Characteristics of the study participants
A total of 165 participants, 139 DS and 26 DR-TB of which 106 (63.9%) males were recruited in the study. Overall, 118 (71.7%) participants were HIV uninfected. Of the 118, 103 (87.3%) had DS and 15 (12.7%) DR TB. Overall, 37 (22.4%) participants had a history of previous TB treatment with 9 defaulting and 3 failing on treatment. The proportion of participants with previous history of PTB was higher among DR TB compared to DS TB group (46.2% versus 18%, p = 0.04). (Table 1. Summarizes the baseline characteristics of the study participants.
Table 1
Baseline demographic Characteristics of 165 participants.
Baseline characteristics | All | Drug sensitivity | P-value |
DS TB(n = 139), % | DR TB (n = 26), % |
Gender Female Male | 59 (36.1) 106 (63.9) | 49 (35.3) 90 (64.7) | 10 (38.5) 16 (61.5) | 0.8 |
Age, median (range), years | 30 (15–65) | 30 (15–65) | 33 (20–65) | 0.103 |
HIV serostatus Negative Positive | 118 (71.7) 47 (28.3) | 103 (74.1) 36 (25.8) | 15 (57.7) 11 (42.3) | 0.099 |
CD4 counts, median (range) | 218 (2–896) | 208.5 (2-896) | 218.0 (61–783) | 0.268 |
History of smoking Yes No | 36 (21.7) 129 (78.3) | 31 (22.3) 108 (77.6) | 5 (19.2) 21 (80.8) | 1.0 |
History of PTB Yes No | 37 (22.3) 128 (77.7) | 25 (18.0) 114 (82.0) | 12 (46.2) 14 (53.8) | 0.04 |
Treatment outcomes (n = 37) Failure Completed Defaulted Cure | 3 (8.1) 7 (18.9) 9 (24.3) 18 (48.8) | 0 (0.0) 4 (16.0) 7 (28.0) 14 (56.0) | 3 (25.0) 3 (25.0) 2 (16.7) 4 (33.3) | 0.037 |
Extrapulmonary TB Yes No | 14 (8.4) 151 (91.6) | 14 (10.1) 125 (90.0) | 0 (0.0) 26 (100.0) | 0.130 |
Current or previous alcohol use Yes No | 91 (54.8) 74 (45.2) | 71 (51.1) 68 (49.0) | 20 (76.9) 6 (23.1) | 0.018 |
Chest X-ray findings
Five (3%) participants, 3 DS and 2 DR TB, had normal CXR. The most dominant feature of active PTB was consolidations (77%, n = 127). There was no statistically significant difference in the proportion of consolidation among DR compared to DS TB participants (88.5% versus 74.8%, p = 0.2). The participants with miliary pattern opacities on CXR were 3 (1.8%) and all of them were from DS-TB group (Table 2).
Table 2
Chest X-ray Findings of 165 participants
Radiological findings (N = 165) | Total n (%) | Drug sensitivity | P-value |
DS-TB (%) | DR-TB (%) |
Normal | 5 (3.0) | 3 (2.2) | 2 (7.7) | 0.177 |
Bronchopneumonic process | 89 (53.3) | 78 (56.1) | 11 (42.3) | 0.207 |
Consolidation | 127 (77.0) | 104 (74.8) | 23 (88.5) | 0.203 |
Cavities | 65 (39.4) | 53 (38.1) | 12 (46.2) | 0.514 |
Miliary | 3 (1.8) | 3 (2.2) | 0 (0.0) | > 0.999 |
Bronchiectasis | 50 (30.3) | 44 (31.7) | 6 (23.1) | 0.488 |
Atelectasis | 17 (10.3) | 13 (9.4) | 4 (15.4) | 0.314 |
Fibrotic bands | 50 (30.3) | 43 (30.9) | 7 (26.9) | 0.818 |
Participants with DS TB had consolidation as the commonest (104, 74.8%) CXR finding of active PTB followed by bronchopneumonic opacities (78, 56.1%) and cavities (53, 38.1%). A similar proportion of HIV uninfected compared to HIV infected had cavities (41.7 versus 27.8%, p = 0.165) (Table 3).
Table 3
Chest X-ray Findings in DS TB stratified by HIV status.
Radiological findings (N = 139) | Total n (%) | HIV status | P-value |
Negative | Positive |
Bronchopneumonic process | 78 (56.1) | 55 (53.4) | 23 (63.9) | 0.331 |
Consolidation | 104 (74.8) | 77 (74.8) | 27 (75.0) | > 0.999 |
Cavities | 53 (38.1) | 43 (41.7)) | 10 (27.8) | 0.165 |
Bronchiectasis | 44 (31.7) | 29 (28.2) | 15 (41.7) | 0.149 |
Atelectasis | 13 (9.4) | 11 (10.7) | 2 (5.6) | 0.514 |
Fibrotic bands | 43 (30.9) | 32 (31.1) | 11 (30.6) | > 0.999 |
Of the 26 participants with DR TB, 23 (88.5%) had consolidations followed by cavities and bronchopneumonic opacities respectively. Stratified by HIV status, there was no statistically significant difference in the proportion of participants with cavities (53.3% for HIV negative versus 36.4% for HIV positive, p = 0.45) (Table 4).
Table 4
Chest X-ray Finding in DR TB stratified by HIV status
Radiological findings (N = 26) | Total n (%) | HIV status | P-value |
Negative | Positive |
Bronchopneumonic process | 11 (42.3) | 7 (46.7) | 4 (36.4) | 0.701 |
Consolidation | 23 (88.5) | 14 (93.3) | 9 (81.8) | 0.556 |
Cavities | 12 (46.2) | 8 (53.3) | 4 (36.4) | 0.453 |
Bronchiectasis | 6 (23.1) | 5 (33.3) | 1 (9.1) | 0.197 |
Atelectasis | 4 (15.4) | 1 (6.7) | 3 (27.3) | 0.279 |
Fibrotic bands | 7 (26.9) | 6 (40.0) | 1 (9.1) | 0.178 |
Location and number of lesions
Among HIV uninfected participants, consolidations were predominantly in the upper lung zones (47.1% in DS versus 9.2% in DR TB, p = 0.38) and middle lung zones (48.7% in DS Vs 7.6% in DR TB, p = 0.27). The bronchopneumonic opacifications were predominantly in the middle lung zones (37% in DS versus 5.9% in DR p = 0.59).
Of the HIV infected participants, the consolidations were predominantly in the middle lung zone (42.5%) in the DS TB group and in the lower lung zone (12.8%) in the DR TB group (p = 0.48). Bronchopneumonic opacities were mostly seen in the middle and lower lung zones (34% versus 32%, p = 0.46) in the DS TB group and in the three lung zones unilaterally in DR TB group.
The average number of zones affected by signs of active disease was comparable between the DS TB and DR TB groups (2.7 versus 3, p = 0,46) (Table 5).
Table 5
Average Number of Zones affected by Active disease
Drug sensitivity | Average number of zones with active disease (SD) | P-value |
DS TB | 2.7 (1.9) | 0.46 |
DR TB | 3 (1.8) |
Among the HIV infected participants, cavity sizes were statistically significantly large in those with DR TB compared to HIV uninfected participants with DR TB (7.7 ± 6.8 cm versus 4.2 ± 1.3 cm, p = 0.004). There was no statistically significant difference in the mean consolidation sizes (p = 0.8) and the mean number of cavities (p = 0.4) among HIV uninfected participants with DR TB compared to HIV infected participants with DR TB. The commonest extrapulmonary findings were pleural effusion followed by fibrosis and lymphadenopathy with no statistically significant difference between the DS and DR TB groups (Table 6).
Table 6
| HIV negative n = 118 | HIV positive n = 47 |
X-ray features | DS TB n(%) | DR TB n(%) | p-value | DS TB n(%) | DR TB n(%) | p-value |
Lymphadenopathy Unilateral Bilateral Pleural effusion Unilateral Bilateral Fibrosis Unilateral Bilateral | 3 (2.5) 2 (1.7) 1 (0.8) 21 (17.6) 19 (16.0) 2 (1.7) 6 (5.0) 5 (4.2) 1 (0.8) | 1 (0.8) 1 (0.8) 0 (0) 3 (2.5) 3 (2.5) 0 (0) 2 (1.7) 2 (1.7) 0 (0) | 0.52 0.86 0.40 | 1 (2.1) 1 (2.1) 0 (0) 4 (8.5) 3 (6.4) 1 (2.1) 0 (0) 0 (0) 0 (0) | 4 (8.5) 1 (2.1) 3 (6.4) 5 (10.6) 3 (6.4) 2 (4.3) 4 (8.5) 4 (8.5) 0 (0) | 0.43 0.22 0.33 |
CXR of HIV uninfected and HIV infected participants are demonstrated in Fig. 1 and Fig. 2 respectively.