A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients |
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Authors: | Jun-Jun Yeh Solomon Chih-Cheng Chen Cheng-Ren Chen Ting-Chun Yeh Hsin-Kai Lin Jia-Bin Hong Bing-Tsang Wu Ming-Ting Wu |
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Institution: | 1. Section of Thoracic Imaging, Department of Chest Medicine and Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China 4. Chia Nan University of Pharmacy and Science, Tainan, Taiwan, Republic of China 5. Meiho University, Pingtung, Taiwan, Republic of China 6. Pingtung Christian Hospital, Pingtung, Taiwan, Republic of China 2. Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China 3. Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd, Chiayi City, Taiwan, 600, Republic of China 7. Section of Thoracic and Circulation Imaging, Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, 813-62, Republic of China 8. Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Republic of China
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Abstract: | Objective The objective of this study was to use high-resolution computed tomography (HRCT) imaging to predict the presence of smear-positive active pulmonary tuberculosis (PTB) in elderly (at least 65 years of age) and non-elderly patients (18–65 years of age). Methods Patients with active pulmonary infections seen from November 2010 through December 2011 received HRCT chest imaging, sputum smears for acid-fast bacilli and sputum cultures for Mycobacterium tuberculosis. Smear-positive PTB was defined as at least one positive sputum smear and a positive culture for M. tuberculosis. Multivariate logistic regression analyses were performed to determine the HRCT predictors of smear-positive active PTB, and a prediction score was developed on the basis of receiver operating characteristic curve analysis. Results Of 1,255 patients included, 139 were diagnosed with smear-positive active PTB. According to ROC curve analysis, the sensitivity, specificity, positive predictive value, negative predictive value, false positive rates and false negative rates were 98.6 %, 95.8 %, 78.5 %, 99.8 %, 4.2 % and 1.4 %, respectively, for diagnosing smear-positive active PTB in elderly patients, and 100.0 %, 96.9 %, 76.5 %, 100.0 %, 3.1 % and 0.0 %, respectively, for non-elderly patients. Conclusions HRCT can assist in the early diagnosis of the most infectious active PTB, thereby preventing transmission and minimizing unnecessary immediate respiratory isolation. Key Points ? HRCT can assist in the early diagnosis of the infectious active PTB ? HRCT imaging is useful to predict the presence of smear-positive active PTB ? Predictions from the HRCT imaging are valid even before sputum smear or culture results |
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