Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Abstract

Objective: We describe chest radiograph (CXR) findings in a population with a high prevalence of human immunodeficiency virus (HIV) and tuberculosis (TB) in order to identify radiological features associated with TB; to compare CXR features between HIV-seronegative and HIV-seropositive patients with TB; and to correlate CXR findings with CD4 T-cell count. Methods: Consecutive adult patients admitted to a national referral hospital with a cough of duration of 2 weeks or longer underwent diagnostic evaluation for TB and other pneumonias, including sputum examination and mycobacterial culture, bronchoscopy and CXR. Two radiologists blindly reviewed CXRs using a standardised interpretation form. Results: Smear or culture-positive TB was diagnosed in 214 of 403 (53%) patients. Median CD4+ T-cell count was 50 cells mm -3 [interquartile range (IQR) 14-150]. TB patients were less likely than non-TB patients to have a normal CXR (12% vs 20%, p50.04), and more likely than non-TB patients to have a diffuse pattern of opacities (75% vs 60%, p50.003), reticulonodular opacities (45% vs 12%, p,0.001), nodules (14% vs 6%, p50.008) or cavities (18% vs 7%, p50.001). HIV-seronegative TB patients more often had consolidation (70% vs 42%, p50.007) and cavities (48% vs 13%, p,0.001) than HIV-seropositive TB patients. TB patients with a CD4+ T-cell count of #50 cells mm -3 less often had consolidation (33% vs 54%, p50.006) and more often had hilar lymphadenopathy (30% vs 16%, p50.03) compared with patients with CD4 51-200 cells mm -3 . Conclusion: Although different CXR patterns can be seen in TB and non-TB pneumonias there is considerable overlap in features, especially among HIVseropositive and severely immunosuppressed patients. Providing clinical and immunological information to the radiologist might improve the accuracy of radiographic diagnosis of TB.

Diagnostics for pulmonary tuberculosis

“…In a study from the UK, Amsterdam and Rotterdam looking at newer digital chest X-ray technology, the sensitivity of radiologists and chest physicians for detecting culture-positive TB on chest X-ray was a similar 77% 21. HIV-coinfected TB patients are less likely to have typical chest X-ray infiltrates, especially with declining CD4 cell counts 22. In a community survey in high TB-prevalent and HIV-prevalent South Africa, the specificity for any abnormal chest X-ray was 67%, and when limited to typical changes it was 83% 23…”

Pneumonia in the developing world: Characteristic features and approach to management

“…In practice, there is considerable overlap in the pattern of radiological features seen in patients with PCP and bacterial pneumonia . In HIV, the radiographical features of TB become more variable with increasing degrees of immunocompromise . Whilst standardized reporting tools and computer‐aided systems both reduce the inter‐observer variability of interpretation, the inherent limitations of the modality still apply .…”

Abdominal Sonographic Findings in Severely Immunosuppressed Human Immunodeficiency Virus-Infected Patients Treated for Tuberculosis

“…were examined by Ziehl Nielsen (ZN) stain and Lowenstein Jensen (LJ) culture for TB (details of the microbiological findings have been published elsewhere) [11].…”

“…Patients with abdominal TB tend to present with abdominal pain, weight loss and fevers [5] [7] [11] [21]- [24]. However, a definitive diagnosis in developing countries with high prevalence of HIV is often a challenge due to but not limited to: low sensitivity and specificity of the clinical symptoms, the paucity of radiological and diagnostic modalities, and difficulties in accessing the affected tissues for a diagnostic specimen [6] [28].…”