link
Bookmarks
Tuberculosis
Kyung Soo Lee, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
0
2
0

KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Tuberculosis (TB)
            • Mycobacterium tuberculosis (MTB)
          • Synonyms

            • White plague
          • Definitions

            • MTB: Airborne infection transmitted from person to person via organism-containing droplets
              • Aerobic, nonmotile, non-spore-forming rod
              • Highly resistant to drying, acid, and alcohol
            • Granuloma: Epithelioid histocytes including Langhans giant cells surrounded by lymphocytes
            • Ghon focus: Primary site of pulmonary TB
            • Ranke complex: Ghon focus + affected lymph nodes
            • Recurrent TB
              • TB occurring 12 months or more after last clinical encounter for treatment of 1st TB episode
              • From reactivation
                • Most cases
                • Determined by MTB genotyping: Same DNA finger-printing between initial and subsequent episodes of infection
              • From reinfection
                • ~ 15% of recurrent TB; as high as 60% in certain subpopulations (e.g., immigrants to USA from Africa and Mexico)
                • Determined by MTB genotyping: Different DNA finger-printing between initial and subsequent episodes of infection
                • AIDS endemic areas, reinfection is most common cause of recurrence
            • Multidrug-resistant TB
              • TB resistant to 2 or more drugs including isoniazid and rifampin
            • Extensively drug-resistant TB (XDR TB)
              • TB resistant to isoniazid, rifampin, quinolone family of drugs and injectable drugs such as kanamycin, capreomycin, and amikacin
            • Active TB
              • Frequently contagious
            • Latent TB
              • Infection with MTB without active TB infection
              • Latent TB is not contagious
              • ~ 10% of individuals with latent TB (5% in first 2 years after infection, and 0.1% per year thereafter) eventually develop active TB

          IMAGING

          • Radiographic Findings

            • CT Findings

              • Nuclear Medicine Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          • Microbiology

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    • Prognosis

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Kim W et al: CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis. Acta Radiol. 57(2):197-204, 2016
                                        2. Interrante JD et al: Exogenous reinfection as a cause of late recurrent tuberculosis in the United States. Ann Am Thorac Soc. 12(11):1619-26, 2015
                                        3. Rozenshtein A et al: Radiographic appearance of pulmonary tuberculosis: dogma disproved. AJR Am J Roentgenol. 204(5):974-8, 2015
                                        4. World Health Organization: Global Tuberculosis Report. 20th ed. Geneva: WHO Press, 2015
                                        5. Ko JM et al: Pulmonary changes of pleural TB: up-to-date CT imaging. Chest. 146(6):1604-11, 2014
                                        6. Kim HS et al: Serial CT findings of Mycobacterium massiliense pulmonary disease compared with Mycobacterium abscessus disease after treatment with antibiotic therapy. Radiology. 263(1):260-70, 2012
                                        7. Song I et al: Tuberculous lymphadenitis of the thorax: comparisons of imaging findings between patients with and those without HIV infection. AJR Am J Roentgenol. 199(6):1234-40, 2012
                                        8. Tiemersma EW et al: Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 6(4):e17601, 2011
                                        9. Crampin AC et al: Recurrent TB: relapse or reinfection? The effect of HIV in a general population cohort in Malawi. AIDS. 24(3):417-26, 2010
                                        10. Kim EY et al: Pulmonary mycobacterial disease: diagnostic performance of low-dose digital tomosynthesis as compared with chest radiography. Radiology. 257(1):269-77, 2010
                                        11. Kliiman K et al: Predictors and mortality associated with treatment default in pulmonary tuberculosis. Int J Tuberc Lung Dis. 14(4):454-63, 2010
                                        12. Jeong YJ et al: Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 191(3):834-44, 2008
                                        13. Chung MJ et al: Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings. Eur Radiol. 16(9):1934-41, 2006
                                        14. Heo JN et al: Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol. 184(2):639-42, 2005
                                        15. Andreu J et al: Radiological manifestations of pulmonary tuberculosis. Eur J Radiol. 51(2):139-49, 2004
                                        16. Neralla S et al: Mycobacterium tuberculosis: the treatment of active disease. Semin Respir Infect. 18(4):292-306, 2003
                                        17. Choi YW et al: Tuberculous pleural effusion: new pulmonary lesions during treatment. Radiology. 224(2):493-502, 2002
                                        18. Nakatsu M et al: Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign. AJR Am J Roentgenol. 178(6):1389-93, 2002
                                        19. Lee JY et al: Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr. 24(5):691-8, 2000
                                        20. Cohen RA et al: Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission. Am J Respir Crit Care Med. 157(1):156-61, 1998
                                        21. Ellison E et al: Cytologic features of mycobacterial pleuritis: logistic regression and statistical analysis of a blinded, case-controlled study. Diagn Cytopathol. 19(3):173-6, 1998
                                        Related Anatomy
                                        Loading...
                                        Related Differential Diagnoses
                                        Loading...
                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Tuberculosis (TB)
                                                  • Mycobacterium tuberculosis (MTB)
                                                • Synonyms

                                                  • White plague
                                                • Definitions

                                                  • MTB: Airborne infection transmitted from person to person via organism-containing droplets
                                                    • Aerobic, nonmotile, non-spore-forming rod
                                                    • Highly resistant to drying, acid, and alcohol
                                                  • Granuloma: Epithelioid histocytes including Langhans giant cells surrounded by lymphocytes
                                                  • Ghon focus: Primary site of pulmonary TB
                                                  • Ranke complex: Ghon focus + affected lymph nodes
                                                  • Recurrent TB
                                                    • TB occurring 12 months or more after last clinical encounter for treatment of 1st TB episode
                                                    • From reactivation
                                                      • Most cases
                                                      • Determined by MTB genotyping: Same DNA finger-printing between initial and subsequent episodes of infection
                                                    • From reinfection
                                                      • ~ 15% of recurrent TB; as high as 60% in certain subpopulations (e.g., immigrants to USA from Africa and Mexico)
                                                      • Determined by MTB genotyping: Different DNA finger-printing between initial and subsequent episodes of infection
                                                      • AIDS endemic areas, reinfection is most common cause of recurrence
                                                  • Multidrug-resistant TB
                                                    • TB resistant to 2 or more drugs including isoniazid and rifampin
                                                  • Extensively drug-resistant TB (XDR TB)
                                                    • TB resistant to isoniazid, rifampin, quinolone family of drugs and injectable drugs such as kanamycin, capreomycin, and amikacin
                                                  • Active TB
                                                    • Frequently contagious
                                                  • Latent TB
                                                    • Infection with MTB without active TB infection
                                                    • Latent TB is not contagious
                                                    • ~ 10% of individuals with latent TB (5% in first 2 years after infection, and 0.1% per year thereafter) eventually develop active TB

                                                IMAGING

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • Nuclear Medicine Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              • Microscopic Features

                                                                • Microbiology

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          • Prognosis

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Kim W et al: CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis. Acta Radiol. 57(2):197-204, 2016
                                                                              2. Interrante JD et al: Exogenous reinfection as a cause of late recurrent tuberculosis in the United States. Ann Am Thorac Soc. 12(11):1619-26, 2015
                                                                              3. Rozenshtein A et al: Radiographic appearance of pulmonary tuberculosis: dogma disproved. AJR Am J Roentgenol. 204(5):974-8, 2015
                                                                              4. World Health Organization: Global Tuberculosis Report. 20th ed. Geneva: WHO Press, 2015
                                                                              5. Ko JM et al: Pulmonary changes of pleural TB: up-to-date CT imaging. Chest. 146(6):1604-11, 2014
                                                                              6. Kim HS et al: Serial CT findings of Mycobacterium massiliense pulmonary disease compared with Mycobacterium abscessus disease after treatment with antibiotic therapy. Radiology. 263(1):260-70, 2012
                                                                              7. Song I et al: Tuberculous lymphadenitis of the thorax: comparisons of imaging findings between patients with and those without HIV infection. AJR Am J Roentgenol. 199(6):1234-40, 2012
                                                                              8. Tiemersma EW et al: Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One. 6(4):e17601, 2011
                                                                              9. Crampin AC et al: Recurrent TB: relapse or reinfection? The effect of HIV in a general population cohort in Malawi. AIDS. 24(3):417-26, 2010
                                                                              10. Kim EY et al: Pulmonary mycobacterial disease: diagnostic performance of low-dose digital tomosynthesis as compared with chest radiography. Radiology. 257(1):269-77, 2010
                                                                              11. Kliiman K et al: Predictors and mortality associated with treatment default in pulmonary tuberculosis. Int J Tuberc Lung Dis. 14(4):454-63, 2010
                                                                              12. Jeong YJ et al: Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 191(3):834-44, 2008
                                                                              13. Chung MJ et al: Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings. Eur Radiol. 16(9):1934-41, 2006
                                                                              14. Heo JN et al: Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol. 184(2):639-42, 2005
                                                                              15. Andreu J et al: Radiological manifestations of pulmonary tuberculosis. Eur J Radiol. 51(2):139-49, 2004
                                                                              16. Neralla S et al: Mycobacterium tuberculosis: the treatment of active disease. Semin Respir Infect. 18(4):292-306, 2003
                                                                              17. Choi YW et al: Tuberculous pleural effusion: new pulmonary lesions during treatment. Radiology. 224(2):493-502, 2002
                                                                              18. Nakatsu M et al: Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign. AJR Am J Roentgenol. 178(6):1389-93, 2002
                                                                              19. Lee JY et al: Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr. 24(5):691-8, 2000
                                                                              20. Cohen RA et al: Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission. Am J Respir Crit Care Med. 157(1):156-61, 1998
                                                                              21. Ellison E et al: Cytologic features of mycobacterial pleuritis: logistic regression and statistical analysis of a blinded, case-controlled study. Diagn Cytopathol. 19(3):173-6, 1998