A study of rifampicin and isoniazid resistance in pulmonary tuberculosis patients with various radiological presentations at a designated microscopy center

Background: Correlation between chest X-ray findings and drug resistance can provide valuable guide for physicians working at low-resource settings. Objective: To study tuberculosis (TB) drug sensitivity pattern as per the radiological presentation. Materials and Methods: A hospital-based prospective study was conducted among 67 newly diagnosed sputum-positive pulmonary TB patients who never took anti-TB treatment. They were subjected to history, systemic examination, radiology, and sputum smear examination. Ten patterns of chest X-ray were studied in the present study, which was not studied before. Chest X-ray radiology pattern was correlated with the drug resistance. Results: Isoniazid (INH) monoresistance was present in 11.9% of patients. 1.5% had rifampicin (RIF) resistance but no INH resistance. RIF and INH both resistance (multidrug-resistant [MDR]) was present in 7.5% of cases. Pattern Four was the most common radiological presentation in our patients being present in 20 (29.9%) patients. In this pattern, bacteria of 5.0% were RIF resistant. 15.0% were INH resistant, and 5.0% were both RIF and INH resistant (MDR). RIF resistance was most common in chest X-ray PA view with “Pattern Two” being present in bacteria of 21.42% of patients. Conclusion: Radiological patterns 2, 3, and 4 were highly correlated with the multidrug resistance, but it was not statistically significant. Patients' chest X-ray showing these patterns can be suspected to have MDR-TB and sent for further evaluation for early diagnosis and treatment of MDR-TB, which will give us good outcome. Further studies on this hypothesis should be conducted with bigger sample size to throw more light in this field.