The Radiological Spectrum of Pulmonary Multidrug-Resistant Tuberculosis In HIV-Negative Patients

Background: Multidrug-resistanttuberculosis(MDR-TB)isa majorworldwidehealthproblem. IncountrieswhereTBisofmoderatetohighprevalence,theissueofMDR-TBcarriessignificant importance.MDR-TB, similar to drug-sensitive TB, is contagious.Meanwhile its treatment isnotonlymoredifficultbutalsomoreexpensivewithlowersuccessrates.Regarding clinical findings, there is no significant difference betweenMDR-TB and drug-sensitive TB. ThereforedeterminationofcharacteristicradiologicalfindingsincasesofMDR-TBmightbe ofhelpinearlydetection,andhenceappropriatemanagementofthisdiseasecondition. Objective:ToexplaintheradiologicalspectrumofpulmonaryMDR-TB. PatientsandMethods: Weretrospectivelyevaluatedtheradiographicimagesof35patients with clinically- andmicrobiologically-provenMDR-TB admitted to our tertiary-care TB unit overa periodof13months.ThelatestchestX-rayofallpatientsandtheconventionalchest CT scan without contrast of 15 patientswere reviewed by three expert radiologists who renderedconsensusopinion. Results: Of the 35 patients with imaging studies, 23 (66%)were male and 12 (34%)were female. Themean±SDageofparticipantswas38.2±17.3 (range: 16–80)years.33patients were known as secondary and only 2 had primary MDR-TB. Chest radiography revealed cavitarylesionin80%,pulmonaryinfiltrationin89%andnodulesin80%ofthecases.Pleurisy was the rarest findingobserved inonly5 (14%)patients. All of 15chestCTscans revealed cavitation,93%ofwhichwerebilateralandmultiple.Pleuralinvolvementwasseenin93%of patients. Conclusion: Presence ofmultiple cavities, especially in both lungs, nodular and infiltrative lesions,andpleuraleffusionaremainfeaturesofMDR-TBascomparedtodrug-sensitiveTB.