J B Te Riele1, V Buser2, G Calligaro3, A Esmail4, G Theron5, M Lesosky6, K Dheda7. 1. Department of Public Health and Family Medicine, University of Cape Town, South Africa. Electronic address: julian.teriele@westerncape.gov.za. 2. Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa. Electronic address: virginia.buser@gmail.com. 3. Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa. Electronic address: greg.calligaro@uct.ac.za. 4. Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa. Electronic address: a.esmail@uct.ac.za. 5. Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa. Electronic address: gtheron@sun.ac.za. 6. Department of Public Health and Family Medicine, University of Cape Town, South Africa. Electronic address: lesosky@gmail.com. 7. Centre for Lung Infection and Immunity, Department of Medicine, University of Cape Town, South Africa. Electronic address: keertan.dheda@uct.ac.za.
Abstract
BACKGROUND: Data about the relationship between chest radiographs and sputum bacillary load, with treatment outcomes, in patients with extensively drug-resistant tuberculosis (XDR-TB) from HIV/TB endemic settings are limited. METHODS: Available chest radiographs from 97 South African XDR-TB patients, at the time of diagnosis, were evaluated by two independent readers using a validated scoring system. Chest radiograph findings were correlated with baseline sputum bacillary load (smear-grade and culture time-to-positive in MGIT), and prospectively ascertained clinical outcomes (culture conversion and all-cause mortality). RESULTS: Radiographic bilateral lung disease was present in 75/97 (77%). In the multivariate analysis only a higher total radiographic score (95% CI) was associated with higher likelihood of death [1.16 (1.05-1.28) p=0.003], and failure to culture convert [0.85 (0.74-0.97) p=0.02]. However, when restricting analyses to HIV-infected patients, disease extent, cavitation, and total radiographic scores were not associated with mortality or culture-conversion. Finally, cavitary, disease extent, and total radiographic scores all positively correlated with bacterial load (culture time-to-positive). CONCLUSIONS: In endemic settings, XDR-TB radiological disease extent scores are associated with adverse clinical outcomes, including mortality, in HIV uninfected persons. These data may have implications for clinical and programmatic decision-making and for evaluation of new regimens in clinical trials.
BACKGROUND: Data about the relationship between chest radiographs and sputum bacillary load, with treatment outcomes, in patients with extensively drug-resistant tuberculosis (XDR-TB) from HIV/TB endemic settings are limited. METHODS: Available chest radiographs from 97 South African XDR-TB patients, at the time of diagnosis, were evaluated by two independent readers using a validated scoring system. Chest radiograph findings were correlated with baseline sputum bacillary load (smear-grade and culture time-to-positive in MGIT), and prospectively ascertained clinical outcomes (culture conversion and all-cause mortality). RESULTS: Radiographic bilateral lung disease was present in 75/97 (77%). In the multivariate analysis only a higher total radiographic score (95% CI) was associated with higher likelihood of death [1.16 (1.05-1.28) p=0.003], and failure to culture convert [0.85 (0.74-0.97) p=0.02]. However, when restricting analyses to HIV-infectedpatients, disease extent, cavitation, and total radiographic scores were not associated with mortality or culture-conversion. Finally, cavitary, disease extent, and total radiographic scores all positively correlated with bacterial load (culture time-to-positive). CONCLUSIONS: In endemic settings, XDR-TB radiological disease extent scores are associated with adverse clinical outcomes, including mortality, in HIV uninfected persons. These data may have implications for clinical and programmatic decision-making and for evaluation of new regimens in clinical trials.
Authors: Grant Theron; Jason Limberis; Rouxjeane Venter; Liezel Smith; Elize Pietersen; Aliasgar Esmail; Greg Calligaro; Julian Te Riele; Marianna de Kock; Paul van Helden; Tawanda Gumbo; Taane G Clark; Kevin Fennelly; Robin Warren; Keertan Dheda Journal: Nat Med Date: 2020-06-29 Impact factor: 53.440
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