scholarly journals Early chest X-ray in persons with presumptive tuberculosis increases Xpert® MTB/RIF diagnostic yield and efficiency

2020 ◽  
Vol 10 (1) ◽  
pp. 17-20
Author(s):  
Z. Nadiah ◽  
R. C. Koesoemadinata ◽  
S. M. McAllister ◽  
G. Putriyani ◽  
L. Chaidir ◽  
...  

Adult presumptive tuberculosis (TB) patients (n = 1690) were screened for TB using a questionnaire, chest X-ray (CXR) and sputum microscopy for acid-fast bacilli (AFB); <named-content content-type="genus-species">Mycobacterium tuberculosis</named-content> culture was performed for 74% of the patients and Xpert® MTB/RIF was done for 17.2%. Among patients recruited, 943 (55.8%) were diagnosed with TB, of whom 870 (92.3%) were bacteriologically confirmed and 73 (7.7%) were clinically diagnosed on the basis of CXR. Using CXR prior to culture or Xpert testing reduces the number needed to screen from 7.6 to 5.0. Using CXR to triage for culture or Xpert testing reduces the number of missed cases and increases the efficiency of culture and Xpert testing.

2020 ◽  
Vol 114 (7) ◽  
pp. 499-505
Author(s):  
Bornali Datta ◽  
Ashish Prakash ◽  
David Ford ◽  
Jaya Prasad Tripathy ◽  
Pinky Goyal ◽  
...  

Abstract Background The Tuberculosis (TB) Control Program in India changed the TB diagnostic algorithm and recommended sputum testing and chest x-ray (CXR) for presumptive TB up front. There is no experience of testing this algorithm in routine field settings. Methods In a public–private partnership (PPP), a private hospital provided mobile digital CXR services (mounted on a van) to complement the existing diagnostic services of sputum microscopy and GeneXpert testing. All presumptive TB patients (cough &gt;2 weeks) underwent CXR and sputum microscopy, and GeneXpert testing if eligible (smear-negative CXR suggestive of TB). Results All 2973 presumptive TB patients underwent CXR and sputum microscopy; 471 (15.8%) had abnormal CXR findings suggestive of TB, 129 (4.3%) were smear positive and 17 were extrapulmonary TB. Of the remaining 325 with smear-negative and CXR suggestive of TB, 147 (45.2%) underwent GeneXpert testing, yielding 32 positives (21.8%). Of the remaining 178 with no GeneXpert test done, 106 (60.0%) had CXR definitely suggesting TB (clinically diagnosed TB). Thus a total of 284 cases of TB (161 microbiologically confirmed, 106 clinically diagnosed, 17 extrapulmonary TB) were identified, giving a potential diagnostic yield of 19.6%. Conclusions Systematic screening with mobile digital X-ray service via a PPP model integrated into the national program is feasible and scalable with a high yield.


2013 ◽  
Vol 21 (2) ◽  
pp. 111-118 ◽  
Author(s):  
K. Schepers ◽  
F. Mouchet ◽  
V. Dirix ◽  
I. De Schutter ◽  
K. Jotzo ◽  
...  

ABSTRACTThe diagnosis of childhood active tuberculosis (aTB) and latentMycobacterium tuberculosis(M. tuberculosis) infection (LTBI) remains a challenge, and the replacement of tuberculin skin tests (TST) with commercialized gamma interferon (IFN-γ) release assays (IGRA) is not currently recommended. Two hundred sixty-six children between 1 month and 15 years of age, 214 of whom were at risk of recentM. tuberculosisinfection and 51 who were included as controls, were prospectively enrolled in our study. According to the results of a clinical evaluation, TST, chest X ray, and microbiological assessment, each children was classified as noninfected, having LTBI, or having aTB. Long-incubation-time purified protein derivative (PPD), ESAT-6, and CFP-10 IGRA were performed and evaluated for their accuracy in correctly classifying the children. Whereas both TST and PPD IGRA were suboptimal for detecting aTB, combining the CFP-10 IGRA with a TST or with a PPD IGRA allowed us to detect all the children with aTB with a specificity of 96% for children who were positive for the CFP-10 IGRA. Moreover, the combination of the CFP-10 IGRA and PPD IGRA detected 96% of children who were eventually classified as having LTBI, but a strong IFN-γ response to CFP-10 (defined as >500 pg/ml) was highly suggestive of aTB, at least among the children who were <3 years old. The use of long-incubation-time CFP-10 IGRA and PPD IGRA should help clinicians to quickly identify aTB or LTBI in young children.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rajit Nair ◽  
Santosh Vishwakarma ◽  
Mukesh Soni ◽  
Tejas Patel ◽  
Shubham Joshi

Purpose The latest 2019 coronavirus (COVID-2019), which first appeared in December 2019 in Wuhan's city in China, rapidly spread around the world and became a pandemic. It has had a devastating impact on daily lives, the public's health and the global economy. The positive cases must be identified as soon as possible to avoid further dissemination of this disease and swift care of patients affected. The need for supportive diagnostic instruments increased, as no specific automated toolkits are available. The latest results from radiology imaging techniques indicate that these photos provide valuable details on the virus COVID-19. User advanced artificial intelligence (AI) technologies and radiological imagery can help diagnose this condition accurately and help resolve the lack of specialist doctors in isolated areas. In this research, a new paradigm for automatic detection of COVID-19 with bare chest X-ray images is displayed. Images are presented. The proposed model DarkCovidNet is designed to provide correct binary classification diagnostics (COVID vs no detection) and multi-class (COVID vs no results vs pneumonia) classification. The implemented model computed the average precision for the binary and multi-class classification of 98.46% and 91.352%, respectively, and an average accuracy of 98.97% and 87.868%. The DarkNet model was used in this research as a classifier for a real-time object detection method only once. A total of 17 convolutionary layers and different filters on each layer have been implemented. This platform can be used by the radiologists to verify their initial application screening and can also be used for screening patients through the cloud. Design/methodology/approach This study also uses the CNN-based model named Darknet-19 model, and this model will act as a platform for the real-time object detection system. The architecture of this system is designed in such a way that they can be able to detect real-time objects. This study has developed the DarkCovidNet model based on Darknet architecture with few layers and filters. So before discussing the DarkCovidNet model, look at the concept of Darknet architecture with their functionality. Typically, the DarkNet architecture consists of 5 pool layers though the max pool and 19 convolution layers. Assume as a convolution layer, and as a pooling layer. Findings The work discussed in this paper is used to diagnose the various radiology images and to develop a model that can accurately predict or classify the disease. The data set used in this work is the images bases on COVID-19 and non-COVID-19 taken from the various sources. The deep learning model named DarkCovidNet is applied to the data set, and these have shown signification performance in the case of binary classification and multi-class classification. During the multi-class classification, the model has shown an average accuracy 98.97% for the detection of COVID-19, whereas in a multi-class classification model has achieved an average accuracy of 87.868% during the classification of COVID-19, no detection and Pneumonia. Research limitations/implications One of the significant limitations of this work is that a limited number of chest X-ray images were used. It is observed that patients related to COVID-19 are increasing rapidly. In the future, the model on the larger data set which can be generated from the local hospitals will be implemented, and how the model is performing on the same will be checked. Originality/value Deep learning technology has made significant changes in the field of AI by generating good results, especially in pattern recognition. A conventional CNN structure includes a convolution layer that extracts characteristics from the input using the filters it applies, a pooling layer that reduces calculation efficiency and the neural network's completely connected layer. A CNN model is created by integrating one or more of these layers, and its internal parameters are modified to accomplish a specific mission, such as classification or object recognition. A typical CNN structure has a convolution layer that extracts features from the input with the filters it applies, a pooling layer to reduce the size for computational performance and a fully connected layer, which is a neural network. A CNN model is created by combining one or more such layers, and its internal parameters are adjusted to accomplish a particular task, such as classification or object recognition.


2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Joanitah Nalunjogi ◽  
Frank Mugabe ◽  
Irene Najjingo ◽  
Pastan Lusiba ◽  
Francis Olweny ◽  
...  

The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93% sensitivity and 65% specificity compared to LJ culture results, while symptoms had 76% sensitivity and 31% specificity. The screening algorithm involving the CXR in addition to symptoms led to a 38% increment in the yield of diagnosed tuberculosis. The number needed to screen using the CXR and symptoms screening algorithm was 32 compared to 45 when the symptoms are used alone. Therefore, the CXR in combination with symptoms is a good TB screening tool and increases the yield of diagnosed TB.


2018 ◽  
Vol 56 (5) ◽  
Author(s):  
David A. Barr ◽  
Andrew D. Kerkhoff ◽  
Charlotte Schutz ◽  
Amy M. Ward ◽  
Gerry R. Davies ◽  
...  

ABSTRACT We assessed the additional diagnostic yield for Mycobacterium tuberculosis bloodstream infection (BSI) by doing more than one tuberculosis (TB) blood culture from HIV-infected inpatients. In a retrospective analysis of two cohorts based in Cape Town, South Africa, 72/99 (73%) patients with M. tuberculosis BSI were identified by the first of two blood cultures during the same admission, with 27/99 (27%; 95% confidence interval [CI], 18 to 36%) testing negative on the first culture but positive on the second. In a prospective evaluation of up to 6 blood cultures over 24 h, 9 of 14 (65%) patients with M. tuberculosis BSI had M. tuberculosis grow on their first blood culture; 3 more patients (21%) were identified by a second independent blood culture at the same time point, and the remaining 2 were diagnosed only on the 4th and 6th blood cultures. Additional blood cultures increase the yield for M. tuberculosis BSI, similar to what is reported for nonmycobacterial BSI.


mBio ◽  
2018 ◽  
Vol 9 (6) ◽  
Author(s):  
Pradeep Kumar ◽  
Glenn C. Capodagli ◽  
Divya Awasthi ◽  
Riju Shrestha ◽  
Karishma Maharaja ◽  
...  

ABSTRACTWe report GSK3011724A (DG167) as a binary inhibitor of β-ketoacyl-ACP synthase (KasA) inMycobacterium tuberculosis. Genetic and biochemical studies established KasA as the primary target. The X-ray crystal structure of the KasA-DG167 complex refined to 2.0-Å resolution revealed two interacting DG167 molecules occupying nonidentical sites in the substrate-binding channel of KasA. The binding affinities of KasA to DG167 and its analog, 5g, which binds only once in the substrate-binding channel, were determined, along with the KasA-5g X-ray crystal structure. DG167 strongly augmented thein vitroactivity of isoniazid (INH), leading to synergistic lethality, and also synergized in an acute mouse model ofM. tuberculosisinfection. Synergistic lethality correlated with a unique transcriptional signature, including upregulation of oxidoreductases and downregulation of molecular chaperones. The lead structure-activity relationships (SAR), pharmacokinetic profile, and detailed interactions with the KasA protein that we describe may be applied to evolve a next-generation therapeutic strategy for tuberculosis (TB).IMPORTANCECell wall biosynthesis inhibitors have proven highly effective for treating tuberculosis (TB). We discovered and validated members of the indazole sulfonamide class of small molecules as inhibitors ofMycobacterium tuberculosisKasA—a key component for biosynthesis of the mycolic acid layer of the bacterium’s cell wall and the same pathway as that inhibited by the first-line antitubercular drug isoniazid (INH). One lead compound, DG167, demonstrated synergistic lethality in combination with INH and a transcriptional pattern consistent with bactericidality and loss of persisters. Our results also detail a novel dual-binding mechanism for this compound as well as substantial structure-activity relationships (SAR) that may help in lead optimization activities. Together, these results suggest that KasA inhibition, specifically, that shown by the DG167 series, may be developed into a potent therapy that can synergize with existing antituberculars.


Author(s):  
Z Rachadi ◽  
M Idalene ◽  
L Arsalane ◽  
A Raji ◽  
N Tassi

The objective of this study was to report a case of miliary tuberculosis revealed by a pharyngeal localization, and study this disease through a literature review.We report the clinical case of a 23 year old patient presented for chronic tonsillitis treated as bacterial but without improvement. Dysphonia and dysphagia were added later with the same signs of tuberculous impregnation. The chest x-ray done before the onset of coughing had objectified miliary. The diagnosis of tuberculosis was selected before the detection of acid-fast bacilli in cytobacteriological examination of the pharyngeal swab and sputum. Specific antituberculous treatment led to a favourable outcomeIn a context of endemic tuberculosis, the diagnosis of miliary tuberculosis of the pharynxshould be considered in all pharyngeal syndrome did not improve with medical treatment.Keywords: Isambert disease; oropharynx ; tuberculosis


2007 ◽  
Vol 35 (3) ◽  
pp. 393-397 ◽  
Author(s):  
S. H. Haddad ◽  
A. S. Aldawood ◽  
Y. M. Arabi

A chest X-ray (CXR) is routinely performed after percutaneous dilatational tracheostomy (PDT). The purpose of this study was to evaluate the diagnostic yield of routine CXR following PDT and its impact on patient management and to identify predictors of post-PDT CXR changes. Two-hundred-and-thirty-nine patients who underwent PDT in a 21-bed intensive care unit were included prospectively in the study. The following data were collected: patient demographics, APACHE III scores, pre-PDT FiO2 and PEEP, PDT technique, perioperative complications and the use of bronchoscopic guidance. We compared post-PDT CXR with the last pre-PDT CXR. We documented any post-PDT new radiographic findings including atelectasis, pneumothorax, pneumomediastinum, surgical emphysema, pulmonary infiltrates or tracheostomy tube malposition. We also recorded management modifications based on post-PDT radiographic changes, including increased PEEP, chest physiotherapy, therapeutic bronchoscopy or chest tube insertion. Atelectasis was the only new finding detected on post-PDT CXRs of 24 (10%) patients. The new radiographic findings resulted in a total of 14 modifications of management in 10 (4%) patients including increased PEEP in six, chest physiotherapy in six and bronchoscopy in two patients. Trauma and pre-PDT PEEP >5 cmH2O were independent predictors of post-PDT CXR changes. Routine CXR following PDT has a low diagnostic yield, detecting mainly atelectasis and leading to a change in the management in only a minority of patients. Routine CXR after apparently uncomplicated PDT performed by an experienced operator may not be necessary and selective use may improve its diagnostic yield. Further studies are required to validate the safety of selective versus routine post-PDT CXR.


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