Digital CXR with computer aided diagnosis versus symptom screen to define presumptive tuberculosis among household contacts and impact on tuberculosis diagnosis

Monde Muyoyeta,Nathan Kapata,Maureen Moyo-Chilufya,Isaac Mushanga,Deborah Milimo,Nkatya Chanda Kasese,Mapopa Ndhlovu,Helen Ayles

doi:10.1186/s12879-017-2388-7

Monde Muyoyeta, Nathan Kapata + Show 6 more

Open Access

https://doi.org/10.1186/s12879-017-2388-7

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Abstract

BackgroundHousehold (HH) contact tracing is a strategy that targets high risk groups for TB. Symptom based screening is the standard used to identify HH contacts at risk for TB during HH contact tracing for TB. However, this strategy may be limited due to poor performance in predicting TB. The objective of this study was to compare CXR with Computer Aided Diagnosis (CAD) against symptom screen for defining presumptive TB and how TB detection changes with each method.MethodsHousehold contacts of consecutive index bacteriologically confirmed TB cases were visited by study teams and given TB/HIV education to raise awareness of the risk of TB following close contact with a TB patient. Contacts were encouraged to visit the health facility for screening; where symptoms history was obtained and opt out HIV testing was provided as part of the screening process. CXR was offered to all regardless of symptoms, followed by definitive sputum test with either Xpert MTB RIF or smear microscopy.ResultsAmong 919 HH contacts that presented for screening, 865 were screened with CXR and 464 (53.6%) had an abnormal CXR and the rest had a normal CXR. Among 444 HH contacts with valid sputum results, 274 (61.7%) were symptom screen positive and 255 (57.4%) had an abnormal CXR. Overall, TB was diagnosed in 32/444 (7.2%); 13 bacteriologically unconfirmed and 19 bacteriologically confirmed. Of 19 bacteriologically confirmed TB 8 (42.1%) were symptom screen negative contacts with an abnormal CXR and these 6/8 (75.0%) were HIV positive. Among the 13 bacteriologically unconfirmed TB cases, 7 (53.8%) were HIV positive and all had an abnormal CXR.ConclusionSymptom screen if used alone with follow on definitive TB testing only for symptom screen positive individuals would have missed eight of the 19 confirmed TB cases detected in this study. There is need to consider use of other screening strategies apart from symptom screen alone for optimal rule out of TB especially in HIV positive individuals that are at greatest risk of TB and present atypically.

Highlights

Household (HH) contact tracing is a strategy that targets high risk groups for TB
We evaluated using Computer Aided Diagnosis (CAD) as a tool to define presumptive TB as opposed to the traditional method that uses symptom screening among HH contacts of newly diagnosed TB patients with bacteriologically confirmed TB
In this study, using digital Chest X-ray (CXR) with CAD to define presumptive TB found active TB among symptom screen negative CXR abnormal HH contacts accounting for 42% (8 out of 19) of all bacteriologically confirmed TB cases detected

Summary

Introduction

Household (HH) contact tracing is a strategy that targets high risk groups for TB. Symptom based screening is the standard used to identify HH contacts at risk for TB during HH contact tracing for TB. This strategy may be limited due to poor performance in predicting TB. Household (HH) contacts of newly diagnosed tuberculosis (TB) patients are considered to be a high risk group for TB [1,2,3]. Among HIV negative patients, a person is generally considered to be a presumptive TB patient if they have a cough greater or equal 2 weeks duration with or without other symptoms of TB. Symptom screen to define presumptive TB has been observed to result in missed active TB cases among those who are symptom screen negative and are not considered for follow on testing with definitive TB tests [7,8,9]

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