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Original Research: TUBERCULOSIS |

The Role of Chest CT Scanning in TB Outbreak Investigation

Sei Won Lee, MD; Yoon Soo Jang, MD; Chang Min Park, MD; Hee Yoon Kang; Won-Jung Koh, MD; Jae-Joon Yim, MD; Kyeongman Jeon, MD
Author and Funding Information

From the Department of Internal Medicine (Dr Lee), Armed Forces Capital Hospital, Gyeonggi-do; Three Armed Forces (Dr Jang), Korean Army, Gyeonggi-do; Department of Radiology (Dr Park), Seoul National University College of Medicine and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul; Department of Microbiology (Ms Kang), Korean Institute of Tuberculosis, Seoul; Division of Pulmonary and Critical Care Medicine (Drs Koh and Jeon), Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and Division of Pulmonary and Critical Care Medicine (Dr Yim), Department of Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.

Correspondence to: Kyeongman Jeon, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea; e-mail: kjeon@skku.edu


Funding/Support: The study was supported by a military medicine grant from the Defense Ministry of South Korea.

Drs Yim and Jeon contributed equally to this work.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).

For editorial comment see page 1011


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1057-1064. doi:10.1378/chest.09-1513
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Background:  In TB outbreaks, detecting active cases is the key step in stopping transmission of the disease. The aim of this study was to evaluate the role of high-resolution CT (HRCT) scanning of the chest in the investigation of a TB outbreak that developed in a cohort of 92 soldiers in the South Korean army.

Methods:  Outbreak investigation, including tuberculin skin test (TST), QuantiFERON TB Gold In-Tube (QFT) test, and simple chest radiograph (CXR), was performed. For participants with any abnormal findings in these tests, HRCT scanning was done. Active pulmonary TB was diagnosed based on sputum studies or HRCT scan findings. In addition, participants with positive results in both TST and QFT were treated as having a latent TB infection (LTBI). TST and QFT were repeated in participants with a positive result in one of these tests. CXR was repeated in all participants at 3 and 6 months of follow-up.

Results:  Eighty-seven participants completed the study protocol. Among them, 18 active TB cases were diagnosed. Nine of these had normal CXR, but had lesions that were suggestive of active TB on HRCT scan. Twenty-two participants with normal HRCT scans and positive results with TST and QFT at initial investigation were treated as LTBI. Among 13 participants with normal CXR and positive results in either TST or QFT, nine completed a 3-month investigation. All but one of nine participants revealed positive results in both tests.

Conclusion:  Inclusion of HRCT scanning in the outbreak investigation of TB may be helpful in differentiating active TB from LTBI more reliably.

Trial registration:  clinicaltrials.gov; Identifier: NCT00889759.

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