Abstract
Background: Tuberculosis (TB) is one of the leading causes of death worldwide. Radiology has an important role in the diagnosis of both drug-sensitive (DS) and drug-resistant (DR) pulmonary TB (PTB). This study aimed at comparing the chest x-ray (CXR) patterns of microbiologically confirmed cases of DS and DR PTB in Uganda.Methods: We conducted a hospital based retrospective study at the Mulago National Referral Hospital (MNRH) TB wards. All participants had microbiologically confirmed diagnosis of PTB. CXR findings extracted included infiltrate, consolidation, cavity, fibrosis, bronchiectasis, atelectasis and other non-lung parenchymal findings. All films were independently examined by two experienced radiologists blinded to clinical diagnosis.Results: We analyzed CXR findings of 165 participants: 139 DS- and 26 DR-TB cases. Majority (n=118, 71.7%) of the participants were seronegative for HIV. Overall, 5/165 (3%) participants had normal CXR. There was no statistically significant difference in the proportion of participants with consolidations (74.8% versus 88.5%; p – 0.203), bronchopneumonic opacities (56.1% versus 42.3%, p=0.207) and cavities (38.1% versus 46.2%, p=0.514), across drug susceptibility status (DS versus DR TB). Among HIV infected participants, consolidations were predominantly in the middle lung zone in the DS TB group and in the lower lung zone in the DR TB group (42.5% versus 12.8%, p – 0.66). HIV infected participants with DR TB had statistically significantly larger cavity sizes compared to their HIV uninfected counterparts with DR TB (7.7 ± 6.8cm versus 4.2 ± 1.3cm, p – 0.004). Conclusion- We observed that a vast majority of participants had similar CXR changes, irrespective of drug susceptibility status. However, HIV infected DR PTB had larger cavities. The diagnostic utility of cavity sizes for the differentiation of DR from DS TB could be investigated further.
Chest X-Ray Findings in Drug Sensitive and Drug Resistant Pulmonary Tuberculosis Patients in Uganda