Clinico-radiological Difference between Primary and Secondary MDR Pulmonary Tuberculosis OC08-OC10
Dr. Deependra Kumar Rai,
Associate Professor, Department of Pulmonary Medicine, AIIMS, Patna-801105, Bihar, India.
Introduction: Multidrug Resistant Tuberculosis (MDR-TB) is classified into primary and secondary type depending upon history of Anti-TB drug received in past. MDR-TB generally remains undetected in newly detected TB cases as the index of suspicion is low.
Aim: To compare the clinical and radiological features of primary and secondary MDR-TB.
Materials and Methods: This was a hospital based retrospective observational study on 74 MDR Pulmonary Tuberculosis (PTB) patients seen in the pulmonary medicine department of a tertiary hospital of Bihar, India between 1st January 2016 and 31st December 2017. Because of the lack of conventional culture or Line Probe Assay (LPA) facilities at the institute, rifampicin resistance on GeneXpert was taken as a surrogate marker for MDR-TB.
Results: A total of 85 patients were diagnosed as having MDR PTB in the study period. Eleven patients were excluded from the study due to non-availability of clinical details. Out of the 74 patients, 19 (25.67%) were primary MDR cases and 55 (74.33%) were secondary. The mean age of primary MDR-TB was 24.2±13.8 years and secondary MDR-TB was 27.8±13.13 years. A 78.9% of primary MDR and 81.8% of secondary MDR patients were male. Patients were symptomatic for a mean duration of 4.5 months in primary and 11.9 months in the case of secondary MDR-TB before the diagnosis. Haemoptysis as a presenting symptom was more common in primary MDR-TB (47.3%) than in secondary MDR-TB (20%) (p<0.05). On the other hand breathlessness was more common in secondary MDR tuberculosis (52.7% vs 15.7%) (p<0.05). Moderate lesion on Chest X-ray (CXR) was most common in both primary and secondary MDR-TB (73.68% vs 45.54%) (p<0.05).
Conclusion: Haemoptysis was more common in primary MDR than secondary MDR PTB patient, while breathlessness occured more frequently in secondary MDR PTB; bilateral and moderate lesion in chest radiograph was seen more with primary MDR PTB.