Question:

Which of the following regarding TB diagnosis are true (select all that apply)?
1. Findings classically considered unique to either primary TB or postprimary TB can in fact overlap.
2. Early diagnosis is not urgent, as it will not significantly alter the course of clinical management.
3. Diagnosis requires a high index of suspicion, since chest radiographs appear normal in up to 15% of patients who have proven primary TB.
4. Hilar and paratrachial lymphadenopathy is an uncommon finding in primary TB and supports the diagnosis of postprimary TB.
5. Imaging can facilitate early diagnosis of TB, since definitive diagnosis through culture takes a minimum of ten days.





Answer:

The correct answers for the question "Which of the following regarding TB diagnosis are true (select all that apply)? " are:

1. Findings classically considered unique to either primary TB or postprimary TB can in fact overlap.

3. Diagnosis requires a high index of suspicion, since chest radiographs appear normal in up to 15% of patients who have proven primary TB.

5. Imaging can facilitate early diagnosis of TB, since definitive diagnosis through culture takes a minimum of ten days.



Explanation
1. Findings classically considered unique to primary TB or postprimary TB have been shown to overlap considerably. [Furthermore, recent studies using genotyping methods for M. tuberculosis have challenged the notion that clinical, pathologic, and radiologic manifestations of primary and postprimary TB are unique, emphasizing that the only independent predictor of the radiographic presentation may be host immune response status.]

2. Early diagnosis allows for prompt initiation of appropriate patient therapy, as well as public health infectious control measures. [With the advent of multidrug-resistant (MDR) and extensively drug-resistant TB, prompt diagnosis is especially crucial for both public health infection control measures as well as ensuring appropriate patient management.]

3. Chest radiographs appear normal in up to 15% of patients who have proven primary TB, emphasizing the importance of a clinician`s high index of suspicion to ensure follow up with other diagnostic studies. [Of note, chest radiographs appear normal in 15% of patients with proven primary TB.]

4. Lymphadenopathy is commonly associated with primary TB, and is quite uncommon in postprimary TB. [Lymphadenopathy (LA) on radiologic exam is seen in up to 96% of children and 43% of adults, and is uncommon in postprimary TB.]

5. Imaging can facilitate more rapid diagnosis of TB than culture, since culture takes a minimum of 10 days. [Radiologic diagnosis of TB allows for early intervention in infected patients, as acid-fast bacilli are found in the sputum of only a limited number of patients with active pulmonary TB, and definitive diagnosis via radiometric broth culture takes a minimum of ten days.]



From the manuscript:
Primary tuberculosis in a malnourished adolescent
Radiology Case. 2012 Jul; 6(7):1-8


This article belongs to the General section.




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From the manuscript

Primary tuberculosis in a malnourished adolescent

Free full text article: Primary tuberculosis in a malnourished adolescent

Abstract
Although the overall prevalence of tuberculosis has decreased in the United States, with the increasing prevalence of tuberculosis globally, higher rates of tuberculosis in some states and localities have been reported, with some component probably related to immigrant populations. We report a case of primary pulmonary tuberculosis in a malnourished adolescent.






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