Chest Radiograph Findings and Time to Culture Conversion in Patients with Multidrug-Resistant Tuberculosis and HIV in Tugela Ferry, South Africa
Chest Radiograph Findings and Time to Culture Conversion in Patients with Multidrug-Resistant Tuberculosis and HIV in Tugela Ferry, South Africa
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DOI：
10.1371/journal.pone.0073975
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发表时间：
2013-09-06
期刊：
影响因子：
3.7
通讯作者：
Gandhi, Neel R.
中科院分区：
文献类型：
--
作者：
Brust, James C. M.;Berman, Andrew R.;Gandhi, Neel R.
工作背景：大多数耐多药结核病（MDR-TB）在南非的患者合并感染艾滋病毒，但MDR-TB的放射学特征及其与时间的关系痰培养转换在抗逆转录病毒therapy.Methods：我们回顾了基线胸片56例MDR-TB从南非农村地区。我们分析了空洞、实变、胸腔积液和肺门淋巴结病与痰培养转换时间的关系，调整了HIV状态、基线痰涂片和CD 4计数。结果：在56例受试者中，49例（88%）为HIV阳性，中位CD 4计数为136个细胞/mm 3（IQR 65-249）。32例（57%）患者痰涂片阳性。22例（39%）患者有空洞，37例（66%）患者有实变。在双变量分析中，空洞性疾病和实变均与较长的培养转化时间相关，但在调整痰涂片状态后与此无关（aOR分别为1.79 [0.94-3.42]和1.09 [0.67-1.78]）。基线痰涂片阳性仍与较长的转换时间独立相关（aOR 3.45 [1.39-8.59]）。我们发现胸腔积液或肺门淋巴结肿大与转复时间之间没有关联。79%的患者在治疗结束时治愈。结论：尽管HIV合并感染和晚期免疫缺陷的发病率很高，但大多数患者在基线胸片上有严重的病理变化。尽管如此，培养转化率高，治疗结果是有利的。空洞和实变似乎与基线痰涂片状态以外的培养转换时间没有独立相关性。
Background: 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.Methods: 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.Results: 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.Conclusions: 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.