title: Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus.
abstract: OBJECTIVE
  We describe chest radiograph (CXR) findings in a population with a high prevalence of human immunodeficiency virus (HIV) and tuberculosis (TB) in order to identify radiological features associated with TB; to compare CXR features between HIV-seronegative and HIV-seropositive patients with TB; and to correlate CXR findings with CD4 T-cell count.
  
  
  METHODS
  Consecutive adult patients admitted to a national referral hospital with a cough of duration of 2 weeks or longer underwent diagnostic evaluation for TB and other pneumonias, including sputum examination and mycobacterial culture, bronchoscopy and CXR. Two radiologists blindly reviewed CXRs using a standardised interpretation form.
  
  
  RESULTS
  Smear or culture-positive TB was diagnosed in 214 of 403 (53%) patients. Median CD4+ T-cell count was 50 cells mm(-3) [interquartile range (IQR) 14-150]. TB patients were less likely than non-TB patients to have a normal CXR (12% vs 20%, p = 0.04), and more likely than non-TB patients to have a diffuse pattern of opacities (75% vs 60%, p = 0.003), reticulonodular opacities (45% vs 12%, p < 0.001), nodules (14% vs 6%, p = 0.008) or cavities (18% vs 7%, p = 0.001). HIV-seronegative TB patients more often had consolidation (70% vs 42%, p = 0.007) and cavities (48% vs 13%, p < 0.001) than HIV-seropositive TB patients. TB patients with a CD4+ T-cell count of ≤ 50 cells mm(-3) less often had consolidation (33% vs 54%, p = 0.006) and more often had hilar lymphadenopathy (30% vs 16%, p = 0.03) compared with patients with CD4 51-200 cells mm(-3).
  
  
  CONCLUSIONS
  Although different CXR patterns can be seen in TB and non-TB pneumonias there is considerable overlap in features, especially among HIV-seropositive and severely immunosuppressed patients. Providing clinical and immunological information to the radiologist might improve the accuracy of radiographic diagnosis of TB.
authors: Department of Radiology, Mulago National Referral Hospital, Kampala, Uganda. kisemboharriet@yahoo.co.uk
authors: H N
authors: HN
authors: Kisembo
authors: S Den
authors: SD
authors: Boon
authors: J L
authors: JL
authors: Davis
authors: R
authors: R
authors: Okello
authors: W
authors: W
authors: Worodria
authors: A
authors: A
authors: Cattamanchi
authors: L
authors: L
authors: Huang
authors: M G
authors: MG
authors: Kawooya
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D013902:Radiography, Thoracic; D012720:Severity of Illness Index; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology