Abstract
The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb) levels (P=0.028) and male gender (P=0.03). An association was also detected between cavitation and MDR (P=0.048). In new cases, bilateral cavities were associated with MDR (P=0.018) and male gender (P=0.01), low body mass index with infiltrates (P=0.008), and smoking with cavitation (P=0.0238). Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002). Poor outcome showed borderline significance with extensive lesions at onset (P=0.053). Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS) spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of X-rays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.
Highlights
This analysis is based on an epidemiological obtained from the Foundation for Medical project on multidrug o resistant TB (MDRTB) transmission in Mumbai.[13]
A glycosylatrc ed hemoglobin (GHb) level of 6.5% or under was con- patient types, a majority were in the 15-35 smaller cavities as compared to the older sidered normal.[16] years age group
(presence of cavitation, extent of pulmonary Though our HIV seropositive cohort is small, involvement)[19] and microbial load at diagnosis. our study revealed an association between
Summary
This analysis is based on an epidemiological obtained from the Foundation for Medical project on MDRTB transmission in Mumbai.[13]. Gm% for females and below 14 gm% for cases opted for HIV testing Amongst both Younger patients were more likely to have males.[15] A GHb level of 6.5% or under was con- patient types, a majority were in the 15-35 smaller cavities as compared to the older sidered normal.[16] years age group. The cohort of treatment failure and new proportion of patients with a low BMI had infilwhether cavitary or not; presence of infiltrates, cases revealed 17% and 35% of samples were trates (χ2=6.87, P=0.008) and bilateral cavimiliary shadows, pleural effusion, mediastinal sensitive, 41% and 24% were MDR, 26% and ties (χ2=3.86, P=0.049) compared to those lymphadenopathy; b. The CAS was associated with extensive lesions on X-ray (χ2=15.17, P=0.00009) and a significantly higher number of CAS strains showed cavitation (χ2=10.6, P=0.001). A cluster was defined as two or more strains having an identical pattern
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