Respiratory Care |

Clinical Indicators of Smear-Positive Pulmonary Tuberculosis Among Hospitalized Patients FREE TO VIEW

Rylene Baquilod, MD; Albert Rafanan, MD
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Chong Hua Hospital, Mandaue City, Philippines

Chest. 2014;146(4_MeetingAbstracts):910A. doi:10.1378/chest.1991826
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SESSION TITLE: Respiratory Infections Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The Philippines has a high TB burden. All hospitalized patients with suspected pulmonary tuberculosis (PTB) are placed in respiratory isolation until they are proven non-infectious by negative sputum AFB smears. Lack of specific criteria that point to positive smears often lead to overisolation and increased healthcare cost. The purpose of the study was to identify the clinical indicators of smear-positive PTB patients,

METHODS: Charts of all patients admitted within a one-year period to the Isolation Ward due to suspicion of PTB in a tertiary regional referral hospital in the Philippines were reviewed . The proportion of factors including clinical presentation, chest x-ray (CXR) and physical findings which had significant association with smear-positive PTB were determined. A logistic regression model was then made to determine which set of variables had the strongest association with smear-positive PTB.

RESULTS: Of the 92 patients studied, 28% had smear-positive PTB. Variables not significantly associated with smear-positive PTB included: history of PTB exposure, cough of at least 2 weeks, night sweats, hemoptysis, lymphadenopathy and CXR findings of upper lobe infiltrates, hilar adenopathy, and pleural effusion. Variables significantly associated with smear-positive PTB included cavitation (58% vs. 5%, p<0.001) or diffuse infiltrates on CXR (31% vs. 11%, p=0.018), history of anorexia (35% vs. 15%, p=0.048), fatigue (38% vs. 9%,p=0.002) and weight loss(54% vs. 27%, p=0.027), and physical finding of fever (31% vs. 9%, p=0.009) and rales on auscultation (58% vs. 32%, p=0.022). No smear-positive PTB patient presented with a normal CXR. The most discriminative indicator of smear-positive PTB was cavitation on CXR with a positive and negative predictive value of 83% and 85%, respectively. With logistic regression, variables that were significantly associated with smear-positive PTB were weight loss,fatigue, fever on admission and CXR findings of diffuse infiammatory infiltrates or cavitation.

CONCLUSIONS: Although overisolation was not a significant problem in the institution, patients who are suspected of PTB but have a normal CXR or who does not have any of the following - weight loss, fatigue and fever, CXR findings of diffuse infiammatory infiltrates or cavitation, may not need to be isolated.

CLINICAL IMPLICATIONS: In a resource-constrained country with high burden of the PTB,identification of admission clinical parameters can help clinicians decide which PTB cases need to be placed in isolation.

DISCLOSURE: The following authors have nothing to disclose: Rylene Baquilod, Albert Rafanan

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