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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The Union
2025-06-01
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| Series: | Public Health Action |
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| author | D.S. Singini N. Sanjase M. Kagujje J. Shatalimi C.P. Chisanga Z.D. Lupatali D. Phiri T. Tatila W. Olwit A.D. Kerkhoff M. Muyoyeta |
| author_facet | D.S. Singini N. Sanjase M. Kagujje J. Shatalimi C.P. Chisanga Z.D. Lupatali D. Phiri T. Tatila W. Olwit A.D. Kerkhoff M. Muyoyeta |
| author_sort | D.S. Singini |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0d41b487c7bd4f1fb61507a7ddb3989b |
| institution | Kabale University |
| issn | 2220-8372 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | The Union |
| record_format | Article |
| series | Public Health Action |
| spelling | doaj-art-0d41b487c7bd4f1fb61507a7ddb3989b2025-08-20T03:47:10ZengThe UnionPublic Health Action2220-83722025-06-01152939510.5588/pha.25.001210Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosisD.S. Singini0N. Sanjase1M. Kagujje2J. Shatalimi3C.P. Chisanga4Z.D. Lupatali5D. Phiri6T. Tatila7W. Olwit8A.D. Kerkhoff9M. Muyoyeta10Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;The Ministry of Health, Lusaka, Zambia;The Ministry of Health, Lusaka, Zambia;The Ministry of Health, Lusaka, Zambia;The Ministry of Health, Lusaka, Zambia;Uganda Cancer Institute, Kampala, Uganda;University of California, Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA.Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;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.https://www.ingentaconnect.com/contentone/iuatld/pha/2025/00000015/00000002/art00010tuberculosischest x-rayunconfirmed tbcomputer-aided diagnosistb burdenzambia |
| spellingShingle | D.S. Singini N. Sanjase M. Kagujje J. Shatalimi C.P. Chisanga Z.D. Lupatali D. Phiri T. Tatila W. Olwit A.D. Kerkhoff M. Muyoyeta Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis Public Health Action tuberculosis chest x-ray unconfirmed tb computer-aided diagnosis tb burden zambia |
| title | Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis |
| title_full | Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis |
| title_fullStr | Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis |
| title_full_unstemmed | Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis |
| title_short | Clinical diagnosis of TB: lessons on misdiagnosis and overdiagnosis |
| title_sort | clinical diagnosis of tb lessons on misdiagnosis and overdiagnosis |
| topic | tuberculosis chest x-ray unconfirmed tb computer-aided diagnosis tb burden zambia |
| url | https://www.ingentaconnect.com/contentone/iuatld/pha/2025/00000015/00000002/art00010 |
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