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Assessment of previous tuberculosis status using questionnaires, chest X-rays and computed tomography scans
B W Allwood1, J Goldin2, Q Said-Hartley3
1Division of Pulmonology, Department of Medicine, Stellenbosch University and University of Cape Town (UCT) Lung Institute, Cape Town, South Africa.
Summary
Diagnosing previous pulmonary tuberculosis (PPTB) is challenging due to unreliable records. Questionnaires and chest X-rays underestimate PPTB prevalence in COPD patients, while CT scans offer better assessment.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Accurate diagnosis of previous pulmonary tuberculosis (PPTB) is crucial for clinical management and research.
- Reliable bacteriologically confirmed tuberculosis (TB) records are often unavailable, complicating PPTB status assessment.
Purpose of the Study:
- To evaluate the efficacy of questionnaires and chest imaging techniques in determining PPTB status.
- To assess PPTB prevalence in a population with a high TB burden and obstructive lung disease.
Main Methods:
- PPTB status was determined using two questionnaires (BOLD and PTbQ), chest X-ray (CXR), and high-resolution chest computed tomography (CT).
- The study included adults over 40 with obstructive lung disease from a community-based prevalence survey.
- Experienced readers interpreted imaging findings, and a composite definition was used for comparison.
Main Results:
- Questionnaires identified PPTB history in 38% (BOLD) and 36.4% (PTbQ) of participants.
- CXR showed evidence of PPTB in 43.3% of subjects with good inter-reader agreement (κ = 0.73).
- Chest CT identified PPTB-compatible changes in 68.3% of subjects, with questionnaires and CXR showing low negative predictive values (48% and 47%, respectively).
Conclusions:
- Both questionnaires and CXR significantly underestimate PPTB prevalence in patients with chronic obstructive pulmonary disease (COPD).
- A combination of a structured questionnaire and CT scan is more effective for ruling out PPTB.
- Improved diagnostic methods are needed for accurate PPTB assessment in high-prevalence settings.
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