Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective study
Objectives: Subclinical tuberculosis (TB) is challenging to diagnose due to the lack of a clear definition and symptoms. This study aimed to describe the subclinical disease spectrum among people with culture-confirmed pulmonary TB routinely diagnosed in Singapore, a country with moderate incidence,...
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Elsevier
2025-04-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224008439 |
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| author | Yi Rong Chew Jun Yang Tay Win Mar Kyaw Po Ying Chia Deborah Hee Ling Ng |
| author_facet | Yi Rong Chew Jun Yang Tay Win Mar Kyaw Po Ying Chia Deborah Hee Ling Ng |
| author_sort | Yi Rong Chew |
| collection | DOAJ |
| description | Objectives: Subclinical tuberculosis (TB) is challenging to diagnose due to the lack of a clear definition and symptoms. This study aimed to describe the subclinical disease spectrum among people with culture-confirmed pulmonary TB routinely diagnosed in Singapore, a country with moderate incidence, using different definitions. It also aimed to identify risk factors for subclinical TB and the current diagnostic approaches in detecting subclinical TB. Methods: A retrospective analysis of sputum culture-positive pulmonary TB cases reported to the Singapore National TB Registry from January 1, 2004 to December 31, 2023 was conducted. Two definitions for subclinical TB were used: sputum culture-positive TB with no cough or cough for less than 2 weeks for definition 1 and no cough for definition 2. Results: Of 18,693 pulmonary TB cases notified, 41.6% and 31.6% met the first and second definition of subclinical TB, respectively. However, neither definition performed better in detecting subclinical TB (receiver operating characteristics curve). The majority of cases (96.7% and 96.0% respectively) had abnormal chest X-ray findings, and a high proportion had smear-positive results (40.0% and 35.6%, respectively). Sputum TB polymerase chain reaction (PCR) was significant in picking up subclinical TB adjusted odds ratio 1.20 (95% confidence interval 1.10-31), although 42.2% with no persistent cough and 41.2% with no cough did not have sputum TB PCR tested, highlighting gaps in diagnostic practices. Together, older adults (aged ≥70 years) and immunocompromised individuals, including those with end-stage renal failure, steroid therapy, malignancy, and HIV, were more likely to have subclinical TB. Conclusions: Our study suggests that subclinical TB are more likely to occur in those older than 70 years and those with immunocompromising conditions. The use of diagnostics such as chest X-ray and sputum TB PCR are helpful in diagnosing subclinical TB. Further research is necessary to evaluate other screening tools in detecting these early disease states. |
| format | Article |
| id | doaj-art-8ecb1c33c2f94b2a8466469906e471ae |
| institution | Kabale University |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-8ecb1c33c2f94b2a8466469906e471ae2025-01-13T04:18:23ZengElsevierInternational Journal of Infectious Diseases1201-97122025-04-01153107768Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective studyYi Rong Chew0Jun Yang Tay1Win Mar Kyaw2Po Ying Chia3Deborah Hee Ling Ng4National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, SingaporeNational Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Corresponding author: Tel.: (65) 6357-7925.National Centre for Infectious Diseases, SingaporeNational Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, SingaporeNational Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, SingaporeObjectives: Subclinical tuberculosis (TB) is challenging to diagnose due to the lack of a clear definition and symptoms. This study aimed to describe the subclinical disease spectrum among people with culture-confirmed pulmonary TB routinely diagnosed in Singapore, a country with moderate incidence, using different definitions. It also aimed to identify risk factors for subclinical TB and the current diagnostic approaches in detecting subclinical TB. Methods: A retrospective analysis of sputum culture-positive pulmonary TB cases reported to the Singapore National TB Registry from January 1, 2004 to December 31, 2023 was conducted. Two definitions for subclinical TB were used: sputum culture-positive TB with no cough or cough for less than 2 weeks for definition 1 and no cough for definition 2. Results: Of 18,693 pulmonary TB cases notified, 41.6% and 31.6% met the first and second definition of subclinical TB, respectively. However, neither definition performed better in detecting subclinical TB (receiver operating characteristics curve). The majority of cases (96.7% and 96.0% respectively) had abnormal chest X-ray findings, and a high proportion had smear-positive results (40.0% and 35.6%, respectively). Sputum TB polymerase chain reaction (PCR) was significant in picking up subclinical TB adjusted odds ratio 1.20 (95% confidence interval 1.10-31), although 42.2% with no persistent cough and 41.2% with no cough did not have sputum TB PCR tested, highlighting gaps in diagnostic practices. Together, older adults (aged ≥70 years) and immunocompromised individuals, including those with end-stage renal failure, steroid therapy, malignancy, and HIV, were more likely to have subclinical TB. Conclusions: Our study suggests that subclinical TB are more likely to occur in those older than 70 years and those with immunocompromising conditions. The use of diagnostics such as chest X-ray and sputum TB PCR are helpful in diagnosing subclinical TB. Further research is necessary to evaluate other screening tools in detecting these early disease states.http://www.sciencedirect.com/science/article/pii/S1201971224008439Subclinical tuberculosisTuberculosisDiagnosisSingapore |
| spellingShingle | Yi Rong Chew Jun Yang Tay Win Mar Kyaw Po Ying Chia Deborah Hee Ling Ng Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective study International Journal of Infectious Diseases Subclinical tuberculosis Tuberculosis Diagnosis Singapore |
| title | Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective study |
| title_full | Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective study |
| title_fullStr | Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective study |
| title_full_unstemmed | Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective study |
| title_short | Subclinical disease among people with culture-confirmed pulmonary tuberculosis in Singapore - a retrospective study |
| title_sort | subclinical disease among people with culture confirmed pulmonary tuberculosis in singapore a retrospective study |
| topic | Subclinical tuberculosis Tuberculosis Diagnosis Singapore |
| url | http://www.sciencedirect.com/science/article/pii/S1201971224008439 |
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