Pathological features seen on medical imaging in hospitalized patients treated for tuberculosis in a reference hospital in Rwanda

BACKGROUND: Tuberculosis (TB) and HIV are major causes of morbidity and mortality worldwide. Abdominal ultrasound and Chest X-ray may reveal suggestive features of TB disease in hospitalized sputum AFB negative patients treated for TB. This study describes the pathological features seen on Chest X-ray and abdominal ultrasound in inpatients treated for TB and their association with bacteriological TB diagnosis and HIV co-infection.
METHODS: All patients being initiated on TB treatment during hospitalization were included. TB was confirmed when acid-fast bacilli were found in sputum or elsewhere, and probable when composite clinical, laboratory and radiological findings were consistent with TB disease. Disseminated TB was defined on medical imaging criteria. HIV testing was done in all.

RESULTS: Of 199 patients included, TB was confirmed in 80 (40%) and 125 people (63%) were co-infected with HIV. Lesions consistent with TB were seen in 148/187 (87%) on Chest X-ray and in 156/183 (85%) on abdominal ultrasound. Pulmonary TB and/or concurrent pulmonary/extrapulmonary TB was seen in 130 (65%), and isolated extrapulmonary TB in the remaining 69 (35%) patients. Disseminated TB was seen in 121/199 (61%) patients. HIV co-infection was associated with disseminated TB, abdominal TB and miliary TB, but inversely associated with TB pleurisy. Bacteriological TB confirmation was not associated with HIV co-infection nor with TB dissemination.

CONCLUSION: Pathological features on medical imaging were seen in the vast majority of hospitalized patients treated for TB, and disseminated TB in more than half. TB dissemination is more frequently seen in HIV co-infection. Abdominal ultrasound is essential to reveal the true extent of TB dissemination.

Keywords
Medical Imaging; Disseminated tuberculosis; abdominal ultrasound; chest X-ray.