scholarly journals 794. Infectivity of Smear-Positive Pulmonary TB After 2 Weeks of Rifampicin-based Anti-Tuberculous Therapy

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S285-S286
Author(s):  
Faraj Alhowady ◽  
Nada Elmaki ◽  
Maisa Ali ◽  
Ahmad Husain ◽  
Muna Al-Maslamani ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Conversion Rate ◽  
Clinical Characteristics ◽  
Communicable Disease ◽  
Sputum Culture ◽  
Sputum Smear ◽  
P Value ◽  
Duration Of Symptoms ◽  
Pulmonary Tb ◽  
Culture Conversion

Abstract Background Pulmonary tuberculosis (TB) remains one of the leading infectious causes of morbidity and mortality worldwide. Most data showed that infectiousness of pulmonary TB diminishes rapidly after 2 weeks of effective anti-tuberculous therapy and the bacilli seen in the smear after 2 weeks are most likely nonviable. We aim to assess this hypothesis by doing sputum culture after 2 weeks of therapy to assess the viability of the bacilli in the smear. Methods A prospective cohort study was conducted on patients admitted to Communicable Disease Centre (CDC), Qatar with smear positive pulmonary tuberculosis during the period November 2013–November 2014. We repeated sputum smear and culture after 2 weeks of rifampicin based regimen to assess the infectivity. Demographic and clinical characteristics of patients was evaluated and compared with smear and culture conversion rate. Results Ninety-five cases were included in the study. All had sputum smear and culture after 2 weeks of supervised rifampicin based therapy (Table 1). Sputum culture at two weeks of treatment was positive in 91 cases (95.7%) and only four cases were culture negative after 2 weeks. Demographic and clinical characteristics were compared with the culture status after 2 weeks, found Patient from Indian subcontinent and symptoms duration more than 1 month are less likely to clear infection after 2 weeks with P-value 0.01 and 0.009, respectively (Table 2). The calculated mean for sputum smear and culture conversion rate was 4 and 8 weeks, respectively. The presence of cough and the duration of symptoms were associated significantly with rapid sputum conversion (P < 0.05); however, the presence of cavity on CXR had no statistical significant effect (Table 3). Conclusion Majority of our patients in the study have positive TB culture after two weeks of rifampicin based anti-tuberculosis therapy. So, discontinuation of the isolation after 2 weeks of treatment assuming that bacilli in the smear are nonviable may not be safe. Disclosures All authors: No reported disclosures.

scholarly journals Time to culture conversion in smokers with pulmonary tuberculosis

2016 ◽  
Vol 71 (3) ◽  
Author(s):  
J.A. Gullón ◽  
I. Suárez ◽  
M. Lecuona ◽  
R. Fernández ◽  
G. Rubinos ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pulmonary Tuberculosis ◽  
Univariate Analysis ◽  
Female Gender ◽  
Drug Susceptibility ◽  
Sputum Culture ◽  
Smoking History ◽  
Sputum Smear ◽  
P Value ◽  
Culture Conversion

Background and objective. It has been reported that tobacco smoking slows the sterilisation of sputum culture in pulmonary tuberculosis, but the factors that could delay culture conversion in patients who smoke are not known. Our aim is to identify the factors influencing sputum culture conversion in smokers with pulmonary tuberculosis. Methods. Ninety-nine patients with a smoking history and diagnosed with pulmonary tuberculosis were analysed retrospectively. The relationship between sputum culture status at the second month and the following variables: age, gender, pack-years index, comorbid diseases, number acid-fast bacilli (AFB) in sputum smear examination, radiological findings (cavitary, extensive or limited disease), drug susceptibility pattern and initial treatment, was analysed. The Student t-test, chi-square test and logistic regression model with forward stepwise conditional methods were used for statistical analysis. A p value of <0.05 was considered to be statistically significant. Results. Twenty six patients (26.2%): 18 males (22.2%) and 8 females (44%) were sputum culture positive at the end of the second month of treatment. In univariate analysis, culture conversion time was significantly associated with female gender and extensive disease, but in a logistic regression analysis was only correlated with female gender (OR=5.63 95% CI 1.21-20.64-p=0.02). Conclusion. In current smokers with pulmonary tuberculosis, the ‘time to culture’ conversion relates only to the female gender.

scholarly journals TO ASSESS THE RESPONSE AND OUTCOME OF THE TB PATIENTS REGISTERED AT DTC REWA OF CENTRAL INDIA

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Anjana Niranjan ◽  
Sanjeev Sharma ◽  
Rohit Trivedi ◽  
Pahram Adhikari ◽  
Achala Jain ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Conversion Rate ◽  
The Body ◽  
Treatment Result ◽  
Sputum Smear ◽  
Prospective Longitudinal Study ◽  
Pulmonary Tb ◽  
Sputum Conversion ◽  
Extra Pulmonary ◽  
Prospective Longitudinal

Background-Tuberculosis is a highly infectious disease caused by Mycobacterium tuberculosis. The disease primarily affects lungs so it known as Pulmonary TB and other tissues of the body which is known as Extra-pulmonary TB. The vast majority of TB deaths are in the developing world left untreated, Tuberculosis is treatable with a course of antibiotics. The most successful strategy to treat TB patients is DOTS. Material and Method: This is a Prospective Longitudinal  study conducted  among the patients attending DOTS center of DTC located at S.G.M.H. campus  Rewa for the Treatment  provided under of a definitive time period ( as per RNTCP, last quarter of 2014) from 1st Oct to 31st Dec 2014. Aim & Objective:  1. To observe the sputum conversion rate of study population. 2. To find out the outcome of treatment. Result: 69.92%were pulmonary tuberculosis and 30.07% was Extra-pulmonary tuberculosis and sputum conversion rate of Pulmonary TB cases at the end of IP in new sputum smear positive cases was 96.66% but at the end of 5 month it was 100%. In retreatment cases Sputum Conversion rate at the end of IP was 89.28% and at the end of 5 month 92.85%.and overall treatment success rate were 90.97%.  Conclusion: At the end of treatment as per DOTS schedules sputum smear examination is mandatory to know the exact treatment cure rate.  Key words: Pulmonary, Extra-Pulmonary, Sputum Conversion, cured, Treatment completed, Defaulter etc.

scholarly journals Kepatuhan menelan obat, merokok dan resiko kegagalan konversi (BTA positif) pada pasien tuberculosis

2021 ◽  
Vol 14 (4) ◽  
pp. 581-589
Author(s):  
Mariawati Mariawati ◽  
Khoidar Amirus ◽  
Marliyana Marliyana
Keyword(s):  
Medication Adherence ◽  
Pulmonary Tuberculosis ◽  
Health Workers ◽  
Treatment Compliance ◽  
Patient Treatment ◽  
Sputum Smear ◽  
P Value ◽  
Active Smoking ◽  
Directly Observed Therapy ◽  
Pulmonary Tb

Active smokers, treatment compliance and sputum smear conversion failed among patients treated for active tuberculosisBackground: One of the infectious diseases that often affects people is pulmonary tuberculosis (pulmonary TB). World data, there are 10.4 million recent cases of tuberculosis or 142 cases / 100,000 populations, with 480,000 cases of failed conversions. Indonesia is a country with the second largest number of recent cases in the world after India. With the success of treatment in Indonesia, it is low at 85%. Data from Lampang Province, the number of new patients with pulmonary tuberculosis is reaching 110 per 100,000 populations. Data in Central Lampung Regency found 954 cases out of 20,184 people suspected (4.73%). Data in Poncowati Public Health Center in Central Lampung in 2018, conversion failure rates were quite high at 16 people out of 42 people with pulmonary TB (38.1% ), and the success of the treatment is also still low, at 76.2% (target> 90%).Purpose: Knowing relation factors active smoker, treatment compliance with failed sputum smear conversion among patients treated for active tuberculosis.Method: A quantitative study with the design by observational analytic. The samples in this study were 42 pulmonary TB patients. Data analysis in this study used the chi-square test.Results: Most respondents smoke <10 cigarettes per day (not at risk), 22 (52.4%). Most respondents obey the ingestion of drugs, which are  28 (66.7%). There was a correlation between active smoking (p-value = 0.002 and OR = 11.762) and medication adherence (p-value = 0.002 and OR = 9,167) with conversion failure in pulmonary tuberculosis patients.Conclusion: There were active smokers, treatment compliance, and sputum smear conversion failed among patients treated for active tuberculosis. It needs to further improve Directly Observed Therapy (DOT) support and the role of health workers in improving patient treatment compliance and motivation in quitting smoking.Keywords  : Active smoking; Medication adherence; Conversion failure; Active tuberculosisPendahuluan: Salah satu penyakit menular yang sering diderita masyarakat adalah Tuberculosis paru (TB paru). Data dunia, terdapat 10,4 juta kasus baru tuberkulosis atau 142 kasus/100.000 populasi, dengan 480.000 kasus gagal konversi. Indonesia merupakan negara dengan jumlah kasus baru terbanyak kedua di dunia setelah India. Dengan angka keberhasilan pengobatan di Indonesia rendah, yaitu 85%. Data Provinsi Lampung, jumlah pasien baru tuberculosis paru  yaitu mencapai 110 per 100.000 penduduk. Data di Kabupaten Lampung Tengah ditemukan sebanyak 954 kasus dari 20.184 orang suspek (4,73%).Data di Puskesmas Poncowati Lampung Tengah pada tahun 2018, angka kegagalan konversi cukup tinggi yaitu sebanyak 16 orang dari 42 orang penderita TB paru (38,1%), dan keberhasilan pengobatan juga masih rendah, yaitu 76,2% (target >90%). Tujuan: Diketahui hubungan para perokok aktif, kepatuhan menelan obat dan kegagalan konversi (BTA positif) pada pasien tuberculosis.Metode: Jenis penelitian kuantitatif, rancangan penelitian dengan analitik observasional. Sampel sejumlah 42 pasien TB paru. Analisis data pada penelitian ini menggunakan uji chi-square.Hasil: Sebagian besar responden merokok <10 batang perhari (tidak berisiko) yaitu sebanyak 22 orang (52,4%).Sebagian besar responden patuh dalam menelan obat, yaitu sebanyak 28 orang (66,7%). Terdapat hubungan antara merokok aktif (p-value = 0,002 dan OR= 11,762) dan kepatuhan menelan obat  (p-value = 0,002 dan OR= 9,167) dengan kegagalan konversi pada pasien tuberculosis.Simpulan: Terdapat hubungan para perokok aktif, kepatuhan menelan obat dan kegagalan konversi (BTA positif) pada pasien tuberculosis. Perlu lebih ditingkatkannya dukungan PMO serta peran petugas kesehatan dalam meningkatkan kepatuhan berobat pasien dan motivasi dalam menghentikan kebiasaan merokok. 

scholarly journals Synergistic effect of genetic polymorphisms in TLR6 and TLR10 genes on the risk of pulmonary tuberculosis in a Moldavian population

2021 ◽  
pp. 175342592110299
Author(s):  
Alexander Varzari ◽  
Igor V. Deyneko ◽  
Elena Tudor ◽  
Harald Grallert ◽  
Thomas Illig
Keyword(s):  
Pulmonary Tuberculosis ◽  
Interaction Analysis ◽  
P Value ◽  
Fisher Exact Test ◽  
Snp Analysis ◽  
Nucleotide Polymorphism ◽  
Single Nucleotide ◽  
Exact Test ◽  
Pulmonary Tb ◽  
The Republic

Polymorphisms in genes that control immune function and regulation may influence susceptibility to pulmonary tuberculosis (TB). In this study, 14 polymorphisms in 12 key genes involved in the immune response ( VDR, MR1, TLR1, TLR2, TLR10, SLC11A1, IL1B, IL10, IFNG, TNF, IRAK1, and FOXP3) were tested for their association with pulmonary TB in 271 patients with TB and 251 community-matched controls from the Republic of Moldova. In addition, gene–gene interactions involved in TB susceptibility were analyzed for a total of 43 genetic loci. Single nucleotide polymorphism (SNP) analysis revealed a nominal association between TNF rs1800629 and pulmonary TB (Fisher exact test P = 0.01843). In the pairwise interaction analysis, the combination of the genotypes TLR6 rs5743810 GA and TLR10 rs11096957 GT was significantly associated with an increased genetic risk of pulmonary TB (OR = 2.48, 95% CI = 1.62–3.85; Fisher exact test P value = 1.5 × 10−5, significant after Bonferroni correction). In conclusion, the TLR6 rs5743810 and TLR10 rs11096957 two-locus interaction confers a significantly higher risk for pulmonary TB; due to its high frequency in the population, this SNP combination may serve as a novel biomarker for predicting TB susceptibility.

scholarly journals Mantoux test results and BCG vaccination status in TB-exposed children

2015 ◽  
Vol 55 (1) ◽  
pp. 7
Author(s):  
Fadilah Harahap ◽  
Ridwan M. Daulay ◽  
Muhammad Ali ◽  
Wisman Dalimunthe ◽  
Rini Savitri Daulay
Keyword(s):  
Pulmonary Tuberculosis ◽  
Nutritional Status ◽  
Household Contact ◽  
Mantoux Test ◽  
Skin Tests ◽  
Sputum Smear ◽  
Test Results ◽  
Time Duration ◽  
Pulmonary Tb ◽  
Bcg Vaccination

Background Tuberculosis (TB) infection is highly prevalent in Indonesia. The source of transmission of TB to a child is usually via an adult with sputum smear-positive pulmonary tuberculosis. The Mantoux test is a diagnostic tool for tuberculosis infection. The BCG vaccine has been used for the prevention of TB, but its efficacy is still debated. Objective To assess for an association between Mantoux test results and BCG vaccination in children who had contact with adult pulmonary tuberculosis and to assess for differences in Mantoux test induration with regards to nutritional status, age, type of TB contact, and time duration since BCG vaccination in BCG-vaccinated and BCG-unvaccinated children. Methods A cross-sectional study was conducted in FebruaryMarch 2011 on infants and children (aged 3 months to five years), who had household contact with adult pulmonary TB. We performed tuberculin (Mantoux) skin tests to detect TB infection in the children. Subjects were consisted of two groups: BCG-vaccinated and BCG-unvaccinated. Results Subjects were 100 children (50 BCG-vaccinated and 50 BCG-unvaccinated subjects). Positive Mantoux test results were observed in 9 vaccinated subjects and 33 unvaccinated subjects. The mean diameters of induration in the vaccinated and unvaccinated groups were 7.6 mm and 9.6 mm, respectively (95%CI of difference -4.25 to 0.20; P=0.074). In children who had household contact with sputum smear-positive adult pulmonary TB, BCG vaccination was a protective factor against TB infection, with an odds ratio (OR) of 0.113 (95%CI 0.045 to 0.286; P=0.0001). There were no significant differences in Mantoux test induration associated with nutritional status, age, type of TB contact, and duration since BCG vaccination, between the two groups. Conclusion BCG vaccination has a protective effect on TBexposed children, based on Mantoux test results. However, there are no differences in Mantoux test induration associated with nutritional status, age, type of TB contact, or duration since BCG vaccination, between the BCG-vaccinated and BCGunvaccinated groups.

scholarly journals Tuberculosis Status and Coinfection of Pulmonary Fungal Infections in Patients Referred to Reference Laboratory of Health Centers Ghaemshahr City during 2007-2017

1970 ◽  
Vol 28 (6) ◽  
Author(s):  
Mohammad Reza Jabbari Amiri ◽  
Rora Siami ◽  
Azad Khaledi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Fungal Infections ◽  
Cross Sectional Study ◽  
Health Centers ◽  
Sputum Smear ◽  
P Value ◽  
Reference Laboratory ◽  
Cross Sectional ◽  
Pulmonary Fungal Infections ◽  
Student’S T

BACKGROUND: Pulmonary tuberculosis is one of the most important health concerns. Pulmonary fungal infections have clinical and radiological characteristics similar to tuberculosis which may be easily misdiagnosed as tuberculosis. This study aimed to evaluate tuberculosis (TB) status and coinfection of TB with pulmonary fungal infections in patients referred to reference laboratory of health centers Ghaemshahr city during 2007-2017.METHODS: This cross-sectional study was conducted during eleven years, between 2007 2017, on 3577 patients with suspected TB referred to health centers of Ghaemshahr City. For isolation, sputum smear preparation and Ziehl-Neelson staining in companying with microscopy direct observation and KOH 10% + white Calcofluor staining was used. The culture of fungi was performed on Sabouraud Dextrose agar, Czapek and chrome agar media. Then, data were analyzed using SPSS software (version 16) through Student's t-test, Fisher test, and Odds Ratio. P values <0.05 were considered statistically significant.RESULTS: Of 3577 patients, 10731 smears were prepared, 3.6% (n=130) of patients were identified as smear-positive pulmonary tuberculosis, 86.4% (n=3090) were smear negative and 10% (n=357) drug-resistant TB. The mean age of patients was 48±1.8 years. With increasing age, the prevalence of TB has increased which was statistically significant (P value <0.05). Prevalence of tuberculosis in the age group over than 57 years in males and females had an ascending trend. Amongst the positive tuberculosis patients, 16/130 cases (12.3%) had the coinfection of TB with fungi microorganisms.CONCLUSION: Our findings showed the coinfection of fungi agents in patients with tuberculosis that should be considered. 

scholarly journals Factors Influencing Sputum Smear and Culture Conversion Time among Patients with Pulmonary Tuberculosis

2018 ◽  
Vol 1 (01) ◽  
pp. 41-46
Author(s):  
Pushpa Man Shrestha ◽  
Minani Gurung ◽  
Nabin Kumar Chaudhary
Keyword(s):  
Pulmonary Tuberculosis ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Smoking Habit ◽  
Sputum Smear ◽  
Erythrocyte Sedimentation ◽  
Sputum Conversion ◽  
Conversion Time ◽  
Index Value ◽  
Culture Conversion

Introduction: Pulmonary tuberculosis is a contagious bacterial infection that involves the lungs and it may spread to other organs. Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The present study aims to find sputum smear and culture conversion time and the factors that influence the conversion time among tuberculosis patients at National Tuberculosis Centre in Nepal. Methods: A total of 54 patients, who were diagnosed with laboratory confirmed pulmonary tuberculosis and under antitubercular therapy were monitored for sputum smear and culture conversion time. The blood specimens from each patient were processed for hemoglobin, platelets, erythrocyte sedimentation rate and blood glucose levels. Patient’s clinical history, risk factors that prolong conversion time and sociodemographic information were also collected by direct interview. Results: The mean sputum smear and culture conversion were found to be 54.4 days and 45.5 days respectively. Old age, smoking habit, low body mass index value, Treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate values were found to be associated with long sputum conversion time. Radiographic involvement of only left lungs, presence of fewer symptoms, aged between 15-45 years, having normal weight, without smoking habit and being married, were found to be associated with short sputum conversion time. Conclusions: The sputum microscopy, old age, smoking habit, low body mass index value, treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate value had been found to be significantly associated with long sputum conversion time.

scholarly journals Radiological Findings of Pulmonary Tuberculosis in Patients with and Without HIV Infections

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Radhiana binti Hassan ◽  
Haziq Hussaini bin Fauzi ◽  
Kamil Irsyad bin Yusoff ◽  
Muhammad Faizol bin Mohd Satar ◽  
Hafizah bt Pasi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Chest Radiograph ◽  
Chest Radiographs ◽  
Mediastinal Lymphadenopathy ◽  
Hiv Positive ◽  
Sputum Smear ◽  
P Value ◽  
Radiological Findings ◽  
Radiological Manifestation ◽  
Hiv Negative

Introduction: Radiological manifestation of pulmonary tuberculosis in HIV positive patients is different with HIV negative patients. We aim to determine the differences in chest radiological findings of Pulmonary Tuberculosis among HIV and non-HIV infected patients in HTAA. Materials and method: A retrospective study was conducted in Chest Clinic, Hospital Tunku Ampuan Afzan, Kuantan Pahang. There were 101 chest radiographs with sputum smear-positive retrieved and reviewed. Socio-demographic status and chest radiographs findings were documented and analyzed. Results: Of the 101 patients, 12 patients were HIV positive. Of the 89 HIV negative patients, 96% had consolidation change on chest radiograph, in contrast with HIV positive patients, only 4% among them had this appearance and this is statistically significant (p value less than 0.05). Mediastinal lymphadenopathy is significantly higher (17%) in HIV positive patients compared to HIV negative patients (1%). Normal chest radiographs were more common in HIV positive patients (33%) as compared to HIV negative patients (2%). Conclusion: HIV positive patients with pulmonary tuberculosis exhibit different radiological manifestation on chest radiograph when compared to HIV negative patients.

scholarly journals Sputum Smear Positive Pulmonary Tuberculosis Diagnostic Dropout Rate in Public Health Facilities, Addis Ababa, Ethiopia

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Daniel Melese Desalegn ◽  
Kumera Terfa Kitila ◽  
Boja Dufera Taddese ◽  
Tinsae Kidanemariam Hailu ◽  
Tariku Takle Dinku ◽  
...  
Keyword(s):  
Public Health ◽  
Pulmonary Tuberculosis ◽  
Addis Ababa ◽  
Dropout Rate ◽  
Sputum Smear ◽  
P Value ◽  
Smear Microscopy ◽  
Sputum Smear Microscopy ◽  
Public Health Facilities ◽  
Smear Positive Pulmonary Tuberculosis

Background. Prolonged laboratory diagnostic process of tuberculosis can lead to failure to complete the diagnosis and increase dropout rate of smear positive pulmonary tuberculosis (PTB) cases. This implies such dropout patients without completing diagnosis are critical as infected individuals remain untreated in the community, providing more opportunities for transmission of the disease and adversely affecting the epidemic. The aim of this research is to determine the level of smear positive PTB diagnosis dropout rate of spot-morning-spot sputum microscopy diagnosis method in public health facilities, in Addis Ababa, Ethiopia. Methods. Retrospective review of patient documents in 13 public health facilities’ TB laboratory in Addis Ababa was conducted from October 2011 to March 2016. Data was computerized using Epi-info software and analysed using SPSS version 20.0 software. Descriptive numerical summaries were used to present the findings. Association between the dropout rate and demographic variables was assessed by Chi-square (X2). Bivariate model using Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated. P-Value less than 0.05 was taken as statistically significant. Results. Of 41,884 presumptive TB patients registered during the 53 months for laboratory investigation, 5.9% were positive for the first spot sputum smear microscopy. Among these positive cases, 142 (5.8%) and 298 (12.1%) did not come back to the laboratory to submitted early morning and second spot sputum specimens, respectively. The diagnostic dropout for morning sputum specimen in hospitals was 5.6% (58/1039) and in health centres was 5.9% (84/1424). However, higher proportion of dropout for second spot sputum specimen in hospitals was 16.4% (170/1039), compared to the health centres, 8.9% (128/1424). Diagnostic dropout of sputum smear microscopy had no significant association with sociodemographic variable (P value >0.05), while it had significant association with facility type (P value <0.05). Conclusion. In this study smear positive pulmonary tuberculosis diagnostic dropout rate was high compared to WHO reported for the new strategy shift implying the importance of shifting to same-day approach. Hence, shifting from conventional to same day is crucial to minimize the TB diagnostic dropout rate in the study area and other similar settings. Further research is needed/recommended in the local setting to compare the yield and dropout rates between same-day and conventional sputum smear microscopy approach.

scholarly journals 792. Number and Volume of Cavitary Lesions on Chest Computed Tomography Associated With Prolonged Time to Culture Conversion in Drug-Susceptible Pulmonary Tuberculosis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S284-S284
Author(s):  
Alfonso Hernandez
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chest Roentgenogram ◽  
Sputum Smear ◽  
Chest Computed Tomography ◽  
Median Difference ◽  
Cox Proportional Hazards Models ◽  
Culture Conversion

Abstract Background Cavitary lesions (CLs) may be a marker of poor treatment response in pulmonary tuberculosis (PTB). Identification of CLs by chest roentgenogram (CXR) has important limitations. Chest computed tomography (CT) is more sensitive than CXR to detect CLs but the clinical relevance of CLs identified by CT remains understudied. We compared detection of CLs between CT and CXR and assessed their association with time to sputum culture conversion (tSCC). We hypothesized that increasing number and volume of CLs on CT would be associated with prolonged tSCC. Methods Retrospective cohort study of 141 culture confirmed PTB patients who underwent chest CT. We used multivariate Cox proportional hazards models to evaluate the association between chest radiological features and tSCC. Results Seventy-five (53%) patients had one or more CLs on CT. CT identified cavities in 31% of patients without a CL on CXR. Detection of cavity on CT was associated with an increased median [IQR] time to culture conversion (15 [7–35] days among noncavitary CT vs. 39 [25–55] days among cavitary CT; P &lt; 0.0001). Among patients without CL on CXR, detection of CL on CT was associated with prolonged tSCC (median difference (CI): 16 (7–25) days, P = 0.0008). Similar results were observed among patients with 3–4+ sputum smear (median difference: 19.5 (8–31) days, P = 0.001). Adjusted Kaplan–Meier curves of number and volume of CLs and tSCC are shown in Figure 1. After confounder adjustment patients with single and multiple CL had a prolonged tSCC relative to patients without CLs on CT (adjusted Hazard Ratio [aHR] 0.56 (0.32–0.97) and 0.31 (0.16–0.60), respectively). Similarly, patients with CL volume 25 mL or more had a prolonged tSCC (aHR 0.39 (0.21–0.72)). CXR CL was not associated with prolonged tSCC. Conclusion We observed a dose–response relationship between increasing number and volume of CLs on CT and delayed tSCC independent of sputum bacillary load. Our findings highlight a role for CT in a clinical research setting to predict shorter time to culture conversion. Disclosures All authors: No reported disclosures.

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