Radiological features of pulmonary tuberculosis in HIV-positive and HIV-negative adult patients in south-eastern Nigeria

E U Nwonwu, P G Oyibo, C D Ndukwe, and C N Obionu, Department of Community Medicine, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria; A O C Imo, Department of Radiology, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria; and C J Uneke, Department of Medical Microbiology, Faculty of Clinical Medicine, Ebonyi State University Abakaliki, Nigeria. Correspondence to: Dr E U Nwonwu, Department of Community Medicine, Ebonyi State University Teaching Hospital, PMB 077, Abakaliki, Nigeria. Email: [email protected] Introduction Tuberculosis (TB) has been declared a global public health emergency by the World Health Organization (WHO).1 TB incidence has been rising all over the world, but is worse in developing countries. Human TB is a chronic bacterial infection caused usually by Mycobacterium tuberculosis, although similar disease can be due to other mycobacteria such as M bovis and M avium. In individuals who have compromised body immunity, such as in uncontrolled diabetes, human immuno-deficiency virus (HIV) infection, cancer, and lymphoma, normally opportunistic mycobacteria such as M kansasii and M intracellularis may cause infection.2–4 In Africa, due to the low standard of living, famine, and inadequate shelter with attendant overcrowding, the TB scourge has increased.4 HIV infection has also contributed significantly to the resurgence of TB especially in subSaharan Africa.5–8 Most cases of TB in patients with HIV infection are probably due to reactivation of TB infection often acquired many years before.9 Pulmonary tuberculosis (PTB) is the most common clinical presentation of TB accounting for 74% of all cases.10–12 Radiology remains one of the important diagnostic modalities of TB infection.13 In fact, WHO recommendations for diagnosis of PTB include, ‘one sputum smear positive for acid fast bacilli (AFB) and radiographic abnormalities consistent with active PTB’ for sputum positive PTB and ‘symptoms suggestive of PTB and three negative smears for AFB and radiographic abnormalities consistent with active PTB’ for sputum-negative PTB.1 Sputum negativity does not exclude PTB especially when clinical symptoms and radiographic features are in support of the diagnosis.1,13 In the follow-up of PTB patients, radiology is also very valuable both in the short-term and on a long-term basis. This is important as about 25% of radiologically stable PTB lesions could still have active disease.14 There is a paucity of information on the radiological features of PTB in south-eastern Nigeria. Most of the documented studies on the radiological features of PTB in Nigeria were done in the south-west.15,16 The objective of the current study was to assess the radiological features of PTB in Abakaliki, Ebonyi State, south-eastern Nigeria in order to provide scientific information that would have policy relevance and which will aid TB control programmes, in Nigeria. Pulmonary tuberculosis (PTB) is the most common clinical presentation of tuberculosis. This study was carried out to appraise the radiological features of PTB in adult HIV-positive and HIV-negative patients. The chest radiographs of the patients were evaluated in the tuberculosis, leprosy, and endemic disease (TBL) clinic, Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki, south-eastern Nigeria, from April 2004 to June 2006. Of the total of 117 individuals studied, 68 (58.1) were males and 49 (41.8%) females, indicating a male preponderance of 1.4:1. Up to 49.6% of the subjects had PTB/HIV co-infection. The highest prevalence of PTB/HIV co-infection was recorded among males aged 31–40 (12.8%), and females aged 21–30 (11.1%). The commonest radiological features observed were cavitory lesions (64.1%), patchy opacities (44.4%), and hilar opacities (38.5%). Bilateral cavitory lesions, patchy opacities and hilar opacities were more prominent than the right-sided or left-sided ones and appeared more frequently among individuals with PTB/HIV co-infection. Perihilar patchy opacities, consolidation and pleural effusion were seen in 19.6%, 6.0%, and 4.3% of all cases, respectively. There was no statistically significant difference in the association between the radiological features and patient category (χ2 = 17.74, df = 18, p = 0.47). The chest radiography remains an important tool in the diagnosis of PTB and will continue to provide essential information for the management and follow-up of patients.