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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 168-172

Patterns of request and radiographic findings in patients with pulmonary tuberculosis in a secondary healthcare center in Borno State, Nigeria


1 Department of Radiology and Imaging, Maryam Abatcha Women and Children Hospital, Maiduguri, Borno State, Nigeria
2 Department of Radiology, Federal Neuro Psychiatric Hospital, Maiduguri, Borno State, Nigeria
3 Department of Medical Radiography, Faculty of Allied Health Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria

Date of Submission27-Nov-2020
Date of Decision03-May-2021
Date of Acceptance03-May-2021
Date of Web Publication08-Jan-2022

Correspondence Address:
Alhaji Modu Ali
Department of Radiology, Federal Neuro Psychiatric Hospital, P.M.B 1322, Maiduguri, Borno State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_126_20

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  Abstract 


BACKGROUND AND AIM: Pulmonary tuberculosis (PTB) is a major public health problem globally with relatively high morbidity and mortality rates. Chest radiography plays a key role in describing the patterns of appearances which help in predicting treatment progress. In this study, we evaluated the patterns of radiographic findings among patients diagnosed with PTB.
MATERIALS AND METHODS: This was a retrospective study of clinical and chest radiographic features of PTB in 105 patients. All the radiographs were reported by a consultant radiologist. The age, gender, clinical presentation, nature and location of the lung changes, and diagnosis were recorded. Descriptive statistics were employed in analysing mean ± standard deviation, percentages, and frequencies. Data were analyzed using the SPSS software version 22.0.
RESULTS: The male-to-female ratio was 3:2 with 58.1% (n = 61) male and 41.9% (n = 44) female. The average age of the patients was 36.29 ± 15.95 years with 21–30 years age group most affected. Fibrocavitatory changes alone were the most common finding and the majority of the lung changes involved the entire both lungs.
CONCLUSION: Fibrocavitatory changes and involvement of the entire both lungs were found to be the common radiographic findings of patients diagnosed with PTB. Age group 21–30 years was most commonly affected.

Keywords: Chest radiography, Nigeria, patterns, pulmonary tuberculosis


How to cite this article:
Abba-Sulum HK, Ali AM, Njitti MM, Hassan JM, Abubakar A, Shettima A. Patterns of request and radiographic findings in patients with pulmonary tuberculosis in a secondary healthcare center in Borno State, Nigeria. BLDE Univ J Health Sci 2021;6:168-72

How to cite this URL:
Abba-Sulum HK, Ali AM, Njitti MM, Hassan JM, Abubakar A, Shettima A. Patterns of request and radiographic findings in patients with pulmonary tuberculosis in a secondary healthcare center in Borno State, Nigeria. BLDE Univ J Health Sci [serial online] 2021 [cited 2022 Jul 6];6:168-72. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/2/168/335323



Pulmonary tuberculosis (PTB) is a contagious bacterial disease which mostly affects the lungs but may spread to other organs in the body.[1],[2],[3] TB is caused by the bacteria called tubercle bacillus or Mycobacterium tuberculosis.[4] The disease spread either by droplet infection from an individual with active TB, or in dust contaminated by infected sputum.[5] PTB remains the most common global infectious disease which is characterized by high mortality and morbidity rates, especially in the developing nations.[6] The World Health Organization referred TB as the single most important deadly infectious disease, with a incidence rate of 10.0 million and an annual mortality rate of 1.7 million.[7] TB is a major public health problem in Nigeria and it ranks 7th among the 30 high TB burden countries worldwide and 2nd in Africa, accounting for 4% of the estimated incidence cases globally.[8] It has been estimated that about 460,000 cases of TB occur in Nigeria every year with incidence and mortality rates of 219/100,000 and 39/100,000 population, respectively.[8]

PTB can be symptomatic or asymptomatic (latent) form.[9] Latent TB infection (LTBI) is defined as a state of persistent infection without clinical features of active disease.[10],[11] When the clinical feature of the disease is present, the term TB is used without a further prerequisite is used to designate the disease.[11] Based on this description, both TB and LTBI may be considered different phases in a continual pathological process, and both conditions are usually distinguished on the basis of the presence (TB) or absence (LTBI) of clinical, microbiological (direct microscopy or culture), and radiographic findings.[10] Chest radiography is currently used for screening, diagnosis and management of patients on anti-TB treatment.[12] Despite its low sensitivity and a high interobserver variability, it remains a valuable adjunct to clinical and microbiological diagnosis.[13] Several quantitative chest radiographic scoring systems have been developed over the years and some have shown the potential to reduce the interobserver variability and increase the sensitivity of the chest radiograph in TB cases especially with digital radiographic systems.[14],[15]

The radiographic feature of PTB varies with the stage of the infection, radiographic technique used and other associated conditions. However, the typical feature chest X-ray include focal upper lobe opacities, diffuse opacities, reticulonodular opacities, cavities, nodules, consolidation, unilateral pleural effusion, miliary pattern, mediastinal, and hilar lymphadenopathy.[16] Primary PTB appears homogeneous and mimics community-acquired pneumonia. Any lobe may be involved; size varies from subsegmental to an entire lobe. Compared with community-acquired pneumonia, primary PTB may exhibit nodal enlargement, usually ipsilateral, hilar, and/or mediastinal.[17] In fact, lymphadenopathy is the most common manifestation of primary TB in children and occurs with or without pneumonia.[17] Postprimary PTB radiographically, present in 95% of patients the initial lesions are poorly marginated, nodular and linear opacities which arise in the apicoposterior segments of an upper lobe and/or the superior segment of a lower lobe.[17] Cavitation, fibrosis, pleural effusion, and calcification are also forms of manifestation of postprimary TB. Military TB now occurs more commonly as a manifestation of postprimary than of primary disease.[17]

Among the diagnostic tools traditionally used for the diagnosis of PTB, the chest radiography plays a pivotal role, mainly because it is widely available, accessible, and cheap within the public health system, even in local areas. Therefore, we designed this study to determine the patterns of clinical indication/request and radiographic findings in patients with PTB in the study locality which will go a long way in the proper diagnosis of the patients.


  Materials and Methods Top


Chest radiographs of (105) patients referred to the radiology department of the Maryam Abatcha women and children hospital, Jere, Nigeria from May to September 2019 with a radiographic features of PTB coupled with clinical information were retrospectively reviewed. All the radiographs were interpreted by a consultant radiologist. Data were retrieved from the radiological information systems of the hospital. All the radiographic examinations were carried out on a Triup stationary digital X-ray machine (Model № TR50KW-WT, Nanjing, China).

Data were collected using data capture sheet with age, clinical presentation, nature, and location of the lungs changes as variables. Descriptive statistics (mean ± standard deviation, range, frequency, and percentage) were used to analyze the data, and statistical analysis was performed using the Statistical Package for the Social Sciences software version 22.0 (IBM, Armonk, NY, USA).


  Results Top


A total of 105 clinical and radiographic records of patients with features of PTB were evaluated for the study. The study comprised 61 (58.1%) males and 44 (41.9%) females. Their ages ranged from the ages 6 to 75 years, with mean age of 36.29 ± 15.95 years. The most affected age group was 21–30 years (32.4%) as shown in [Table 1].
Table 1: Age distribution of patients

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The most common clinical indications based on the request form was the querying (?) chest infection (26.7%) followed by querying (?) PTB (13.3%) while acute respiratory infection, peripartum cardiomyopathy, immunosuppression, cough + weight loss + poor appetite + headache, and cough + fever + headache + hemoptysis and cough + weight loss + chest pain + loss of appetite had the least occurrences (1% each) as shown in [Table 2].
Table 2: Clinical indications based on request forms

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[Table 3] shows the distribution of the chest radiographic pattern of the PTB. The most common feature was the fibrocavitatory changes alone which was found in 39 (37.1%) cases as seen on [Figure 1], followed by nodular opacities with cystic background changes which had 10 (9.5%) cases as in [Figure 2] while pinhead opacities, consolidation + nodular opacities, fibrocavitatory changes + pleural effusion, fibrocavitatory changes + pleural calcification, and reticolu-nodular opacities + cystic changes + pleura effusion + calcification had the least occurrence (1% each).
Table 3: Distribution of the chest radiographic features of pulmonary tuberculosis

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Figure 1: A posteroanterior chest radiograph showing fibro-cavitatory changes in a 50-year-old man presented with cough fever and weight loss

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Figure 2: An anteroposterior AP chest radiograph showing widespread nodular opacities with cystic changes involving both lungs in a 16-year-old female presented with chronic cough and progressive weight loss

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[Table 4] shows the pattern of changes in relation to part of the lungs affected. Both lungs were affected in the majority of the cases (41.9%) while both mid zones, right mid zone, left mid and upper zones and; both upper zones and left mid zones were affected in only 1 (1%) case each.
Table 4: Patterns of changes in relations to part of the lungs affected

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  Discussion Top


PTB is one of the top ten causes of death globally. About 1/4 of the world's population had latent PTB.[18] Chest radiography is the primary radiographic examination for suspected or proven PTB cases.

The result of this study showed that the male-to-female ratio was 3:2. This finding is in agreement with those of Akhigbe et al.,[19] van Cleeff et al.[20] and Rao[21] who reported a male-to-female ratios of 2.6:1, 3:2, and 2:1, respectively. This could be attributable biological, environmental and lifestyle factors. On the contrary, Umar et al.[22] reported a male-–to-female ratio of 5:7.

The average age of the affected patient in this study was 36.29 ± 15.95 years with 21–30 years was the most affected age group (32.4%). This finding is in agreement with those of Desalu et al.[23] and Peters et al.[24] who reported a mean age of 35.1 ± 8.4 years and 34.60 ± 1.2 years in Yola and Calabar, Nigeria, respectively. On the contrary, Akhigbe et al.[9] and Umar et al.[22] in Lagos and Kano, Nigeria, respectively, reported in their study a mean age of 32.16 ± 8.72 and 31.62 ± 16.93 years; with 26–38 and <30 years, respectively, as predominantly affected age group. This variation could be attributable to the differences in geographical location, environmental factors, nature of the study adopted, etc.,

The clinical presentations of PTB are nonspecific, and there is no clinical sign or symptom that is exclusive to the disease. Chronic cough (>3 weeks) is a sentinel of PTB.[25] One study found that symptom in 96% of a group of patients with PTB.[26] These findings are similar to that found in the present study.

In this study, fibrocavitary changes alone was the most common lungs changes (37.1%), followed by nodular opacities with cystic background changes (9.5%) and both lungs were affected in most cases (41.9%). This finding is in agreement with that of Besen et al.[27] who reported highest occurrence of cavitations among HIV negative patients. On the contrary, Akhigbe et al.[9] and Akhigbe et al.[19] reported consolidation as the most common findings, followed by fibrocavitation. The predominance of the cavitations over consolidation can be explained by the large proportion of nonimmunocompromised individuals in our study sample. The predominance of cavitation might also be due to the fact that the disease was diagnosed lately.[25],[28]

In the current study, the abnormal chest radiographic patterns are distributed around six different anatomical regions of the lungs. The six identified anatomic regions were: left upper zone, left lower zone, right upper zone, right lower zone, and right middle zone. Entire both lungs were affected in the majority of the cases (41.9%) while both mid zones, right mid zone, left mid and upper zones and; both upper zones and left mid zones were affected in only 1 (1%) case each. This finding is in agreement with that of Wilcke et al.[29] who found that the entire both lungs were affected in most cases (55%). On the contrary, Akhigbe et al.[19] who found that the left upper zone is affected in the majority of the cases (37.56%) while entire both lungs were affected in only 7.18% of the cases. Furthermore, Lachi and Nakayama[30] reported that the entire right lung was affected in most cases in their study. This discrepancy in our findings may be attributed to the nature of the subjects studied, study design and variation in geographical location. Our study had the following limitations: Radiographic findings were not compared with the results of either microbiological or advance imaging modality such as computed tomography, patient's HIV status was unknown and the anti TB treatment status of the patients was also unknown.


  Conclusion Top


Fibrocavitatory changes and involvement of the entire both lungs were found to be the common radiographic findings of patients diagnosed with PTB in this study which is a radiographic manifestation of postprimary TB. Male preponderance was noted. The most affected age group of 21–30 years.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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