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Related Experiment Videos

Abnormal chest x-rays in intravenous drug users: implications for tuberculosis screening programs

E Bellin1, D Fletcher, S Safyer

  • 1Montefiore-Rikers Island Health Service, East Elmhurst, NY 11370.

American Journal of Public Health
|May 1, 1993
PubMed
Summary

Routine chest x-rays are crucial for screening tuberculosis in intravenous drug users, as the purified protein derivative skin test often misses significant abnormalities. All intravenous drug users in congregate settings need chest imaging for accurate diagnosis.

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Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Radiology

Background:

  • Intravenous drug users (IDUs) are a high-risk population for tuberculosis (TB).
  • Screening for TB in IDUs is essential, particularly in congregate settings like correctional facilities.
  • Routine screening methods require evaluation for their effectiveness in this population.

Purpose of the Study:

  • To determine the prevalence of significant chest x-ray abnormalities indicative of pulmonary tuberculosis in IDUs.
  • To assess the efficacy of the purified protein derivative (PPD) skin test in identifying IDUs with these chest x-ray abnormalities.

Main Methods:

  • A cross-sectional screening study was conducted on 1314 individuals admitted to an opiate detoxification unit in an urban jail.
  • Purified protein derivative (PPD) tuberculin reactivity was assessed.

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  • Screening chest x-rays were obtained independently to evaluate for abnormalities consistent with tuberculosis.

    • Main Results:

    • 5.6% (73 out of 1314) of inmates exhibited chest x-ray abnormalities consistent with tuberculosis.
    • The PPD skin test failed to detect significant infiltrates on chest x-rays in 65% (17 out of 26) of cases.

    Conclusions:

    • Purified protein derivative (PPD) screening demonstrates low sensitivity for detecting chest x-ray abnormalities requiring further tuberculosis evaluation.
    • Routine chest x-ray screening is recommended for all intravenous drug users admitted to congregate housing to ensure adequate diagnostic evaluation for tuberculosis.