ArticleBMC medicine2018
Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis.
Article in BMC medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it.
- CXCL9/CXCL10 as biomarkers the monitoring of treatment responses in Pulmonary TB patients: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Clinical testing of drug treatment shortening in patients with TB using PET/CT imaging of lung lesions.Science translational medicine · 2026Trial
- Radiographic characteristics of rifampicin-resistant tuberculosis in the STREAM stage 1 trial and their influence on time to culture conversion in the short regimen.BMC infectious diseases · 2024Trial
- Immune endotypes in tuberculosis: Keys to decoding disease complexity.Journal of internal medicine · 2026Review
- Article
- Circulating antibody signatures againstFrontiers in immunology · 2026Article
- Association between the extent of intrapulmonary spread on chest CT and false-negative results of T-SPOT.TB in pulmonary tuberculosis: a retrospective study.BMC infectious diseases · 2025Article
- High prevalence and risk factors of positive sputum smear in newly diagnosed pulmonary tuberculosis patients in Vietnam.Le infezioni in medicina · 2025Article
- PET/CT guided tuberculosis treatment shortening: a randomized trial.medRxiv : the preprint server for health sciences · 2024Article
- Feasibility and utility of a combined nasogastric-tube-and-string-test device for bacteriologic confirmation of pulmonary tuberculosis in young children.Diagnostic microbiology and infectious disease · 2024Article
- Construction and Validation of a Nomogram to Identify the Risk of Cavitation in Pulmonary Tuberculosis.Infection and drug resistance · 2024Article
- Nutritional status affects immune function and exacerbates the severity of pulmonary tuberculosis.Frontiers in immunology · 2024Article
- Superimposed Pulmonary Tuberculosis (PTB) in a 26-Year-Old Female with No Underlying Co-Morbidities Recovering from COVID-19-Case Report.Tropical medicine and infectious disease · 2023Article
- Unsuccessful treatment outcome and associated risk factors. A prospective study of DR-TB patients from a high burden country, Pakistan.PloS one · 2023Observational
- RTP4, a Biomarker Associated with Diagnosing Pulmonary Tuberculosis and Pan-Cancer Analysis.Mediators of inflammation · 2023Article
- Proteomic analyses of smear-positive/negative tuberculosis patients uncover differential antigen-presenting cell activation and lipid metabolism.Frontiers in cellular and infection microbiology · 2023Article
- Inflammatory immune profiles associated with disease severity in pulmonary tuberculosis patients with moderate to severe clinical TB or anemia.Frontiers in immunology · 2023Article
- Tuberculosis Treatment Monitoring and Outcome Measures: New Interest and New Strategies.Clinical microbiology reviews · 2022Review
- Rv3737 is required for Mycobacterium tuberculosis growth in vitro and in vivo and correlates with bacterial load and disease severity in human tuberculosis.BMC infectious diseases · 2022Article
- Differences in CT imaging signs between patients with tuberculosis and those with tuberculosis and concurrent lung cancer.American journal of translational research · 2022Article
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Authors and funding
13 authors.
Funding
Abstract
backgroundChest radiographs are used for diagnosis and severity assessment in tuberculosis (TB). The extent of disease as determined by smear grade and cavitation as a binary measure can predict 2-month smear results, but little has been done to determine whether radiological severity reflects the bacterial burden at diagnosis.
methodsPre-treatment chest x-rays from 1837 participants with smear-positive pulmonary TB enrolled into the REMoxTB trial (Gillespie et al., N Engl J Med 371:1577-87, 2014) were retrospectively reviewed. Two clinicians blinded to clinical details using the Ralph scoring system performed separate readings. An independent reader reviewed discrepant results for quality assessment and cavity presence. Cavitation presence was plotted against time to positivity (TTP) of sputum liquid cultures (MGIT 960). The Wilcoxon rank sum test was performed to calculate the difference in average TTP for these groups. The average lung field affected was compared to log
resultsFor 1354 participants, the median TTP was 117 h (4.88 days), being 26 h longer (95% CI 16-30, p < 0.001) in patients without cavitation compared to those with cavitation. The median percentage of lung-field affected was 18.1% (IQR 11.3-28.8%). For every 10-fold increase in TTP, the area of lung field affected decreased by 11.4%. Multivariable models showed that serum albumin decreased significantly as the percentage of lung field area increased in both those with and without cavitation. In addition, BMI and logged TTP had a small but significant effect in those with cavitation and the number of severe TB symptoms in the non-cavitation group also had a small effect, whilst other factors found to be significant on univariable analysis lost this effect in the model.
conclusionsThe radiological severity of disease on chest x-ray prior to treatment in smear positive pulmonary TB patients is weakly associated with the bacterial burden. When compared against other variables at diagnosis, this effect is lost in those without cavitation. Radiological severity does reflect the overall disease severity in smear positive pulmonary TB, but we suggest that clinicians should be cautious in over-interpreting the significance of radiological disease extent at diagnosis.
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