Chest X-Ray Findings May Help Detect Drug-Resistant TB Early in Children, Study Suggests

"Pediatric DR-TB cases were more likely to present with cavitary lesions (OR: 2.62) and consolidation (OR: 2.29) compared to drug-sensitive cases. Identifying these radiographic patterns may aid in the early initiation of treatment while awaiting microbiological confirmation," the researchers reported in the journal Pediatric Pulmonology.

Tuberculosis remains a major public health challenge, particularly in high-burden regions. Drug resistance in pediatric TB cases is a growing concern, often leading to delayed diagnosis and treatment initiation. Since microbiological confirmation of DR-TB can take time, Sarika Gupta, Department of Pediatrics, King George's Medical University, Lucknow, India, and colleagues aimed to identify CXR features that distinguish pediatric pulmonary drug-resistant tuberculosis from drug-sensitive tuberculosis (DS-TB) to facilitate early detection and timely treatment of DR-TB.

For this purpose, the researchers conducted a prospective cross-sectional study analyzing chest X-ray patterns in drug-sensitive (DS) and drug-resistant (DR) tuberculosis patients aged 1 month to 18 years. The CXR findings were categorized into various patterns, including pleural effusion, cavitary lesions, hilar or mediastinal lymph node enlargement, consolidation, pneumothorax, pericardial effusion, miliary TB, nodular shadows, and lung collapse. Agreement between the pulmonary physician and radiologist was assessed using the weighted kappa test. Adjusted logistic regression analysis was performed to identify CXR patterns indicative of DR-TB.

Based on the study, the researchers reported the following findings:

• Two-hundred thirty-seven pulmonary tuberculosis (TB) patients were enrolled between June 1, 2022, and May 31, 2023.
• Among 175 drug-sensitive TB (DSTB) cases, 47 were younger than 12 years, while 128 were older than 12 years.
• Among 62 microbiologically confirmed drug-resistant TB (DRTB) cases, 12 were younger than 12 years, and 50 were older than 12 years.
• Cavitary TB lesions and consolidation were significantly associated with DR-TB.
• After adjusting for age, gender, and socioeconomic status, DR-TB was linked with:
  • Cavitary lesions (OR = 2.62).
  • Consolidation (OR = 2.29).

The researchers conclude that the presence of cavitary lesions or consolidation in "presumptive" or "probable" DR-TB cases should serve as a warning sign for pediatricians. These chest X-ray patterns indicative of drug resistance can help initiate timely treatment while awaiting microbiological confirmation, potentially improving patient outcomes.

The researchers note that given the high burden of tuberculosis and the increasing prevalence of drug resistance, incorporating radiological assessments into routine clinical practice could enhance early diagnosis and management strategies.

"Healthcare professionals should closely monitor pediatric patients with these CXR patterns and consider starting treatment while awaiting laboratory confirmation," they concluded.

Reference:

Gupta, S., Khanna, H., Gupta, V., Barman, N. K., Parihar, A., & Kant, S. (2025). Chest X-Ray Features of Drug Resistance Tuberculosis in Pediatric Population; A Prospective Study in High-Endemic Area. Pediatric Pulmonology, 60(3), e71039. https://doi.org/10.1002/ppul.71039