{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:09:11Z","timestamp":1785427751760,"version":"3.56.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2017,6,17]],"date-time":"2017-06-17T00:00:00Z","timestamp":1497657600000},"content-version":"vor","delay-in-days":167,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Evaluation of patients with suspected tuberculosis and negative sputum smears for acid-fast bacilli (AFB) is challenging, especially in high human immunodeficiency virus coinfection settings where sputum smears have lower sensitivity for detecting AFB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We examined the utility of chest radiographs for detecting smear-negative pulmonary tuberculosis. Three hundred sixty sputum smear\u2013negative patients who were referred from primary care clinics in the KwaZulu-Natal province of South Africa were evaluated. Chest radiographs were read by experienced pulmonologists using a previously validated Chest X-Ray Reading and Recording System (CRRS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Agreement between observers using CRRS was high at 91% with a Cohen\u2019s kappa of 0.64 (95% confidence interval [CI] = 0.52\u20130.76). Against a reference standard of sputum culture, sensitivity was 93% (95% CI = 86%\u201397%), whereas specificity was 14% (95% CI = 10%\u201319%). Performance against clinical diagnosis (following World Health Organization guidelines) was similar with sensitivity of 92% (95% CI = 88%\u201395%) and specificity of 20% (95% CI = 13%\u201328%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The low specificity of CRRS in this setting indicates poor diagnostic utility for detecting pulmonary tuberculosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofx123","type":"journal-article","created":{"date-parts":[[2017,6,17]],"date-time":"2017-06-17T17:01:05Z","timestamp":1497718865000},"source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic Outcomes After Chest Radiograph Interpretation in Patients With Suspected Tuberculosis and Negative Sputum Smears in a High-Burden Human Immunodeficiency Virus and Tuberculosis Setting"],"prefix":"10.1093","volume":"4","author":[{"given":"Patrick G. T.","family":"Cudahy","sequence":"first","affiliation":[{"name":"Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Dawson","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cape Town Lung Institute and Division of Pulmonology, Groote Schuur Hospital, Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Allwood","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cape Town Lung Institute and Division of Pulmonology, Groote Schuur Hospital, Cape Town"},{"name":"Department of Medicine, Division of Pulmonology, Stellenbosch University\/Tygerberg Academic Hospital, Stellenbosch"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Maartens","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,6,17]]},"reference":[{"key":"2020081005180181000_CIT0001","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1136\/postgradmedj-2015-133278","article-title":"Diagnostics for pulmonary tuberculosis","volume":"92","author":"Cudahy","year":"2016","journal-title":"Postgrad Med J"},{"key":"2020081005180181000_CIT0002","article-title":"World Health Organization","volume-title":"Toman\u2019s Tuberculosis: Case Detection, Treatment, and Monitoring : Questions and 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patients with the human immunodeficiency virus","volume":"85","author":"Kisembo","year":"2012","journal-title":"Br J Radiol"},{"key":"2020081005180181000_CIT0014","doi-asserted-by":"crossref","first-page":"e54235","DOI":"10.1371\/journal.pone.0054235","article-title":"Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis","volume":"8","author":"Pinto","year":"2013","journal-title":"PLoS One"},{"key":"2020081005180181000_CIT0015","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1007\/s00330-013-2840-z","article-title":"The effect of a tuberculosis chest X-ray image reference set on non-expert reader performance","volume":"23","author":"Waitt","year":"2013","journal-title":"Eur Radiol"},{"key":"2020081005180181000_CIT0016","first-page":"52","article-title":"Chest radiograph reading and recording system: evaluation for tuberculosis screening in patients with advanced 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New data on an old test","volume":"94","author":"Barnes","year":"1988","journal-title":"Chest"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/4\/3\/ofx123\/33622722\/ofx123.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/4\/3\/ofx123\/33622722\/ofx123.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,10]],"date-time":"2020-08-10T09:22:14Z","timestamp":1597051334000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofx123\/3869778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofx123","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017]]},"published":{"date-parts":[[2017]]},"article-number":"ofx123"}}