Pakistan Journal of Chest Medicine

Radiological Differentiation of Multi-Drug Resistant and Drug-Sensitive Tuberculosis Using Chest X-Rays

Shumaila Anees, Haleema Shah, Iqra Jalal, Laila Aarzoo, Naveed Usman — Fri, 25 Sep 2026 00:00:00 +0000

Background: Tuberculosis continues to pose a significant global health challenge, with increasing incidence of multidrug-resistant TB (MDR-TB). Radiological features have the potential to distinguish MDR-TB from drug-sensitive TB (DS-TB). Early radiographic identification facilitates timely diagnosis and treatment, particularly in resource-limited settings.

Objective: To compare chest X-ray findings between cases of multidrug-resistant TB (MDR-TB) and drug-sensitive TB (DS-TB).

Methodology: This retrospective comparative study included 240 pulmonary TB patients (120 with MDR-TB and 120 with DS-TB). Chest X-rays were assessed for lesion size, cavitation, consolidation, and non-parenchymal changes. Findings were compared between groups based on lung zones and cavity characteristics. Data analysis was performed using SPSS, with p < 0.05 considered statistically significant.

Results: Patients with MDR-TB exhibited a higher prevalence of large lesions (93.3%) and multiple cavities (68.3%). Consolidation and fibrosis were more frequently observed in MDR-TB, whereas infiltrates were predominant in DS-TB. The upper lung zones were primarily affected in MDR-TB, often with extensive bilateral involvement. Non-parenchymal features such as pleural thickening and tracheal deviation occurred more frequently in MDR-TB.

Conclusion: Chest X-rays demonstrate distinct radiographic patterns in MDR-TB compared to DS-TB. The presence of large lesions, multiple cavitations, and chronic fibrotic changes is suggestive of drug resistance. Recognition of these radiological differences can facilitate early suspicion of MDR-TB. Radiographic assessment continues to be a valuable tool for TB evaluation, particularly in low-resource settings.

Cost-Effective Monitoring of MDR-TB Treatment: A Comparative Assessment of C-Reactive Protein and Erythrocyte Sedimentation Rate in a High-Burden Setting

Natasha Junaid, Areeba Junaid, Muhammad Saleh Faisal, Ziad Bahadar — Wed, 02 Sep 2026 00:00:00 +0000

Background:

Monitoring treatment response in multidrug-resistant tuberculosis (MDR-TB) is challenging, particularly in resource-limited settings. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are inexpensive and routinely available inflammatory markers that may provide complementary information during treatment.

Objective:

To compare the effectiveness and potential cost implications of serial CRP and ESR measurements for monitoring treatment response among patients with MDR-TB during the first three months of therapy.

Methodology:

This prospective prognostic cohort study was conducted at the Programmatic Management of Drug-Resistant Tuberculosis Unit of Lady Reading Hospital and Khyber Medical College, Peshawar, from January 2024 to June 2025. Patients with confirmed MDR-TB were followed for three months with monthly clinical assessment, sputum examination, CRP, and ESR measurements. Treatment response was assessed by sputum conversion. Changes in biomarkers were analyzed using repeated-measures ANOVA, while factors associated with unfavorable outcomes were assessed using logistic regression.

Results:

Of 102 enrolled patients, 92 completed follow-up and were included in the final analysis. The mean age was 37.2 ± 13.8 years, and 52.2% were male. Sputum conversion was achieved in 65 (70.6%) patients. Mean CRP decreased progressively from 30.8 ± 27.4 mg/dL at baseline to 19.8 ± 18.6, 12.4 ± 12.9, and 9.6 ± 10.2 mg/dL at months 1, 2, and 3, respectively (P < 0.001). ESR similarly declined from 52.6 ± 31.8 to 40.2 ± 28.5, 29.8 ± 24.6, and 24.4 ± 22.1 mm/h (P < 0.001). CRP improved in 88.0% and ESR in 85.9% of patients.

Conclusion:

Serial CRP and ESR demonstrated significant declines during MDR-TB treatment and may serve as useful complementary markers of treatment response. ESR may be particularly practical where resources are limited, although formal cost-effectiveness studies are required.

Antibiotic Prescribing Practices and Antimicrobial Resistance in Pediatric Pneumonia

Umar Farooq, Habib Ullah, Hakeem Ullah, Aimen Ali, Uzma Mehar — Wed, 02 Sep 2026 00:00:00 +0000

Background: Antimicrobial resistance (AMR) among pediatric pneumonia patients presents a significant challenge, particularly in low- and middle-income countries such as Pakistan, where empirical antibiotic use is prevalent and stewardship interventions remain limited. Comprehensive knowledge of local prescribing practices, resistance patterns, and treatment outcomes is essential for effective stewardship and enhanced patient care.

Objective: To determine the prevalence and antimicrobial susceptibility patterns of bacterial pathogens isolated from pediatric pneumonia patients and to evaluate antibiotic prescribing practices in a tertiary care hospital.

Methodology: This prospective observational study enrolled 423 pediatric patients diagnosed with pneumonia. Data collection included antibiotic prescribing patterns, specimen microbiology, antimicrobial susceptibility, and clinical outcomes. Respiratory specimens underwent bacterial identification and susceptibility testing. Associations among prescribing practices, resistance, and clinical outcomes were analyzed.

Results: Nearly all patients (98.3%) received antibiotics, with 59.8% receiving combination therapy and 87.3% treated intravenously. Clinically significant bacteria were isolated from 41.9% of processed specimens. Among these isolates, 68.3% demonstrated resistance to at least one antibiotic, and 34.5% were classified as multidrug-resistant. Streptococcus pneumoniae was the most frequently identified pathogen, exhibiting substantial resistance to ampicillin-cloxacillin and penicillin. Inappropriate initial empirical therapy was observed in 57.2% of culture-positive cases and was associated with increased antibiotic switching and prolonged hospital stays.

Conclusion: This pediatric pneumonia cohort showed antibiotic resistance. Improved antimicrobial stewardship, guided by local surveillance data, is urgently required to optimize therapy, mitigate resistance, and improve patient outcomes.