Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance).
OBJECTIVE
To assess the efficacy of chest radiography in the detection of active pulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).


METHODS
Initial interpretations of chest radiographs of 133 adult patients with AIDS and positive sputum or bronchoalveolar lavage cultures for Mycobacterium tuberculosis were reviewed. Radiographic findings were correlated with CD4 T-cell counts, sputum stains for acid-fast bacilli (AFB), and antituberculous drug sensitivity.


RESULTS
Forty-eight (36%) patients had a primary M tuberculosis pattern, 38 (28%) had a postprimary M tuberculosis pattern, 19 (14%) had normal radiographs, 17 (13%) had atypical infiltrates, seven (5%) had minimal radiographic changes, and four (3%) had a miliary pattern. Normal chest radiographs were seen for 10 (21%) of 48 patients with less than 200 T cells per microliter and one (5%) of 20 patients with more than 200 T cells per microliter. Drug sensitivity and sputum staining for AFB did not correlate with radiographic findings. Overall, 19% of cases had multidrug resistance to antituberculous medications.


CONCLUSIONS
Chest radiographs did not suggest active tuberculosis in 43 (32%) of 133 AIDS patients with active pulmonary tuberculosis.
Greenberg
S D
SD
Department of Radiology, St. Luke's-Roosevelt Hospital Center, New York, NY.
Frager
D
D
Suster
B
B
Walker
S
S
Stavropoulos
C
C
Rothpearl
A
A
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011859:Radiography; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology