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Chinese expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis.

ABSTRACT: Tuberculosis (TB) remains one of the major infectious diseases in the world with a high incidence rate. Drug-resistant tuberculosis (DR-TB) is a key and difficult challenge in the prevention and treatment of TB. Early, rapid, and accurate diagnosis of DR-TB is essential for selecting appropriate and personalized treatment and is an important means of reducing disease transmission and mortality. In recent years, imaging diagnosis of DR-TB has developed rapidly, but there is a lack of consistent understanding. To this end, the Infectious Disease Imaging Group, Infectious Disease Branch, Chinese Research Hospital Association; Infectious Diseases Group of Chinese Medical Association of Radiology; Digital Health Committee of China Association for the Promotion of Science and Technology Industrialization, and other organizations, formed a group of TB experts across China. The conglomerate then considered the Chinese and international diagnosis and treatment status of DR-TB, China's clinical practice, and evidence-based medicine on the methodological requirements of guidelines and standards. After repeated discussion, the expert consensus of imaging diagnosis of DR-PB was proposed. This consensus includes clinical diagnosis and classification of DR-TB, selection of etiology and imaging examination [mainly X-ray and computed tomography (CT)], imaging manifestations, diagnosis, and differential diagnosis. This expert consensus is expected to improve the understanding of the imaging changes of DR-TB, as a starting point for timely detection of suspected DR-TB patients, and can effectively improve the efficiency of clinical diagnosis and achieve the purpose of early diagnosis and treatment of DR-TB.

SUBMITTER: Xu CJ

PROVIDER: S-EPMC10784038 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Chinese expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis.

Xu Chuan-Jun CJ Lu Pu-Xuan PX Li Chun-Hua CH He Yu-Lin YL Fang Wei-Jun WJ Xie Ru-Ming RM Jin Guan-Qiao GQ Lu Yi-Bo YB Zheng Qiu-Ting QT Zheng Guang-Ping GP Lv Sheng-Xiu SX Huang Hua H Li Li L Ren Meiji M Shi Yu-Xin YX Wen Xin-Nian XN Li Lin L Wei Fang-Jun FJ Hou Dai-Lun DL Lv Yan Y Shan Fei F Wu Zheng-Can ZC Hu Zhi-Liang ZL Zhang Xiang-Rong XR Liu Du-Xian DX Shi Wei-Ya WY Li Hui-Ru HR Zhang Na N Song Min M Zhang Xin X Deng Ying-Ying YY Li Jinlong J Liu Qiang Q Li Dechun D Zhao Lingling L Chen Bu-Dong BD Shi Yan-Bin YB Jiang Feng-Li FL Tang Xin X Wu Li-Ji LJ Ma Wei W Xu Xin-Yue XY Li Hong-Jun HJ

Quantitative imaging in medicine and surgery 20231025 1

Tuberculosis (TB) remains one of the major infectious diseases in the world with a high incidence rate. Drug-resistant tuberculosis (DR-TB) is a key and difficult challenge in the prevention and treatment of TB. Early, rapid, and accurate diagnosis of DR-TB is essential for selecting appropriate and personalized treatment and is an important means of reducing disease transmission and mortality. In recent years, imaging diagnosis of DR-TB has developed rapidly, but there is a lack of consistent u ...[more]

PMID: 38223121

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Project description:BackgroundPatients with highly drug-resistant forms of tuberculosis have limited treatment options and historically have had poor outcomes.MethodsIn an open-label, single-group study in which follow-up is ongoing at three South African sites, we investigated treatment with three oral drugs - bedaquiline, pretomanid, and linezolid - that have bactericidal activity against tuberculosis and to which there is little preexisting resistance. We evaluated the safety and efficacy of the drug combination for 26 weeks in patients with extensively drug-resistant tuberculosis and patients with multidrug-resistant tuberculosis that was not responsive to treatment or for which a second-line regimen had been discontinued because of side effects. The primary end point was the incidence of an unfavorable outcome, defined as treatment failure (bacteriologic or clinical) or relapse during follow-up, which continued until 6 months after the end of treatment. Patients were classified as having a favorable outcome at 6 months if they had resolution of clinical disease, a negative culture status, and had not already been classified as having had an unfavorable outcome. Other efficacy end points and safety were also evaluated.ResultsA total of 109 patients were enrolled in the study and were included in the evaluation of efficacy and safety end points. At 6 months after the end of treatment in the intention-to-treat analysis, 11 patients (10%) had an unfavorable outcome and 98 patients (90%; 95% confidence interval, 83 to 95) had a favorable outcome. The 11 unfavorable outcomes were 7 deaths (6 during treatment and 1 from an unknown cause during follow-up), 1 withdrawal of consent during treatment, 2 relapses during follow-up, and 1 loss to follow-up. The expected linezolid toxic effects of peripheral neuropathy (occurring in 81% of patients) and myelosuppression (48%), although common, were manageable, often leading to dose reductions or interruptions in treatment with linezolid.ConclusionsThe combination of bedaquiline, pretomanid, and linezolid led to a favorable outcome at 6 months after the end of therapy in a high percentage of patients with highly drug-resistant forms of tuberculosis; some associated toxic effects were observed. (Funded by the TB Alliance and others; ClinicalTrials.gov number, NCT02333799.).

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Chinese expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis.

Publications

Chinese expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis.

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