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Clinical and Radiographic Factors Do Not Accurately Diagnose Smear-Negative Tuberculosis in HIV-infected Inpatients in Uganda: A Cross-Sectional Study

Publication Date: March 26, 2010
Journal: PLOS ONE
Authors: J. Lucian Davis, William Worodria, Harriet Kisembo, John Z. Metcalfe, et al
Volume: 5
Issue: 3
Pages: e9859
DOI: https://dx.plos.org/10.1371/journal.pone.0009859
Publisher URL: http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0009859
PubMed: http://www.ncbi.nlm.nih.gov/pubmed/20361038
PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845634
Europe PMC: http://europepmc.org/abstract/MED/20361038
Web of Science: 000275969600001
Scopus: 84873397817
Mendeley: http://www.mendeley.com/research/clinical-radiographic-factors-not-accurately-diagnose-smearnegative-tuberculosis-hivinfected-inpatie

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{"title"=>"Clinical and radiographic factors do not accurately diagnose smear-negative tuberculosis in HIV-infected inpatients in Uganda: A cross-sectional study", "type"=>"journal", "authors"=>[{"first_name"=>"J.", "last_name"=>"Lucian Davis", "scopus_author_id"=>"26534726200"}, {"first_name"=>"William", "last_name"=>"Worodria", "scopus_author_id"=>"9943021600"}, {"first_name"=>"Harriet", "last_name"=>"Kisembo", "scopus_author_id"=>"6506573332"}, {"first_name"=>"John Z.", "last_name"=>"Metcalfe", "scopus_author_id"=>"35292715100"}, {"first_name"=>"Adithya", "last_name"=>"Cattamanchi", "scopus_author_id"=>"6507176526"}, {"first_name"=>"Michael", "last_name"=>"Kawooya", "scopus_author_id"=>"6603570297"}, {"first_name"=>"Rachel", "last_name"=>"Kyeyune", "scopus_author_id"=>"25226736700"}, {"first_name"=>"Saskia", "last_name"=>"den Boon", "scopus_author_id"=>"56069803100"}, {"first_name"=>"Krista", "last_name"=>"Powell", "scopus_author_id"=>"36822577900"}, {"first_name"=>"Richard", "last_name"=>"Okello", "scopus_author_id"=>"37002107300"}, {"first_name"=>"Samuel", "last_name"=>"Yoo", "scopus_author_id"=>"25226970200"}, {"first_name"=>"Laurence", "last_name"=>"Huang", "scopus_author_id"=>"56144978300"}], "year"=>2010, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"20361038", "doi"=>"10.1371/journal.pone.0009859", "sgr"=>"84873397817", "isbn"=>"1932-6203 (Electronic) 1932-6203 (Linking)", "scopus"=>"2-s2.0-84873397817", "issn"=>"19326203", "pui"=>"368277909"}, "id"=>"994969e8-2277-3a94-aa8f-6f2532590dd1", "abstract"=>"BACKGROUND: Although World Health Organization guidelines recommend clinical judgment and chest radiography for diagnosing tuberculosis in HIV-infected adults with unexplained cough and negative sputum smears for acid-fast bacilli, the diagnostic performance of this approach is unknown. Therefore, we sought to assess the accuracy of symptoms, physical signs, and radiographic findings for diagnosing tuberculosis in this population in a low-income country with a high incidence of tuberculosis. METHODOLOGY: We performed a cross-sectional study enrolling consecutive HIV-infected inpatients with unexplained cough and negative sputum smears for acid-fast bacilli at Mulago Hospital in Kampala, Uganda. Trained medical officers prospectively collected data on standard symptoms and signs of systemic respiratory illness, and two radiologists interpreted chest radiographs in a standardized fashion. We calculated positive- and negative-likelihood ratios of these factors for diagnosing pulmonary tuberculosis (defined when mycobacterial cultures of sputum or bronchoalveolar lavage fluid were positive). We used both conventional and novel regression techniques to develop multivariable prediction models for pulmonary tuberculosis. PRINCIPAL FINDINGS: Among 202 enrolled HIV-infected adults with negative sputum smears for acid-fast bacilli, 72 (36%) had culture-positive pulmonary tuberculosis. No single factor, including respiratory symptoms, physical findings, CD4+ T-cell count, or chest radiographic abnormalities, substantially increased or decreased the likelihood of pulmonary tuberculosis. After exhaustive testing, we were also unable to identify any combination of factors which reliably predicted bacteriologically confirmed tuberculosis. CONCLUSIONS AND SIGNIFICANCE: Clinical and radiographic criteria did not help diagnose smear-negative pulmonary tuberculosis among HIV-infected patients with unexplained cough in a low-income setting. Enhanced diagnostic methods for smear-negative tuberculosis are urgently needed.", "link"=>"http://www.mendeley.com/research/clinical-radiographic-factors-not-accurately-diagnose-smearnegative-tuberculosis-hivinfected-inpatie", "reader_count"=>67, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Researcher"=>15, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>14, "Student > Postgraduate"=>3, "Student > Master"=>15, "Other"=>3, "Student > Bachelor"=>1, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1, "Professor"=>7}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Researcher"=>15, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>14, "Student > Postgraduate"=>3, "Student > Master"=>15, "Other"=>3, "Student > Bachelor"=>1, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1, "Professor"=>7}, "reader_count_by_subject_area"=>{"Unspecified"=>6, "Environmental Science"=>1, "Nursing and Health Professions"=>1, "Medicine and Dentistry"=>33, "Agricultural and Biological Sciences"=>9, "Veterinary Science and Veterinary Medicine"=>3, "Social Sciences"=>8, "Computer Science"=>1, "Immunology and Microbiology"=>2, "Economics, Econometrics and Finance"=>1, "Chemistry"=>1, "Biochemistry, Genetics and Molecular Biology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>33}, "Chemistry"=>{"Chemistry"=>1}, "Social Sciences"=>{"Social Sciences"=>8}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>9}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>6}, "Environmental Science"=>{"Environmental Science"=>1}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>3}}, "reader_count_by_country"=>{"United States"=>2, "Brazil"=>3, "South Africa"=>1, "Malaysia"=>1}, "group_count"=>4}

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Figshare 3003 May 13:32 UTC

Figshare

{"files"=>["https://ndownloader.figshare.com/files/857358"], "description"=>"<p><b>Abbreviations:</b> 95% CI, 95% Confidence Interval; LR(+), positive likelihood ratio; LR (−), negative likelihood ratio; TB, tuberculosis; %, percent.</p><p><b>Legend:</b> *TB defined by any positive sputum or bronchoalveolar lavage mycobacterial culture on solid media.</p>", "links"=>[], "tags"=>["radiographic", "characteristics", "specificity"], "article_id"=>527810, "categories"=>["Medicine", "Cancer", "Infectious Diseases"], "users"=>["J. Lucian Davis", "William Worodria", "Harriet Kisembo", "John Z. Metcalfe", "Adithya Cattamanchi", "Michael Kawooya", "Rachel Kyeyune", "Saskia den Boon", "Krista Powell", "Richard Okello", "Samuel Yoo", "Laurence Huang"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0009859.t003", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Diagnostic_performance_of_clinical_and_radiographic_characteristics_with_high_specificity_for_tuberculosis_/527810", "title"=>"Diagnostic performance of clinical and radiographic characteristics with high specificity for tuberculosis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-03-26 02:10:10"}
{"files"=>["https://ndownloader.figshare.com/files/857400"], "description"=>"<p><b>Abbreviations:</b> 95% CI, 95% Confidence Interval; LR(+), positive likelihood ratio; LR (−), negative likelihood ratio; SD, standard deviation; TB, tuberculosis; %, percent; µL, microliter.</p><p><b>Legend:</b> *TB defined by any positive sputum or bronchoalveolar lavage mycobacterial culture on solid media.</p>†<p>4 responses missing.</p>", "links"=>[], "tags"=>["radiographic", "characteristics"], "article_id"=>527845, "categories"=>["Medicine", "Cancer", "Infectious Diseases"], "users"=>["J. Lucian Davis", "William Worodria", "Harriet Kisembo", "John Z. Metcalfe", "Adithya Cattamanchi", "Michael Kawooya", "Rachel Kyeyune", "Saskia den Boon", "Krista Powell", "Richard Okello", "Samuel Yoo", "Laurence Huang"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0009859.t002", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Diagnostic_performance_of_clinical_and_radiographic_characteristics_with_high_sensitivity_for_tuberculosis_/527845", "title"=>"Diagnostic performance of clinical and radiographic characteristics with high sensitivity for tuberculosis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-03-26 02:10:45"}
{"files"=>["https://ndownloader.figshare.com/files/857176"], "description"=>"<p>The diagram presents the total numbers of patients enrolled, eligible, and analyzed, and the vital status of all patients at two-month follow-up.</p>", "links"=>[], "tags"=>["enrollment"], "article_id"=>527626, "categories"=>["Medicine", "Cancer", "Infectious Diseases"], "users"=>["J. Lucian Davis", "William Worodria", "Harriet Kisembo", "John Z. Metcalfe", "Adithya Cattamanchi", "Michael Kawooya", "Rachel Kyeyune", "Saskia den Boon", "Krista Powell", "Richard Okello", "Samuel Yoo", "Laurence Huang"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0009859.g001", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Patient_enrollment_and_outcome_flow_diagram_/527626", "title"=>"Patient enrollment and outcome flow diagram.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-03-26 02:07:06"}
{"files"=>["https://ndownloader.figshare.com/files/426302"], "description"=>"<div><h3>Background</h3><p>Although World Health Organization guidelines recommend clinical judgment and chest radiography for diagnosing tuberculosis in HIV-infected adults with unexplained cough and negative sputum smears for acid-fast bacilli, the diagnostic performance of this approach is unknown. Therefore, we sought to assess the accuracy of symptoms, physical signs, and radiographic findings for diagnosing tuberculosis in this population in a low-income country with a high incidence of tuberculosis.</p><h3>Methodology</h3><p>We performed a cross-sectional study enrolling consecutive HIV-infected inpatients with unexplained cough and negative sputum smears for acid-fast bacilli at Mulago Hospital in Kampala, Uganda. Trained medical officers prospectively collected data on standard symptoms and signs of systemic respiratory illness, and two radiologists interpreted chest radiographs in a standardized fashion. We calculated positive- and negative-likelihood ratios of these factors for diagnosing pulmonary tuberculosis (defined when mycobacterial cultures of sputum or bronchoalveolar lavage fluid were positive). We used both conventional and novel regression techniques to develop multivariable prediction models for pulmonary tuberculosis.</p><h3>Principal Findings</h3><p>Among 202 enrolled HIV-infected adults with negative sputum smears for acid-fast bacilli, 72 (36%) had culture-positive pulmonary tuberculosis. No single factor, including respiratory symptoms, physical findings, CD4+ T-cell count, or chest radiographic abnormalities, substantially increased or decreased the likelihood of pulmonary tuberculosis. After exhaustive testing, we were also unable to identify any combination of factors which reliably predicted bacteriologically confirmed tuberculosis.</p><h3>Conclusions and Significance</h3><p>Clinical and radiographic criteria did not help diagnose smear-negative pulmonary tuberculosis among HIV-infected patients with unexplained cough in a low-income setting. Enhanced diagnostic methods for smear-negative tuberculosis are urgently needed.</p></div>", "links"=>[], "tags"=>["radiographic", "factors", "smear-negative", "tuberculosis", "hiv-infected", "inpatients", "cross-sectional"], "article_id"=>144155, "categories"=>["Medicine", "Cancer"], "users"=>["J. Lucian Davis", "William Worodria", "Harriet Kisembo", "John Z. Metcalfe", "Adithya Cattamanchi", "Michael Kawooya", "Rachel Kyeyune", "Saskia den Boon", "Krista Powell", "Richard Okello", "Samuel Yoo", "Laurence Huang"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0009859", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Clinical_and_Radiographic_Factors_Do_Not_Accurately_Diagnose_Smear_Negative_Tuberculosis_in_HIV_infected_Inpatients_in_Uganda_A_Cross_Sectional_Study/144155", "title"=>"Clinical and Radiographic Factors Do Not Accurately Diagnose Smear-Negative Tuberculosis in HIV-infected Inpatients in Uganda: A Cross-Sectional Study", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-03-26 01:09:15"}
{"files"=>["https://ndownloader.figshare.com/files/857250"], "description"=>"<p>The sensitivity versus one minus the specificity of the cross-validated multivariable logistic regression model for diagnosing tuberculosis developed in this study is plotted at every threshold of probability of tuberculosis predicted by the model.</p>", "links"=>[], "tags"=>["infectious diseases/hiv infection and aids", "public health and epidemiology/global health", "respiratory medicine/respiratory infections"], "article_id"=>527698, "categories"=>["Medicine", "Cancer", "Infectious Diseases"], "users"=>["J. Lucian Davis", "William Worodria", "Harriet Kisembo", "John Z. Metcalfe", "Adithya Cattamanchi", "Michael Kawooya", "Rachel Kyeyune", "Saskia den Boon", "Krista Powell", "Richard Okello", "Samuel Yoo", "Laurence Huang"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0009859.g002", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Receiver_operating_characteristic_ROC_curve_/527698", "title"=>"Receiver operating characteristic (ROC) curve.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-03-26 02:08:18"}
{"files"=>["https://ndownloader.figshare.com/files/857440"], "description"=>"<p><b>Abbreviations:</b> AFB, acid-fast bacilli; IQR, inter-quartile range; %, percent; TB, tuberculosis; µL, microliter.</p><p><b>Legend:</b> *TB defined by any positive sputum or bronchoalveolar lavage mycobacterial culture on solid media.</p>†<p>4 responses missing.</p>¶<p>All but one patient had been taking co-trimoxazole for ≥1 month.</p>§<p>All patients reported taking antiretroviral therapy for ≥1 month.</p>‡<p>8 patients with TB and 12 patients without TB were lost to follow-up.</p>", "links"=>[], "tags"=>["characteristics", "202"], "article_id"=>527886, "categories"=>["Medicine", "Cancer", "Infectious Diseases"], "users"=>["J. Lucian Davis", "William Worodria", "Harriet Kisembo", "John Z. Metcalfe", "Adithya Cattamanchi", "Michael Kawooya", "Rachel Kyeyune", "Saskia den Boon", "Krista Powell", "Richard Okello", "Samuel Yoo", "Laurence Huang"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0009859.t001", "stats"=>{"downloads"=>7, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Demographic_and_clinical_characteristics_of_the_202_study_participants_/527886", "title"=>"Demographic and clinical characteristics of the 202 study participants.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-03-26 02:11:26"}

PMC Usage Stats 156217 Jan 15:11 UTC

PMC Usage Stats | Further Information

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Relative Metric 51912510 May 16:18 UTC

Relative Metric

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F1000Prime20 Jan 12:22 UTC

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