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Radiographic findings and patterns in multidrug-resistant tuberculosis
J E Fishman1, G J Sais, D S Schwartz
1Department of Radiology, Jackson Memorial Hospital, University of Miami School of Medicine, Florida 33101, USA.
Journal of Thoracic Imaging
|January 24, 1998
Summary
Chest X-rays for multidrug-resistant tuberculosis (MDR TB) show similar patterns to drug-sensitive TB. However, MDR TB presentation differs based on acquisition, with outbreaks showing primary patterns and noncompliance showing postprimary patterns.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Multidrug-resistant tuberculosis (MDR TB) poses a significant public health challenge, particularly in urban settings with high HIV prevalence.
- Understanding radiographic differences between MDR TB and drug-sensitive TB (DS TB) is crucial for diagnosis and management.
Purpose of the Study:
- To retrospectively evaluate and compare chest radiographic findings in MDR TB patients versus DS TB patients.
- To identify distinct radiographic patterns associated with different modes of MDR TB acquisition.
Main Methods:
- Retrospective analysis of chest radiographs from MDR TB and DS TB patients.
- Comparison of radiographic findings, including consolidation, cavitation, and pleural effusion.
- Correlation of radiographic patterns with patient history, specifically TB treatment and acquisition source (outbreak vs. noncompliance).
Main Results:
- Overall radiographic findings were similar between MDR TB and DS TB.
- MDR TB patients from outbreaks often presented with noncavitary consolidations, pleural effusions, and primary radiographic patterns (70%).
- MDR TB patients with noncompliance-acquired infection frequently showed cavitary consolidations (50%) and postprimary patterns.
- Cavitation in MDR TB occurred similarly in HIV-positive patients irrespective of CD4 count.
- Approximately one-third of patients did not exhibit the expected radiographic pattern.
Conclusions:
- Chest radiographic patterns in MDR TB are most accurately interpreted when considered alongside clinical history, particularly prior treatment.
- Distinguishing between outbreak-related and noncompliance-related MDR TB acquisition can be aided by radiographic pattern analysis.
- Radiographic interpretation requires careful consideration of clinical context due to variability in presentation.