Pulmonary TB: varying radiological presentations in individuals with HIV in Soweto, South Africa

Kistan, Jesne; Laher, Fatima; Otwombe, Kennedy; Panchia, Ravindre; Mawaka, Nohemie; Lebina, Limakatso; Diacon, Andreas H.; Kana, Bavesh D; Martinson, Neil

doi:10.1093/trstmh/trx028

Cited by 19 publications

(16 citation statements)

References 12 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rise in cavitary TB incidence during adolescence is believed to be caused by the bolstering of host response to Mtb by pubertal hormones [ 27 ]. Our observation of an inverse association between HIV coinfection and lung cavitation in older adolescents—which mirrors findings from studies in adults—supports this hypothesis [ 30 , 31 ]. The low number of 10–14-year-olds with cavitary TB may explain the lack of association between HIV and cavitation in the younger group.…”

Section: Discussionsupporting

confidence: 89%

Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine

et al. 2020

View full text Add to dashboard Cite

BackgroundDuring adolescence, childhood and adult forms of tuberculosis (TB) overlap, resulting in diverse disease manifestations. Knowing which patient characteristics are associated with which manifestations may facilitate diagnosis and enhance understanding of TB pathophysiology.MethodsIn this cross-sectional study, we included 10–19-year-olds in Ukraine's national TB registry who started TB treatment between 2015 and 2018. Using multivariable regression, we estimated associations between patient characteristics and four presentations of TB: pleural, extrathoracic, cavitary and rifampicin-resistant (RR). We also described the epidemiology of adolescent TB in Ukraine.ResultsAmong 2491 adolescent TB cases, 88.4% were microbiologically confirmed. RR-TB was confirmed in 16.9% of new and 29.7% of recurrent cases. Of 88 HIV-infected adolescents, 59.1% were not on antiretroviral therapy at TB diagnosis. Among 10–14-year-olds, boys had more pleural disease (adjusted OR (aOR) 2.12, 95% CI: 1.08–4.37). Extrathoracic TB was associated with age 15–19 years (aOR 0.26, 95% CI: 0.18–0.37) and HIV (aOR 3.25, 95% CI: 1.55–6.61 in 10–14-year-olds; aOR 8.18, 95% CI: 3.58–17.31 in 15–19-year-olds). Cavitary TB was more common in migrants (aOR 3.53, 95% CI: 1.66–7.61) and 15–19-year-olds (aOR 4.10, 95% CI: 3.00–5.73); among 15–19-year-olds, it was inversely associated with HIV (aOR 0.32, 95% CI: 0.13–0.70). RR-TB was associated with recurrent disease (aOR 1.87, 95% CI: 1.08–3.13), urban residence (aOR 1.27, 95% CI: 1.01–1.62) and cavitation (aOR 2.98, 95% CI: 2.35–3.78).ConclusionsAge, sex, HIV and social factors impact the presentation of adolescent TB. Preventive, diagnostic and treatment activities should take these factors into consideration.

show abstract

Section: Discussionsupporting

confidence: 89%

Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Another challenge is that CXRs of HIV-positive TB patients may show atypical radiological signs. 9,10 Computer-aided detection (CAD) systems to support clinicians in detecting TB-related abnormalities in digital CXRs have the potential to make health screening programmes more efficient. 11 One commercial product, CAD4TB (©Thirona, Nijmegen, the Netherlands) scores CXRs according to abnormal signs, such as cavities and consolidation.…”

Section: Introductionmentioning

confidence: 99%

“…Another challenge is that CXRs of HIV-positive TB patients may show atypical radiological signs. 9,10…”

Section: Introductionmentioning

confidence: 99%

Computer-aided interpretation of chest radiography reveals the spectrum of tuberculosis in rural South Africa

Fehr

Konigorski

Olivier

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Computer-aided digital chest radiograph (CXR) interpretation can facilitate high-throughput screening for tuberculosis (TB), but its use in population-based screening has been limited. We applied an automated image interpretation algorithm, CAD4TBv5, prospectively in an HIV-endemic area. Methods Participants underwent CXR and, for those with symptoms or lung field abnormality, microbiological assessment of sputum collected at a mobile camp in rural South Africa. CAD4TBv5 scored each CXR on a 0-100 scale in the field. An expert radiologist, blinded to the CAD4TBv5 score and other data, assessed CXRs for 1) lung field abnormality and 2) findings diagnostic of active TB (R+). We estimated the performance of CAD4TBv5 for triaging (identifying lung field abnormality as a criteria for sputum examination) and diagnosis (detection of active TB as defined by microbiologic (M+) or radiologic (R+) gold standards). Findings For triaging, a CAD4TBv5 threshold of 25 identified abnormal lung fields with a sensitivity of 90.3% and specificity of 48.2%. For diagnosis, CAD4TBv5 had less agreement with the microbiological reference standard (M+) used to define definite TB (AUC 0.78) than with the radiological reference standard (R+) used to define probable TB (AUC 0.96). HIV-serostatus did not impact CAD4TB's performance. Interpretation A low CAD4TBv5 threshold was required to achieve acceptable triaging sensitivity. Low specificity at this threshold led to high rates of sputum collection despite normal lung fields. CAD4TBv5 had difficulty identifying microbiologically-confirmed TB cases with subtle radiological features but had excellent agreement with the radiologist in identifying radiologically-defined TB cases. We conclude that computer-aided CXR interpretation can be useful in population-based screening in HIV-endemic settings, but threshold selection should be guided by setting-specific piloting and priorities. CXR interpretation algorithms require refinement for the identification of radiologically-subtle early TB.

show abstract

“…10 HIV individuals with PTB may have a proportionally higher infiltrates and a lower cavitations. 11 India is considered as "an ageing nation" with 7.7% of its population being more than 60 years old. Pulmonary tuberculosis may presents differently amongst adults and the elderly hence need to be evaluated differently.…”

Section: Introductionmentioning

confidence: 99%

Clinico-radiological variability of pulmonary tuberculosis in young patients as compared to elder patients prior to RNTCP and after 18 years RNTCP

et al. 2018

View full text Add to dashboard Cite

Background: Tuberculosis, a chronic disease causing high morbidity and mortality with multiple host related and socio-demographic risk factors. Incidence is 3-4 times among in diabetics. HIV is considered to be a most powerful risk factor other being malnutrition, Tubercular contacts, smoking habits and alcoholism. Many ecological and societal threats increase a vulnerability to infection and succession of the disease. Objective was to study and compare various clinico-radiological presentations and clinical risk factors for pulmonary tuberculosis in the young (<50yrs) and elderly (>50yrs) patients.Methods: Total 300 pulmonary tuberculosis patients each admitted in hospital during 1999 (group ‘A’) and 2016 (group ‘B’) respectively were included in our study. Socio-demographic risk factors and presence of any existing co morbidities and clinical as well radiological presentation data were evaluated.Results: Majority patients in both group ‘A’ and ‘B’ were males (67% and 61.3%), younger (71.3% and 63.3%) patients. Elder patients had more smokers in both groups (48.8% and 33.6%). COPD trends seems to be receding in group ‘B’ as compared to group ‘A’ in younger (6.3% vs. 8.9%) as well elder (13.6% vs. 29.1%) but on the contrary lifestyle disease trends like DM increased in group ‘B’ than group ‘A’ patients more in elder subgroup (30% vs. 9.3%). HIV infected was more in younger 2.1 % (elder 0.9%) group ‘B’ patients. Haemoptysis (17.8% and 18.6% vs. 13.7% and 9.1%) and cough (~87% vs. ~85%) were almost similar but fever (~90% vs. ~65%) was seen significantly higher in the young patients. Radiologically bilateral upper lobe cavitations (15%-30%) was a higher in group A patients as compared to negligible less than ~3% cavitations in group B, on the contrary infiltrations (15%-32%) was more in group B.Conclusions: Young adults are more likely to have fever while haemoptysis cough and advanced lung field involvement is more common in elderly. Elderly patients had a higher number of co-morbidities like COPD and DM. The present study reveals that various demographic, socioeconomic and clinical risk factors have a potential role in causation/augmentation of pulmonary tuberculosis hence life style modification, prevention and timely management of these risk factors could be helpful to reduce the burden of disease.

show abstract

Pulmonary TB: varying radiological presentations in individuals with HIV in Soweto, South Africa

Abstract: Individuals with HIV co-infected with PTB have a higher proportion of infiltrates and a lower proportion of cavitations relative to the HIV-uninfected PTB individuals. The absence of classical upper lobe cavitatory disease on CXR does not exclude PTB in individuals with HIV.

Cited by 19 publications

References 12 publications

Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine

Clinical manifestations and epidemiology of adolescent tuberculosis in Ukraine

Computer-aided interpretation of chest radiography reveals the spectrum of tuberculosis in rural South Africa

Clinico-radiological variability of pulmonary tuberculosis in young patients as compared to elder patients prior to RNTCP and after 18 years RNTCP

Contact Info

Product

Resources

About