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Bacteriologically-negative pulmonary tuberculosis--the Singapore tuberculosis control unit experience
W Y Pek1, C B E Chee, Y T Wang
1Department of Respiratory Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. Wee_Yang_Pek@notes.ttsh.gov.sg
Annals of the Academy of Medicine, Singapore
|March 12, 2002
Summary
Treating suspected pulmonary tuberculosis (PTB) in patients with negative bacteriology is appropriate. Key indicators for active PTB include cough, TB contact history, and lung cavitation.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Patients with radiological signs of active pulmonary tuberculosis (PTB) from high-prevalence areas are often presumed to have PTB, even with negative bacteriology.
- Initiating anti-tuberculous treatment is common practice in such cases globally.
- This study evaluates the appropriateness of treating bacteriologically-negative PTB in a specific population.
Purpose of the Study:
- To determine if treating bacteriologically-negative PTB is appropriate in the local population.
- To identify predictive features of active PTB among patients with negative bacteriology, based on treatment response.
Main Methods:
- Retrospective review of 100 bacteriologically-negative PTB patients treated at the Singapore Tuberculosis Control Unit (TBCU).
- Patients were classified as having probable active PTB or unlikely active PTB based on treatment response.
- Analysis of patient characteristics, clinical presentation, and radiological findings for association with probable active PTB.
Main Results:
- 56% of patients were classified as having probable active PTB, validating the treatment decision.
- No serious adverse reactions were reported during anti-tuberculous treatment.
- Predictive factors for probable active PTB included cough, tuberculosis contact history, and chest radiograph cavitation.
Conclusions:
- The TBCU's practice of treating patients with radiological PTB suspicion and negative sputum results is generally appropriate.
- Clinical and radiological features can help identify patients likely to benefit from anti-tuberculous therapy.