RT Journal Article
SR Electronic
T1 Detecting pulmonary involvement in extra-pulmonary tuberculosis using chest radiographs (CXR) and sputum sampling: What happens in practice?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p2707
VO 38
IS Suppl 55
A1 Suzanne Bartington
A1 Marc Lipman
A1 Joanne Cleverley
A1 Charlotte Cash
A1 Ian Cropley
A1 Susan Hopkins
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p2707.abstract
AB Background: CXR plus sputum microscopy & culture (TBC) for M.tuberculosis (MTB) can identify co-existing pulmonary TB (PTB) in subjects presenting with extra-pulmonary tuberculosis (EPTB). In practice, EPTB subjects with normal CXR may not have sputum sampling performed, leading to underestimation of pulmonary disease.Objectives: To determine the use of CXR & TBC in patients with EPTB & their diagnostic utility to detect co-existent PTB.Study design: Retrospective clinical and demographic data for TB patients at our hospital (1.1.06 - 31.12.08) obtained from the London TB Register were linked to hospital microbiology & HIV test data. Baseline CXR (B-CXR) were scored by 2 respiratory radiologists blind to patient diagnosis.Results: Of 308 cases (median age 39y, 52.9% female), 155 were notified as EPTB only. 143 (92.3%) had B-CXR, with abnormal (abN) features identified in 67 patients (46.9%): 48 (33.6%) consistent with possible PTB & 9 (6.3%) probable PTB, independent of HIV status. Sputum samples were obtained from 54 patients (37.8%). This was less likely in those with a normal B-CXR (21.4% vs. 56.2% abN, p<0.001). TBC was MTB positive in 9 patients (16.7%): 7 with abN B-CXR (5 possible PTB, 2 probable PTB) & 2 with normal B-CXR.Conclusion: Most EPTB patients had a B-CXR, 40% of which were consistent with possible/probable active PTB. Sputum samples were infrequently obtained, though when performed MTB yield was high. Clinical diagnosis of EPTB using B-CXR review alone may underestimate co-existing PTB. To identify infectious cases & improve TB control, sputum collection & TBC should be performed in all patients.