Skip to content

Research at St Andrews

Pretreatment chest x-ray severity and its relation to bacterial burden in smear positive pulmonary tuberculosis

Research output: Contribution to journalArticle

Author(s)

S. E. Murthy, F. Chatterjee, A. Crook, R. Dawson, C. Mendel, M. E. Murphy, S. R. Murray, A. J. Nunn, P. P. J. Phillips, Kasha P. Singh, T. D. McHugh, S. H. Gillespie, REMoxTB Consortium

School/Research organisations

Abstract

Background:  Chest 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.
Methods:  Pre-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 10 TTP by linear regression. Baseline markers of disease severity and patient characteristics were added in univariable regression analysis against radiological severity and a multivariable regression model was created to explore their relationship.
Results:  For 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.
Conclusions:  The 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.
Close

Details

Original languageEnglish
Article number73
Number of pages11
JournalBMC Medicine
Volume16
DOIs
Publication statusPublished - 21 May 2018

    Research areas

  • Pulmonary tuberculosis, Chest x-ray, Cavitation, Pretreatment

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Can phenotypic data complement our understanding of antimycobacterial effects for drug combinations?

    Kloprogge, F., Hammond, R., Copas, A., Gillespie, S. H. & Della Pasqua, O., 25 Aug 2019, In : Journal of Antimicrobial Chemotherapy.

    Research output: Contribution to journalArticle

  2. Toxicity related to standard TB therapy for pulmonary tuberculosis and treatment outcomes in the REMoxTB study according to HIV status

    Tweed, C. D., Crook, A. M., Dawson, R., Diacon, A. H., McHugh, T. D., Mendel, C. M., Meredith, S. K., Mohapi, L., Murphy, M. E., Nunn, A. J., Phillips, P. P. J., Singh, K. P., Spigelman, M. & Gillespie, S. H., 14 Aug 2019, In : BMC Pulmonary Medicine. 19, 9 p., 152.

    Research output: Contribution to journalArticle

  3. Model-based relationship between the molecular bacterial load assay and time-to-positivity in liquid culture

    Svensson, R. J., Sabiiti, W., Kibiki, G. S., Ntinginya, N. E., Bhatt, N., Davies, G., Gillespie, S. H. & Simonsson, U. S. H., 29 Jul 2019, In : Antimicrobial Agents and Chemotherapy. Early

    Research output: Contribution to journalArticle

  4. Molecular bacterial load assay (MBLA) concurs with culture on the NaOH-induced Mycobacterium tuberculosis loss of viability

    Mtafya, B., Sabiiti, W., Sabi, I., John, J., Sichone, E., Ntinginya, N. E. & Gillespie, S. H., 25 Jun 2019, In : Journal of Clinical Microbiology. 57, e01992-18.

    Research output: Contribution to journalArticle

  5. Heat-inactivation renders sputum safe and preserves Mycobacterium tuberculosis RNA for downstream molecular tests

    Sabiiti, W., Azam, K., Esmeraldo, E., Bhatt, N., Rachow, A. & Gillespie, S. H., Mar 2019, In : Journal of Clinical Microbiology. 57, 4, 8 p., e01778-18.

    Research output: Contribution to journalArticle

Related by journal

  1. Gender differences in tuberculosis treatment outcomes: a post hoc analysis of the REMoxTB study

    Murphy, M. E., Wills, G. H., Murthy, S., Louw, C., Bateson, A. L. C., Hunt, R. D., McHugh, T. D., Nunn, A. J., Meredith, S. K., Mendel, C. M., Spigelman, M., Crook, A. M., Gillespie, S. H. & REMoxTB Consortium, 17 Oct 2018, In : BMC Medicine. 16, 11 p., 189.

    Research output: Contribution to journalArticle

  2. Liver toxicity associated with tuberculosis chemotherapy in the REMoxTB study

    Tweed, C. D., Wills, G. H., Crook, A. M., Dawson, R., Diacon, A. H., Louw, C. E., McHugh, T. D., Mendel, C., Meredith, S., Mohapi, L., Murphy, M. E., Murray, S., Murthy, S., Nunn, A. J., Phillips, P. P. J., Singh, K., Spigelman, M. & Gillespie, S. H., 28 Mar 2018, In : BMC Medicine. 16, 10 p., 46.

    Research output: Contribution to journalArticle

  3. A comparison of liquid and solid culture for determining relapse and durable cure in phase III TB trials for new regimens

    Phillips, P. P. J., Mendel, C. M., Nunn, A. J., McHugh, T. D., Crook, A. M., Hunt, R., Bateson, A. & Gillespie, S. H., 24 Nov 2017, In : BMC Medicine. 15, 9 p., 207.

    Research output: Contribution to journalArticle

  4. A review of renal histology in HIV-1 infected individuals on tenofovir disoproxil fumarate (TDF), could there be glomerular involvement?

    Cevik, M., Leen, C. & Raha, D., Apr 2017, In : BMC Medicine. 18, p. 31-31 1 p.

    Research output: Contribution to journalAbstract

ID: 253137300