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Clinical determinants of tuberculosis screening.
Southern Medical Journal
|February 1, 1981
Summary
Tuberculosis screening in the US is challenging due to low prevalence. Classic symptoms like weight loss and cough, combined with chest x-rays and PPD tests, can effectively identify active tuberculosis (TB) cases.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Pulmonology
Background:
- Declining tuberculosis prevalence in the US impacts standard laboratory test sensitivity.
- Mycobacterium tuberculosis (MTB) cultures yield low positive rates (2%) in low-prevalence settings.
- Effective screening tools are needed to identify active tuberculosis (TB) patients.
Purpose of the Study:
- To identify effective screening variables for active tuberculosis (TB).
- To evaluate the utility of classic signs, symptoms, and diagnostic tests for TB screening.
- To propose an improved approach for TB diagnosis in low-prevalence environments.
Main Methods:
- Retrospective chart review of 79 active TB patients and 226 controls.
- Analysis of 45 signs, symptoms, and laboratory tests at initial patient contact.
- Algorithmic analysis to determine the predictive value of combined variables.
Main Results:
- Weight loss, prior exposure, night sweats, fever, abnormal chest roentgenogram, positive purified protein derivative (PPD) skin test, cough, and abnormal pulmonary examination distinguished active TB.
- An algorithm using weight loss/cough and chest x-ray/PPD detected 77% of active TB cases.
- Classic signs and symptoms remain valuable screening indicators.
Conclusions:
- Classic signs and symptoms of pulmonary tuberculosis are effective screening variables.
- Combining clinical signs, chest x-ray, and PPD can improve TB detection rates.
- Tuberculosis cultures may be better utilized as confirmatory rather than primary screening tests in low-prevalence settings.