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Chest X-Ray Features of Drug Resistance Tuberculosis in Pediatric Population; A Prospective Study in High-Endemic
Sarika Gupta1, Harshika Khanna1, Vidushi Gupta1
1Department of Pediatrics, King George's Medical University, Lucknow, India.
Insights
Pediatric drug-resistant tuberculosis (DRTB) often shows cavitary lesions or consolidation on chest X-rays (CXRs). These findings can help doctors start treatment early for children with suspected DRTB.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Infectious Diseases
Background:
- Pediatric tuberculosis (TB) diagnosis can be challenging, especially for drug-resistant TB (DRTB).
- Early identification of DRTB in children is crucial for effective treatment and preventing transmission.
- Chest X-ray (CXR) plays a role in TB diagnosis, but distinguishing drug-sensitive TB (DSTB) from DRTB requires specific indicators.
Purpose of the Study:
- To identify characteristic chest X-ray (CXR) findings in pediatric pulmonary drug-resistant tuberculosis (DRTB).
- To compare CXR patterns in pediatric DRTB versus drug-sensitive TB (DSTB).
- To aid in the early identification and treatment of pediatric DRTB.
Main Methods:
- A prospective cross-sectional study involving 237 pediatric TB patients (1 month to 18 years).
- CXR patterns were categorized, including pleural effusion, cavity lesion, lymphadenopathy, consolidation, pneumothorax, and others.
- Adjusted logistic regression analysis identified CXR patterns suggestive of DRTB.
Main Results:
- Cavitary TB lesions (OR=2.62) and consolidation (OR=2.29) were significantly associated with DRTB in pediatric patients.
- These associations remained significant after adjusting for age, gender, and socioeconomic status.
- The study analyzed 175 DSTB and 62 DRTB cases.
Conclusions:
- Cavitary lesions and consolidation on CXR should alert pediatricians to the possibility of DRTB in children.
- These CXR patterns can guide the early initiation of therapy for presumptive or probable DRTB.
- Radiographic findings may expedite DRTB treatment while awaiting microbiological confirmation.
Objective:
To identify chest X-ray (CXR) characteristic of Pediatric pulmonary drug-resistant tuberculosis (DRTB) in comparison to drug sensitive tuberculosis (DSTB) for early identification and treatment of DRTB.
Methods:
This was a prospective cross-sectional study in which CXR patterns of DS and DR patients aged 1 month to 18 years were categorized into different variants including pleural effusion, cavity lesion, hilar or mediastinal lymph node (LN), consolidation, pneumothorax, pericardial effusion, miliary TB, nodular shadow, and collapse. The consensus between the pulmonary physician and radiologist was measured using weighted kappa test. Adjusted logistic regression analysis was used to identify DRTB suggestive CXR pattern.
Results:
From June 1, 2022 to May 31, 2023, 237 pulmonary TB subjects were recruited. Out of 175 DSTB subjects, 47 were below the age of 12 and 128 were above the age of 12. 62 were microbiologically confirmed DRTB where 12 were below the age of 12 and 50 were above the age of 12. Cavitary TB lesions (p = 0.001) and Consolidation (p = 0.003) were found significant in DR patients. Adjusting for age, gender, socioeconomic status DRTB was associated with cavity lesion (OR = 2.62; 95% CI = 1.39-4.93; p = 0.001) and consolidation (OR = 2.29; 95% CI = 1.27-4.14; p = 0.003).
Conclusion:
We conclude that presence of cavitary lesion or consolidation in "presumptive" or "probable" DRTB patients should alert pediatricians. Our findings suggest that these DR suggestive CXR pattern can guide for early start of therapy while awaiting microbiological report.
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