Radiological Findings of Extensively Drug-Resistant Pulmonary Tuberculosis in Non-AIDS Adults: Comparisons with Findings of Multidrug-Resistant and Drug-Sensitive Tuberculosis

Radiological Findings of Extensively Drug-Resistant Pulmonary Tuberculosis in Non-AIDS Adults: Comparisons with Findings of Multidrug-Resistant and Drug-Sensitive TuberculosisObjective: This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients. Materials and Methods:From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study.All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment.In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs.In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison.Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups.Results: For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones.As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients).For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001).Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001).Imaging findings were not different between patients with MDR TB and XDR TB.Conclusion: By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested.There is no significant difference in imaging findings between patients with XDR TB and MDR TB.xtensively drug-resistant (XDR) tuberculosis (TB) is an emerging lifethreatening infection and is caused by a strain of Mycobacterium tuberculosis that is resistant to any type of fluoroquinolone and at least one of the three following injectable drugs: amikacin, capreomycin or kanamycin in addition to isoniazid and rifampin.Multidrug-resistant (MDR) TB is defined as a strain resistant to at least isoniazid and rifampin (1).