Clinical Manifestations and usual and unusual CXR manifestation of smear positive Pulumonary tuberculosis; in Sari, Qaemshahr and Neka

Background and Clinical and radiological manifestations of Pulumonary tuberculosis are well known. However, it appears there is an increasing rate of unusual radiological patterns in immuno-competent adults, with smear positive pulmonary tuberculosis (based on our experience). The aim of this study was to analyze chest X-ray (CXR) findings and clinical patterns among immuno-competent men and women with smear positive pulmonary tuberculosis (TB) in Sari, Qaemshahr and Neka, during March 2006 to March of 2007. All new cases of pulmonary TB diagnosed during 12 months in 3 districts in Northern Iran, (Mazandaran Province) were included in a cross-sectional study. Inclusion criteria's were: positive smear of sputum and absence of any immuno-suppressive state. 65 cases fulfilled the inclusion criteria. Descriptive methods were used for data analysis. The common presenting symptoms were: coughing at 83%, hemoptysis at 24.6%, night sweating at 55%, anorexia at 60%, weight loss at 73.8 %, and fever at 60%. Usual radiological patterns was found in 70.8% of patients (upper lobe lesion with or without the remaining part) and incidence of an unusual radiographic pattern was 29.2%(middle and lower lob infiltration without upper lob lesion, milliary pattern, hilar lymphadenopathy and normal CXR). This study showed that TB with atypical radiographic manifestations is more common than reported previously.These varieties of radiologic manifestations can mimic other disease entities. Therefore, recognition and understanding of radiologic manifestations and complication of tuberculosis are important to facilitate a diagnosis.