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Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal
S D Greenberg1, D Frager, B Suster
1Department of Radiology, St. Luke's-Roosevelt Hospital Center, New York, NY.
Purpose:
To assess the efficacy of chest radiography in the detection of active pulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).
Materials And Methods:
Initial interpretations of chest radiographs of 133 adult patients with AIDS and positive sputum or bronchoalveolar lavage cultures for Mycobacterium tuberculosis were reviewed. Radiographic findings were correlated with CD4 T-cell counts, sputum stains for acid-fast bacilli (AFB), and antituberculous drug sensitivity.
Results:
Forty-eight (36%) patients had a primary M tuberculosis pattern, 38 (28%) had a postprimary M tuberculosis pattern, 19 (14%) had normal radiographs, 17 (13%) had atypical infiltrates, seven (5%) had minimal radiographic changes, and four (3%) had a miliary pattern. Normal chest radiographs were seen for 10 (21%) of 48 patients with less than 200 T cells per microliter and one (5%) of 20 patients with more than 200 T cells per microliter. Drug sensitivity and sputum staining for AFB did not correlate with radiographic findings. Overall, 19% of cases had multidrug resistance to antituberculous medications.
Conclusion:
Chest radiographs did not suggest active tuberculosis in 43 (32%) of 133 AIDS patients with active pulmonary tuberculosis.