Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States of America.
PLoS One. 2013 Sep 6;8(9):e73975. doi: 10.1371/journal.pone.0073975. eCollection 2013.
The majority of patients with multidrug-resistant tuberculosis (MDR-TB) in South Africa are co-infected with HIV, but the radiographic features of MDR-TB and their relationship with time to sputum culture conversion in the antiretroviral therapy era have not been described.
We reviewed baseline chest radiographs for 56 patients with MDR-TB from a rural area of South Africa. We analyzed the association of cavities, consolidation, pleural effusion and hilar lymphadenopathy with time to sputum culture conversion, adjusting for HIV status, baseline sputum smear and CD4 count.
Of the 56 subjects, 49 (88%) were HIV-positive, with a median CD4 count of 136 cells/mm(3) (IQR 65-249). Thirty-two (57%) patients were sputum smear positive. Twenty-two (39%) patients had a cavity and 37 (66%) patients had consolidations. Cavitary disease and consolidations were each associated with longer time to culture conversion on bivariate analysis but not after adjusting for sputum smear status (aORs 1.79 [0.94-3.42] and 1.09 [0.67-1.78], respectively). Positive baseline sputum smear remained independently associated with longer time to conversion (aOR 3.45 [1.39-8.59]). We found no association between pleural effusion or hilar lymphadenopathy and time to conversion. Seventy-nine percent of patients were cured at the end of treatment.
Despite high rates of HIV co-infection and advanced immunodeficiency, the majority of patients had severe pathology on baseline chest radiograph. Nevertheless, culture conversion rates were high and treatment outcomes were favorable. Cavitation and consolidation do not appear to have an independent association with time to culture conversion beyond that of baseline sputum smear status.
南非大多数耐多药结核病（MDR-TB）患者合并感染 HIV，但在抗逆转录病毒治疗时代，MDR-TB 的放射学特征及其与痰培养转阴时间的关系尚未被描述。
我们回顾了南非农村地区 56 例 MDR-TB 患者的基线胸片。我们分析了空洞、实变、胸腔积液和肺门淋巴结肿大与痰培养转阴时间的关系，调整了 HIV 状态、基线痰涂片和 CD4 计数。
56 名受试者中，49 名（88%）为 HIV 阳性，CD4 计数中位数为 136 个细胞/mm³（IQR 65-249）。32 名（57%）患者痰涂片阳性。22 名（39%）患者有空洞，37 名（66%）患者有实变。空洞病变和实变在单变量分析中与培养转换时间较长相关，但在调整痰涂片状态后则无相关性（比值比 1.79 [0.94-3.42]和 1.09 [0.67-1.78]）。阳性基线痰涂片仍与转换时间延长独立相关（比值比 3.45 [1.39-8.59]）。我们未发现胸腔积液或肺门淋巴结肿大与转换时间之间存在关联。79%的患者在治疗结束时治愈。
尽管 HIV 合并感染率高且免疫缺陷严重，但大多数患者在基线胸片上有严重的病理学表现。尽管如此，培养转化率高，治疗结局良好。空洞和实变与痰培养转阴时间的关系似乎并不独立于基线痰涂片状态。
