Pulmonary tuberculosis in patients with normal chest radiograph in a region with a high incidence of tuberculosis
Abstract
The objective was to describe early symptoms of pulmonary tubeculosis (T) when the chest radiograph (CXR) is normal.
Seventy patients with culture-positive pulmonary T and normal CXR were selected from a review of 377 consecutive patients with smear- or culture-positive pulmonary T in Babol (Iran) in 1994-2000. Patients with abnormal CXR at the time of the diagnosis were excluded from the analysis.
Sixty-eight of the 70 patients (98%) were symptomatic at the time of the diagnosis with cough and sputum production being reported most commonly (97%). Two patients were examined due to contact tracing of a case of infectious pulmonary T, while other 68 patients were tested because of symptoms presence. Sixtyeight patients (97%) had cough longer that 1 month, sputum production was in 63 patients (90%), fever for more than 1 week was in 18 patients (25%), haemoptysis was in 28 patients (40%), weight loss was in 21 patients (30%), hoarseness was in 1 patient (1,4%), dyspnea was in 5 patients (7%). The sputum smears of 5 patients (7 % ) were positive. No-one of patients had underlying diseases. Fifty-six patients (80%) had positive Mantoux skin test. The incidence of culture-positive pulmonary T with a normal chest radiograph was less than 1% in the period from 1988 to 1989 and steadily increased to 10% in the period from 1996 to 1997.
The culture-positive pulmonary T with abnormal CXR is not uncommon and the incidence of such presentation is increasing. Patients with this presentation of T are typically symptomatic and/or are detected by contact tracing of infectious pulmonary T cases. The results suggest that patients presenting cough for more than 1 month, a fever longer than 1 week or documented weight loss after known exposure to infectious T should undergo sputum examination for a mycobacterium tuberculosis despite a normal CXR.
About the Authors
K. A. Bijani
Пульмонологическое отделение, госпиталь Бехешти;
Госпиталь Амикрола;
Отделение внутренних болезней, госпиталь Бехешти
Islamic Republic of Iran
Islamic Republic of Iran
N. T. Esmail
Пульмонологическое отделение, госпиталь Бехешти;
Госпиталь Амикрола;
Отделение внутренних болезней, госпиталь Бехешти
Islamic Republic of Iran
Islamic Republic of Iran
B. Graeilli
Пульмонологическое отделение, госпиталь Бехешти;
Госпиталь Амикрола;
Отделение внутренних болезней, госпиталь Бехешти
Islamic Republic of Iran
Islamic Republic of Iran
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Review
For citations:
Bijani K.A., Esmail N.T., Graeilli B. Pulmonary tuberculosis in patients with normal chest radiograph in a region with a high incidence of tuberculosis. PULMONOLOGIYA. 2003;(3):47-51. (In Russ.)
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