Assessment of Radiological Lesion Burden and Serum Oxidative Stress in Multidrug-Resistant Pulmonary Tuberculosis

Background: Multidrug-resistant tuberculosis (MDR-TB) presents a significant clinical challenge, characterized by prolonged treatment, high morbidity, and increased mortality. Radiological imaging provides critical information on disease burden, while oxidative stress biomarkers offer insights into host-pathogen interactions and tissue injury. However, limited studies have examined the association between radiological lesion extent and systemic oxidative stress in MDR-TB. This is study to evaluate the correlation between radiological lesion burden and serum oxidative stress markers in patients with microbiologically confirmed MDR-TB. Materials and Methods: This cross-sectional observational study was conducted from May 2023 to April 2024 at a tertiary care center. Fifty adult patients with confirmed MDR-TB were enrolled. Radiological assessment was performed using chest X-ray and high-resolution computed tomography (HRCT), and lesion burden was quantified using a standardized scoring system. Venous blood samples were analyzed for malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), and catalase activities. Statistical analysis included Pearson correlation and multiple linear regression to evaluate relationships between lesion scores and oxidative stress parameters, adjusting for confounders. Results: Patients with higher radiological scores exhibited significantly elevated MDA levels (mean ± SD: 6.89 ± 1.12 nmol/mL) and reduced antioxidant defenses, including GSH (2.54 ± 0.46 μmol/L), SOD (6.31 ± 1.14 U/mL), and catalase (32.2 ± 4.7 kU/L) (all p < 0.001). Radiological burden showed a strong positive correlation with MDA (r = 0.67, p < 0.001) and significant negative correlations with GSH (r = –0.59), SOD (r = –0.56), and catalase (r = –0.53). Regression analysis confirmed lesion burden as an independent predictor of oxidative imbalance. Conclusion: Radiological lesion extent in MDR-TB is strongly associated with increased lipid peroxidation and reduced antioxidant activity, indicating that oxidative stress intensifies with greater pulmonary involvement. Integrating oxidative stress profiling with imaging could enhance prognostic assessment and guide adjunctive therapeutic strategies. Keywords: Multidrug-resistant tuberculosis; Oxidative stress; Radiological lesion burden; Malondialdehyde; Antioxidant enzymes; High-resolution computed tomography.