Comparison between the radiographic findings in pulmonary tuberculosis of children with or without HIV infection.

OBJECTIVE

Identify the difference between radiographic findings in children with pulmonary tuberculosis with and without HIV infection.

MATERIAL AND METHOD: The authors retrospectively reviewed the chest radiography of 93 children (under 15 years of age) with pulmonary tuberculosis between January 2000 and June 2005. Fifty-two of the children had an HIV co-infection while the remaining 41 children did not. The chest radiographic findings were assessed for parenchymal changes, lymphadenopathy, and pleural effusion.

RESULTS

The radiographic manifestations in the HIV-infected group included interstitial infiltration in 39 patients (75%), alveolar infiltration in five patients (9.6%), combined interstitial and alveolar infiltration in seven patients (13.4%), miliary infiltration in one patient (1.9%), and hilar/mediastinal lymphadenopathy in 17 patients (32.6%). One patient had extensive alveolar infiltration in conjunction with multiple cavitatary formations. The findings in the non-HIV-infected group were interstitial infiltration in 30 patients (73.1%), hilar/mediastinal lymphadenopathy in 13 patients (31.7%, 3 of whom had adenopathy without parenchymal infiltration), and pleural effusion in two patients (4.8%). Other less frequent abnormalities included bronchiectasis, peribronchial thickening in the HIV-infected group, and atelectasis and granuloma in the non-HIV-infected group. There was no statistically significant difference in the radiographic findings between the two groups, except the association of hilar/mediastinal lymphadenopathy and pulmonary infiltration. Regarding hilar/mediastinal lymphadenopathy with or without pulmonary infiltration between the two groups, all cases in the HIV-infected group with hilar/mediastinal lymphadenopathy were significantly more associated with pulmonary infiltration (17 patients) than the other group (8 patients) (p = 0.009).

CONCLUSION

Hilar/mediastinal lymphadenopathy with pulmonary infiltration strongly suggests the presence of HIV infection in children with pulmonary tuberculosis.