Relationship between chest radiographic characteristics, sputum bacterial load, and treatment outcomes in patients with extensively drug-resistant tuberculosis. (February 2019)

• Record Type: Journal Article
• Authors: te Riele, J.B.; Buser, V.; Calligaro, G.; Esmail, A.; Theron, G.; Lesosky, M.; Dheda, K.
• Is Part Of: International journal of infectious diseases. Volume 79(2019)
• Page Start: 65
• Page End: 71
• Publication Date: 2019-02
• Subjects: BCH Brooklyn Chest TB hospital -- CD4 cluster of differentiation 4 -- CRRS chest radiograph recording and reporting -- CXR chest radiography -- DR-TB drug-resistant tuberculosis -- HIV human immunodeficiency virus -- ICC intraclass coefficient -- MDR-TB multidrug-resistant tuberculosis -- MGIT mycobacteria growth indicator tube -- PAS para-aminosalicylic acid -- PET-CT positron emission tomography–computed tomography -- TB tuberculosis -- TTP time-to-positive -- WHO World Health Organisation -- XDR-TB extensively drug-resistant tuberculosis; XDR-TB -- Chest radiography -- Lung disease extent -- Cavitary disease; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2018.10.026
• Languages: English
• ISSNs: 1201-9712

Abstract

Abstract: Background: Data about the relationship between chest radiographs and sputum bacillary load, with treatment outcomes, in patients with extensively drug-resistant tuberculosis (XDR-TB) from HIV/TB endemic settings are limited. Methods: Available chest radiographs from 97 South African XDR-TB patients, at the time of diagnosis, were evaluated by two independent readers using a validated scoring system. Chest radiograph findings were correlated with baseline sputum bacillary load (smear-grade and culture time-to-positive in MGIT), and prospectively ascertained clinical outcomes (culture conversion and all-cause mortality). Results: Radiographic bilateral lung disease was present in 75/97 (77%). In the multivariate analysis only a higher total radiographic score (95% CI) was associated with higher likelihood of death [1.16 (1.05–1.28) p = 0.003], and failure to culture convert [0.85 (0.74–0.97) p = 0.02]. However, when restricting analyses to HIV-infected patients, disease extent, cavitation, and total radiographic scores were not associated with mortality or culture-conversion. Finally, cavitary, disease extent, and total radiographic scores all positively correlated with bacterial load (culture time-to-positive). Conclusions: In endemic settings, XDR-TB radiological disease extent scores are associated with adverse clinical outcomes, including mortality, in HIV uninfected persons. These data may have implications for clinical and programmatic decision-making and for evaluation of new regimens in clinical trials.