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.