Clinical and Radiographic Correlates of Primary and Reactivation Tuberculosis

Geng, Elvin; Kreiswirth, Barry N.; Burzynski, Joseph; Schluger, Neil W.

doi:10.1001/jama.293.22.2740

Cited by 162 publications

(106 citation statements)

References 25 publications

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“…4). Atypical CXR findings are associated with an altered immunity to reactivation and primary TB infection in HIV-infected patients (110). As the CD4 count falls below 200 cells/l, HIV-infected patients with pulmonary TB are more likely to have atypical CXR findings, including pleural effusion, lower or middle lobe infiltrates, mediastinal adenopathy, interstitial nodules, or a normal CXR (33,117,144,210,214).…”

Section: Effect Of Hiv On Tuberculosis: Atypical Presentation and Extmentioning

confidence: 99%

HIV and Tuberculosis: a Deadly Human Syndemic

2011

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SUMMARY A syndemic is defined as the convergence of two or more diseases that act synergistically to magnify the burden of disease. The intersection and syndemic interaction between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have had deadly consequences around the world. Without adequate control of the TB-HIV syndemic, the long-term TB elimination target set for 2050 will not be reached. There is an urgent need for additional resources and novel approaches for the diagnosis, treatment, and prevention of both HIV and TB. Moreover, multidisciplinary approaches that consider HIV and TB together, rather than as separate problems and diseases, will be necessary to prevent further worsening of the HIV-TB syndemic. This review examines current knowledge of the state and impact of the HIV-TB syndemic and reviews the epidemiological, clinical, cellular, and molecular interactions between HIV and TB.

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Section: Effect Of Hiv On Tuberculosis: Atypical Presentation and Extmentioning

confidence: 99%

HIV and Tuberculosis: a Deadly Human Syndemic

2011

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“…First, it is confined to the basal segments of lower lobes, the right middle lobe or lingular, or the anterior segment of an upper lobe and second, it can manifest as a mass-like density that mimics carcinoma, tuberculoma, or reversible multiple cysts (7)(8)(9). Atypical manifestations of pulmonary TB are common in patients with impaired host immunity (10)(11)(12) and are now considered to be manifestations of primary TB (13,14).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease

et al. 2014

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Pulmonary tuberculosis (TB) is a common lung infection worldwide. Detection of acid-fast bacilli (AFB) in stained sputum typically allows for the diagnosis of pulmonary TB (1-3). However, AFB smear results may be negative, and early diagnosis is often difficult if the process is not discovered via radiological means or by a clinician. Early diagnosis is equally as significant as treatment in reducing the morbidity and mortality associated with pulmonary TB. Transthoracic biopsy and fine-needle aspiration have been demonstrated to be valuable for the diagnosis of tuberculosis (3, 4). Specifically, they are beneficial for patients who have unusual manifestations discovered via radiography. The incidence of pulmonary tuberculosis is higher in patients with chronic interstitial lung disease than in the general population. Furthermore, radiologic findings of TB are frequently atypical (5) and findings of patients with underlying emphysema have not been reported.Our purpose in this study was therefore to assess computed tomography (CT) findings in patients with pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB) with negative sputum, fiberoptic bronchoscopy and/ or bronchial lavage smear results. An additional aim was to determine the correlation between the CT findings of pulmonary TB and those of co-existing pulmonary diseases.Background: Pulmonary tuberculosis (TB) can produce unusual radiographic findings. Further, negative sputum and bronchoscopic results are common. Early diagnosis is equally as significant as treatment in the reduction of morbidity and mortality associated with pulmonary TB. Aims: The aim of this study was to assess computed tomography (CT) findings of pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB), and to correlate these findings with coexisting, underlying, lung diseases if present. Study Design: Cross sectional study. Methods: We selected eighty-four patients who were diagnosed with pulmonary TB by way of PTNB. Initially, acid-fast bacilli smear test results from these patients were negative. CT findings were reviewed to detect the presence of parenchymal abnormalities as follows: nodule(s) (<3 cm in diameter), mass (any masses ≥3 cm), daughter nodules, air-space consolidation, cavitation, calcification, lymphadenopathy, mediastinal lymphadenopathy, and associated lung parenchymal disease. Results:The CT findings of pulmonary TB confirmed by PTNB included nodules in 44 of 84 (52.4%) cases; 15 of these 44 cases (34.1%) had daughter nodules. The second most common finding was masses in 24 cases (28.6%), nine of which also had daughter nodules. 16 cases (19.0%) displayed nonsegmental consolidation. Of these 16 cases, four had coexisting usual interstitial pneumonia; four others had emphysema. Two patients with a mass had underlying pneumoconiosis. Conclusion: Nodules or a mass mimicking lung cancer were the most common findings on CT scans in patients with pulmonary TB, confirmed via PTNB. The second most common finding was airspace consolida...

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“…Neonates, young children, or HIVinfected persons who have impaired cell-mediated immune responses tend to have atypical manifestation of TB, whereas immunocompetent patients tend to have typical manifestation of previously known reactivated TB. Thus, the only independent predictor of radiographic appearance may be integrity of the host immune response (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we did not use the serial tuberculin skin test or DNA fingerprinting test that confirms the strain of M. tuberculosis to demonstrate recent or remote infection and determine primary TB or postprimary TB (8). In some cases, Bacillus Calmette-Guérin (BCG) vaccination in the neonatal period may affect the host immune response and radiologic manifestation of TB infection.…”

Section: Ct Findings In Apical Versus Basal Involvement Of Pulmonary mentioning

confidence: 99%

Apical versus basal involvement of pulmonary tuberculosis: comparison of CT findings

Yoon

Lee²,

Im³

et al. 2012

Diagn Interv Radiol

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T uberculosis (TB) is a common infection worldwide and remains an important cause of morbidity and mortality, particularly in developing countries (1). In 2010, 8.8 million people developed overt disease; approximately 1.1 million deaths occurred among human immunodeficiency virus (HIV)-negative people and 0.35 million deaths occurred among HIV-positive people (2).Several host factors may contribute to radiologic manifestations of pulmonary TB, including prior exposure to TB, age, and underlying immune status (3). Radiologic manifestation of pulmonary TB has been divided into primary and postprimary TB, each with a characteristic radiologic pattern. Primary TB occurs most commonly in children without prior exposure to TB and without acquired specific immunity. Primary TB commonly presents as hilar or mediastinal lymphadenopathy, airspace consolidation, or pleural effusion. Postprimary TB is considered to be a reactivation of a previous TB lesion. Radiographically, postprimary TB usually presents as focal or patchy heterogeneous consolidation involving the apical and posterior segments of the upper lobes and less frequently in the superior segments of the lower lobes. On computed tomography (CT) scans, the most common findings of postprimary TB are centrilobular small nodules, branching linear and nodular opacities (tree-in-bud sign), patchy or lobular areas of consolidation, and cavitation (1, 3-6).Isolated involvement of basal segments of the lower lobes in pulmonary TB cases is unusual, and often causes great confusion in the diagnosis of pulmonary TB (3, 7). Because early diagnosis of pulmonary TB plays an important role in the treatment of TB, proper understanding of atypical radiologic manifestation is critical (8, 9).To the best of our knowledge, the CT findings of pulmonary TB involving basal segments have not been widely investigated. The present study compared clinical features and CT findings of pulmonary TB in basal segments and apical or apicoposterior segments, and assessed the frequent radiologic findings of TB in basal segments. Materials and methods PatientsApproval of the hospital ethics committee was obtained for this study. We retrospectively reviewed chest CT scans of 986 consecutive adults who were diagnosed with active pulmonary TB at our institution, an 814-bed urban community-based university teaching hospital, from March 2005 to February 2011. Patients were included in the study if they had a positive culture or staining for Mycobacterium tuberculosis from a sputum specimen, bronchial washing, or lung biopsy. Disease confined to the basal segments of the lower lobes, segments 7, 8, 9, and 10 of the right lower lobe and segments 7+8, 9, and 10 of the left lower lobe, was found in 21 patients. We excluded pulmonary TB cases involving CHEST IMAGING ORIGI NAL ARTICLE CT findings in apical versus basal involvement of pulmonary tuberculosisJi Young Yoon, In Jae Lee, Hyoung June Im, Kwanseop Lee, Yul Lee, Sang Hoon Bae PURPOSE We aimed to compare clinical features and computed tomography (CT) n...

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Clinical and Radiographic Correlates of Primary and Reactivation Tuberculosis

Cited by 162 publications

References 25 publications

HIV and Tuberculosis: a Deadly Human Syndemic

HIV and Tuberculosis: a Deadly Human Syndemic

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease

Apical versus basal involvement of pulmonary tuberculosis: comparison of CT findings

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