Clinical and imaging factors that can predict contagiousness of pulmonary tuberculosis

Abstract

Background Knowledge on predicting pulmonary tuberculosis (PTB) contagiosity in the hospital admission setting is limited. The objective was to assess clinical and radiological criteria to predict PTB contagiosity. Methods Retrospective analysis of 7 clinical, 4 chest X-ray (CXR) and 5 computed tomography (CT) signs in 299 PTB patients admitted to an urban tertiary hospital from 2008 to 2016. If the acid fact bacilli stain was positive (AFB+) on admission, the case was considered high contagiosity. Results Best predictors for high PTB contagiosity (AFB+) were haemoptysis (OR 4.33), cough (3.00), weight loss (2.96), cavitation in CT (2.75), cavitation in CXR (2.55), tree-in-bud-sign in CT (2.12), German residency of the patient (1.89), and abnormal auscultation findings (1.83). A previous TB infection reduced the risk of contagiosity statistically (0.40). Radiographic infiltrates, miliary picture, and pleural effusion were not helpful in predicting high or low contagiosity. 34% of all patients were clinically asymptomatic (20% of the highly contagious group, 50% of the low contagious group). Conclusion Haemoptysis, cough and weight loss as well as cavitation and tree-in-bud sign in CXR/CT can be helpful to predict PTB contagiosity and to improve PTB management.

How We Treat Drug-Susceptible Pulmonary Tuberculosis: A Practical Guide for Clinicians

“…Chest X-rays, most of the time, provide enough information to confirm the clinical suspicion. In doubtful cases, a CT scan is required if the epidemiological, clinical and microbiological criteria are not enough to make a diagnosis [40][41][42]. Magnetic resonance imaging (MRI) is routinely employed in the diagnostic work-up of extrapulmonary TB when involving the central nervous system or the bones or in pediatric age [43][44][45][46][47].…”