I don't think. Only an ESR can't tell this. Well! It can be supportive to other diagnosis or suggestive along with other parameters/diagnosis. Microbiological/ mycobacteriological, immunological and radiological diagnosis are needed. ESR increases in several chronic infectious diseases (e.g., infective endocarditis etc.) not only in tuberculosis.

Regards

Surajit is correct, there is no way you may predict TB only from ESR, as it is a very non specific inflammatory marker. combine it with a full blood panel, chest xray, and clinical history, and then you may be able to predict (diagnose) TB.

Please review the following references

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See comment in PubMed Commons belowInt J Tuberc Lung Dis. 2000 Mar;4(3):237-9.

Erythrocyte sedimentation rate in childhood tuberculosis: is it still worthwhile?

Al-Marri MR1, Kirkpatrick MB.

Author information

1Pulmonary and Critical Care Medicine, Qatar Armed Forces Medical Unit and Hamad General Hospital, Doha. [email protected]

Abstract

OBJECTIVE:

To evaluate the utility of the erythrocyte sedimentation rate (ESR) in the diagnosis of childhood tuberculosis.

DESIGN:

Data were collected retrospectively from the Qatar National Tuberculosis (TB) Registry for children (birth to 14 years of age) from 1983 to 1996. The diagnosis of active tuberculosis was based on positive sputum cultures (or histology) or an abnormal chest radiograph that responded to anti-tuberculosis chemotherapy.

RESULTS:

Of 144 childhood TB patients, 68 (47%) had an ESR documented at the time of diagnosis. Twenty-two children (33%) had a normal ESR ( or =10 mm/hour) at the time of diagnosis. Culture positive and symptomatic children had significantly higher ESR values than culture negative and asymptomatic children, respectively, at the time of diagnosis. There was no significant difference in ESR values for children with extrapulmonary versus pulmonary disease, and likewise no significant correlation between either age or size of tuberculin skin test reactivity and ESR values.

CONCLUSION:

Although an elevated ESR may be expected in children with tuberculosis, this study found that one-third of children with TB had a normal ESR at the time of diagnosis, and consequently there would seem to be little value in using ESR as a diagnostic test for childhood tuberculosis.

Erythrocyte sedimentation rate values in active tuberculosis with and without HIV co-infection

May 2006, Vol. 96, No. 5 SAMJ

I S Ukpe, L Southern

You need to first understand the way ESR functions. It requires something called Rouleaux formation. This in turn is influenced by other immunological factors such as acute phase reactants and immunoglobulins. When the body is immunosuppressed, these values no longer remain valid - the body can't mount a reaction to the existing infection.

 There are other simpler chronic infection markers. For example, reactive thrombocytosis (you need to correlate to clinical signs/symptoms) would indicate an underlying chronic infection like TB (significantly raised platelet levels).

 A positive test does not predict but merely provides you with means to suspect tuberculosis.

Rabin

ESR is a nonspecific test and I agree with comments that this test should not be used for diagnosis of TB .Also we can not judge the response to therapy by serial ESR test as practiced by some doctors.

I think  ESR is useful  in  the follow-up  rather than the diagnosis

In this study they founded some a relation of ESR with patients HIV positive TB confirmed bacteriologically.

Lawson L, Yassin MA, Thacher TD, et al. Clinical presentation of adults with pulmonary tuberculosis with and without HIV infection in Nigeria. Scand J Infect Dis. 2008;40(1):30-35

I have the same opinion as Sandip. Sputum(microscopy) and/or culture is better as ESR is lacking specificity and sensitivity. It could be indication for other diseases

Although ESR can be raised in any systemic inflammatory conditions and in different malignancies, we can predict for tuberculosis in clinical association with other findings like, prolonged fever, wt loss, recc cough, e/o lymphadenopathy etc. If ESR is more than 100 mm AEFH, we have to consider few differential diagnosis e.g. Tuberculosis, Multiple Myeloma, SLE/Vasculitis, Polymyalgia Rheumatica and Giant cell arteritis.

Thanks for all of your opinions and articles attached. I do agree with Mr Lawrence. But also with Mr Bhupen  and Sandip. Sputum microscopy, culture techniques are sensitive but in conditions of sputum smear negative, in resource constrained settings,elevated ESR of more than 75mm correlating to clinical conditions (fever, wt loss,cough,.....) could be served as one of the tool to predict TB?  obviously culture/molecular techniques depending on resource settings can in-turn be used to confirm TB.

ESR in other infections also get elevated but correlating to clinical conditions could be used to suspect and diagnose TB.

Any kind of bacterial infection will elevated ESR. ESR is additional confirmative lab test rather than decisive tool. Clinical symptom also play important role to confirm the diagnosis. With ESR we can't confirm TB , but it assist physician in diagnosis...   

I'll go with Sandip.ESR is not sensitive and far less specific for TB.In the past,we used it to monitor treatment for want of other modalities for monitoring therapy in adults.The advent of more convenient culture methods,better isolation of organisms,PCR has made ESR less attractive.

Various studies showed that ESR values were found to be significantly raised in patients with tuberculosis.

Maurya, in those studies described, was all other confounding factors accounted for? ESR is known to be a highly non specific lab test. Do post those studies so that we can all verify this fact.

ESR can not predict tuberculosis because it is non specific test and there are many other conditions where ESR is rised.

But we can always rule  out tuberculosis by doing other specific tests when ESR is rised

As Sandip said you have to take the decision holistically, also it could be a diagnosis of exclusion after you have ruled out all other causes for a raised ESR

Dear  Vinaykumar Hallur   I think  we have to  agree with  Saileela Kondapaneni opinion

Warm  Regards

I fully agree that ESR is a non specific test and can be increased in lot of conditions including TB. Occasionally in the work up of a patient with PUO  elevated ESR may be the only abnormality found in cases of Cryptic TB. Therapeutic trial of anti_ TB treatment is indicated in such cases where you have excluded other causes of PUO.

Elevated ESR though not a specific test for TB, few TB studies show elevated ESR. obviously correlating with clinical symptoms and elevated ESR can serve as one of the tool to suspec and diagnose especially in smear negative TB cases

ESR by itself  not consider as diagnostic test for TB, but it is a screening test and when its high in patients can raised the suspicion of TB in associated with other parameters.

ESR is a non specific test and is therefore elevated in a number a condition ranging from anaemia to infections. In the case where Tb is strongly suspected, even when slides are negative, request a chest x-ray to determine the presence of pulmonary involvement. Otherwise try concentrating the sputum specimen and repeat the microscopy. This will increase the sensitivity of your microscopy. Culturing may also be helpful.

I agree with  you Kwenti Emmanuel Tebit 

ESR is non specific 

ESR is very non-specific in all types of TB -Does not confirm, refute, predict nor help in progress

ESR is non specic.In our set up most of the time it is used as one criteria of suspicion for TB infection.After rulling out other possible infection.TB can be diagnosed.

Raised ESR alone can never be a true predictor for TB until and unless proven otherwise.

The latest  researches identified a minimum rise in ESR even in HIV positive or negative patients..

Similarly is for smear positive or negative cases as well

ESR is a non specific tests for diagnosis of any disease. The major mechanism of ESR is anchored on rouleuax formation which is precipitated by increase in acute phase protein like CRP, immunolgoins and inflmmation. Although, there is marked increase in ESR of Tb patients which could be as a result of anaemia and cytokine interplay.It is important to correlate clinical details of the patients with other investigations to arrive at conclusion of TB infection.

A v comprehensive and accurate interpretation Emmanuel

Undoubtedly, ESR can't predict tuberculosis; however, elevated level of ESR predict that the body had acquired an infection ( It might be TB).Therefore, ESR may be useful to diagnose TB only with TB specific test.

The advancement in tb fiagnosis invludes confirmation by gene xpert test eith rpo gene resistance and quantiferon tb gold.

So without confirmation only a clue can be analysed by raised ESR

Certainly raised ESR does not confirm nor a moral ESR refutes the diagnosis.

We have seen lots of cases of TB With moral ESR

I ve seen patients even with ESR ranging between 20 to 25 turned to be positive for AFB culture and sensitivity

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