgny Wilcke; Niels Seersholm; Sidse Graff Jensen

doi:10.1016/j.jctube.2019.01.003

Chest x-ray findings in tuberculosis patients identified by passive and active case finding: A retrospective study

J Clin Tuberc Other Mycobact Dis. 2019 Jan 9:14:26-30. doi: 10.1016/j.jctube.2019.01.003. eCollection 2019 Feb.

Authors

Ema Rastoder¹, Saher Burhan Shaker¹, Matiullah Naqibullah¹, Mathilde Marie Winkler Wille², Mette Lund², Jon Torgny Wilcke¹, Niels Seersholm¹, Sidse Graff Jensen¹

Affiliations

¹ Department of Respiratory Medicine, Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Copenhagen, Denmark.
² Department of Radiology, Hillerød Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.

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.

Keywords: Active case finding; Chest x-ray assessment; Chest x-ray changes; Normal chest x-ray; Passive case finding; Tuberculosis.