Chest X-ray patterns of pulmonary multidrug-resistant tuberculosis in children in a high HIV-prevalence setting

Abstract

Background: Paediatric multidrug-resistant tuberculosis (MDR-TB) necessitates a prolonged duration of treatment with an intensive treatment regimen. The chest X-ray patterns of pulmonary TB depend on a multiplicity of factors, including immune status, and therefore identifying the influence of HIV on the chest X-ray appearances of MDR-TB may assist with improving the diagnostic criteria. Objectives: To describe the demographic characteristics and chest X-ray patterns of children with pulmonary MDR-TB and to compare the chest X-ray patterns of pulmonary MDR-TB between children who are HIV-infected and HIV-uninfected.Method: Retrospective chart review of hospital notes and chest X-rays of children with pulmonary MDR-TB at King Dinuzulu Hospital, Durban. The chest X-rays were systematically reviewed for the presence of the following variables: hilar/mediastinal lymphadenopathy, bronchopneumonic opacification, segmental/lobar consolidation, cavities, miliary opacification and pleural effusion.Results: Forty-five children (mean age, 6.29 years; median age, 6.00 years) with pulmonary MDR-TB met the inclusion criteria. The most common chest X-ray finding was consolidation (53.5%), followed by lymphadenopathy (35.6%), bronchopneumonic opacification (33.3%) and cavities (31.1%). Cavities were more common (OR 6.1; 95% CI 1.52–24.66) in children who had been initiated on standard anti-TB treatment for the current TB episode. There were no statistically significant differences in any of the chest X-ray patterns in HIV-uninfected (n = 22) compared with HIV-infected (n = 20) children. Conclusion: The most common chest X-ray finding was consolidation, followed by lymphadenopathy, bronchopneumonic opacification and cavities. The finding of a significantly higher frequency of cavities in children who had received prior standard anti-TB treatment for the current TB episode could reflect poor disease containment and increased parenchymal damage, owing to a delay in the recognition of MDR-TB. The development of cavitation in chest X-rays of children with TB could raise concern for the possibility of MDR-TB, and prompt further testing.