Chest Radiographic Predictors of Hiv/Aids in Childhood Pulmonary Tuberculosis-An African Study

Background: Tuberculosis remains a major public health problem in Nigeria and the world at large. Substantial number of cases of tuberculosis occurs in children, especially in this era of HIV pandemic. Chest radiograph is an important examination in evaluation for pulmonary tuberculosis. There is paucity of literature on the chest radiographic features predictive of HIV in pulmonary tuberculosis patients. Objective: To describe the pattern of chest radiographic features of children with tuberculosis. The chest radiographic features predictive of HIV in tuberculosis patients were also determined. Methods: A review of chest radiographs of children below the age of 15 years, who were managed for tuberculosis at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, over a period of four years was conducted. Results: The chest radiographs of the 111 children with tuberculosis taken at presentation who were subsequently managed for tuberculosis were reviewed. The commonest chest radiographic feature was peri-hilar and basal infiltrates (broncho-pneumonic consolidations). The peri-hilar and basal infiltrates occurred with other radiographic features as well. Hilar adenopathy and miliary shadows were common among the children younger than 5 years. Other radiographic features included reticulonodular opacities (12 cases) and cavitatory lesions (9 cases). Reticulonodular chest radiographic feature was highly predictive of HIV infection. Conclusion: Majority of children with tuberculosis had peri-hilar and basal infiltrates on chest radiograph. We recommend screening of children with peri-hilar and basal infiltrates on chest radiograph for tuberculosis, likewise, screening of all tuberculosis patients for HIV especially those with reticulonodular chest radiographic features.