X-ray survey for pulmonary tuberculosis and chest diseases in the Ok Tedi

X-ray photofluorography is a relatively expensive way to detect pulmonary tuberculosis (PTB). Those patients with suggestive positive chest X-ray still require Mantoux skin testing, blood tests and a positive sputum smear for the acid-fast bacillus Mycobacterium tuberculosis to make a definitive diagnosis of PTB. Photofluorography does detect most pulmonary pathological conditions, including lesions suggestive of PTB, and possible cardiac abnormalities. It is more cost-effective for large numbers in urban areas where there is poverty and overcrowding; and it is useful in early detection of cases of PTB. It is impractical to use in the isolated mountainous areas in the highlands region of Papua New Guinea and in Western Province, and where there is no road system. It cannot detect other forms of TB. In children and infants it is difficult to obtain good quality films and to interpret them. The scoring chart devised by Biddulph and Edwards is an excellent alternative where a diagnosis is not obvious in a chronically ill child. Active case detection by health workers in the field offers an excellent chance of finding TB cases. Although the cost of staining and looking at sputum smears and performing Mantoux tests can also be time consuming, these methods are relatively less expensive and more accurate. A simple method of processing sputum before Ziehl-Neelsen staining using ordinary household bleach vastly improves the detection rate of acid-fast bacilli. The new technology of demonstrating positive TB antigens in the blood of patients with active disease is still being assessed