J Korean Med Sci.  2017 Nov;32(11):1779-1783. 10.3346/jkms.2017.32.11.1779.

Submillisievert Computed Tomography of the Chest in Contact Investigation for Drug-Resistant Tuberculosis

• Lee SC
• Yoon SH
• Goo JM
• Yim JJ
• Kim CK

• KMID: 2390303
• DOI: http://doi.org/10.3346/jkms.2017.32.11.1779

Abstract

Close contacts with infectious tuberculosis (TB) are persons at high risk for developing active disease. We preliminarily introduced submillisievert chest computed tomography (CT) scan (effective dose, 0.19-0.25 millisievert) in a contact investigation of multi-drug resistant (MDR)-TB. Baseline CT scan showed minimal nodules or branching opacities in two of six contacts. A two-month follow-up examination revealed a radiologic progression in contact 1, subsequently having the microbiologic diagnosis of MDR-TB at an asymptomatic early stage, whereas nodules transiently increased after 3 months in contact 2, followed by a decrease after one year. Contact 1 was cured after 1.5-year of anti-MDR-TB treatment. In conclusion, early identification of secondary MDR-TB is feasible with submillisievert chest CT scans in contact investigations of MDR-TB, minimizing of MDR-TB transmission and offering a favorable treatment outcome. This was a clinical trial study and was registered at www.ClinicalTrials.gov (Identifier: NCT02454738).

Keyword

Tuberculosis; Drug-resistance; Computed Tomography

MeSH Terms

Diagnosis
Follow-Up Studies
Humans
Thorax*
Tomography, X-Ray Computed
Treatment Outcome
Tuberculosis
Tuberculosis, Multidrug-Resistant*

Figure

• 

  Fig. 1 Chest radiograph and CT of a secondary case of MDR-TB in contact 1. (A) Chest radiograph at baseline contact investigation is normal. (B) Baseline submillisievert computed tomographic scans of the chest shows tuberculous granuloma and focal bronchiolitis (arrows) in the superior segment of the right lower lobe on baseline scan. (C) Chest radiograph 2 months later shows subtle opacities (arrow) in the right upper lung zone. (D) Submillisievert computed tomographic scans of the chest 2 months later shows the progression of pre-existing lesions into ill-defined lobular consolidation (arrows) in the superior segment of the right lower lobe. (E) Results of spoligotyping 24-loci MIRU-VNTR analysis are identical between index and secondary MDR-TB. (F) Chest radiograph taken after completion of 1.5-year of anti-MDR-TB treatment shows small residual opacity (arrows) in the right upper lung zone. CT = computed tomography, MDR-TB = multi-drug resistant tuberculosis, MIRU-VNTR = mycobacterial interspersed repetitive units-variable-number tandem repeats, TB = tuberculosis.

• 

  Fig. 2 Chest radiograph and CT in contact 2, having sub-centimeter-sized nodules. (A) Chest radiograph at baseline contact investigation is normal. (B) Baseline, 3-month, and 1-year follow-up submillisievert computed tomographic scans of the chest shows two suspected tuberculous granulomas (arrows). Lesions increased slightly 3 months later, and decreased after 1 year of observation. CT = computed tomography.

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