Clinical and imaging features of drug-resistant pulmonary tuberculosis in HIV/AIDS patients

doi:10.19871/j.cnki.xfcrbzz.2025.04.009

Abstract

Abstract: Objective To analyze and compare the clinical manifestations and computed tomography(CT) findings of HIV/AIDS patients with drug-resistant pulmonary tuberculosis（DR-PTB）,and observe the dynamic changes of CT findings. Method The clinical and CT findings of 20 patients with HIV/AIDS diagnosed DR-PTB from May 2018 to February 2024 were analyzed retrospectively. Chest CT signs including micronodules, tree-in-bud appearance, consolidation,cavity, bronchial lesion, emphysema, pleural effusion and lymphadenopathy were analyzed, and their CT features, lesion involvement extent, and dynamic changes were compared between groups. Result The main clinical manifestations of DR-PTB in HIV/AIDS patients were cough (85.00%) and fever (65.00%). Micronodules and tree-in-bud appearance were the most frequent CT abnormalities and were seen in all DR-PTB patients (100.00%). Consolidations, bronchial lesions, lymphadenopathy, pleural effusion and cavities were found in DR-PTB patients with rate of 85.00%, 70.00%, 70.00%, 55.00% and 50.00% respectively. The lesion distribution in extensively drug-resistant pulmonary tuberculosis (XDR-PTB) patients was the widest, followed by multidrug-resistant pulmonary tuberculosis(MDR-PTB)and rifampicin-resistant pulmonary tuberculosis (RR-PTB) patients. As for Chest CT features and clinical manifestation,there were no significant differences between different DR-PTB types and between initial treatment and retreatment groups (P>0.05). 3 cases of hematogenous disseminated pulmonary tuberculosis with micronodules appeared in RR-PTB, MDR-PTB and XDR-PTB. The mean CD4+T lymphocytes were 38.67(20.00,55.00)cells/μl. The proportion of cavities in the retreatment group was 66.67%, which was higher than that in the initial treatment group (42.86%), which manifested thick-walled cavities involving multiple lobes (>3 lobes), but there was no statistically significant difference (P>0.05). Among 16 follow-up patients, symptoms improved in 14 patients (87.50%) ,showing lesion absorption,1 patients (6.25%) died showing increased lesions, and chest lesions didn't change in 1 patient(6.25%). Conclusion The CT findings of different DR-PTB in patients with HIV/AIDS were similar, and are related to the state of immunosuppression and tuberculosis treatment history. In the immunosuppressive state, CT findings are atypical, and hematogenous disseminated pulmonary tuberculosis is prone to occur. XDR-PTB tends to have more extensive distribution,the proportion of cavity in retreatment DR-PTB was high relatively.

Key words: Human immunodeficiency virus, Acquired immune deficiency syndrome, Drug-resistant pulmonary tuberculosis, Computed tomography, Imaging feature

CLC Number:

R512.91
R52

Huang Hua, Chen Shilin, Zhou Yun, Luo Weijun, Zheng Qiuting, Deng Yingying. Clinical and imaging features of drug-resistant pulmonary tuberculosis in HIV/AIDS patients[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(4): 52-57.

References

[1] 余卫业, 谭卫国, 陆普选. 耐药肺结核的分类、分型及影像学表现[J/CD].新发传染病电子杂志, 2019, 4(1):42-47.
[2] 中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志, 2015,8(5):385-401.
[3] 中国研究型医院学会感染与炎症放射学专业委员会, 中华医学会放射学分会传染病学组, 中国科技产业化促进会数字健康专业委员会, 等. 耐药肺结核影像学诊断专家共识[J/CD]. 新发传染病电子杂志, 2023, 8(5):63-74.
[4] WORLD HEALTH ORGANIZATION.Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, 27-29 October 2020[R]. Geneva: World Health Organization, 2021.
[5] WANG Y, CHUNG M, SKRAHIN A, et al.Radiological signs associated with pulmonary multidrug resistant tuberculosis: an analysis of published evidences[J]. Quant Imaging Med Surg, 2018, 8(2): 161-173.
[6] ES LEE, MP CHANG, MG JIN, et al.Computed tomography features of extensively drug-resistant pulmonary tuberculosis in non-HIV-infected patients[J]. J Comput Assist Tomogr,2010,34(4):559-563.
[7] FISHMAN JE, SAIS GJ, SCHWARTZ DS, et al.Radiographic findings and patterns in multidrug-resistant tuberculosis[J].J Thorac Imaging,1998,13(1):65-71.
[8] LONG R, MAYCHER B, SCALCINI A, et al.The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodefciency virus type I[J]. Chest, 1991, 99(1):123-127
[9] 方瑞,吴重重,吴坚,等. 活动性肺结核的烟花征CT表现[J]. 中华放射学杂志, 2019, 53(3):196-199.
[10] 中华医学会结核病学分会, 结核病病理学诊断专家共识编写组. 中国结核病病理学诊断专家共识[J]. 中华结核和呼吸杂志, 2017, 40(6):419-425.
[11] HATIPOGLU ON, OSMA E, MANISALI M, et al.High resolution computed tomographic findings in pulmonary tuberculosis[J]. Thorax, 1996, 51(4): 397-402.
[12] YANG F, YU H, KANTIPUDI K, et al.Differentiating between drug-sensitive and drug-resistant tuberculosis with machine learning for clinical and radiological features[J]. Quant Imaging Med Surg, 2022, 12(1): 675-687.
[13] NEL M, FRANCKLING-SMITH Z, PILLAY T, et al.Chest Imaging for Pulmonary TB-An Update[J]. Pathogens, 2022, 11(2):161.
[14] WORLD HEALTH ORGANIZATION.Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, 27-29 October 2020[R]. Geneva: World Health Organization, 2021.
[15] 中华医学会放射学分会传染病学组, 中国医师协会放射医师分会感染影像专业委员会, 中国研究型医院学会感染与炎症放射专业委员会, 等. 获得性免疫缺陷综合征相关肺结核影像诊断标准专家共识[J]. 中华医学杂志, 2021, 101(37):2962-2967.
[16] NUNES EA, DE CAPITANI EM, COELHO E, et al.Patterns of anti-tuberculosis drug resistance among HIV-infected patients in Maputo, Mozambique, 2002-2003[J]. Int J Tuberc Lung Dis, 2005, 9(5):494-500.
[17] SULTANA ZZ, HOQUE FU, BEYENE J, et al.Correction to: HIV infection and multidrug resistant tuberculosis: a systematic review and meta-analysis[J]. BMC Infectious Diseases, 2021, 21(1):1-13.