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Chest Radiographic Findings in Primary Pulmonary Tuberculosis: Observations from High School Outbreaks

  • Koh, Won-Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Yeon-Joo (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute) ;
  • Kwon, O-Jung (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hee-Jin (Korean Institute of Tuberculosis) ;
  • Cho, En-Hi (Korea Centers for Disease Control and Prevention) ;
  • Lew, Woo-Jin (Korean Institute of Tuberculosis) ;
  • Lee, Kyung-Soo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2010.06.25
  • Accepted : 2010.07.01
  • Published : 2010.12.01

Abstract

Objective: To describe the radiographic findings of primary pulmonary tuberculosis (TB) in previously healthy adolescent patients. Materials and Methods: The Institutional Review Board approved this retrospective study, with a waiver of informed consent from the patients. TB outbreaks occurred in 15 senior high schools and chest radiographs from 58 students with identical strains of TB were analyzed by restriction fragment length polymorphism analysis by two independent observers. Lesions of nodule(s), consolidation, or cavitation in the upper lung zones were classified as typical TB. Mediastinal lymph node enlargement; lesions of nodule(s), consolidation, or cavitation in lower lung zones; or pleural effusion were classified as atypical TB. Inter-observer agreement for the presence of each radiographic finding was examined by kappa statistics. Results: Of 58 patients, three (5%) had normal chest radiographs. Cavitary lesions were present in 25 (45%) of 55 students. Lesions with upper lung zone predominance were observed in 27 (49%) patients, whereas lower lung zone predominance was noted in 18 (33%) patients. The remaining 10 (18%) patients had lesions in both upper and lower lung zones. Pleural effusion was not observed in any patient, nor was the mediastinal lymph node enlargement. Hilar lymph node enlargement was seen in only one (2%) patient. Overall, 37 (67%) students had the typical form of TB, whereas 18 (33%) had TB lesions of the atypical form. Conclusion: The most common radiographic findings in primary pulmonary TB by recent infection in previously healthy adolescents are upper lung lesions, which were thought to be radiographic findings of reactivation pulmonary TB by remote infection.

Keywords

References

  1. Diagnostic Standards and Classification of Tuberculosis in Adults and Children. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 2000;161:1376-1395 https://doi.org/10.1164/ajrccm.161.4.16141
  2. Small PM, Fujiwara PI. Management of tuberculosis in the United States. N Engl J Med 2001;345:189-200 https://doi.org/10.1056/NEJM200107193450307
  3. Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH. Adultonset pulmonary tuberculosis: findings on chest radiographs and CT scans. AJR Am J Roentgenol 1993;160:753-758 https://doi.org/10.2214/ajr.160.4.8456658
  4. Lee JY, Lee KS, Jung KJ, Han J, Kwon OJ, Kim J, et al. Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr 2000;24:691-698 https://doi.org/10.1097/00004728-200009000-00005
  5. Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol 2008;191:834-844 https://doi.org/10.2214/AJR.07.3896
  6. Jones BE, Ryu R, Yang Z, Cave MD, Pogoda JM, Otaya M, et al. Chest radiographic findings in patients with tuberculosis with recent or remote infection. Am J Respir Crit Care Med 1997;156:1270-1273 https://doi.org/10.1164/ajrccm.156.4.9609143
  7. Geng E, Kreiswirth B, Burzynski J, Schluger NW. Clinical and radiographic correlates of primary and reactivation tuberculosis: a molecular epidemiology study. JAMA 2005;293:2740-2745 https://doi.org/10.1001/jama.293.22.2740
  8. Tabet SR, Goldbaum GM, Hooton TM, Eisenach KD, Cave MD, Nolan CM. Restriction fragment length polymorphism analysis detecting a community-based tuberculosis outbreak among persons infected with human immunodeficiency virus. J Infect Dis 1994;169:189-192 https://doi.org/10.1093/infdis/169.1.189
  9. Small PM, Hopewell PC, Singh SP, Paz A, Parsonnet J, Ruston DC, et al. The epidemiology of tuberculosis in San Francisco. A population-based study using conventional and molecular methods. N Engl J Med 1994;330:1703-1709 https://doi.org/10.1056/NEJM199406163302402
  10. Alland D, Kalkut GE, Moss AR, McAdam RA, Hahn JA, Bosworth W, et al. Transmission of tuberculosis in New York City. An analysis by DNA fingerprinting and conventional epidemiologic methods. N Engl J Med 1994;330:1710-1716 https://doi.org/10.1056/NEJM199406163302403
  11. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Mu ¨ller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697-722 https://doi.org/10.1148/radiol.2462070712
  12. Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG. Update: the radiographic features of pulmonary tuberculosis. AJR Am J Roentgenol 1986;146:497-506 https://doi.org/10.2214/ajr.146.3.497
  13. Krysl J, Korzeniewska-Kosela M, Mu ¨ller NL, FitzGerald JM. Radiologic features of pulmonary tuberculosis: an assessment of 188 cases. Can Assoc Radiol J 1994;45:101-107
  14. Choyke PL, Sostman HD, Curtis AM, Ravin CE, Chen JT, Godwin JD, et al. Adult-onset pulmonary tuberculosis. Radiology 1983;148:357-362
  15. Khan MA, Kovnat DM, Bachus B, Whitcomb ME, Brody JS, Snider GL. Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult. Am J Med 1977;62:31-38 https://doi.org/10.1016/0002-9343(77)90346-1
  16. Kim WS, Choi JI, Cheon JE, Kim IO, Yeon KM, Lee HJ.Primary tuberculosis in infants: radiographic and CT findings. AJR Am J Roentgenol 2006;187:1024-1033 https://doi.org/10.2214/AJR.04.0751
  17. Leung AN, Mu ¨ller NL, Pineda PR, FitzGerald JM. Primary tuberculosis in childhood: radiographic manifestations. Radiology 1992;182:87-91
  18. Sant'Anna C, March MF, Barreto M, Pereira S, Schmidt C. Pulmonary tuberculosis in adolescents: radiographic features. Int J Tuberc Lung Dis 2009;13:1566-1568
  19. Kim HJ, Lee HJ, Kwon SY, Yoon HI, Chung HS, Lee CT, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest 2006;129:1253-1258 https://doi.org/10.1378/chest.129.5.1253
  20. Marais BJ, Parker SK, Verver S, van Rie A, Warren RM. Primary and postprimary or reactivation tuberculosis: time to revise confusing terminology. AJR Am J Roentgenol 2009;192:W198 https://doi.org/10.2214/AJR.08.1726
  21. Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, Starke JJ, et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the prechemotherapy era. Int J Tuberc Lung Dis 2004;8:392-402
  22. Andronikou S, Vanhoenacker FM, De Backer AI. Advances in imaging chest tuberculosis: blurring of differences between children and adults. Clin Chest Med 2009;30:717-744 https://doi.org/10.1016/j.ccm.2009.08.022
  23. Barnes PF, Bloch AB, Davidson PT, Snider DE Jr. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1991;324:1644-1650 https://doi.org/10.1056/NEJM199106063242307
  24. Leung AN, Brauner MW, Gamsu G, Mlika-Cabanne N, Ben Romdhane H, Carette MF, et al. Pulmonary tuberculosis: comparison of CT findings in HIV-seropositive and HIVseronegative patients. Radiology 1996;198:687-691
  25. Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis 2008;8:498-510 https://doi.org/10.1016/S1473-3099(08)70182-8

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