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MDR-TB vs pneumonia

By parsa Aliabadi | 01 Jan, 2016

how we can differentiate TB vs pneumonia in CXR?

cxr Guidelines



Masoud Dara, MD Moderator Replied at 2:01 AM, 4 Jan 2016

Dear Parsa,

As you know CXR changes in TB are not specific. One needs to consider age, clinical signs and patient's symptoms as well. The following website provides a good overview of four pattern approach to reading abnormalities.


Sofia Alexandru Replied at 2:45 AM, 4 Jan 2016

Also, is important to consider contact or no with TB patient

Dear Masoud,
Thank you very much for this precious information

2016-01-04 9:08 GMT+02:00 Masoud Dara, MD via GHDonline <>

Haluk Çalışır Replied at 3:42 AM, 4 Jan 2016

Dear Parsa,

Tuberculosis, MDRTB and some of the radiological presentations of pneumonia
may mimic each other at the radiological examinations. ( Chest x.ray,
Thorax CT etc.) The key element is bacteriological examination of sputum
for AFB. If it is negative, diasease history, physical examination
findings, laboratory results and radiological features may help to
differentiate tuberculosis or pneumonia. ( not for MDRTB versus pneumonia)
Best Regards,
Haluk Çalışır M.D.

2016-01-04 9:04 GMT+02:00 Masoud Dara, MD via GHDonline <>

Dylan Tierney Moderator Emeritus Replied at 11:07 AM, 27 Jan 2016

Differentiating between pulmonary TB and pneumonia can be difficult even with the use of the best imaging techniques like chest CT, especially if microbiologic tests (smear, NAAT, culture) are negative.

In these situations, a strategy of treating for pneumonia with using a short course of antibiotics that has little activity against TB can be helpful. Some examples of these medications are beta-lactam antibiotics like amoxicillin/clavulanic acid or macrolides like azithromycin. Medications in the fluoroquinolone class should be avoided though because they have activity against TB.

If the patient responds clinically and demonstrates radiologic improvement to treatment with antibiotics that have no activity against TB, it increases the likelihood that the diagnosis was bacterial pneumonia rather than pulmonary TB. If the disease progresses despite the empiric antibiotics, it makes TB more likely.

Rakesh Biswas MD Replied at 12:04 PM, 27 Jan 2016

Thanks Dr Dylan, How long should one persist with non-mycobacterial
antibiotics to see the response? Would 2 weeks be a reasonable time period?
<http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1213> one
of our recent patient's online record where we resorted to the same
strategy (you will need to scroll down to the bottom once the link opens).



Dylan Tierney Moderator Emeritus Replied at 1:14 PM, 27 Jan 2016

Antibiotic therapy for bacterial pneumonia is usually given for five to ten days, with the exact length determined based on the severity of disease.

It should be noted that radiologic resolution of bacterial pneumonia can lag, sometime for weeks. I would probably re-image four to six weeks after treatment (assuming that smear positive pulmonary TB has already been exonerated with negative AFB smear microscopy).

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