The Validity of Classic Symptoms and Chest Radiographic Configuration in Predicting Pulmonary Tuberculosis

doi:10.1378/chest.109.2.420

Chest

Volume 109, Issue 2, February 1996, Pages 420-423

https://doi.org/10.1378/chest.109.2.420 Get rights and content

Objective

Patients admitted to the pulmonary isolation service to rule out tuberculosis (TB) were prospectively studied to identify predictors of smear-positive TB.

Methods

History of symptoms—cough, sputum production, fever, weight loss, night sweats, hemoptysis, anorexia, and dyspnea; medical history—TB, tuberculin skin test (TST) status, TB contact; and social factors—crowding index, history of incarceration or living in a shelter, and employment status were obtained in face-to-face interviews. Chest x-rays (CXRs) were scored as typical, atypical, or negative. Serial morning sputa were collected.

Results

Complete data were collected on 101 patients; 44 had pulmonary TB; 33 patients were smear positive and considered infectious; 11 patients were smear negative but culture positive. There was no difference between TB and non-TB patients with respect to HIV status and social risk factors. Significant differences were found between patients who were smear positive for TB and smear negative with respect to cough, sputum, and typical CXR (79%, 76%, and 79% sensitivity, respectively). Eleven patients without TB had an atypical CXR and denied cough, sputum, and weight loss. Only one patient with TB presented this way.

Conclusion

Even in high-risk populations, symptoms of cough, sputum, weight loss for less than 2 weeks, and the absence of a typical CXR are strong negative predictors for TB.

Section snippets

Setting

This study was conducted at Cook County Hospital (CCH), a large, public, urban hospital that serves the population groups that have been most severely affected by the TB epidemic. CCH is at the front line of the TB epidemic. The state of Illinois has suffered the second largest increase (6.5%) in cases in the United States and Chicago ranks third among all US cities in percentage increase (5.9%) of new cases.⁵ CCH bears the distinction of having the largest burden of TB of any institution in

RESULTS

Of the 101 patients, 44 were found to have pulmonary tuberculosis. Of these 44, 33 were smear positive on at least one specimen and 11 were smear negative but culture positive. Table 1 shows characteristics of study subjects. Demographic breakdown revealed that 75% of patients were African-American, 5% white, 15% Hispanic, and 5% Asian; 11% were female and 89% were male. There were no significant demographic differences between TB and non-TB populations.

Of the 57 patients who did not have

DISCUSSION

The CDC's recommendations for isolation of patients are quite broad and result in the isolation of large numbers of patients, straining the resources of many institutions. Our data showed significant negative predictive values in the range of 85% for classic symptoms and CXR configuration that may help triage these beds. Only one patient with TB (2%) had an absence of the three strongest predictors.

We are unaware of other published studies that have systematically evaluated the clinical,

CONCLUSION

The absence of the sentinel symptoms of 2 weeks of cough sputum, weight loss, combined with the absence of a typical CXR are still extremely useful predictors of the absence of infectious TB. More than 10% of our patients, who denied cough, sputum, and weight loss and had atypical CXRs, may not have required isolation—a potential savings of valuable resources.

ACKNOWLEDGMENTS

The authors wish to thank David Schwartz, MD, and Tzyy-Chyn Hu, RN, MS, for their critical review of the manuscript.

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: Data published as an abstract in J Infect Control Hosp Epidemiol 1994; 15(12):766.

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Chest

Clinical Investigations: VascularThe Validity of Classic Symptoms and Chest Radiographic Configuration in Predicting Pulmonary Tuberculosis

Objective

Methods

Results

Conclusion

Section snippets

Setting

RESULTS

DISCUSSION

CONCLUSION

ACKNOWLEDGMENTS

Am J Med

Eur J Radiol

Chest

Am J Med

Chest

Chest

Early identification and isolation of inpatients at high risk for tuberculosis

Arch Intern Med

Preventing the nosocomial transmission of tuberculosis

Ann Intern Med

Clinical Investigations: Vascular
The Validity of Classic Symptoms and Chest Radiographic Configuration in Predicting Pulmonary Tuberculosis