Normal chest radiography in pulmonary tuberculosis: implications for obtaining respiratory specimen cultures
Abstract: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.
Document Type: Regular Paper
Affiliations: 1: Vanderbilt University School of Medicine, Nashville, Tennessee, USA 2: Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti 3: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 4: Nashville Metro Public Health Department Tuberculosis Clinic, Nashville, Tennessee, USA 5: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; and Vanderbilt University Department of Microbiology and Immunology, Nashville, Tennessee, USA 6: Division of Infectious Diseases; and Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
Publication date: 2008-04-01
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