Chest Radiograph Screening for Detecting Subclinical Tuberculosis in Asymptomatic Household Contacts, Peru

Emerg Infect Dis. 2024 Jun;30(6):1115-1124. doi: 10.3201/eid3006.231699.


The World Health Organization's end TB strategy promotes the use of symptom and chest radiograph screening for tuberculosis (TB) disease. However, asymptomatic early states of TB beyond latent TB infection and active disease can go unrecognized using current screening criteria. We conducted a longitudinal cohort study enrolling household contacts initially free of TB disease and followed them for the occurrence of incident TB over 1 year. Among 1,747 screened contacts, 27 (52%) of the 52 persons in whom TB subsequently developed during follow-up had a baseline abnormal radiograph. Of contacts without TB symptoms, persons with an abnormal radiograph were at higher risk for subsequent TB than persons with an unremarkable radiograph (adjusted hazard ratio 15.62 [95% CI 7.74-31.54]). In young adults, we found a strong linear relationship between radiograph severity and time to TB diagnosis. Our findings suggest chest radiograph screening can extend to detecting early TB states, thereby enabling timely intervention.

Keywords: Peru; bacteria; chest radiography; contact tracing; global health; mass chest x-ray; pulmonary; subclinical infections; tuberculosis and other mycobacteria.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Contact Tracing / methods
  • Family Characteristics*
  • Female
  • Humans
  • Infant
  • Latent Tuberculosis / diagnosis
  • Latent Tuberculosis / diagnostic imaging
  • Latent Tuberculosis / epidemiology
  • Longitudinal Studies
  • Male
  • Mass Screening* / methods
  • Middle Aged
  • Peru / epidemiology
  • Radiography, Thoracic*
  • Tuberculosis / diagnosis
  • Tuberculosis / diagnostic imaging
  • Tuberculosis / epidemiology
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / diagnostic imaging
  • Tuberculosis, Pulmonary / epidemiology
  • Young Adult