Nalunjogi Joanitah, Mugabe Frank, Najjingo Irene, Lusiba Pastan, Olweny Francis, Mubiru Joseph, Kayongo Edward, Sekibira Rogers, Katamba Achilles, Kirenga Bruce
Makerere University Lung Institute, College of Health Sciences, Makerere University, Uganda.
Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Uganda.
Tuberc Res Treat. 2021 Mar 19;2021:6622809. doi: 10.1155/2021/6622809. eCollection 2021.
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.
世界卫生组织终止结核病战略要求结核病病例发现率≥90%以抗击结核病。提高结核病病例发现率需要更敏感、特异的筛查工具。目前，已发现推荐用于结核病筛查的症状并不理想，因为高达44%的结核病患者无症状。本研究评估了胸部X线（CXR）作为肺结核筛查工具的情况，以及使用横断面研究对其在结核病诊断中的增量收益进行评估，该横断面研究涉及对2014年至2015年期间参与乌干达全国结核病患病率调查的4512名年龄≥15岁的同意/赞成参与的参与者的数据进行二次分析。咳嗽≥2周、发热、体重减轻和盗汗的参与者使用症状筛查方法筛查结核病呈阳性，而CXR有结核病定义异常的参与者通过CXR筛查方法筛查结核病呈阳性。 Löwenstein-Jensen（LJ）培养被用作结核病诊断的金标准。与LJ培养结果相比，CXR的敏感性为93%，特异性为65%，而症状的敏感性为76%，特异性为31%。除症状外还包括CXR的筛查算法使确诊结核病的收益提高了38%。与仅使用症状时的45相比，使用CXR和症状筛查算法进行筛查所需的人数为32。因此，CXR与症状相结合是一种良好的结核病筛查工具，可提高确诊结核病的收益。
