Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance).

Greenberg, S D; Frager, David; Suster, Bernard; Walker, Scott; Stavropoulos, Christos; Rothpearl, A

doi:10.1148/radiology.193.1.7916467

Cited by 210 publications

(112 citation statements)

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“…All patients with CD4+ T-lymphocyte counts < 200 cells/mm 3 presented radiological patterns that were different from the post-primary ones. These results are in accordance with other studies, where cavitation 19 20 , post-primary or typical tuberculin radiological patterns 9 were correlated with CD4+ T-lymphocyte counts > 200 cells/mm 3 and lymphadenopathy and atypical findings with lower counts 9 19 20 .…”

Section: Discussionsupporting

confidence: 93%

“…Normal radiography of the thorax may be present in 5% to 10% of HIV-positive patients 8 and in up to 20% of the patients with an advanced level of immunodepression 9 . It remains uncertain whether the absence of findings represents early stages of either primary disease or reactivation, or disease caused by intrathoracic adenopathy that has not been detected by simple radiographic examination 20 .…”

Section: Discussionmentioning

confidence: 99%

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Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

Garcia

Moura

Ferreira

et al. 2007

Rev. Soc. Bras. Med. Trop.

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Medical charts and radiographs from 38 HIV-infected patients with positive cultures for Mycobacterium tuberculosis from sputum or bronchoalveolar lavage were reviewed in order to compare the clinical, radiographic, and sputum bacilloscopy characteristics of HIV-infected patients with pulmonary tuberculosis according to CD4+ lymphocyte count (CD4). The mean age of the patients was 32 years and 76% were male. The median CD4 was 106 cells/mm³ and 71% had CD4 < 200 cells/mm³. Sputum bacilloscopy was positive in 45% of the patients. Patients with CD4 < 200 cells/mm³ showed significantly less post-primary pattern (7% vs. 63%; p = 0.02) and more frequently reported weight loss (p = 0.04). Although not statistically significant, patients with lower CD4 showed lower positivity of sputum bacilloscopy (37% vs. 64%; p = 0.18). HIV-infected patients with culture-confirmed pulmonary tuberculosis had a high proportion of non-post-primary pattern in thoracic radiographs. Patients with CD4 lower than 200 cells/mm³ showed post-primary patterns less frequently and reported weight loss more frequently.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

Garcia

Moura

Ferreira

et al. 2007

Rev. Soc. Bras. Med. Trop.

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“…HIV/AIDS epidemic has considerably increased the incidence of middle and lower lung field tuberculosis (LLF TB) which is frequently associated with negative sputum smear because of lower bacillary load. [2] LLF TB is defined [3] as "tuberculosis disease found below an imaginary line traced across the hila and including the parahilar regions on a standard posterior-anterior chest roentgenogram." Ossen [4] subdivided his cases into pure and impure groups: the pure group has no visible lesions in the upper lung fields and the impure group has nodular or fibrotic infiltrations in one or both apices.…”

Section: Introductionmentioning

confidence: 99%

Bronchial wash Gene Xpert MTB/RIF in lower lung field tuberculosis: Sensitive, superior, and rapid in comparison with conventional diagnostic techniques

Patil

Narwade

Mirza

2017

Journal of Translational Internal Medicine

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Background: Lower lung field tuberculosis (LLF TB) is an atypical presentation of tuberculosis (TB). LLF TB is common, and a proportionate number of non-resolving pneumonia cases are diagnosed to have pulmonary TB. Materials and Methods: The prospective observational study was conducted during June 2013 to December 2015 in the Department of Pulmonary Medicine, MIMSR Medical College, Latur, India; the objective of the study is clinical, microbiological, and radiological presentation of LLF TB and the comparison of yield of conventional diagnostic techniques and bronchoscopy guided modalities in LLF TB. Additional important objective of the study is to find LLF TB in patients with nonresolving pneumonia (NRP). A total of 2,600 patients with pulmonary TB were included in the study after inclusion and exclusion criteria. Ethical clearance was taken from the ethical committee of the institutional review board. Consent was taken from the patients before inclusion in the study. Statistical analysis was done using chisquare test. Results: In the present study, 300 (11.53%) cases of LLF TB of total 2600 pulmonary tuberculosis were included, females constitutes 66.66% (200/300) with mean age of 58.4 ± 11.8 years and males constitutes 33.34% (100/300) with mean age of 56.8 ± 10.6 years. Constitutional symptoms were observed as cough in 93% cases, fever in 83% cases, shortness of breath in 72% cases, anorexia in 91% cases, and weight loss in 84% cases. Radiological assessment of study cases documented the involvement of right lower zone in 84% cases and left lower zone in only 16% cases. In the studied LLF TB cases, 57 cases (20.66%) were diagnosed by routine sputum microscopic examination for acid fast bacilli (AFB) and 80 cases (28%) were diagnosed by induced sputum microscopic examination for AFB. In the study of 170 LLF TB cases, headto-head comparison between conventional diagnostic techniques (sputum microscopy and Induced sputum microscopy for AFB) made diagnosis in 60 cases, while bronchoscopy-guided sampling techniques (BAL for AFB and BAL for Gene Xpert MTB/RIF) made diagnosis in 155 cases (91.17%) (P < 0.00001). Comorbid conditions such as human immunodeficiency virus (HIV) coinfection in 36 cases (12.00%), Diabetes mellitus in 64 cases (21.33%), and chronic kidney disease (CKD) in 22 cases (7.33%) were observed. Comorbidities were observed in 41.67% of the studied cases and found very significant assessment to have successful treatment outcome (P < 0.00001). In the study of 300 LLF TB cases, 60 cases were having NRP pattern. In LLF TB cases with NRP pattern, bronchoscopy-guided bronchial wash microscopy for AFB made diagnosis in 18 cases (42%), while bronchoscopy-guided BAL for Gene Xpert MTB/RIF made diagnosis in 58 cases (96.66%) (P < 0.00001). Conclusion: LLF TB is usually underdiagnosed because of diverse clinical and radiological presentation, less diagnostic yield of conventional diagnostic modalities, and these modalities used routinely and universally. Bronchoscopy-guided diagnostic techniques ar...

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“…et al [2] in their study of chest radiograph of 133 adult patients with AIDS observed the following pattern. IJBR (2015) 6 (08) www.ssjournals.com…”

Section: Discussionmentioning

confidence: 87%

CT in detection and diagnosis of thoracic conditions in symptomatic HIV patients

Hegde¹,

Chavadi²

2015

Int Jour of Biomed Res

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Thoracic manifestations of HIV positive patients have undergone a gradual metamorphosis due to more awareness about the disease and prolonged longevity of the patients due to better treatment options available now, therefore it is necessary for the radiologist to be aware of changing trends in disease prevalence, epidemiology and the possible pathology. Present study was conducted at Sassoon General Hospital, Pune. Twenty five seropositive patients (ELISA positive) showing signs/ symptoms like fever, cough, breathlessness, hemoptysis, dull note on percussion, lymphadenopathy etc are included in the study. CT sections of thorax were taken at 10mm intervals before and after intravenous contrast administration using spiral mode.We concluded that M. tuberculosis infection was the commonest opportunistic agent in HIV positive patients, however, community acquired bacterial pneumonia was the most frequent cause of pneumonia in HIV infected patients. We concluded that CT is the most important imaging modality used to evaluate chest in HIV positive patients. Contrast enhanced spiral CT is needed to adequately demonstrate lymphadenopathy and HRCT shows distinct advantage in terms of delineation of parenchymal changes.

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Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance).

Abstract: Chest radiographs did not suggest active tuberculosis in 43 (32%) of 133 AIDS patients with active pulmonary tuberculosis.

Cited by 210 publications

References 0 publications

Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

Bronchial wash Gene Xpert MTB/RIF in lower lung field tuberculosis: Sensitive, superior, and rapid in comparison with conventional diagnostic techniques

CT in detection and diagnosis of thoracic conditions in symptomatic HIV patients

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