Radiologic pattern as a predictor of multi-drug resistant tuberculosis; a multicenter study

Multi-drug resistant Tuberculosis (MDR-TB) remains big problem worldwide and it get worse since increasing number of primary DR-TB, in Indonesia from 1.2% in 2006 and now 1,8%. The use of rapid molecular test fasten diagnosis of DR-TB, but it has not yet been distributed in all provider. Therefore we need other predictor such as radiological findings. Studies found difference radiological appearance between drug-susceptible TB (DS-TB) and DR TB. Here we evaluate radiologic appearance as a prediction tool of DR TB especially among primary case. This report was part of a multicenter study titled Tuberculosis Research of INA-RESPOND on Drug Resistance (TRIPOD). We determined DR-TB using Xpert MTB/Rif and drug susceptibility test with Ogawa or MGIT and baseline CXR for radiologic appearance. Ethical clearance has been approved by NIHRD of MoH. There were 297 subjects with average age were 40 years old, mostly were male (61%), 160 (54%) primary TB, and almost half of them were DR-TB (49%). About 35% of DR-TB were primary cases. Radiologic appearance showed that DR-TB cases had cavity more than DS-TB (63.3% vs 37.3%, p <0.001). It also found in primary DR-TB vs DS-TB (60.8% vs 29.4%, p <0.001), but previously treated subjects showed no significant difference (64.6% vs 58.5%, p = 0.5). The average of percentage of lung affected in DR-TB were wider than DS-TB (59.1, CI: 55.2-63.1 vs 39.9, CI: 36.5-43.3, p <0.001), and so with primary (DR vs DS TB : 56, CI: 49.2-62.8 vs 38.4, CI: 34.2-42.5 p <0.001) and previously treated TB cases (DR vs DS TB : 60.8 CI: 55.9-65.7, vs 44, CI: 38.1-49.9, p <0.001). Radiologic appearance among DR-TB tend to be more severe with cavity and wider lung affected.