The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert<sup>®</sup> MTB/Rif era

Jayasooriya, Shamanthi; Jobe, Alhaji; Badjie, S.; Owolabi, Olumuyiwa; Rachow, Andrea; Sutherland, Jayne S.; Kampmann, Beate

doi:10.5588/pha.19.0046

Cited by 6 publications

(23 citation statements)

References 8 publications

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“…An outpatient research clinic pilot study in The Gambia reports a similar finding of cardiac abnormalities being prevalent among patients without TB (n=108). 21 The prevalence of cardiac abnormalities in our study is higher than in The Gambia (26.3% vs 20%). 21 Cardiac abnormality diagnosis in The Gambia was through clinical assessment, ECG and echocardiography (as indicated) versus CXR only in our study.…”

Section: Discussioncontrasting

confidence: 65%

“…21 The prevalence of cardiac abnormalities in our study is higher than in The Gambia (26.3% vs 20%). 21 Cardiac abnormality diagnosis in The Gambia was through clinical assessment, ECG and echocardiography (as indicated) versus CXR only in our study. This, together with higher median age in our study compared with The Gambia (51 years vs 40 years), could explain our higher observed prevalence.…”

Section: Discussioncontrasting

confidence: 65%

“…TB prevalence surveys and ACF activities using mass CXR offer an opportunity to identify other potential diseases; however, as currently structured, when TB is not confirmed, there is limited further diagnosis and management of these other conditions. 21 The findings of our study are also timely in the wake of disruption in the health system caused by COVID-19. 22 As countries accelerate ACF activities using CXR screening to make up for reductions in TB case-notification rates due to COVID-19, they could plan systems to manage other findings.…”

Section: Discussionmentioning

confidence: 57%

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‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Mungai

Joekes

Masini

et al. 2021

Thorax

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BackgroundThe prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.MethodsWe reviewed a random sample of 1140 adult (≥15 years) CXRs classified as ‘abnormal, suggestive of TB’ or ‘abnormal other’ during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).

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Section: Discussioncontrasting

confidence: 65%

Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 57%

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‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Mungai

Joekes

Masini

et al. 2021

Thorax

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“…There were seven studies including (Table 1a) 6,17,[19][20][21][22][23] and five studies not including (Table 1b) 18,[24][25][26][27] clinically diagnosed tuberculosis cases that used passive case finding strategies. Of the five studies (Table 1b) not including clinically diagnosed tuberculosis cases, only Dorman et al (2018) 25 did not document whether a clinical assessment was performed.…”

Section: Resultsmentioning

confidence: 99%

“…Only five studies reported diagnoses other than active tuberculosis (Table 4). 6,20,21,26,33 Two described non-tuberculous mycobacteria and one Pneumocystis jirovecii pneumonia as the only alternative diagnoses. 20,26,33 reported giving empirical antibiotics to all patients subsequently found not to have active tuberculosis amounting to mass administration of antibiotics to 207 and 380 patients respectively.…”

Section: Resultsmentioning

confidence: 99%

Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

Jayasooriya

Dimambro-Denson

Beecroft

et al. 2021

Preprint

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Background: Many patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed. Methods: We searched four databases from inception to April 27, 2020, without language restrictions (PROSPERO: CRD42018100004). We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random-effects meta-analysis to obtain pooled estimates stratified by passive and active case finding. Results: Our search identified 1799 studies, of which 18 studies with 14527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 38.4-56.7) in passive and 92.7% (95% CI 83.1-97.0) in active case finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. Past history of tuberculosis was documented in only 55% of studies, with just five out of 18 reporting any alternative diagnoses. Discussion: Nearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs. Funding NIHR, UK MRC

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Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

Jayasooriya

Dimambro-Denson

Beecroft

et al. 2022

Thorax

View full text Add to dashboard Cite

BackgroundMany patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed.MethodsWe searched four databases from inception to 27 April 2020, without language restrictions. We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random effects meta-analysis to obtain pooled estimates stratified by passive and active case finding.ResultsOur search identified 1799 studies, of which 18 studies (2002–2019) with 14 527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 39.0 to 58.0) in passive and 92.8% (95% CI 85.0 to 96.7) in active case-finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. A history of tuberculosis was documented in 55% of studies, with just five out of 18 reporting any alternative diagnoses.DiscussionNearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case-finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs.PROSPERO registration numberCRD42018100004.

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The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert^® MTB/Rif era

Cited by 6 publications

References 8 publications

‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

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The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert® MTB/Rif era

Cited by 6 publications

References 8 publications

‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

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The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert^® MTB/Rif era