Pulmonary tuberculosis with normal chest radiography in a region with a high incidence of tuberculosis

ABSTRACT

To describe the early symptoms of pulmonary tuberculosis [TB] when the chest radiograph [CXR] is normal. Seventy patients with culture-positive pulmonary TB and a normal CXR were identified from reviewing 377 patients with smear or culture-positive pulmonary TB in Babol-Iran from 1994-2000. Patients with abnormal CXR at the time of diagnosis were excluded from analysis. Sixty-eight of the seventy patients [98%] were symptomatic at the time of diagnosis, with cough sputum [97%] being reported most commonly. Two patients were identified because of contact tracing from cases of infections pulmonary TB, while the other 68 patients were identified by investigation of symptoms. Sixty-eight patients [97%] had cough for more than one month, sputum in 63[90%], fever for more than one week in 18 patients [25%], haemoptysis in 28 patients [40%], weight loss in 21 patients [30%], Hoarseness in 1 patient [1/4%], Dyspnea in 5 patients [7%]. The sputum smear of five patients [7%] were positive. None of them had underlying disease. Fifty-six patients [80%] had positive mantoux skin-test. The incidence of culture positive pulmonary TB with a normal chest radiograph was less than one percent from 1988 to 1989 and steadily increased to 10 percent from 1996 to 1997. culture-positive pulmonary TB with a normal CXR is not uncommon, and the incidence of this presentation is increasing. Patients with this presentation of TB are typically symptomatic and /or are detected by contact tracing of infectious cases of pulmonary TB. The results suggest that patients presenting with a cough for more than one month, with a fever for more than one week, or with documented weight loss after known exposure to known cases of TB should have their sputum submitted for mycobacterium tuberculosis culture despite a normal CXR