Abstract
The purpose of the present study was to evaluate the changes in successive chest CT examinations in patients with pulmonary tuberculosis who achieved culture conversion with linezolid treatment. We reviewed the follow-up CT scans of 14 patients with pulmonary tuberculosis who had sputum-culture conversion after linezolid treatment. This study evaluated cavity, centrilobular nodules, consolidation, bronchial wall thickening, calcified nodule or consolidation, bronchiectasis, irregular lines, and lung destruction. The presence of pleural thickening, pleural effusion and lymphadenopathy was recorded. Follow-up CT scans showed a partial decrease in the extent of centrilobular nodules in all cases. Consolidation was partially cleared in 8 patients and newly developed consolidation was observed in 2 patients. All of the cavities showed a decrease in size and thickness. But the cavities persisted after linezolid treatment in 8 of 9 patients. Bronchial wall thickening was completely or partially cleared in 6 patients and 5 patients, respectively. Newly developed irregular lines, lung destruction and pleural thickening were observed in 1, 1, and 3 patients, respectively. Successive chest CT examinations in patients with linezolid treatment may help in the early assessment of linezolid treatment efficacy because of its rapid availability. Early assessment of linezolid treatment efficacy will help to set up a treatment plan, such as duration of treatment or linezolid dosage. However, they may not be useful for deciding pulmonary tuberculosis activity following linezolid treatment.
Highlights
The overall prevalence of drug-susceptible tuberculosis has reduced, the worldwide incidences of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis during the past decade threaten tuberculosis control since treatment is less effective, more complex, and far more costly than that for drug-susceptible disease (Frieden et al 1993; Shah et al 2007; Raviglione 2007)
Linezolid has been shown to be effective in the treatment of MDRtuberculosis (TB) and XDR-TB (Anger et al 2010; Singla et al 2012; Condos et al 2008)
The purpose of the present study was to evaluate the changes in successive chest CT examinations in patients with pulmonary tuberculosis who achieved culture conversion with linezolid treatment
Summary
The overall prevalence of drug-susceptible tuberculosis has reduced, the worldwide incidences of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis during the past decade threaten tuberculosis control since treatment is less effective, more complex, and far more costly than that for drug-susceptible disease (Frieden et al 1993; Shah et al 2007; Raviglione 2007). Linezolid (Zyvox, Pfizer) was approved in 2000 for drug-resistant, gram-positive bacterial infections (Leach et al 2011). Linezolid has been shown to be effective in the treatment of MDRtuberculosis (TB) and XDR-TB (Anger et al 2010; Singla et al 2012; Condos et al 2008). Determination of disease activity must be based on the results of sputum cultures. Performing sputum culture is much faster nowaday, determination of drug resistance still takes several weeks. In such situation, chest CT may help in the early assessment of linezolid treatment efficacy because of its rapid availability
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