Radiographic findings in HIV-positive patients with sensitive and resistant tuberculosis.
To facilitate early recognition of multi-drug resistant (MDR) Mycobacterium tuberculosis (MTB) disease in HIV-positive patients we evaluated the chest x-ray films of 72 patients in a tertiary care center in New York City. Thirty-three patients had sensitive MTB, 3 had single-drug resistant (SDR) MTB, and 36 patients had multi-drug resistant (MDR) MTB. All chest x-ray films were reviewed and correlated with drug sensitivities, additional diagnostic results, and clinical courses. There were no significant radiographic differences among the 3 groups on initial presentation (p > 0.05). Cavities were found in 12 patients, upper lobe disease in 23, lower lobe disease in 15, possible intrathoracic lymphadenopathy in 30, diffuse infiltrates in 12, pleural effusion in 13, and a miliary pattern in 3 patients. Normal chest x-ray films were found in ten patients. After 2 weeks of therapy, 20 out of 35 MDR-MTB patients developed new effusions, possible intrathoracic lymphadenopathy, or worsening infiltrates. With deterioration, the probability of MDR MTB was 95 percent in our case control study. Thus, it would be reasonable to adjust antituberculosis therapy in HIV-positive patients with deteriorating conditions shown on chest x-ray films after 2 weeks of therapy.
Lessnau
K D
KD
Cabrini Medical Center, New York 10003.
Gorla
M
M
Talavera
W
W
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D006679:HIV Seropositivity / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology
D000995:Antitubercular Agents