Abstract
Background A large proportion of the huge global burden of extrapulmonary tuberculosis (EPTB) cases are treated empirically without accurate definition of disease sites and extent of multi-organ disease involvement. Positron emission tomography (PET) imaging using 2-deoxy-2-(fluorine-18) fluoro-d-glucose (18F-FDG) in tuberculosis could be a useful imaging technique for localising disease sites and extent of disease.
Methods We conducted a study of HIV-negative adult patients with a new clinical diagnosis of EPTB across eight centres located in six countries: India, Pakistan, Thailand, South Africa, Serbia and Bangladesh, to assess the extent of disease and common sites involved at first presentation. 18F-FDG PET/computed tomography (CT) scans were performed within 2 weeks of presentation.
Findings 358 patients with EPTB (189 females; 169 males) were recruited over 45 months, with an age range of 18–83 years (females median 30 years; males median 38 years). 350 (98%) out of 358 patients (183 female, 167 male) had positive scans. 118 (33.7%) out of 350 had a single extrapulmonary site and 232 (66.3%) out of 350 had more than one site (organ) affected. Lymph nodes, skeleton, pleura and brain were common sites. 100 (28%) out of 358 EPTB patients had 18F-FDG PET/CT-positive sites in the lung. 110 patients were 18F-FDG PET/CT-positive in more body sites than were noted clinically at first presentation and 160 patients had the same number of positive body sites.
Interpretation 18F-FDG PET/CT scan has potential for further elucidating the spectrum of disease, pathogenesis of EPTB and monitoring the effects of treatment on active lesions over time, and requires longitudinal cohort studies, twinned with biopsy and molecular studies.
Abstract
18F-FDG PET/CT can localise EPTB disease sites not clinically detected. It may serve a useful tool for research studies defining pathogenetic mechanisms and cure, relapse and recurrence. http://bit.ly/2CKSH9a
Footnotes
Author contributions: J. Bomanji, T.N.B Pascual and A. Zumla developed the concept and initiated discussions which led to the formation of the consortium. All authors developed and helped finalise the study protocols. R. Sharma, B.R. Mittal, S. Gambhir, A. Qureshy, S.M.F. Begum, M. Sathekge, M. Vorster, D. Sobic Saranovic and P. Pusuwan led the study sites. S. Vinjamuri conducted quality assessment of imaging data. V. Mann performed the data analyses. J. Bomanji led the imaging studies, and with A. Zumla, D. Paez and T.N.B Pascual developed the first and subsequent drafts of the manuscript. All authors contributed to data interpretation and writing of the manuscript.
Conflict of interest: J. Bomanji was the PI and received non-financial support from IAEA, Vienna, during the conduct of the study.
Conflict of interest: R. Sharma reports grants and non-financial support for research from IAEA, Vienna, during the conduct of the study.
Conflict of interest: B.R. Mittal reports grants and non-financial support for research from IAEA, Vienna, during the conduct of the study.
Conflict of interest: S. Gambhir reports grants and non-financial support from IAEA, Vienna, during the conduct of the study.
Conflict of interest: A. Qureshy reports grants and non-financial support for research from IAEA, Vienna, during the conduct of the study.
Conflict of interest: S.M.F. Begum reports grants and non-financial support for research from IAEA, Vienna, during the conduct of the study.
Conflict of interest: D. Paez has nothing to disclose.
Conflict of interest: M. Sathekge reports grants from International Atomic Energy association (IAEA), during the conduct of the study.
Conflict of interest: M. Vorster reports grants from International Atomic Energy Association (IAEA), during the conduct of the study.
Conflict of interest: D. Sobic Saranovic reports grants and non-financial support from IAEA, Vienna, during the conduct of the study.
Conflict of interest: P. Pusuwan reports grants and non-financial support for research from IAEA, Vienna, during the conduct of the study.
Conflict of interest: V. Mann reports payment for statistical software purchase from UCLH, during the conduct of the study.
Conflict of interest: S. Vinjamuri has nothing to disclose.
Conflict of interest: A. Zumla has nothing to disclose.
Conflict of interest: T.N.B. Pascual has nothing to disclose.
Support statement: The International Atomic Energy Agency (IAEA) assisted in selection of recruitment centres with optimal 18F-FDG PET/CT imaging facilities and provided support for 18F-FDG PET/CT scans, consortium meetings and centralised facilities for data storage. A. Zumla and J. Bomanji acknowledge support from the NIHR Biomedical Centre at UCL Hospitals Foundation NHS Trust. A. Zumla is a member of the Pan-African network for Rapid research, Response and Preparedness for Infectious Diseases Epidemics (PANDORA-ID-NET consortium (www.pandora-id.net/)) and acknowledges support from the PANDORA-ID-NET, EDCTP CANTAM2, TESA2 and EACCR2 grants from the European and Developing Countries Clinical Trials Partnership (EDCTP2) programme. A. Zumla is in receipt of a National Institutes of Health Research (NIHR) senior investigator award. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received October 8, 2019.
- Accepted November 11, 2019.
- Copyright ©ERS 2020
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