Talk:Tuberculosis/GA1
GA Review[edit]
| GA toolbox |
|---|
| Reviewing |
Article (edit | visual edit | history) · Article talk (edit | history) · Watch
Reviewer: Axl (talk · contribs) 20:30, 20 April 2012 (UTC)
Okay, I'll review it. Axl ¤ [Talk] 20:30, 20 April 2012 (UTC)
From the lead section, paragraph 2: "Diagnosis relies on ... blood tests." Diagnosis does not rely on blood tests. Axl ¤ [Talk] 20:31, 20 April 2012 (UTC)
- The ref says "Tuberculin skin test has been the only screen avliable for the diagnosis of latent infection with TB. Its major failing is its inability to reliably distinguish individuals infects from individuals immunized with BCG. IGRAs were developed whereby interferon-gama titres were measured after in vitro stimulation of peripheral blood mononuclear cells... These have now become the gold standard for identifying individuals whose immune system has previously encountered MTB" It is a blood test. 90% of the population has been immunized with BCG.
- IGRAs can be used as rule out but not rule in tests for diagnosis of active tuberculosis.Page 64 of the Lancet.--Doc James (talk · contribs · email) 04:07, 21 April 2012 (UTC)
On a related note, from "Diagnosis", subsection "Active tuberculosis", paragraph 1: "a tuberculin skin test (Mantoux test) or a interferon gamma release assay are typically part of the initial evaluation." An IGRA is not typically part of the initial evaluation. Axl ¤ [Talk] 20:37, 20 April 2012 (UTC)
From the lead section, paragraph 2: "Antibiotic resistance is a growing problem in (extensively) multiple drug-resistant tuberculosis." I don't think that "extensively" needs to included in parentheses here in the lead section. XDR is mentioned in the "Management" section. Axl ¤ [Talk] 20:49, 20 April 2012 (UTC)
From "Signs and symptoms": "General symptoms such as: fever, chills, night sweats, appetite loss, weight loss, fatigue, and finger clubbing may also occur." Finger clubbing is not a symptom. (Fever and weight loss may be both signs and symptoms.) Axl ¤ [Talk] 20:59, 20 April 2012 (UTC)
From "Signs and symptoms", subsection "Pulmonary": "Spitting up stones known as lithoptysis has been described due to bronchial lymph nodes communicated with the airways." I wasn't aware of that symptom. A PubMed search for "lithoptysis" revealed only 23 results. Most of these describe broncholithiasis, often in association with bronchiectasis. Admittedly TB can cause bronchiectasis and broncholithiasis. However I believe that this symptom is exceedingly rare, in my opinion not worth mentioning in this article. Axl ¤ [Talk] 21:25, 20 April 2012 (UTC)
- It is mentioned in "Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. pp. Chapter 250" But yes I assume it is very uncommon. Doc James (talk · contribs · email) 05:50, 21 April 2012 (UTC)
From "Signs and symptoms", subsection "Extrapulmonary": "In the other 25% of active cases, the infection moves from the lungs." The first 75% haven't been explicitly noted. Axl ¤ [Talk] 21:30, 20 April 2012 (UTC)
From "Causes", subsection "Mycobacteria", paragraph 1: "The main cause of TB is Mycobacterium tuberculosis, a small, aerobic nonmotile bacillus or less commonly, the closely related Mycobacterium bovis." The third paragraph goes on to discuss MTB complex, including M. bovis. Perhaps remove the mention of M. bovis from the first paragraph? Axl ¤ [Talk] 09:56, 21 April 2012 (UTC)
From "Causes", subsection "Mycobacteria", paragraph 1: "Mycobacteria have an outer membrane lipid bilayer, yet microbiology textbooks continue to classify them as a Gram-positive bacteria." This sentence implies that the reader should know that the presence of an outer membrane lipid bilayer precludes the label of Gram-positive bacteria. The sentence needs to be refactored, in conjunction with the subsequent sentence. Axl ¤ [Talk] 10:03, 21 April 2012 (UTC)
From "Causes", subsection "Mycobacteria", paragraph 2: "The most common acid-fast staining technique, the Ziehl-Neelsen stain, dyes AFBs a bright red that stands out clearly against a blue background. Other ways to visualize AFBs include an auramine-rhodamine stain and fluorescent microscopy." These sentences do not have a reference. In the UK, I believe that auramine-rhodamine is more commonly used, although I have been unable to find a reference. Interestingly, Mandell, Douglas & Bennett states: "Fluorescent stains [such as auramine-rhodamine] are more sensitive for the detection of mycobacteria, particularly in direct specimens, because the organisms stain brightly and can be clearly distinguished from background material." Axl ¤ [Talk] 18:02, 23 April 2012 (UTC)
The latter sentence: "Other ways to visualize AFBs include an auramine-rhodamine stain and fluorescent microscopy." seems to imply that auramine-rhodamine is a distinct technique separate from fluorescence microscopy. Axl ¤ [Talk] 18:05, 23 April 2012 (UTC)
From "Causes", subsection "Risk factors": "Worldwide, the most important of these is HIV, with coinfection present in about 13% of cases." Can this sentence be simplified to make it easier for lay readers to understand? Actually, I think that the "Risk factors" subsection should be in "Epidemiology", not "Causes". Axl ¤ [Talk] 18:34, 23 April 2012 (UTC)
- I usually put my comments on risk factors in the section on causes rather than epidemiology. I think it usually fits better their. In epidemiology I than discuss how common the condition is in which parts of the world and how the rate is changing over time. Doc James (talk · contribs · email) 12:48, 24 April 2012 (UTC)
From "Mechanism", subsection "Transmission", paragraph 2: "Others at risk include people in areas where TB is common, people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (eg. prisons, homeless shelters), medically underprivileged and resource-poor populations, high-risk racial or ethnic minorities, children in close contact with high-risk category patients, those who are immunocompromised by conditions such as HIV infection, people who take immunosuppressant drugs, and health care providers serving these clients." This list should be in the "Epidemiology" section, along with the other risk factors. Axl ¤ [Talk] 11:00, 24 April 2012 (UTC)
From "Mechanism", subsection "Transmission", paragraph 3: "The cascade of person-to-person spread can be circumvented by effective segregation of those with active (overt) TB, and putting them on recommended anti-TB drug regimens." Is the word "recommended" required here? Axl ¤ [Talk] 09:55, 26 April 2012 (UTC)
From "Pathogenesis", paragraph 1: "About 90% of those infected with M. tuberculosis have asymptomatic, latent TB infections (sometimes called LTBI), with only a 10% lifetime chance that a latent infection will progress to TB disease." This is referenced to Robbins Basic Pathology. I found the following text in Robbins Basic Pathology: "About 5% of those newly infected develop significant disease [primary tuberculosis].... In approximately 95% of cases, development of cell-mediated immunity controls the infection." Regarding the development of secondary TB (i.e. reactivation of LTBI), Robbins states: "Whatever the source of the organism, only a few individuals (less than 5%) with primary disease subsequently develop secondary tuberculosis." Axl ¤ [Talk] 09:52, 27 April 2012 (UTC)
- The WHO reference states: "People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%." However primary TB isn't distinguished from LTBI reactivation in this figure. Axl ¤ [Talk] 18:04, 27 April 2012 (UTC)
From "Signs and symptoms", subsection "Pulmonary": "The upper lungs are believed to be more frequently affected due to their poor lymph supply rather than more air flow." This is referenced to Mandell, Douglas & Bennett. The reference supports the statement. However Robbins Basic Pathology states: "Secondary pulmonary tuberculosis is classically localized to the apex of one or both upper lobes. The reason is obscure but may relate to high oxygen tension in the apices." Axl ¤ [Talk] 09:56, 27 April 2012 (UTC)
From "Mechanism", subsection "Pathogenesis", paragraph 1: "However, if effective treatment is not rendered, the death rate for active TB cases is more than 50%." The reference (WHO) states: "Without proper treatment up to two thirds of people ill with TB will die." Axl ¤ [Talk] 19:47, 30 April 2012 (UTC)
"Mechanism", subsection "Pathogenesis", paragraph 2 has duplicate text describing Simon foci. Axl ¤ [Talk] 20:00, 30 April 2012 (UTC)
From "Mechanism", subsection "Pathogenesis", paragraph 3: "Tuberculosis is classified as one of the granulomatous inflammatory conditions." How about "diseases" instead of "conditions"? Axl ¤ [Talk] 20:07, 30 April 2012 (UTC)
From "Mechanism", subsection "Pathogenesis", paragraph 3: "Another feature of the granulomas of human tuberculosis is the development of abnormal cell death (necrosis) in the center of tubercles." Why is this called out as "human tuberculosis"? Is this specific to humans? The reference states: "The caseous necrosis is the basic process of tuberculosis disease in humans." Axl ¤ [Talk] 20:14, 30 April 2012 (UTC)
From "Mechanism", subsection "Pathogenesis", paragraph 4: "This severe form of TB disease, most common in infants and the elderly, is called miliary tuberculosis." I am surprised that HIV/AIDS isn't mentioned. This reference states: "In North America, miliary TB is most common in elderly people and in HIV-infected patients." Axl ¤ [Talk] 20:44, 30 April 2012 (UTC)
- Yes and fixed --Doc James (talk · contribs · email) 01:39, 4 May 2012 (UTC)
- Given that the new reference is Textbook of Pediatric HIV care, I'm not convinced that it supports the statement indicating high incidence: "This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis." Axl ¤ [Talk] 19:18, 4 May 2012 (UTC)
- The ref is/was [1] --Doc James (talk · contribs · email) 20:01, 4 May 2012 (UTC)
- You have missed my point. The textbook is about paediatric HIV disease. We cannot infer that miliary TB is common in young children, or even that it is more common than in adults. Axl ¤ [Talk] 21:37, 4 May 2012 (UTC)
- Hum. Okay added a couple of different refs and than there is this one http://books.google.ca/books?id=8dfhwKaCSxkC&pg=PA75 --Doc James (talk · contribs · email) 22:11, 4 May 2012 (UTC)
- You have missed my point. The textbook is about paediatric HIV disease. We cannot infer that miliary TB is common in young children, or even that it is more common than in adults. Axl ¤ [Talk] 21:37, 4 May 2012 (UTC)
- The ref is/was [1] --Doc James (talk · contribs · email) 20:01, 4 May 2012 (UTC)
- Given that the new reference is Textbook of Pediatric HIV care, I'm not convinced that it supports the statement indicating high incidence: "This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis." Axl ¤ [Talk] 19:18, 4 May 2012 (UTC)
From "Mechanism", subsection "Pathogenesis", paragraph 4: "People with this disseminated TB have a fatality rate near 100% if left untreated. However, if treated early, the fatality rate is reduced to about 10%." The reference is Kim, "Miliary tuberculosis and acute respiratory distress syndrome". I don't have access to the paper. However it looks like a primary source. The paper seems to be about miliary TB with ARDS, not miliary TB alone. What exactly does the source say about mortality rate? I am struggling to find a source that gives mortality rates for miliary TB, untreated & treated. Axl ¤ [Talk] 17:36, 1 May 2012 (UTC)
From "Diagnosis", subsection "Active tuberculosis", paragraph 2: "However, the difficult culture process for this slow-growing organism can take four to 12 weeks for blood or sputum culture." The reference is the NICE guideline. Culture really shouldn't take more than six weeks – and even that is usually in cases where mycobacteria are not actually TB. In any case, I can't find the statement in the reference. The reference has 307 pages and it is unhelpful to quote the whole document as the source for a single statement. The main purpose of referencing is for verifiability. Axl ¤ [Talk] 18:13, 1 May 2012 (UTC)
- Ref was just for the very last sentence. Have corrected the statement in question and provided a ref.Doc James (talk · contribs · email) 09:18, 4 May 2012 (UTC)
From "Diagnosis", subsection "Latent tuberculosis": "These are not affected by immunization or environmental mycobacteria, so they generate fewer false-positive results." There are some mycobacteria that create false positives: notably M. szulgai, M. marinum and M. kansasii. "Clinical evaluation of the QuantiFERON-TB Gold test in patients with non-tuberculous mycobacterial disease". Axl ¤ [Talk] 19:02, 1 May 2012 (UTC)
From "Diagnosis", subsection "Latent tuberculosis": "There is also evidence IGRAs are more sensitive than the skin test." This is referenced to Lalvani. This looks like a letter, not a secondary source. Also, Lalvani is the guy who invented T-SPOT.TB. Axl ¤ [Talk] 10:40, 3 May 2012 (UTC)
From "Causes", subsection "Risk factors": "Chronic lung disease is another significant risk factor - smoking more than 20 cigarettes a day seems to increase the risk of TB by two to four times." Smoking isn't a chronic lung disease. Axl ¤ [Talk] 18:04, 4 May 2012 (UTC)
In "Causes", subsection "Risk factors", can I recommend this 2010 review article from the European Respiratory Journal over the existing 2006 article from Transactions of the Royal Society of Tropical Medicine and Hygiene? Axl ¤ [Talk] 19:38, 6 May 2012 (UTC)
From "Prognosis", paragraph 1: "These dormant bacilli can produce tuberculosis in 2% to 23% of these latent cases, often many years after infection." It's odd that this range is quoted; earlier in the article, 10% lifetime risk of re-activation of LTBI is quoted. Axl ¤ [Talk] 19:51, 6 May 2012 (UTC)
From "Epidemiology", paragraph 1: "However, not all infections with M. tuberculosis cause TB disease, and many infections are asymptomatic." 90–95% are asymptomatic at the time of infection. Axl ¤ [Talk] 09:18, 7 May 2012 (UTC)
From "Epidemiology", paragraph 2: "China has achieved particularly dramatic progress, with an approximate 80% decline in its TB mortality rate." Over what period of time? Axl ¤ [Talk] 10:05, 7 May 2012 (UTC)
From "Epidemiology", paragraph 2: "Hopes of totally controlling the disease have been dramatically dampened because of a number of factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, and the emergence of drug-resistant cases in the 1980s." What about HIV? Axl ¤ [Talk] 21:32, 8 May 2012 (UTC)
From "Epidemiology", paragraph 3: "These rates contrast with 98 per 100,000 in China and 48 per 100,000 in Brazil." Why are China and Brazil singled out for comparison with Western Europe? Axl ¤ [Talk] 10:32, 9 May 2012 (UTC)
- Both are very large countries. I guess I could add India aswell... --Doc James (talk · contribs · email) 00:43, 12 May 2012 (UTC)
- Okay removed most country specific data and replaced it with region specific data. --Doc James (talk · contribs · email) 00:57, 12 May 2012 (UTC)
- Both are very large countries. I guess I could add India aswell... --Doc James (talk · contribs · email) 00:43, 12 May 2012 (UTC)
In "Epidemiology", I wonder if the last paragraph should be in the "History" section? Axl ¤ [Talk] 10:39, 9 May 2012 (UTC)
From "History", paragraph 1: "A genomic approach comparing M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests that humans did not acquire MTBC from animals during animal domestication, as was previously believed." For the benefit of lay readers, what is a "genomic approach"? Axl ¤ [Talk] 10:53, 9 May 2012 (UTC)
From "History", paragraph 1: ""Phthisis" is a Greek term for consumption." Again, for the benefit of lay readers, what is "consumption" in this context? Axl ¤ [Talk] 11:04, 9 May 2012 (UTC)
From "History", last paragraph: "This technique [artificial pneumothorax] was of little or no benefit and was largely abandoned by the 1950s." Was it really of little/no benefit? I can only view the abstract of the reference. The full article is in German so I won't understand it anyway. Axl ¤ [Talk] 18:11, 9 May 2012 (UTC)
Break[edit]
From "Society and culture": "One molecular diagnostics test which gives results in 100 minutes is currently being offered to 116 low- and middle-income countries at a discount with support from the World Health Organization and the Bill and Melinda Gates Foundation." The merits of the test are being emphasized rather than the cultural impact and charitable work. The position of this test in a formal screening or diagnostic protocol is still being evaluated. The reference is Reuters, which shouldn't be used to describe the merits of the test itself when peer-reviewed medical sources are available. Axl ¤ [Talk] 18:34, 9 May 2012 (UTC)
- Have added a second ref supporting the science part of it.--Doc James (talk · contribs · email) 02:01, 12 May 2012 (UTC)
- The problem here is that the section is "Society and culture". Currently, the text emphasizes the significance of the test, not the societal impact of the WHO and Bill & Melinda Gates Foundation. The short time to a result is not relevant in this section. The text needs to be re-factored to make the societal impact more prominent. Something like: "The World Health Organization and the Bill and Melinda Gates Foundation are subsidizing a new fast-acting diagnostic test for use in low- and middle-income countries." Axl ¤ [Talk] 10:43, 13 May 2012 (UTC)
- Have added a second ref supporting the science part of it.--Doc James (talk · contribs · email) 02:01, 12 May 2012 (UTC)
From "Society and culture", paragraph 1: "It is useful for diagnosis MDR-TB or HIV-associated TB." Again, this isn't really relevant in "Society and culture". Axl ¤ [Talk] 10:56, 13 May 2012 (UTC)
From "Society and culture": "Implementation is pending for programs similar to the Revised National Tuberculosis Control Program that has helped reduce TB levels amongst people receiving public health care." This statement implies that RNTCP is now defunct. Is that correct? The reference is from "Hypothesis" Journal. This journal doesn't appear to be listed on PubMed. Although there does seem to be a degree of peer review, they state: "We aim to establish an interdisciplinary journal that swiftly publishes new, provocative, and sometimes currently untestable ideas". I am not convinced that this journal is a suitable secondary source for referencing Wikipedia's articles. Axl ¤ [Talk] 18:49, 9 May 2012 (UTC)
Regarding the x-ray in the Infobox, it would be helpful if the caption stated the significance of the arrows. Axl ¤ [Talk] 20:13, 11 May 2012 (UTC)
Summary[edit]
I am just waiting on Doc James to address a few more points above. Otherwise, the article looks very good.
- The article is well-written.
- It is accurate and appropriately referenced.
- The article covers the whole topic without undue detail.
- It is neutral in tone.
- The content is stable, without any edit warring.
- The pictures are all freely available from Wikimedia Commons. They help to illustrate the article.
Axl ¤ [Talk] 20:21, 11 May 2012 (UTC)
Okay, the article meets the GA criteria. I am awarding GA status. My thanks and congratulations to Doc James (Jmh649).
There are some areas that can be improved:-
- From "Epidemiology", paragraph 3, the regional incidence values could be better displayed as a table.
- From "Epidemiology", paragraph 3, the information about Canadian aboriginals seems to give undue weight to that population and should be removed.
- The "History" section should include information about thoracoplasty and plombage as well as artificial pneumothorax.
- The references need to be standardized to a single format. Some journal names use abbreviations while others do not; some use capital letters, while others don't.
- Reference 59 (NICE) has several formats, of different length and with different text. The full document is 307 pages long, while the abbreviated document is 63 pages long. In the interest of verifiability, the reference should specify which format is being used, and which page.
Axl ¤ [Talk] 10:53, 14 May 2012 (UTC)
To add[edit]
--Doc James (talk · contribs · email) 21:52, 12 May 2012 (UTC)