Normal chest radiography in pulmonary tuberculosis: implications for obtaining respiratory specimen cultures.

Pepper T, Joseph P, Mwenya C, McKee GS, Haushalter A, Carter A, Warkentin J, Haas DW, Sterling TR
Int J Tuberc Lung Dis. 2008 12 (4): 397-403

PMID: 18371265

SETTING - Urban tuberculosis (TB) clinic, Nashville, Tennessee, USA.

OBJECTIVE - Chest radiographs (CXRs) help in the diagnosis of pulmonary TB, but may be normal. Mycobacterium tuberculosis in culture is diagnostic of TB, but cultures are not routinely obtained in resource-poor settings. We examined rates and risk factors for pulmonary TB associated with normal CXR.

DESIGN - An observational cohort study was performed among all respiratory culture-positive TB cases referred to the Nashville Health Department from October 1992 to July 2003. Clinical factors, demographics and underlying medical conditions were assessed.

RESULTS - Of 601 study patients, 53 (9%) had normal CXRs: 31/138 (22%) were human immunodeficiency virus (HIV) infected and 22/463 (5%) were non-HIV-infected/unknown (P<0.001). Among HIV-infected patients, normal CXR was more likely in persons with renal failure (13% vs. 3%, P=0.048). Among non-HIV-infected/unknown patients, normal CXR was more likely in those who were asymptomatic at presentation (32% vs. 13%, P=0.022). In multivariable logistic regression analysis, HIV infection was associated with an increased risk of normal CXR (odds ratio [OR] 6.61, P<0.0001); factors associated with reduced risk were dyspnea (OR 0.24, P=0.026), positive sputum smear (OR 0.45, P=0.028) and cough (OR 0.48, P=0.038).

CONCLUSIONS - The rate of normal CXR among persons with culture-confirmed pulmonary TB was high. Respiratory specimen cultures should be obtained in TB suspects with a normal CXR, particularly HIV-infected persons.

MeSH Terms (13)

Adult AIDS-Related Opportunistic Infections Cohort Studies Female HIV Infections Humans Male Mass Chest X-Ray Middle Aged Mycobacterium tuberculosis Retrospective Studies Sputum Tuberculosis, Pulmonary

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