Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis
Clinically diagnosed TB patients (n = 335) at two facilities in Lusaka, Zambia were re-evaluated within two weeks of diagnosis. This re-evaluation included sputum Xpert Ultra testing and expert reader interpretation of the chest x-rays (CXRs) used for initial diagnosis. Repeat Xpert Ultra detected T...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
The Union
2025-06-01
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| Series: | Public Health Action |
| Subjects: | |
| Online Access: | https://www.ingentaconnect.com/contentone/iuatld/pha/2025/00000015/00000002/art00010 |
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| Summary: | Clinically diagnosed TB patients (n = 335) at two facilities in Lusaka, Zambia were re-evaluated within two weeks of diagnosis. This re-evaluation included sputum Xpert Ultra testing and expert reader interpretation of the chest x-rays (CXRs) used for initial diagnosis. Repeat Xpert Ultra detected TB in just 2.6% (n=6). Of the remaining patients (n=222), expert CXR re-interpretation classified 18.0% as normal; 36.0% as abnormal, consistent with TB; and 46.0% as abnormal, not consistent with TB. These findings suggest that clinical TB is frequently over diagnosed in those without detectable CXR abnormalities and misdiagnosed in those with abnormal CXRs: these abnormalities are likely due to other respiratory conditions. Such misdiagnosis leads to unnecessary treatment, failure to treat the true underlying condition and incorrect estimates of TB burden. |
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| ISSN: | 2220-8372 |