Differences in Chest X-Ray Imaging in Pulmonary Tuberculosis across Various Comorbidities

Mohammad Subkhan(1*), Meltritania Arief Rezacharawa(2), Muslim Andala Putra(3), Afrita Amalia Laitupa(4), Putu Bagus Dharma Permana(5), Laily Irfana(6)


(1) Department of Respirology and Pulmonology, Siti Khodijah Muhammadiyah Sepanjang Hospital, Sidoarjo, East Java, Indonesia Faculty of Medicine, Universitas Muhammadiyah Surabaya, Surabaya, East Java, Indonesia
(2) Faculty of Medicine, Universitas Muhammadiyah Surabaya, Surabaya, East Java, Indonesia
(3) Department of Radiology, Siti Khodijah Muhammadiyah Sepanjang Hospital, Sidoarjo, East Java, Indonesia Faculty of Medicine, Universitas Muhammadiyah Surabaya, Surabaya, East Java, Indonesia
(4) Department of Respirology and Pulmonology, Siti Khodijah Muhammadiyah Sepanjang Hospital, Sidoarjo, East Java, Indonesia Faculty of Medicine, Universitas Muhammadiyah Surabaya, Surabaya, East Java, Indonesia
(5) Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
(6) Department of Neurology, Siti Khodijah Muhammadiyah Sepanjang Hospital, Sidoarjo, East Java, Indonesia Faculty of Medicine, Universitas Muhammadiyah Surabaya, Surabaya, East Java, Indonesia
(*) Corresponding Author

Abstract


Background:  Tuberculosis (TB) remains a significant public health concern in Indonesia, with a high prevalence of cases, particularly in patients with comorbidities such as HIV infection, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), and chronic kidney disease (CKD). Evidence suggested radiological variations in chest X-ray findings among these complex condition, which may pose significant challenges in accurately diagnosing pulmonary TB in clinical practice.

Objective:  This study aimed to provide a comprehensive understanding of the variations in chest X-ray imaging in pulmonary TB patients with specific comorbidities, focusing on DM, CKD, and COPD.

Methods: A cross-sectional study was conducted at Siti Khodijah Muhammadiyah Sepanjang Hospital by utilizing standardized medical records and chest X-ray results of 50 pulmonary patients with comorbidities.

Results: The most prevalent comorbidity was DM, with radiological findings including fibroinfiltrates, consolidations, and cavities. CKD patients exhibited radiological features such as infiltrates, cavitations, and pleural effusion, while COPD patients presented with infiltrates and consolidations. 

Conclusion: The study provides valuable insights into the radiological manifestations of pulmonary TB and its comorbidities, offering a basis for improved management and treatment strategies for patients with pulmonary TB and comorbidities. Further research employing longitudinal designs and balanced representation of comorbid conditions is recommended to enhance the understanding of the interplay between TB and associated health conditions.

Keywords


Pulmonary tuberculosis; comorbidity; diabetes mellitus; COPD; chronic kidney disease

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References


Directorate General of Prevention and Disease Control. Tuberculosis Control in Indonesia 2022. Jakarta: Ministry of Health Republic of Indonesia; 2023.

World Health Organization. Global Tuberculosis Report 2023. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.

Dinas Kesehatan Kabupaten Sidoarjo. Profil Kesehatan Kab. Sidoarjo Tahun 2019. Sidoarjo: Dinkes Kabupaten Sidoarjo; 2019. Available from URL: www.dinkes.sidoarjokab.go.id.

Cáceres G, Calderon R, Ugarte-Gil C. Tuberculosis and comorbidities: treatment challenges in patients with comorbid diabetes mellitus and depression. Therapeutic Advances in Infectious Disease. 2022 May;9:20499361221095831.

Miftahul S, Zuraida Z, Ramadhan RM. Prevalensi Tuberkulosis Paru Pada Penderita HIV Di RSKO Jakarta Periode Januari 2016− Desember 2017. Anakes: Jurnal Ilmiah Analis Kesehatan. 2019 Sep 30;5(2):152-61.

Lutfiana NC, van Boven JF, Masoom Zubair MA, Pena MJ, Alffenaar JW. Diabetes mellitus comorbidity in patients enrolled in tuberculosis drug efficacy trials around the world: a systematic review. British journal of clinical pharmacology. 2019 Jul;85(7):1407-17.

Hidayah H, Amal S, Rosmalinda AN. Insidensi TB Paru pada Pasien DM tipe 2 di Rumah Sakit Karya Husada Cikampek. Pharma Xplore: Jurnal Sains dan Ilmu Farmasi. 2021 May 5;6(1):23-31.

Pradhan RR, Sigdel MR. Prevalence, clinical presentation, and outcome of tuberculosis in patients with chronic kidney disease at a tertiary care hospital in Nepal. International journal of nephrology. 2020 1 November;2020.

Ruzangi J, Iwagami M, Smeeth L, Mangtani P, Nitsch D. The association between chronic kidney disease and tuberculosis; a comparative cohort study in England. BMC nephrology. 2020 Dec;21:1-9.

Vikrant S. Clinical profile of tuberculosis in patients with chronic kidney disease: A report from an endemic Country. Saudi Journal of Kidney Diseases and Transplantation. 2019 Mar 1;30(2):470-7.

Susilawati TN, Larasati R. A recent update of the diagnostic methods for tuberculosis and their applicability in Indonesia: a narrative review. Medical Journal of Indonesia. 2019 Oct 4;28(3):284-91.

Ramzi M. Perbandingan Derajat Keparahan Gambaran X-Ray Thorax Antara Tuberkulosis Paru Tanpa Diabetes Melitus Dan Tuberkulosis Paru Dengan Diabetes Melitus (Doctoral dissertation, Universitas Muhammadiyah Surabaya); 2020.

Nurmalasari R, Apriantoro NH. Pemeriksaan Radiografi Thorax Dengan Kasus Tuberkulosis Paru. KOCENIN SERIAL KONFERENSI (E) ISSN: 2746-7112. 2020 Oct 11(1):1-3.

Marvellini RY, Izaak RP. Gambaran radiografi foto thorax penderita tuberkulosis pada usia produktif di RSUD Pasar Minggu (Periode Juli 2016 sampai Juli 2017). Jurnal Kedokteran Universitas Palangka Raya. 2021;9(1):1219-23.

Lukum E, Paramata NR, Sadjar MR. Identification of Respondent Characteristics and Relationship of Clinical Manifestations with Chest Radiograph Lesion in Pulmonary Tuberculosis Patients at Aloei Saboe Hospital. Jambura Medical and Health Science Journal. 2023 Jul 31;2(1):28-37.

Cuschieri S. The STROBE guidelines. Saudi journal of anaesthesia. 2019 Apr;13(Suppl 1):S31.

Wei R, Li P, Xue Y, Liu Y, Gong W, Zhao W. Impact of diabetes mellitus on the immunity of tuberculosis patients: a retrospective, cross-sectional study. Risk Management and Healthcare Policy. 2022 Apr 8:611-27.

Segura-Cerda CA, López-Romero W, Flores-Valdez MA. Changes in host response to mycobacterium tuberculosis infection associated with type 2 diabetes: beyond hyperglycemia. Frontiers in cellular and infection microbiology. 2019 4 October;9:342.

Putra ON, Hardiyono H, Rizkiyah F, NH AY. Impact of Uncontrolled HbA1C on The Outcome of Tuberculosis Treatment in TB Patients With Diabetes. Jurnal Profesi Medika: Jurnal Kedokteran dan Kesehatan. 2020 Dec 23;14(2).

Ferlita S, Yegiazaryan A, Noori N, Lal G, Nguyen T, To K, Venketaraman V. Type 2 diabetes mellitus and altered immune system leading to susceptibility to pathogens, especially Mycobacterium tuberculosis. Journal of clinical medicine. 2019 Dec 16;8(12):2219.

Dhamotharaswamy K, Selvaraj H, Lakshmanaperumal P, Sasankan AS, Thangavelu P, Thangavel S. Diabetes and TB: Confluence of Two Epidemic and Its Effect on Clinical Presentation. Current Diabetes Reviews. 2024 Jan 1;20(1):59-66.

Saalai KM, Mohanty A. The effect of glycemic control on clinico-radiological manifestations of pulmonary tuberculosis in patients with diabetes mellitus. The International Journal of Mycobacteriology. 2021 Jul 1;10(3):268-70.

Dousa KM, Hamad A, Albirair M, Al Soub H, Elzouki AN, Alwakeel MI, Thiel BA, Johnson JL. Impact of diabetes mellitus on the presentation and response to treatment of adults with pulmonary tuberculosis in Qatar. InOpen forum infectious diseases 2019 Jan (Vol. 6, No. 1, p. ofy335). US: Oxford University Press.

Zhan S, Juan X, Ren T, Wang Y, Fu L, Deng G, Zhang P. Extensive radiological manifestation in patients with diabetes and pulmonary tuberculosis: A cross-sectional study. Therapeutics and clinical risk management. 2022 May 23:595-602.

Shu CC, Wei YF, Yeh YC, Lin HH, Chen CY, Wang PH, Cheng SL, Wang JY, Yu CJ. The impact on incident tuberculosis by kidney function impairment status: analysis of severity relationship. Respiratory research. 2020 Dec;21:1-8.

Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease. Advances in chronic kidney disease. 2019 Jan 1;26(1):8-15.

Gaffney E, Murphy D, Walsh A, Connolly S, Basdeo SA, Keane J, Phelan JJ. Defining the role of neutrophils in the lung during infection: Implications for tuberculosis disease. Frontiers in Immunology. 2022 20 September;13:984293.

Safitri DA, Mamesah YP, Timban JF. Gambaran Foto Toraks pada Pasien Tuberkulosis Paru dengan Penyakit Ginjal Kronik di RSUP Prof. Dr. RD Kandou Periode Januari-Juni 2022. Medical Scope Journal. 2022;4(1):93-8.

Hulya S, Naz I, Karadeniz G, Erkan S. Clinical effects of TB sequelae in patients with COPD. The International Journal of Tuberculosis and Lung Disease. 2022 Apr 1;26(4):363-8.

Auld SC, Kornfeld H, Maenetje P, Mlotshwa M, Chase W, Vangu MD, Torigian DA, Wallis RS, Churchyard G, Bisson GP. Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis. BMC Pulmonary Medicine. 2021 Dec;21:1-0.

Fan H, Wu F, Liu J, Zeng W, Zheng S, Tian H, Li H, Yang H, Wang Z, Deng Z, Peng J. Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Annals of translational medicine. 2021 Mar;9(5).

Kim DJ, Oh JY, Rhee CK, Park SJ, Shim JJ, Cho JY. Metabolic fingerprinting uncovers the distinction between the phenotypes of tuberculosis associated COPD and smoking-induced COPD. Frontiers in Medicine. 2021 14 May;8:619077.

Amaral EP, Vinhaes CL, Oliveira-de-Souza D, Nogueira B, Akrami KM, Andrade BB. The interplay between systemic inflammation, oxidative stress, and tissue remodeling in tuberculosis. Antioxidants & redox signaling. 2021 Feb 20;34(6):471-85.

Simamora RP, Rasyidah R. Laporan Kasus: Radiografi Thorax pada Pasien Tb Paru dengan Pneumothorax Spontan Sekunder. Jurnal Majority. 2020 Jul 2;9(1):141-5.

Kayongo A, Nyiro B, Siddharthan T, Kirenga B, Checkley W, Joloba ML, Ellner J, Salgame P. Mechanisms of lung damage in tuberculosis: implications for chronic obstructive pulmonary disease. Frontiers in Cellular and Infection Microbiology. 2023;13.

Kang W, Du J, Yang S, Yu J, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P. The prevalence and risks of major comorbidities among inpatients with pulmonary tuberculosis in China from a gender and age perspective: a large-scale multicenter observational study. European Journal of Clinical Microbiology & Infectious Diseases. 2021 Apr;40:787-800.

Tao NN, Li YF, Song WM, Liu JY, Zhang QY, Xu TT, Li SJ, An QQ, Liu SQ, Li HC. Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: A retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004–2019. BMJ open. 2021 Jun 1;11(6):e044349.

Luies L, Du Preez I. The echo of pulmonary tuberculosis: mechanisms of clinical symptoms and other disease-induced systemic complications. Clinical microbiology reviews. 2020 Sep 16;33(4):10-128.


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DOI: https://doi.org/10.26714/magnamed.11.2.2024.169-180

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