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Research Article
Volume 2 Issue 2 - 2016
Computed Tomography (CT) Scan Features of Pulmonary Drug-Resistant Tuberculosis in Non-HIV-Infected Patients
Ehsan Shahverdi1*, Ashkan Shahverdi1, Reza Jafari2, Maryam Allahverdi Khani3,Azam Khandani4 and Sara Beheshtian1
1Students’ Research Committee, Baqiyatallah University of Medical Sciences, Iran
2Department of Radiology, Baqiyatallah University of Medical Sciences, Iran
3Islamic Azad University of Medical Sciences, Najafabad, Iran
4Islamic Azad University of nursing Sciences Najafabad, Iran
*Corresponding Author: Ehsan Shahverdi, Baqiyatallah University of Medical Sciences, Mollasadra st., Vanaq sq., Tehran, Iran.
Received: March 15, 2016; Published: April 11, 2016
Citation: Ehsan Shahverdi.,et al. “Computed Tomography (CT) Scan Features of Pulmonary Drug-Resistant Tuberculosis in Non-HIV-Infected Patients”. EC Bacteriology and Virology Research 2.2 (2016): 77-81.
Abstract
Objective: To describe the CT findings of pulmonary drug-resistant tuberculosis (DR-TB) in non-HIV-infected patients.
Materials and Methods: This cross-sectional study was conducted between 20 March 2012 and 20 November 2013. One-hundred patients with multi drug resistant TB were enrolled in the present study. All the Chest computed tomography (CT) examinations of the patients were assessed in terms of the presence of Parenchymal calcifications, Cavity, Nodular infiltration, lymphnodes, and pleural effusion, Emphysema, Bronchiectasis, Hydropneumothorax and Consolidation and reviewed by a radiologist with at least 10 years of experience.
Results: The most frequent patterns of lung involvement were Lymphnode calcification (85%) followed by Bronchiectasis (76%), Cavity (75%) and Nodular infiltrations (70%), and the Pleural calcification was the least (0%). Mediastinal lymph no decalcification was common in females and mediastinally mphadenopathy and emphysema were common in males.
Conclusion: Calcified lymphnodes, bronchiectasis, cavity and nodular infiltration were the most common findings, respectively. Therefore, the CT scan is recommended to predict the likely outcome of treatment.
Keywords: Computed tomography; Tuberculosis; Drug-resistant TB; HIV; Mediastinal
Abbreviations: MDR: Multidrug-resistant; XDR: Extensively drug-resistant; CT: Computed tomography
Introduction
Tuberculosis is one of the major health problems worldwide and multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis with higher mortality and also treatment failure are the main concern in this area [1-3].
XDR is resistant to fluoroquinolone and at least one of three injectable drugs includes: capreomycin, kanamycin, and amikacin and also both isoniazid and rifampicin. MDR TB is defined as resistant to at least isoniazid and rifampin [2,4].
Appropriate and immediate diagnosis of drug-resistant TB are very important [5] but laboratory evaluation is needed to diagnose is because diagnosis cannot be made by only clinical signs [6,7]. Culture and drug-susceptibility test are two methods that are time consuming and usually need several weeks, are defined as the standard criterion for detecting drug-resistant TB [8]. Thus, computed tomography (CT) scan examination seems to can play an important role in detection and screening of suspicious patients for drug-resistant TB. However, to the best of our knowledge, there has been no report describing the CT scan findings of pulmonary DR-TB, particularly in non HIV-infected patients.
The purpose of this study, therefore, was to describe the CT findings of pulmonary drug-resistant TB in non-HIV-infected patients.
Materials and Methods
The present study was approved by our Institutional Review Board. Patient informed consent was waived for this study.
This cross-sectional study was conducted between 20 March 2013 and 20 November 2014. one- hundred patients admitted to Baqiyatallah Hospital in Tehran with multi drug resistant (MDR) TB with no history of anti-tuberculosis chemotherapy or a history of less than one month of therapy were enrolled in the study. Patients were selected using simple sampling method.
Chest X-ray and spiral- Chest computed tomography (CT) scans were available for all patients. All the CT examinations of the patients were reviewed by a radiologist with at least 10 years of experience.
Each CT-scan was assessed in terms of the presence of Parenchymal calcifications, Cavity (Thin cavity = wall thickness less than 4mm, thick cavity= wall thickness more than 4mm), Nodular infiltration (Micro nodules = Nodule with a diameter of less than 2 mm, macro nodules = Nodule with a diameter of more than 2 mm), lymphnodes, Pleural effusion, Emphysema, Bronchiectasis, Hydro pneumothorax and Consolidation. We considered Data were analyzed using statistical package for social sciences (SPSS) version 13 (SPSS Inc. Chicago, IL) for windows by using Fisher exact test, Chi square test and independent simple t-test. A p value of less than 0.05 considered as statistically significant.
Results
Eventually 100 patients, 57 males and 43 females, with a mean age of 47 ± 20.23 underwent analysis. Seven patients had a positive history of tuberculosis in the family. There was no significant correlation between positive history for tuberculosis in the family and specific finding in Ct-Scan in this study.
In 41% of Study individual right lung and in 45% left lung was involved while 14% showed bilateral involvement. The mean duration of disease inpatients was 2.37 ± 1.03 years. There was no significant relation between imaging findings and duration of disease (p>0.05).
The CT findings of the patients with TB are summarized in Table 1. The most frequent patterns of lung involvement were Lymph node calcification (85%), Bronchiectasis (76%), Cavity (75%) and Nodular infiltrations (70%), while the Pleural calcification was the least (0%).
Ct findings Frequency %
Parenchymal calcifications 39
Size reduction 42
Cavity 75
Thin Cavity 42
Thick Cavity 57
Nodular infiltration 70
Macro nodules 31
Calcified lymph nodes 85
Hilum Calcifiedl ymph nodes 82
Mediastinal Calcified lymph nodes 63
Non-calcified lymph nodes 3
Mediastinal lymphadenopathy 6
Pleural effusion 18
Pleural thickening 57
Pleural calcification -
Emphysema 6
Hydropneumothorax 9
Bronchiectasis 76
Pre-bronchial thickening 64
Consolidation 39
Table 1: Frequency of CT-Scan findings in patients with tuberculosis.
CT-scan findings with regard to patient´s gender are shown in Table 2. There was no significant relation between gender of patients and CT-Scan findings in most cases (p > 0.05) but about mediastinal lymph no decalcification, mediastinal lymphadenopathy and emphysema this relation was significant (p < 0.05) so that mediastinal lymph no decalcification was more common in females and mediastinal lymphadenopathy and emphysema were more common in males.
Ct findings Female % Male %
Parenchymal calcifications 41.9 36.8
Size reduction 34.9 47.4
Cavity 78.9 69.8
Thin Cavity 34.9 47.4
Thick Cavity 55.8 57.9
Nodular infiltration 65.1 73.7
Macro nodules 23.3 36.8
Calcified lymphnodes 84.2 86
Umbilical Calcified lymphnodes 84.2 79.1
Mediastinal Calcified lymph nodes 76.7 52.6
Non-calcified lymph nodes - 5.3
Mediastinal lymphadenopathy - 10.5
Pleural effusion 20.9 15.8
Pleural thickening 48.8 63.2
Pleural calcification - -
Emphysema - 10.5
Hydropneumothorax 7 10.5
Bronchiectasis 72.1 78.9
Pre-bronchial thickening 58.1 68.4
Consolidation 48.8 31.6
Table 2: CT-scan findings and gender of patients.
There was no significant relation between patient´s age and CT findings except for bronchiectasis (p > 0.05). The mean age of patients with bronchiectasis was 63 years and in other cases was 47 years.
Discussion
We found that Drug-resistant TB has specific imaging findings such as Calcified lymph nodes, Bronchiectasis, Cavity and Nodular infiltration. According to our findings mediastinal calcified lymph nodes were more common in females, while mediastinal lymphadenopathy and emphysema were more common in males.
We found no significant relation between imaging findings and duration of disease and also this relation was not significant with side of involved lung.
According to current study, there was no significant correlation between positive history for tuberculosis in the family and specific findings in CT scan in this study. It was consistent with the results of other studies [9,10].
According to Cha., et al. who conducted a study on sixty eight patients with drug-resistant tuberculosis, the most common imaging findings in these patients were nodules, reticulo-nodular densities, consolidation and cavities. In this study it was reported that there is no significant relation between drug resistance and imaging findings [11].
Yeom., et al. demonstrated that bilateral involvement, segmental or lobar consolidation and cavities were more frequently seen in primary MDR TB patients [9]. In our study Cavity was among the most common findings.
In another study Fishman., et al. concluded that Patients who developed MDR TB during an outbreak, showed non cavitary consolidations and pleural effusions and also reported that approximately one-third of patients did not show the expected radiographic pattern [10].
In our study consolidations and pleural effusion were not among the most common findings and also the unexpected radiographic finding was much less.
Lee., et al. reported that micro nodules, consolidations, cavities and bronchiectasis were the most frequent CT abnormalities in extensively drug-resistant pulmonary tuberculosis patients which is in concordance with the present study [5].
Conclusion
In conclusion there are specific imaging findings in patients with drug-resistant tuberculosis. Calcified lymphnodes, Bronchiectasis, Cavity and nodular infiltration were the most common findings respectively. Therefore, the CT scan is recommended to predict the likely outcome of treatment. Finally further studies with control group are suggested to confirm the results of the present study.
Bibliography
  1. Cegielski JP., et al. “Multidrug-Resistant Tuberculosis Treatment Outcomes in Relation to Treatment and Initial Versus Acquired Second-Line Drug Resistance”. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 62.4 (2016): 418-430.
  2. Pym AS., et al. “Bedaquiline in the treatment of multidrug- and extensively drug-resistant tuberculosis”. The European respiratory journal 47.2 (2016): 564-574.
  3. Sabooni K., et al. “Tuberculosis peritonitis with features of acute abdomen in HIV infection”. International Journal of Mycobacteriology 4.2 (2015): 151-153.
  4. Organization WH. “Extensively drug-resistant tuberculosis (XDR-TB): recommendations for prevention and control”. The Weekly Epidemiological Record 81.45 (2006): 430-432.
  5. Lee ES., et al. “Computed tomography features of extensively drug-resistant pulmonary tuberculosis in non-HIV-infected patients”. Journal of computer assisted tomography 34.4 (2010): 559-563.
  6. Leung CC., et al. “Lower risk of tuberculosis in obesity”. Archives of internal medicine 167.12 (2007): 1297-1304.
  7. Brown M., et al. “Prospective study of sputum induction, gastric washing, and bronchoalveolar lavage for the diagnosis of pulmonary tuberculosis in patients who are unable to expectorate”. Clinical Infectious Diseases 44.11 (2007): 15-20.
  8. Moore DA., et al. “Microscopic-observation drug-susceptibility assay for the diagnosis of TB”. New England Journal of Medicine 355.15 (2006): 1539-1550.
  9. Yeom JA., et al. “Imaging findings of primary multidrug-resistant tuberculosis: a comparison with findings of drug-sensitive tuberculosis”. Journal of computer assisted tomography 33.6 (2009): 956-960.
  10. Fishman JE., et al. “Radiographic findings and patterns in multidrug-resistant tuberculosis”. Journal of thoracic imaging 13.1 (1998): 65-71.
  11. Cha J., et al. “Radiological findings of extensively drug-resistant pulmonary tuberculosis in non-AIDS adults: comparisons with findings of multidrug-resistant and drug-sensitive tuberculosis”. Korean Journal of Radiology 10.3 (2009): 207-216.
Copyright: © 2016 Ehsan Shahverdi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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