Prevalence of Chest Radiographic Abnormalities Among Individuals with Latent Tuberculosis Infection in Gulf Cooperation Council Countries: A Systematic Review and Meta-Analysis

Latent tuberculosis infection (LTBI) represents a substantial reservoir for future tuberculosis (TB) disease, even in low-incidence settings. Gulf Cooperation Council (GCC) countries, Saudi Arabia, United Arab Emirates, Qatar, Kuwait, Bahrain, and Oman, are classified as low TB burden countries but face unique epidemiological challenges due to high population mobility, large expatriate workforces from TB-endemic regions, and universal Bacillus Calmette–Guérin (BCG) vaccination. Chest radiography (CXR) remains a cornerstone of TB screening across the GCC, particularly in visa medical examinations, healthcare worker surveillance, Hajj and Umrah screening programs, and occupational health assessments. While LTBI is classically defined by the absence of clinical and radiological evidence of active TB, multiple studies have reported radiographic abnormalities suggestive of prior or healed TB including fibrotic scars, calcified nodules, pleural thickening, and volume loss, among individuals with immunologically confirmed LTBI (positive TST or IGRA). The prevalence of these radiographic abnormalities among LTBI-positive individuals varies widely across studies, populations, and screening contexts. Some reports suggest that a substantial proportion of LTBI cases exhibit abnormal chest radiographs, leading to additional investigations such as chest CT, sputum testing, and prolonged clinical follow-up. However, no systematic review or meta-analysis has synthesized the prevalence of chest radiographic abnormalities among LTBI cases in the GCC region, despite the heavy reliance on imaging in regional TB control programs.