'If not TB, what could it be?' Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey.
COPD epidemiology
bronchiectasis
emphysema
imaging/CT MRI etc
tuberculosis
Journal
Thorax
ISSN: 1468-3296
Titre abrégé: Thorax
Pays: England
ID NLM: 0417353
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
31
08
2020
revised:
20
12
2020
accepted:
23
12
2020
pubmed:
29
1
2021
medline:
14
7
2021
entrez:
28
1
2021
Statut:
ppublish
Résumé
The prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey. We reviewed a random sample of 1140 adult (≥15 years) CXRs classified as 'abnormal, suggestive of TB' or 'abnormal other' during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated. Cardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively. Based on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts. National Institute for Health Research (IMPALA-grant reference 16/136/35).
Sections du résumé
BACKGROUND
The prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.
METHODS
We reviewed a random sample of 1140 adult (≥15 years) CXRs classified as 'abnormal, suggestive of TB' or 'abnormal other' during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.
FINDINGS
Cardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.
INTERPRETATION
Based on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.
FUNDING
National Institute for Health Research (IMPALA-grant reference 16/136/35).
Identifiants
pubmed: 33504563
pii: thoraxjnl-2020-216123
doi: 10.1136/thoraxjnl-2020-216123
pmc: PMC8223623
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
607-614Subventions
Organisme : Wellcome Trust
ID : 206575/Z/17/Z
Pays : United Kingdom
Investigateurs
Emmanuel Addo-Yobo
(E)
Brian Allwood
(B)
Hastings Banda
(H)
Imelda Bates
(I)
Amsalu Binegdie
(A)
Asma El Sony
(AE)
Adegoke Falade
(A)
Jahangir Khan
(J)
Maia Lesosky
(M)
Bertrand Mbatchou
(B)
Hellen Meme
(H)
Kevin Mortimer
(K)
Beatrice Mutayoba
(B)
Louis Niessen
(L)
Nyanda Elias Ntinginya
(NE)
Jamie Rylance
(J)
Miriam Taegtmeyer
(M)
Rachel Tolhurst
(R)
William Worodria
(W)
Heather Zar
(H)
Eliya Zulu
(E)
Lindsay Zurba
(L)
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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