J Korean Med Sci.  2012 May;27(5):525-531. 10.3346/jkms.2012.27.5.525.

Diagnostic Accuracy of Notified Cases as Pulmonary Tuberculosis in Private Sectors of Korea

• Jeong I
• Kim HJ
• Kim J
• Oh SY
• Lee JB
• Bai JY
• Lee CH

• KMID: 1372795
• DOI: http://doi.org/10.3346/jkms.2012.27.5.525

Abstract

The diagnostic accuracy of the data reported in the Korean tuberculosis surveillance system (KTBS) has not been adequately investigated. We reviewed the clinical data of pulmonary tuberculosis (PTB) cases notified from private medical facilities through KTBS between January and June, 2004. PTB cases were classified into definite (culture-proven), probable (based on smear, polymerase chain reaction, histology, bronchoscopic finding, computed tomography, or both chest radiograph and symptoms) or possible (based only on chest radiograph) tuberculosis. Of the 1126 PTB cases, sputum AFB smear and culture were requested in 79% and 51% of the cases, respectively. Positive results of sputum smear and culture were obtained in 43% and 29% of all the patients, respectively. A total of 73.2% of the notified PTB cases could be classified as definite or probable and 81.7% as definite, probable, or possible. However, where infection was not confirmed bacteriologically or histologically, only 60.1% of the patients were definite, probable, or possible cases. More than 70% of PTB notified from private sectors in Korea can be regarded as real TB. The results may also suggest the possibility of over-estimation of TB burden in the use of the notification-based TB data.

Keyword

Tuberculosis; Diagnosis; Electronic Notification; Private Sector; Korea

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Humans
Male
Middle Aged
Mycobacterium tuberculosis/isolation & purification
Private Sector
Republic of Korea/epidemiology
Severity of Illness Index
Sputum/microbiology
Tuberculosis, Pulmonary/*diagnosis/epidemiology/pathology
Young Adult

Reference

1. World Health Organization. Global tuberculosis control: a short update to the 2009 report. 2009. Geneva: World Health Organization.

2. Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA. 1999. 282:677–686.

3. Ministry of Health and Welfare and Korean National Tuberculosis Association. Report on the 7th tuberculosis prevalence survey in Korea. 1995. Seoul: Ministry of Health and Welfare and Korean National Tuberculosis Association.

4. Hong YP, Kim SJ, Lew WJ, Lee EK, Han YC. The seventh nationwide tuberculosis prevalence survey in Korea, 1995. Int J Tuberc Lung Dis. 1998. 2:27–36.

5. Lew WJ, Lee EG, Bai JY, Kim HJ, Bai GH, Ahn DI, Lee JK, Kim SJ. An internet-based surveillance system for tuberculosis in Korea. Int J Tuberc Lung Dis. 2006. 10:1241–1247.

6. World Health Organization. Global tuberculosis control: surveillance, planning, financing. 2003. Geneva: World Health Organization.

7. Pillaye J, Clarke A. An evaluation of completeness of tuberculosis notification in the United Kingdom. BMC Public Health. 2003. 3:31.

8. EuroTB and the National Coordinators for Tuberculosis Surveillance in the WHO. European Region. Surveillance of tuberculosis in Europe. Report on tuberculosis cases notified in 2006. 2006. Saint-Maurice: Institut de Veille Sanitaire.

9. Heo E, Oh SY, Jeong I, Lee JS, Lim HJ, Park YS, Lee JW, Han SK, Lee CH. The diagnostic accuracy of notified new culture-negative pulmonary tuberculosis patients in public healthcare centers. Korean J Med. 2009. 76:44–51.

10. Jelastopulu E, Alexopoulos EC, Venieri D, Tsiros G, Komninou G, Constantinidis TC, Chrysanthopoulos K. Substantial underreporting of tuberculosis in West Greece: implications for local and national surveillance. Euro Surveill. 2009. 14:19152.

11. Baussano I, Bugiani M, Gregori D, van Hest R, Borraccino A, Raso R, Merletti F. Undetected burden of tuberculosis in a low-prevalence area. Int J Tuberc Lung Dis. 2006. 10:415–421.

12. Cojocaru C, van Hest NA, Mihaescu T, Davies PD. Completeness of notification of adult tuberculosis in Iasi County, Romania: a capture-recapture analysis. Int J Tuberc Lung Dis. 2009. 13:1094–1099.

13. Sheldon CD, King K, Cock H, Wilkinson P, Barnes NC. Notification of tuberculosis: how many cases are never reported? Thorax. 1992. 47:1015–1018.

14. Kim CH, Koh WJ, Kwon OJ, Ahn YM, Lim SY, An CH, Youn JW, Hwang JH, Suh GY, Chung MP, et al. The accuracy of tuberculosis notification reports at a private general hospital after enforcement of new Korean tuberculosis surveillance system. Tuberc Respir Dis. 2003. 54:178–190.

15. World Health Organization. International Union Against Tuberculosis and Lung Disease. Royal Netherlands Tuberculosis Association. Revised international definitions in tuberculosis control. Int J Tuberc Lung Dis. 2001. 5:213–215.

16. World Health Organization. International statistical classification of diseases and related health problems: 10th revision. 2008. Geneva: World Health Organization.

17. Migliori GB, Spanevello A, Ballardini L, Neri M, Gambarini C, Moro ML, Trnka L, Raviglione MC. Validation of the surveillance system for new cases of tuberculosis in a province of northern Italy. Varese Tuberculosis Study Group. Eur Respir J. 1995. 8:1252–1258.

18. Rieder HL, Watson JM, Raviglione MC, Forssbohm M, Migliori GB, Schwoebel V, Leitch AG, Zellweger JP. Surveillance of tuberculosis in Europe. Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) for uniform reporting on tuberculosis cases. Eur Respir J. 1996. 9:1097–1104.

19. American Thoracic Society. CDC. Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recomm Rep. 2003. 52:1–77.

20. Koh WJ, Kwon OJ, Kim CH, Ahn YM, Lim SY, Yun JW, Hwang JH, Suh GY, Chung MP, Kim H, et al. Clinical characteristics and treatments outcomes of patients of pulmonary tuberculosis at a private general hospital. Tuberc Respir Dis. 2003. 55:154–164.

21. Korea Center for Disease Control and Prevention. The guideline of TB management. 2004.

22. Siddiqi K, Lambert ML, Walley J. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis. 2003. 3:288–296.

23. Balabanova Y, Coker R, Fedorin I, Zakharova S, Plavinskij S, Krukov N, Atun R, Drobniewski F. Variability in interpretation of chest radiographs among Russian clinicians and implications for screening programmes: observational study. BMJ. 2005. 331:379–382.

24. Schlossberg D. Acute tuberculosis. Infect Dis Clin North Am. 2010. 24:139–146.

25. Korvick JA, Peacock JE Jr, Muder RR, Wheeler RR, Yu VL. Addition of rifampin to combination antibiotic therapy for Pseudomonas aeruginosa bacteremia: prospective trial using the Zelen protocol. Antimicrob Agents Chemother. 1992. 36:620–625.

26. Sharma A, Shariff M, Thukral SS, Shah A. Chronic community-acquired Acinetobacter pneumonia that responded slowly to rifampicin in the anti-tuberculous regime. J Infect. 2005. 51:e149–e152.

27. Catanzaro A, Perry S, Clarridge JE, Dunbar S, Goodnight-White S, LoBue PA, Peter C, Pfyffer GE, Sierra MF, et al. The role of clinical suspicion in evaluating a new diagnostic test for active tuberculosis: results of a multicenter prospective trial. JAMA. 2000. 283:639–645.

28. Llewellyn H. The effect of disease prevalence on positive predictive value: a simple model. Cytopathology. 2006. 17:101–103.

29. Schulman KA, Escarce JJ, Eisenberg JM, Hershey JC, Young MJ, McCarthy DM, Williams SV. Assessing physicians' estimates of the probability of coronary artery disease: the influence of patient characteristics. Med Decis Making. 1992. 12:109–114.

30. Lee S. Yoo S, editor. Clinical epidemiology. 2004. Seoul: Gyechook Publisher;141–159.

31. Jeon K, Koh WJ, Kwon OJ, Suh GY, Chung MP, Kim H, Lee NY, Park YK, Bai GH. Recovery rate of NTM from AFB smear-positive sputum specimens at a medical centre in South Korea. Int J Tuberc Lung Dis. 2005. 9:1046–1051.

32. Scott B, Schmid M, Nettleman MD. Early identification and isolation of inpatients at high risk for tuberculosis. Arch Intern Med. 1994. 154:326–330.

33. Tattevin P, Casalino E, Fleury L, Egmann G, Ruel M, Bouvet E. The validity of medical history, classic symptoms, and chest radiographs in predicting pulmonary tuberculosis: derivation of a pulmonary tuberculosis prediction model. Chest. 1999. 115:1248–1253.

34. Kanaya AM, Glidden DV, Chambers HF. Identifying pulmonary tuberculosis in patients with negative sputum smear results. Chest. 2001. 120:349–355.

35. Bah B, Massari V, Sow O, Siriwardana M, Camara LM, Larouzé B, Murray JF. Useful clues to the presence of smear-negative pulmonary tuberculosis in a West African city. Int J Tuberc Lung Dis. 2002. 6:592–598.

36. Lee KS, Hwang JW, Chung MP, Kim H, Kwon OJ. Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS. Chest. 1996. 110:977–984.