Infectious Disease

Digital chest x-ray, symptom-based screening doubles the number of undiagnosed TB in inmates

January 06, 2022

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The addition of a digital chest x-ray to symptom-based screening doubled the incidence of undiagnosed tuberculosis in inmates in South Africa compared to symptom-based screening alone, researchers reported.

“Despite recent progress in reducing its incidence, South Africa remains a country with a high burden of tuberculosis. Diagnosis and treatment of TB in important populations, including prison inmates, are important to the elimination of TB. In particular, early and effective diagnosis of TB disease in inmates is critical to control TB in this population, “wrote Dr of the American Thoracic Society.

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Symptom-based screening is routinely used to find active TB cases in correctional facilities in South Africa. However, alternatives such as digital chest x-rays could be more accurate than symptom-based screening, according to the researchers.

The researchers examined 3,576 adult inmates (mean age 34 years; 99.6% men) in four prisons in South Africa for TB using symptoms and digital chest X-rays. Participants with at least one symptom or computerized evidence of 50 or more provided two sputa for the liquid culture and the GeneXpert MTB / RIB Ultra (Xpert Ultra; Cepheid) test. Xpert Ultra tests were also performed on a sample of 800 inmates with no symptoms.

The TB yield was defined as the proportion of newly identified bacteriologically confirmed patients with TB.

Of those screened, 24.2% required an examination, of which 11.2% were symptomatic, 19.1% for abnormal computer-aided detection, and 24.2% for both.

The researchers collected sputum from 86.2% of the participants. According to the results, 28 new TB cases were identified, resulting in 7.8 TB cases per 1,000 population.

The TB yield would have been 3.6 per 1,000 population if the symptoms were assessed alone, and 7 per 1,000 population if the digital chest x-ray was assessed based on hypothetical screening modalities alone, the researchers wrote.

The researchers diagnosed five new cases of TB in the 800 inmates who were initially symptom free.

The researchers reported no difference in the TB yield with Xpert Ultra compared to culture (5.6 vs. 4.8 per 1,000 population; P = 0.21).

“The roadmap to eliminating TB, which highlights the importance of screening and treating key populations, requires that we innovate and optimize current approaches,” the researchers write. “Our study found that the use of [digital chest X-ray] and symptom-based TB screening doubled the number of undiagnosed TB in inmates. “

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