Mohd Redhuan Abdul Muin, Abu Bakar Mohd Yusof, Mohd Shahriman Ahmad Fuat, Nur Syafiqa Amri, Noor Faizah Amirudin, Wan Wahida Wan Mohd Zohdi, Idora Ibrahim, Arfah Ahmad, Irham Nordeena Muhammad, Abdul Jalil Ahmad, Jasmaniah Abdul Majid, Mohd Zukri Bin Ibrahim
MB BCh BAO, Dr Fam Med, Klinik Kesihatan Simpang Kuala, Jalan Kuala Kedah, Alor Setar, Kedah, Malaysia. Email:
MD, MMed (Fam Med), Klinik Kesihatan Lubuk Merbau, Jalan Pejabat, Padang Terap, Kedah, Malaysia.
Malays Fam Physician. 2024 Sep 24;19:52. doi: 10.51866/oa.595. eCollection 2024.
Tuberculosis (TB) remains a highly prevalent disease in Malaysia. Early identification using cost-effective methods such as chest radiography can reduce the health burden of a TB epidemic. However, normal chest radiographic findings are common. This study aimed to evaluate the characteristics of smear-positive pulmonary TB with normal chest radiographic findings during an outbreak.
A cross-sectional study was conducted by reviewing the medical records of 56 pulmonary TB cases registered at Kodiang Health Clinic from April to October 2022. Smear-negative and extrapulmonary TB cases were excluded. Relevant information was extracted from the medical records and recorded in a case report form for data management and analysis.
Approximately 60.7% of the cases had symptoms lasting >2 weeks, and 89.3% showed abnormal findings upon clinical examination. Additionally, 73.2% had sputum acid-fast bacilli counts of ≥1+, and the sputum culture and sensitivity test findings were positive in 82.1% of the cases. The proportion of smear-positive pulmonary TB with normal chest radiographic findings was 42.9%. The factors associated with smear-positive pulmonary TB with normal chest radiographic findings included being under 18 years old (P=0.021), being a student (P=0.010), being single (P=0.012) and being asymptomatic (P=0.04).
Normal chest radiographic findings may lead to a misdiagnosis of smear-positive pulmonary TB, especially during an outbreak. Therefore, active case detection among close contacts with risk factors for normal radiographic findings should consider additional supportive tests.
结核病在马来西亚仍然是一种高度流行的疾病。使用胸部X光摄影等具有成本效益的方法进行早期识别，可以减轻结核病流行带来的健康负担。然而，胸部X光检查结果正常的情况很常见。本研究旨在评估疫情期间胸部X光检查结果正常的涂片阳性肺结核的特征。
通过回顾2022年4月至10月在科迪昂健康诊所登记的56例肺结核病例的病历进行横断面研究。排除涂片阴性和肺外结核病例。从病历中提取相关信息，并记录在病例报告表中进行数据管理和分析。
约60.7%的病例症状持续超过2周，89.3%的病例在临床检查时有异常发现。此外，73.2%的病例痰抗酸杆菌计数≥1+，82.1%的病例痰培养和药敏试验结果呈阳性。胸部X光检查结果正常的涂片阳性肺结核的比例为42.9%。与胸部X光检查结果正常的涂片阳性肺结核相关的因素包括年龄在18岁以下（P=0.021）、是学生（P=0.010）、单身（P=0.012）和无症状（P=0.04）。
胸部X光检查结果正常可能导致涂片阳性肺结核的误诊，尤其是在疫情期间。因此，在有正常影像学检查结果风险因素的密切接触者中进行主动病例检测时，应考虑额外的支持性检查。
