{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:37Z","timestamp":1787022097880,"version":"build-2736575974"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Stop TB Partnership\u2019s TB REACH initiative with funding from the government of Canada","award":["STBP\/TBREACH\/GSA\/W5-26"],"award-info":[{"award-number":["STBP\/TBREACH\/GSA\/W5-26"]}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23AI157914"],"award-info":[{"award-number":["K23AI157914"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent respiratory symptoms and radiographic abnormalities are common among individuals previously treated for tuberculosis (TB) and may contribute to misdiagnosis and incorrect treatment when they seek care. We sought to determine if clinical and radiographic characteristics differed among previously treated, presumptive TB patients according to their current TB disease status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults (&gt;18 years of age) seeking care at a public health facility in Lusaka, Zambia were systematically evaluated for active TB using symptom screening and chest X-ray. All patients with presumptive TB submitted a sputum sample for microbiological TB testing. Patients who reported a prior history of TB treatment were included in the present analysis. \u2018Confirmed TB\u2019 was defined by the detection of TB using Xpert Ultra and\/or liquid culture, while \u2018possible TB\u2019 was defined by the receipt of TB treatment without a positive Xpert Ultra or culture result. We evaluated the positive predictive value (PPV) of clinical symptoms and radiographic features for active TB alone and in combination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 740 presumptive TB patients, 144 (19%) had been previously treated for active TB. Of these, 19 (13%) patients had confirmed TB, 14 (10%) had possible TB, and 111 (77%) had no pulmonary TB. Overall, 119 (83%) patients had \u22651 current respiratory symptom\u2014this did not differ according to current TB disease classification (95%, 93%, 79%; p = 0.23). Sixty-one patients (56%) had radiographic abnormalities suggestive of active TB and such findings were more common among patients with confirmed or possible TB compared to those without TB (93%, 71%, vs. 47%; p = 0.002). Most patients (n = 91, 83%) had at least one radiographic abnormality\u2014no difference by current TB classification was observed (93%, 100%, 79%; p = 0.08). The PPV of any current respiratory symptom, active TB radiographic finding, or any radiographic abnormality for TB was 13% (95%CI: 7\u201321%), 21% (95%CI: 12\u201334) and 14% (95%CI: 9\u201323), respectively; combining clinical and radiographic characteristics did not significantly improve the PPV for active TB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among presumptive TB patients previously treated for TB, respiratory symptoms and radiographic abnormalities were common and poorly differentiated those with current active TB from those without current active TB. Reliance on clinical and radiographic characteristics alone in this patient population may result in substantial overtreatment and therefore, microbiological investigations should be used to inform TB treatment decisions whenever possible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0263116","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T13:30:36Z","timestamp":1643290236000},"page":"e0263116","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical and radiographic characteristics of presumptive tuberculosis patients previously treated for tuberculosis in Zambia"],"prefix":"10.1371","volume":"17","author":[{"given":"Kondwelani","family":"Mateyo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-6658","authenticated-orcid":true,"given":"Andrew D.","family":"Kerkhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutinta S.","family":"Nteeni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monde","family":"Muyoyeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"pone.0263116.ref001","unstructured":"World Health Organization. Global Tuberculosis Report 2020. World Health Organization, Geneva; 2020. https:\/\/www.who.int\/publications\/i\/item\/9789240013131."},{"key":"pone.0263116.ref002","unstructured":"World Health Organization. Global Tuberculosis Report 2019. World Health Organization, Geneva; 2019. https:\/\/www.who.int\/publications\/i\/item\/9789241565714."},{"key":"pone.0263116.ref003","doi-asserted-by":"crossref","first-page":"700","DOI":"10.5588\/ijtld.19.0809","article-title":"Functional impact of sequelae in drug-susceptible and multidrug-resistant tuberculosis","volume":"24","author":"M Mu\u00f1oz-Torrico","year":"2020","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0263116.ref004","doi-asserted-by":"crossref","first-page":"e000745","DOI":"10.1136\/bmjgh-2018-000745","article-title":"International research and guidelines on post-tuberculosis chronic lung disorders: a systematic scoping review","volume":"3","author":"SC van Kampen","year":"2018","journal-title":"BMJ Global Health"},{"key":"pone.0263116.ref005","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/S1473-3099(14)70879-5","article-title":"Empiric tuberculosis treatment in retreatment patients in high HIV\/tuberculosis-burden settings","volume":"14","author":"JZ Metcalfe","year":"2014","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0263116.ref006","doi-asserted-by":"crossref","first-page":"820","DOI":"10.5588\/ijtld.20.0067","article-title":"Post-tuberculosis lung health: perspectives from the First International Symposium","volume":"24","author":"BW Allwood","year":"2020","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0263116.ref007","article-title":"Active TB case finding in a high burden setting; comparison of community and facility-based strategies in Lusaka, Zambia","author":"M Kagujje","year":"2020","journal-title":"PLoS ONE"},{"key":"pone.0263116.ref008","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1148\/rg.2017160032","article-title":"Pulmonary Tuberculosis: Role of Radiology in Diagnosis and Management","volume":"37","author":"AC Nachiappan","year":"2017","journal-title":"Radiographics"},{"key":"pone.0263116.ref009","doi-asserted-by":"crossref","first-page":"e100069","DOI":"10.1136\/gpsych-2019-100069","article-title":"Post hoc power analysis: is it an informative and meaningful analysis?","volume":"32","author":"Y Zhang","year":"2019","journal-title":"Gen Psychiatry"},{"key":"pone.0263116.ref010","unstructured":"World Health Organization. WHO Consolidated Guidelines on Tuberculosis, Module 2: Systematic Screening for Tuberculosis Disease. World Health Organization, Geneva; 2021. https:\/\/www.who.int\/publications\/i\/item\/9789240022676."},{"key":"pone.0263116.ref011","unstructured":"World Health Organization. Global Tuberculosis Report 2021. World Health Organization, Geneva; 2021. https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2021."},{"key":"pone.0263116.ref012","doi-asserted-by":"crossref","first-page":"e0141414","DOI":"10.1371\/journal.pone.0141414","article-title":"Outcomes and Diagnostic Processes in Outpatients with Presumptive Tuberculosis in Zomba District, Malawi","volume":"10","author":"M van Lettow","year":"2015","journal-title":"Plos One"},{"key":"pone.0263116.ref013","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1186\/s12879-017-2534-2","article-title":"Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpert\u00ae MTB\/RIF era: a cohort study","volume":"17","author":"SM Hermans","year":"2017","journal-title":"BMC Infect Dis"},{"key":"pone.0263116.ref014","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S1473-3099(17)30691-6","article-title":"Xpert MTB\/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study","volume":"18","author":"SE Dorman","year":"2018","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0263116.ref015","unstructured":"World Health Organization. A patient-centered approach to TB care. World Health Organization, Geneva; 2018. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/272467\/WHO-CDS-TB-2018.13-eng.pdf."},{"issue":"18","key":"pone.0263116.ref016","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1056\/NEJMoa2033400","article-title":"AIDS Clinical Trials Group; Tuberculosis Trials Consortium. Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis","volume":"384","author":"SE Dorman","year":"2021","journal-title":"N Engl J Med"},{"key":"pone.0263116.ref017","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1136\/thoraxjnl-2019-213808","article-title":"Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study","volume":"75","author":"J Meghji","year":"2020","journal-title":"Thorax"},{"key":"pone.0263116.ref018","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.jinf.2018.10.004","article-title":"Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis","volume":"77","author":"IS Pradipta","year":"2018","journal-title":"J Infection"},{"key":"pone.0263116.ref019","doi-asserted-by":"crossref","first-page":"720","DOI":"10.5588\/ijtld.20.0030","article-title":"The need for pulmonary rehabilitation following tuberculosis treatment","volume":"24","author":"D Visca","year":"2020","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0263116.ref020","first-page":"1","article-title":"Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge","author":"BW Allwood","year":"2021","journal-title":"Respiration"},{"key":"pone.0263116.ref021","doi-asserted-by":"crossref","first-page":"e93757","DOI":"10.1371\/journal.pone.0093757","article-title":"The Sensitivity and Specificity of Using a Computer Aided Diagnosis Program for Automatically Scoring Chest X-Rays of Presumptive TB Patients Compared with Xpert MTB\/RIF in Lusaka Zambia","volume":"9","author":"M Muyoyeta","year":"2014","journal-title":"PloS ONE"},{"key":"pone.0263116.ref022","doi-asserted-by":"crossref","first-page":"e543","DOI":"10.1016\/S2589-7500(21)00116-3","article-title":"Tuberculosis detection from chest x-rays for triaging in a high tuberculosis-burden setting: an evaluation of five artificial intelligence algorithms","volume":"3","author":"ZZ Qin","year":"2021","journal-title":"Lancet Digital Heal"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263116","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T13:30:55Z","timestamp":1643290255000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263116"}},"subtitle":[],"editor":[{"given":"Selvakumar","family":"Subbian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,1,27]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0263116","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,27]]}}}