Abstract:
BACKGROUND:The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by CXR) with an alternative pathway using CXR as a screening tool (CXR followed by ZN). METHODS:From TB suspects attending a chest clinic in Nairobi, Kenya, three sputum specimens were examined for ZN and culture (Lowenstein Jensen). Culture was used as gold standard. From each suspect a CXR was made using a four point scoring system: i: no pathology, ii: pathology not consistent for TB, iii: pathology consistent for TB and iv: pathology highly consistent for TB. The combined score i + ii was labeled as "no TB" and the combined score iii + iv was labeled as "TB". Films were re-read by a reference radiologist. HIV test was performed on those who consented. Laboratory and CXR costs were used to compare for cost-effectiveness. RESULTS:Of the 1,389 suspects enrolled, for 998 (72%) data on smear, culture and CXR was complete. 714 films were re-read, showing a 89% agreement (kappa value = 0.75 s.e.0.037) for the combined scores "TB" or "no-TB". The sensitivity/specificity of the CXR score "TB" among smear-negative suspects was 80%/67%. Using chest CXR as a screening tool in all suspects, sensitivity/specificity of the score "any pathology" was 92%, respectively 63%. The cost per correctly diagnosed case was for the routine process 8.72 dollars, compared to 9.27 dollars using CXR as screening tool. When costs of treatment were included, CXR followed by ZN became more cost-effective. CONCLUSION:The diagnostic pathway ZN followed by CXR was more cost-effective as compared to CXR followed by ZN. When cost of treatment was also considered CXR followed by ZN became more cost-effective. The low specificity of chest X-ray remains a subject of concern. Depending whether CXR was performed on all suspects or on smear-negative suspects only, 22%-45% of patients labeled as "TB" had a negative culture. The introduction of a well-defined scoring system, clinical conferences and a system of CXR quality control can contribute to improved diagnostic performance.
journal_name
BMC Infect Disjournal_title
BMC infectious diseasesauthors
van Cleeff MR,Kivihya-Ndugga LE,Meme H,Odhiambo JA,Klatser PRdoi
10.1186/1471-2334-5-111keywords:
subject
Has Abstractpub_date
2005-12-12 00:00:00pages
111issn
1471-2334pii
1471-2334-5-111journal_volume
5pub_type
杂志文章abstract:BACKGROUND:Due to a lack of survey of health care seeking behavior for influenza, the actual magnitude of influenza in Beijing of China has not been well described. METHODS:During 2013-2014 influenza season, two cross-sectional household surveys were carried out respectively during the epidemic and non-epidemic season...
journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/s12879-017-2217-z
更新日期:2017-02-03 00:00:00
abstract:BACKGROUND:This randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma. METHODS:A total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 particip...
journal_title:BMC infectious diseases
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2334-13-596
更新日期:2013-12-17 00:00:00
abstract:BACKGROUND:As most data on hepatitis in resource-poor countries relate to urban communities, surveys in the rural environment are necessary to determine the 'true' prevalence of these viral infections. We undertook a survey to determine the prevalence of hepatitis B virus (HBV) infection in an apparently healthy rural ...
journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/1471-2334-13-286
更新日期:2013-06-24 00:00:00
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journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/1471-2334-6-38
更新日期:2006-02-27 00:00:00
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pub_type: 杂志文章
doi:10.1186/s12879-020-05715-y
更新日期:2021-01-07 00:00:00
abstract:BACKGROUND:Bacterial vaginosis (BV) is a common condition, although its aetiology remains unexplained. The aim of this study was to analyse the composition of vaginal microbiota in women from Greenland to provide a quantitative description and improve the understanding of BV. METHODS:Self-collected vaginal smears and ...
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doi:10.1186/1471-2334-13-480
更新日期:2013-10-16 00:00:00
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更新日期:2014-11-07 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2017-02-20 00:00:00
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pub_type: 临床试验,杂志文章,多中心研究
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pub_type: 杂志文章,meta分析
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pub_type: 杂志文章
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更新日期:2011-09-30 00:00:00
abstract::After publication of the original article [1], the authors would like to add a co-author, Dr. Stephen Pan, who contributed sufficiently to this manuscript. ...
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pub_type: 杂志文章,已发布勘误
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更新日期:2020-02-27 00:00:00
abstract:BACKGROUND:Ebola haemorrhagic fever (EHF) is infamous for its high case-fatality proportion (CFP) and the ease with which it spreads among contacts of the diseased. We describe the course of the EHF outbreak in Masindi, Uganda, in the year 2000, and report on response activities. METHODS:We analysed surveillance recor...
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pub_type: 杂志文章
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journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/1471-2334-13-447
更新日期:2013-09-27 00:00:00
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pub_type: 杂志文章
doi:10.1186/1471-2334-12-149
更新日期:2012-06-29 00:00:00
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pub_type: 杂志文章
doi:10.1186/s12879-019-4459-4
更新日期:2019-10-22 00:00:00
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pub_type: 杂志文章
doi:10.1186/1471-2334-14-298
更新日期:2014-06-02 00:00:00
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pub_type: 历史文章,杂志文章,评审
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pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2020-11-19 00:00:00
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pub_type: 杂志文章
doi:10.1186/s12879-017-2333-9
更新日期:2017-03-27 00:00:00
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pub_type: 杂志文章
doi:10.1186/1471-2334-13-66
更新日期:2013-02-04 00:00:00
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journal_title:BMC infectious diseases
pub_type: 杂志文章,随机对照试验
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更新日期:2015-07-30 00:00:00
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journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/s12879-019-3690-3
更新日期:2019-01-16 00:00:00
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journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/s12879-017-2618-z
更新日期:2017-07-26 00:00:00
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journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/s12879-018-3400-6
更新日期:2018-10-12 00:00:00
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journal_title:BMC infectious diseases
pub_type: 杂志文章
doi:10.1186/1471-2334-12-138
更新日期:2012-06-20 00:00:00