Chest X-Ray Comparison Between Drug-Resistant and Drug-Sensitive Pulmonary Tuberculosis in Children

Abstract

Introduction: Chest X-ray (CXR) remains one of the tools used in diagnosing tuberculosis (TB). However, few studies about such tools exist, specifically in children in Indonesia. We aim to investigate and compare the CXR findings of children with pulmonary drug-resistant TB (DR-TB) and drug-sensitive TB (DS-TB) that could help in the evaluation and management of TB cases in children.

Methods: Retrospective analysis with cross-sectional approach was conducted in children (<18 years old) diagnosed with pulmonary DR-TB and DS-TB from January 2018 to December 2021. Documented data were collected from the Paediatric Respirology Registry and Tuberculosis Information System at Dr. Hasan Sadikin General Hospital Bandung. Characteristics of children, CXR findings, and TB severity were assessed and compared using the chi-square and Fisher's exact tests with significance levels set at p value <0.05.

Results: Sixty-nine children (DR-TB 31 children vs. DS-TB 38 children) were assessed. Of the 31 children with DR-TB, 65% were classified as multidrug-resistant TB (MDR-TB), followed by rifampicin-resistant TB (RR-TB), pre-extensively drug-resistant TB (pre-XDR-TB), and extensively drug-resistant TB (XDR-TB). The most common CXR findings in DR-TB are consolidation (68%), fibrosis (42%), and cavity (29%), whereas in DS-TB, it is pleura effusion (37%). Severe TB accounts for 50% of DR-TB (p = 0.008).

Conclusions: Consolidation, fibrosis, cavities, and findings of severe TB are most common in DR-TB. Pleural effusion is the most common in DS-TB. These findings have the potential to be considered in further examination of children with pulmonary DR-TB and DS-TB; hence, more extensive studies are needed to confirm these results.

Keywords: chest X‐ray; children; pulmonary drug‐resistant; tuberculosis.

FIGURE 1

Pulmonary DS‐TB in 5‐year‐old boy. CXR was taken in AP projection with findings of left pleural effusion (white arrow) accompanied by narrowing of the intercostal space (black arrow). There is enlargement of right perihilar lymph node. AP, anteroposterior; CXR, chest X‐ray; DS‐TB, drug‐sensitive TB.

FIGURE 2

Pulmonary DR‐TB in 16‐year‐old girl. CXR was taken in AP projection with findings of multiple cavities (black arrows) in the bilateral upper zone of lungs and middle zone of left lung. There were also fibrosis (white arrow) and consolidation in the both lungs. Minor fissure thickness (blue arrow) was also seen. AP, anteroposterior; CXR, chest X‐ray; DR‐TB, drug‐resistant TB.