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Oleh :
Putri Milawati (030.12.214)
Indira Wulandari (030.09.120)
Aristya Nur F. (030.12.033)
Brent (030.13.041)
INTRODUCTION
Study Population
Between September 2007 and July 2008
Exlude:
Include:
Patients already receiving
all adult patients admitted to therapy for TB
the medical emergency ward
Patients who were unwilling or
with a cough of ≥ 2 weeks but
unable to consent in English or
<6 month a local language
Data Collection
Informed consent
Provided spot sputum on hospital day 1 and early-morning sputum on hospital day
2. (Unable to produce Nebu)
Posteroanterior (PA)
A posteroanterior chest
radiograph shows
homogeneous and ring
opacities in the left upper and
mid zones, reticulonodular
infiltrates in the left lower
zones and tracheal shift to the
left.
Compares radiographic findings between HIV-
seropositive and HIV-seronegative TB patients
▸ HIV-seropositive TB patient
with a CD4+ T-cell count of 17
cellsmm–3 and extensive
▸ bronchopneumonia.
Anteroposterior chest
radiograph shows bilateral
diffuse reticulonodular and
patchy opacities involving
all lung zones.
▸ HIV-seronegative patient
with TB and cavitary
bronchopneumonia.
▸ A posteroanterior chest
radiograph shows patchy
opacities in the upper and
mid zones bilaterally and a
thick-walled ring shadow in
the left mid zone.
▸ Miliary tuberculosis in a
patient with a CD4+ T-
cellcount of 4 cellsmm–3.
▸ Anteroposterior chest
radiograph shows
innumerable small discrete
nodules 1–2mm in diameter,
diffusely distributed
throughout both lungs
Compares radiographic findings in
HIVseropositive TB patients after stratification by
CD4+ count
HIV-seropositive patient
with a CD4+ T-cell count
of 173 cellsmm–3 & TB.
A posteroanterior chest
radiograph shows patchy
opacities in the upper
and mid zones bilaterally.
HIV-seropositive patient with
TB and a CD4+ T-cell count of 1
cellmm–3.
A posteroanterior chest
radiograph shows enlarged
right paratracheal,
tracheobronchial and bilateral
hilar lymph nodes and a
homogeneous opacity in the
right mid zone, giving a
pattern similar to a primary TB
Discussion
Present Study Previous Studies
▸ Show that typical radiographic findings Described atypical patterns as being more
of TB are still useful for differentiating TB common in HIV-infected TB patients with
from other pneumonias. CD4+ T-cell counts ≤ 200 cells mm–3, few
▸ We have also demonstrated that a lack of have described CXR patterns of patients with
consolidation and a lack of cavities are CD4+ Tcell counts ≤ 50 cellsmm–3.
the radiographic features that may be
considered to define an atypical
presentation since that is more common
in HIV-seropositive than in HIV-
seronegative patients, and in patients
with advanced immunosuppression than
in those with less immunosuppression
Discussion
Present Study
1. The resolution of the CXRs could have been compromised by digitising the
images.
4. Limited in size and large studies of patients across a range of CD4+ T-cell
counts, including patients with a greater frequency of non-TB opportunistic
conditions, are needed in order to determine what features distinguish TB from
other processes in similar populations
Conclusion
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