Radiographic Findings of Pulmonary Tuberculosis in Non-AIDS Immunocompromised adult Patients: Comparison with Immunocompetent Adult Patients

Background: Chest X-ray radiography is a widely available and cheap imaging modality used for identification of pulmonary tuberculosis (PTB) in suspected patients. Knowledge of discriminatory features of PTB among HIV infected patient is of utmost importance to improve tuberculosis case detection and consequently reduce morbidity and mortality associated with TB among HIV infected individuals. We aimed to describe chest radiographic findings among PTB patients and their association with HIV co-infection and CD4 levels among HIV positive patients.Methodology: A total of 170 newly diagnosed consented smear positive PTB patients underwent postero-anterior Chest radiographs (PA - CXR) and HIV testing. Determination of CD4 count was performed among HIV positive patients. The radiographs were interpreted using glossary of terms for thoracic radiology by two independent radiologists who were blinded to HIV diagnosis.Results: Study participants included 100 (58.9%) males and 70 (41.1%) females. Among these 54 (31.8%) had HIV/PTB co-infection. The pattern of radiographic findings among patients with PTB/HIV compared to PTB only were: pulmonary cavities 44.4% vs 61.2%, (p=0.04), alveolar consolidation 64.9% vs 81.7%, (p=0.04), upper zone consolidation 40.7% vs 57.8%, (p=0.039), middle zone consolidation 25.9% vs 44.8%, (p=0.019) and typical PTB 40.7% vs 57.8%, (p=0.039), respectively. Therefore, lesions were less likely to be observed among PTB/HIV compared to PTB only and the differences were statistically significant. When compared to PTB patients only HIV/PTB co-infected patients had more nodules on the left lung field 85.2% vs 60.9% (p=0.023); on each left lung zone upper 59.3% vs 34.4% (p=0.028); mid 77.8% vs 54.7% (p-value=0.039); lower 66.7% vs 34.4% (p=0.005) and miliary nodules 44.4% vs 15.6% (p=0.003), respectively. HIV/PTB co-infected patients with CD4 > 200 cells/μL had more mid zone consolidation (42.9% vs 15.2%, p=0.024).Conclusion: The commonest chest radiographic findings in HIV/PTB co-infected patients were pulmonary cavities and alveolar consolidation are associated with HIV negative status. HIV/PTB co-infected patients with severe immunosuppression had mid zone consolidation. Patients with severe immunosuppression showed less chest radiographic findings. HIV/PTB co-infection was highly associated with mid and lower zone pulmonary nodules and miliary nodules. Key words: PTB, HIV, CXR

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Community-Acquired Pneumonia due to Streptococcus pneumoniae: When to Consider Coinfection with Active Pulmonary Tuberculosis

Case Reports in Infectious Diseases ◽

10.1155/2019/4618413 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Ruslan Garcia

Keyword(s):

United States ◽

Mycobacterium Tuberculosis ◽

Streptococcus Pneumoniae ◽

Pulmonary Tuberculosis ◽

The United States ◽

Geographic Region ◽

Community Acquired Pneumonia ◽

Radiographic Findings ◽

Delay In Diagnosis ◽

Active Pulmonary Tuberculosis

Community-acquired pneumonia (CAP) is an important cause of hospitalizations in adults. In the United States, Streptococcus pneumoniae is the most frequently identified bacterial pathogen responsible for CAP. Other etiologic pathogens of CAP vary based on the geographic region. Mycobacterium tuberculosis is an uncommon cause of CAP in the United States, while it is a principal cause in many African and Asian countries. Coinfection with Streptococcus pneumoniae and Mycobacterium tuberculosis is rare and has only been reported in the setting of underlying HIV infection in areas of high tuberculosis prevalence. Here, we report a case of CAP in the absence of HIV, where Streptococcus pneumoniae was identified on admission and delay in diagnosis of concomitant active pulmonary tuberculosis led to inappropriate isolation. In addition to a high index of suspicion, epidemiologic and radiographic findings can be helpful to recognize tuberculosis as a cause of CAP even when other pathogens have already been identified.

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Serum Procalcitonin Levels Predict Mortality Risk in Patients With Pulmonary Tuberculosis: A Single-Center Prospective Observational Study

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa275 ◽

2020 ◽

Vol 222 (10) ◽

pp. 1651-1654

Author(s):

Takeshi Osawa ◽

Masato Watanabe ◽

Kozo Morimoto ◽

Masao Okumura ◽

Takashi Yoshiyama ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Mortality Risk ◽

Prospective Observational Study ◽

Bacterial Load ◽

Serum Levels ◽

Risk Indicator ◽

Radiographic Findings ◽

Tuberculosis Patients ◽

Antituberculosis Treatment ◽

Immunodeficiency Virus

Abstract Globally, tuberculosis is the leading infectious cause of death; discovering biomarkers that predict a high mortality risk may improve treatment outcomes. We prospectively enrolled 252 pulmonary tuberculosis patients who were not coinfected with human immunodeficiency virus and initiated antituberculosis treatment, measured serum procalcitonin levels (PCT), and assessed mortality risk. PCT serum levels higher than 0.13 (day 0), 0.05 (day 7), 0.12 (day 14), or 0.06 (day 28) ng/mL predicted nonsurvivors with odds ratios of 7.9, 14.3, 20.0, and 7.3, respectively (P ≤ .005 for all), respectively. Therefore, serum PCT levels are a promising mortality risk indicator for patients with pulmonary tuberculosis. Main Point. For patients with pulmonary tuberculosis, a promising mortality risk indicator is the level of serum procalcitonin, which is weakly associated with sputum bacterial load and independent of radiographic findings.

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