Use of chest radiography in the 22 highest tuberculosis burden countries

An estimated 9 million new tuberculosis (TB) cases and 1.5 million deaths were caused by Mycobacterium tuberculosis in 2013 [1], more than 80% of which occurred in the 22 highest TB burden countries (HBCs). Among the confirmed incident cases, 4.9 million were pulmonary TB (PTB), of which 58% were bacteriologically confirmed. For many of these cases, chest radiography (CXR) was used as an important tool for triaging, particularly in smear-negative patients, to select patients for further microbiological workup with culture or Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) [2, 3]. For the diagnosis of 42% of PTB cases who were microbiologically negative, CXR was often used to support the clinical decision, particularly in children [1, 4]. CXR is used widely in the 22 highest TB burden countries but we need strategies for cost and human resources We thank all participants of the 22 high TB burden countries for their time and support. We additionally would like to thank Yogesh Jha (Médecins sans Frontières, Paris, France) and Faiz Ahmad Khan (Montreal Chest Institute, Montreal, QC, Canada) for contacting additional participants in countries where it was difficult to receive a response. Srinath Satyanarayana (McGill University, Montreal, QC, Canada), Neeraj Raizada (Foundation for Innovative Diagnostics, Geneva, Switzerland), Sandra Kik (KNCV Tuberculosis Foundation, The Hague, The Netherlands) and Sarder Hossain (TB control program, BRAC, Dhaka, Bangladesh) helped greatly in improving the survey instrument.