Synchronization of Sputum Conversion and Resolution of Intensive Phase Lesion Areas on Thorax X-rays Determinants of Prognosis for Pulmonary Tuberculosis Therapy


  • Utami Ambarsari Department of Radiology, Faculty of Medicine, Nahdlatul Ulama University Surabaya
  • Muzaijadah Retno Arimbi Department of Internal Medicine - Pulmonology, Faculty of Medicine, Wijaya Kusuma University Surabaya
  • Lysa Veterini Department of Pathology and Anatomy, Faculty of Medicine, Universitas Nahdlatul Ulama Surabaya,Indonesia
  • Yunita Lestari Indrianto Faculty of Medicine, Universitas Brawaijaya Malang, Indonesia
  • Naura Anindya Candini Doctor Profession, Faculty of Medicine, Universitas Brawijaya
  • Hari Basuki Notobroto Department of Public Health, Faculty of Public Health, Universitas Airlangga, Indonesia



Pulmonary TB, Thorax Photo, Sputum BTA


Background: Pulmonary tuberculosis (TB) is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis. Diagnosis of TB can be confirmed in two ways, namely bacteriological diagnosis (if AFB sputum is found (+) and clinical diagnosis is (if BTA sputum is found (-), but chest X-ray is (+) TB).

Objective: to determine the alignment of sputum conversion and extensive resolution of intensive phase lesions on chest radiographs which determine the prognosis of pulmonary TB therapy.

Methods: The study design was a retrospective cohort analytic with a retrospective longitudinal study design. Data from medical records of pulmonary TB patients who have undergone therapy for six months or more at the Pulmonary Polyclinic RSI Jemursari Surabaya. The number of samples was 48 patients aged 41-60 years. All of these pulmonary TB patients were smear positive (BTA+). X-ray examination was done before and after therapy.

Results: analysis using the Wilcoxon Signed Rank test to assess differences in the grade of lung lesions before and after therapy, obtained p = 0.003 (p <0.05) meaning there is a significant difference. Sputum conversion was also carried out after therapy, 89.6% of TB patients in this study experienced sputum conversion (BTA negative). To determine the alignment of sputum conversion with the resolution of lesion area, Kappa coefficient analysis K=0.033 (p>0.05) was performed with the results of 50% of patients, 47.9% showed improvement in lung lesions and sputum conversion, while 2.1% showed no improvement of lung lesions and no sputum conversion. The rest, 50% showed no congruence in the results of lung lesion repair and sputum conversion.

Conclusion: The results of Kappa coefficient analysis showed that K=-0.110 (p>0.05) showed that there was no congruence between the results of chest x-ray examination of lung lesions before and after therapy (improved or not) with sputum conversion


Download data is not yet available.


Abdelaziz MM, Bakr WMK, Hussien SM, Amine AEK. Diagnosis of pulmonary tuberculosis using Ziehl-Neelsen stain or cold staining techniques? J Egypt Public Health Assoc. 2016;91(1):39–43.

Agarwal S, Caplivski D, Bottone EJ. Disseminated tuberculosis presenting with finger swelling in a patient with tuberculous osteomyelitis: a case report. Ann Clin Microbiol Antimicrob. 2005;4:18.

Alzayer Z, Nasser Y Al. Primary Lung Tuberculosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021.

Asmar S, Drancourt M. Rapid culture-based diagnosis of pulmonary tuberculosis in developed and developing countries. Front Microbiol. 2015;6:1184.

Kementerian Kesehatan Republik Indonesia. Petunjuk Teknis Pemeriksaan TB Menggunakan Tes Cepat Molekuler. Jakarta: Gerakan Masyarakat Hidup Sehat; 2017.

Keputusan Menteri Kesehatan Repulik Indonesia. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Tuberkulosis. 2019.

Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017;64(2):111–5.

Nachiappan AC, Rahbar K, Shi X, Guy ES, Barbosa M, J E, et al. Pulmonary Tuberculosis: Role of Radiology in Diagnosis and Management. RadioGraphics. 2017;37(1):52–72.

Pedoman Penatalaksanaan TB (Konsensus TB). Pedoman Diagnosis & Penatalaksanaan Tuberkulosis Di Indonesia. PDPI. 2021.

Shah M, Reed C. Complications of tuberculosis. Curr Opin Infect Dis. 2014;27(05):403–10.

Singh SK, Tiwari KK. Clinicoradiological Profile of Lower Lung Field Tuberculosis Cases among Young Adult and Elderly People in a Teaching Hospital of Madhya Pradesh, India. J Trop Med. 2015;2015:230720.

Suryawati B, Saptawati L, Putri AF, Aphridasari J. Sensitivitas Metode Pemeriksaan Mikroskopis Fluorokrom dan Ziehl-Neelsen untuk Deteksi Mycobacterium tuberculosis pada Sputum. Smart Med J. 2018;1(2).

Yang N. Advanced pulmonary tuberculosis. Case study, DOI: 10.53347/rID-8599. Diakses 29 November 2021




How to Cite

Ambarsari, U. ., Arimbi, M. R. ., Veterini, L., Indrianto, Y. L. ., Candini, N. A. ., & Notobroto, H. B. (2023). Synchronization of Sputum Conversion and Resolution of Intensive Phase Lesion Areas on Thorax X-rays Determinants of Prognosis for Pulmonary Tuberculosis Therapy. Medical and Health Science Journal, 7(02), 57–65.