A clinical study was carried out on newly diagnosed pulmonary tuberculosis cases seen at Iwo Tuberculosis Control Clinic in Nigeria between January 1996 and December 1997. Five hundred newly diagnosed cases of Pulmonary Tuberculosis were treated with directly observed short-course treatment and 100 of them had chest radiographic examination done. The various chest radiographic patterns in the 100 subjects were studied and included: Fluffy exudative changes 80(80%), fibrosis 70(70%), pleural effusion 10(1%), emphysema 30(30%), lymphadenopathy 10(10%), cavitation 10(10%), consolidation 10(10%) and destroyed lung syndrome 5(5%). The cases of pulmonary tuberculosis with Human immunodeficiency virus seropositivity (30) showed a less significantly higher percentages of fluffy exudative changes 30(37.5%), fibrosis 30(32.8%) pleural effusion 6(60%) emphysema 10(33.3%), lymphadenopathy 80(80%), consolidation 8(80%), and destroyed lung syndrome 4(80%), as compared with 70 in the seronegative group (62.5%, 57.1%, 40%, 66.6%, 20%, 20% and 20% respectively). Cavitation 1(10%) was significantly less common in the HIV sero-positive group than in the HIV sero-negative group 9(90%), Upper lobe infiltrates and cavitations are the most frequent radiographic presentations in both the HIV-infected and non-HIV infected pulmonary tuberculosis cases. Left upper lung lobe 48(48%) is more frequently affected than the right upper lung lobe 24(24%). Tuberculosis frequently affects the upper lung lobes more than the other lung lobes. The left upper lung lobe was more frequently involved than the right HIV-seropositive pulmonary tuberculosis subjects showed more significant (P<0.01) radiographic manifestations than HIV –negative pulmonary tuberculosis cases except that there were less cavitating lesions compared to HIV-seronegative pulmonary tuberculosis subjects. In tuberculous endemic area like Nigeria, upper left lung infiltrates with or without a cavitary lesion strongly suggest pulmonary tuberculosis. Florid radiographic lung lesions in a pulmonary tuberculosis case should suggest a concomitant HIV-seropositivity.
Nigerian Medical Practitioner Vol.47(1-2) 2005: 6-8