Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Background: Data about the relationship between chest radiographs and sputum bacillary load, with
treatment outcomes, in patients with extensively drug-resistant tuberculosis (XDR-TB) from HIV/TB
endemic settings are limited.
Methods: Available chest radiographs from 97 South African XDR-TB patients, at the time of diagnosis,
were evaluated by two independent readers using a validated scoring system. Chest radiograph
findings
were correlated with baseline sputum bacillary load (smear-grade and culture time-to-positive in MGIT),
and prospectively ascertained clinical outcomes (culture conversion and all-cause mortality).
Results: Radiographic bilateral lung disease was present in 75/97 (77%). In the multivariate analysis only a
higher total radiographic score (95% CI) was associated with higher likelihood of death [1.16 (1.05–1.28)
p = 0.003], and failure to culture convert [0.85 (0.74–0.97) p = 0.02]. However, when restricting analyses to
HIV-infected patients, disease extent, cavitation, and total radiographic scores were not associated with
mortality or culture-conversion. Finally, cavitary, disease extent, and total radiographic scores all
positively correlated with bacterial load (culture time-to-positive).
Conclusions: In endemic settings, XDR-TB radiological disease extent scores are associated with adverse
clinical outcomes, including mortality, in HIV uninfected persons. These data may have implications for
clinical and programmatic decision-making and for evaluation of new regimens in clinical trials.
Description
CITATION: Te Riele, J. B., et al. 2019. Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis. International Journal of Infectious Diseases, 79:65-71, doi:10.1016/j.ijid.2018.10.026.
The original publication is available at https://www.clinicalkey.com/
The original publication is available at https://www.clinicalkey.com/
Keywords
Cavitary disease, Multidrug-resistant tuberculosis, Extensively drug-resistant tuberculosis, Radiography, Medical, Chest -- Examination, Pulmonary respiration -- Diseases, Obstructive Lung Disease
Citation
Te Riele, J. B., et al. 2019. Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis. International Journal of Infectious Diseases, 79:65-71, doi:10.1016/j.ijid.2018.10.026