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Int J Infect Dis. 2018 Nov 2. pii: S1201-9712(18)34574-0. doi: 10.1016/j.ijid.2018.10.026. [Epub ahead of print]

Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis.

Author information

1
Department of Public Health and Family Medicine, University of Cape Town, South Africa. Electronic address: julian.teriele@westerncape.gov.za.
2
Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa. Electronic address: virginia.buser@gmail.com.
3
Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa. Electronic address: greg.calligaro@uct.ac.za.
4
Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa. Electronic address: a.esmail@uct.ac.za.
5
Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa. Electronic address: gtheron@sun.ac.za.
6
Department of Public Health and Family Medicine, University of Cape Town, South Africa. Electronic address: lesosky@gmail.com.
7
Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town, South Africa. Electronic address: keertan.dheda@uct.ac.za.

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.

KEYWORDS:

XDR-TB; cavitary disease; chest radiography; lung disease extent

PMID:
30395979
DOI:
10.1016/j.ijid.2018.10.026
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