Singini D S, Sanjase N, Kagujje M, Shatalimi J, Chisanga C P, Lupatali Z D, Phiri D, Tatila T, Olwit W, Kerkhoff A D, Muyoyeta M
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
The Ministry of Health, Lusaka, Zambia.
Public Health Action. 2025 Jun 4;15(2):93-95. doi: 10.5588/pha.25.0012. eCollection 2025 Jun.
Clinically diagnosed TB patients (n = 335) at two facilities in Lusaka, Zambia were re-evaluated within two weeks of diagnosis. This re-evaluation included sputum Xpert Ultra testing and expert reader interpretation of the chest x-rays (CXRs) used for initial diagnosis. Repeat Xpert Ultra detected TB in just 2.6% (n=6). Of the remaining patients (n=222), expert CXR re-interpretation classified 18.0% as normal; 36.0% as abnormal, consistent with TB; and 46.0% as abnormal, not consistent with TB. These findings suggest that clinical TB is frequently over diagnosed in those without detectable CXR abnormalities and misdiagnosed in those with abnormal CXRs: these abnormalities are likely due to other respiratory conditions. Such misdiagnosis leads to unnecessary treatment, failure to treat the true underlying condition and incorrect estimates of TB burden.
在赞比亚卢萨卡的两家医疗机构中，对临床诊断为结核病的335名患者在诊断后的两周内进行了重新评估。此次重新评估包括痰液Xpert Ultra检测以及由专业阅片人员解读用于初步诊断的胸部X光片（CXR）。重复进行的Xpert Ultra检测仅在2.6%（n = 6）的患者中检测到结核病。在其余患者（n = 222）中，专业阅片人员对胸部X光片的重新解读结果为：18.0%为正常；36.0%异常，与结核病相符；46.0%异常，但与结核病不符。这些发现表明，在胸部X光片未发现异常的患者中，临床结核病常常被过度诊断，而在胸部X光片异常的患者中则被误诊：这些异常可能是由其他呼吸道疾病引起的。这种误诊会导致不必要的治疗、无法治疗真正的潜在疾病以及对结核病负担的错误估计。
