The effect of sputum smear grade on the anatomical position of lung involvement: A cross-sectional study

Abstract

INTRODUCTION Tuberculosis is a chronic bacterial disease which is caused by mycobacterium and in most cases by mycobacterium tuberculosis. Chest radiography is one of the most basic diagnostic tools in the initial evaluation of the patient for further evaluation and progression of the disease. Hence, this study was performed to investigate the effect of grade smear on the involvement of different lung zones in chest radiography of patients with pulmonary tuberculosis referred to the Zabol tuberculosis center. METHODS A descriptive-analytical study was conducted on all patients with pulmonary tuberculosis referred to the Zabol tuberculosis center in 2020, except patients with immunodeficiency hepatitis and diabetes. Patients with smear grading who did not have chest radiography were excluded. RESULTS The frequency of women in patients with grade 1, 2 and 3 were 73.3%, 50% and 70.6%, respectively, and the frequency of men in grade 1, 2 and 3 were 25.7%, 50% and 29.4%, respectively. There was a significant difference between these two groups. Gender did not show significant difference in terms of smear grade (p=0.192). The frequency of right or left lung involvement or both lungs in patients with grade 1, 2 and 3 was not statistically significant (p=0.306). CONCLUSIONS It seems that there is no relationship between the smear grade and the involvement of different zones in the graph. INTRODUCTION Tuberculosis is a chronic bacterial disease which is caused by a collection of mycobacteria and in most cases by mycobacterium tuberculosis. More than 90% of cases and deaths from tuberculosis occur in developing countries, countries where 75% of the cases occur, in the most economically active age group (15–54 years)1. In these countries, an adult with tuberculosis is not able to work for an average of 3 to 4 months, and therefore lowers by 20– 30% his family’s annual income, while the death of such a person is equal to on average 15 years of family income. It is clear that tuberculosis, in addition to the economic burden, has other indirect negative effects on the quality of life of patients or their families. On the other hand, multidrug resistance, which is the result of poor management of TB treatment, is a serious and growing problem in many countries of the world2. After the initial infection, 90% of people with healthy immunity prevent further proliferation of TB bacilli, causing it to enter the latent phase. The remaining 10% develop tuberculous pneumonia with lymphatic spread at the site of primary implantation or near the umbilical cord, and may present with umbilical lymphadenopathy or with disease in distant sites such as cervical lymphadenopathy, meningitis, pericarditis, or millet distribution3. The basis of the diagnosis of pulmonary tuberculosis is a direct and simple test of patients’ sputum. In the best case scenario, the susceptibility of the patients’ sputum test is examined. Chest radiography should be used as one of the most basic diagnostic tools in the initial evaluation of the patient for further evaluation and progression of the disease. Chest radiography is a suitable and sensitive tool for diagnosing lung damage, including tuberculosis, so that in case of normal chest X-ray, tuberculosis diagnosis is removed. On the other hand, in cases where we are actively looking for this disease and when it is diagnosed in its early stages, pulmonary involvement and the chance of transmission to others is low. The type and extent of pulmonary involvement can indicate the degree of success in early detection of this disease. Therefore, this study aimed to evaluate the effect of smear grade on involvement of different lung zones in chest radiography of patients with pulmonary tuberculosis referred to the TB center Zabol. METHODS A descriptive-analytical study was conducted on all patients with pulmonary tuberculosis referred to the Zabol Tuberculosis Center in 2020, except for patients with immunodeficiency hepatitis and diabetes. In this study, 101 patients were studied, of which 71 were female and 30 were male. Samples were recorded according to a checklist that included demographic information, sputum smear grade, and radiographic findings of the chest. Demographic information AFFILIATION 1 Department of Radiology, Zabol University of Medical Sciences, Zabol, Iran CORRESPONDENCE TO Razieh Behzadmehr. Department of Radiology, Zabol University of Medical Sciences, Zabol, Iran. E-mail: razbebehzadmehr@gmail.com