Background/Objectives: Inhaled corticosteroids (ICS) increase the risk of pneumonia caused by various pathogens in patients with chronic obstructive pulmonary disease (COPD). Treatment may also increase the risk of infection with non-tuberculous mycobacteria (NTM), although evidence remains limited. The aim of this study was to assess the association between ICS treatment and the risk of NTM isolation among patients with COPD. Methods: This retrospective register-based cohort study included patients with a specialist-verified COPD diagnosis between 2008 and 2021. ICS exposure was based on redeemed prescriptions during the year preceding the index date. Exposure was calculated as the mean daily budesonide-equivalent dose and categorized as none, low, medium, or high. A cause-specific Cox proportional hazards regression model with death as a competing risk was applied, adjusted for potential confounders. Sensitivity analyses included, among others, an inverse probability of treatment weighted model, and a time-dependent Cox regression model. Results: A total of 120,006 patients were included, with a median follow-up time of 4.9 years. During follow-up, 378 (0.32%) patients reached the primary endpoint. Medium-and high-dose ICS were associated with an increased hazard of NTM isolation, with hazard ratios of 1.39 (95% CI 1.06-1.88, p = 0.020) and 1.52 (95% CI 1.14-2.04, p = 0.005), respectively. This association remained significant for high-dose ICS across all sensitivity analyses. Conclusions: In patients with COPD, ICS treatment was associated with an increased and dose-dependent hazard of NTM isolation, particularly at high doses. High-dose ICS should, therefore, be prescribed with caution.

Macrolides are known to play a key role in the treatment of nontuberculous mycobacteria. However, the optimal combination and number of drugs remains uncertain. Nagawawa et al. and Zweijpfenning et al. investigated these questions in two randomised controlled trials exploring treatment regimens for Mycobacterium avium complex (MAC) infections, while Nguyen et al. summarised some of these questions in a meta-analysis. Nagawawa et al. compared an intermittent three-drug regimen to daily therapy, while Zweijpfenning et al. compared rifampicin or clofazimine as adjuncts to ethambutol and a macrolide. Tolerance levels for intermittent therapy were not significantly superior to those of daily therapy, while a clofazimine-ethambutol-macrolide regimen was non-inferior to one including rifampicin. Finally, Nguyen et al. conclude that a two-drug regimen may be a viable option for treating MAC infections.

Despite low TB incidence in Denmark, the disease disproportionately affects vulnerable groups. Implementation of screening, contact tracing, and preventive treatment remains fragmented. A national TB elimination plan, combining targeted outreach and social support, is needed to align with WHO goals and move toward elimination by 2050, as argued in this review.

Background:Nontuberculous mycobacterial pulmonary disease (NTM-PD) is associated with a significant economic burden due to complex diagnostics, prolonged multidrug treatments and hospitalisations. However, cost data are limited, particularly from countries with universal healthcare. We evaluated the economic burden of NTM-PD in Denmark. Methods:We conducted a nationwide cost analysis of all adults diagnosed with NTM-PD between 2005 and 2017, identified through International Classification of Diseases, 10th Revision codes. Each case was matched 1:4 to comparators by age, sex, marital/cohabitation status and municipality of residence. We assessed direct healthcare costs (primary and secondary care, and medications) and indirect costs (foregone earnings and public benefits for those aged 18-64 years) 3 years before and after the diagnosis. Annual costs were estimated using a generalised linear model with a gamma distribution and log link. Results:We included 545 NTM-PD patients and 2150 comparators. Patients had lower education levels and employment rates. Direct healthcare costs peaked in the diagnosis year at EUR 24 454 (95% CI 22 378-26 723) for patients versus EUR 4233 (95% CI 4057-4417) for comparators. Employment income declined before diagnosis and remained significantly lower (EUR 9547 versus 18 720), while public benefit payments were higher (EUR 18 005 versus 8978). Net costs peaked at EUR 29 394 (95% CI 27 523-31 408) in the diagnosis year, with comorbidity-adjusted direct healthcare costs being 4.8 times higher for patients (p<0.001). Conclusion:NTM-PD is associated with a substantial economic burden in Denmark, with nearly 5-fold higher direct healthcare costs, reduced income, increased public benefit payments and with net costs exceeding EUR 29 000 in the diagnosis year.

Introduction:Lung abscess (LA) is a rare but severe necrotizing pulmonary infection associated with substantial morbidity and mortality. Current management relies on prolonged systemic antibiotic therapy without systematic use of abscess drainage. However, small case series and retrospective studies suggest that transthoracic drainage may be a safe and effective adjunctive intervention improving treatment response. Historically, drainage has been avoided for fear of fistulation, but evidence supporting this is weak. High-quality evidence from randomized trials regarding interventional treatment of LA is lacking. This trial aims to determine whether transthoracic drainage combined with standard antibiotic therapy reduces hospital stay, compared with standard antibiotics alone in patients with LA. Methods:This is a national, multicentre, randomized open-label trial. Adults diagnosed with an LA ≥ 4 cm in diameter, containing fluid, and in contact with the outer third of the lung, will be eligible for the study. A total of 84 patients will be randomized 1:1 to either (1) transthoracic drainage combined with standard antibiotic treatment or (2) standard antibiotic treatment alone. Patients will undergo clinical assessments, laboratory testing, microbiological analyses, CT imaging, and standardized patient-reported outcome measures. Follow-up is scheduled at 1, 4, and 12 weeks post‑discharge. The primary outcome is length of hospital stay. Recruitment started February 2026 with an anticipated inclusion period of 4 years. Perspective:This study will provide the first randomized evidence on the role of transthoracic drainage in LA management. The results may inform national and international clinical guidelines and improve outcomes in patients with this severe condition. Trial registration:ClinicalTrial.gov (NCT07247461).

We estimated the direct and indirect costs associated with extrapulmonary nontuberculous mycobacteria (ENTM) disease in Denmark during 2005-2017. ENTM disease was associated with substantially higher healthcare costs, lower employment income, and increased public benefits before, around, and after diagnosis. Our findings highlight the substantial socioeconomic burden associated with ENTM disease.

Background Lung abscesses (LAs) are severe respiratory infections characterised by necrosis of pulmonary tissue. Despite the need for long-term antibiotic treatment, evidence on optimal treatment is limited, and no international guidelines exist. We aimed to evaluate different treatment strategies for treating LAs.Methods Patients hospitalised from 2016 to 2021 with LA were included in a retrospective multicentre cohort study. Descriptive statistics were presented for the current treatment strategies of LA regarding the choice and duration of antibiotic treatment, as well as the use of interventional treatments and associated treatment outcomes.Results In 222 patients diagnosed with LA, 89.2% were treated with intravenous antibiotics for a median duration of 14 days, followed by oral antibiotics for a median of 26 days; 10.8% received oral antibiotics as first-line therapy. Duration of intravenous treatment, total length of antibiotic treatment, and occurrence of treatment failure did not differ across the four most used antibiotic regimens: Benzylpenicillin and metronidazole, piperacillin/tazobactam with or without metronidazole, cefuroxime and metronidazole, or clindamycin monotherapy. Duration of hospitalisation varied slightly between treatment groups, with a trend of the shortest length of stay for patients treated with clindamycin. Fifteen patients underwent interventional treatment. These patients were characterised by larger abscesses, longer duration of antibiotic treatment, and higher mortality.Conclusions Within the limitations of a descriptive design, no significant differences in clinical outcomes of LA were observed across the four most common antibiotic regimens. The selection of regimens varied considerably between the four study sites. Randomised studies are urgently needed to guide the best treatment choice.

Background:Nontuberculous mycobacterial (NTM) disease, predominantly caused by Mycobacterium avium complex (MAC), is an emerging global health concern. The evidence regarding MAC-specific mortality and causes of death remains limited. This study investigated mortality and causes of death among patients with MAC isolates. Methods:A nationwide study in Denmark (1991-2018) included all patients with MAC isolates, excluding those identified using gastric lavages alone. Data from the International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, were linked with national registries. Patients were classified as having pulmonary (PMAC), extrapulmonary (EMAC), or disseminated MAC (DMAC) disease. Cumulative mortality rates were calculated, and adjusted hazard ratios (aHR) for mortality were estimated using Cox models, adjusting for age, sex, disease manifestation, and comorbidities. Results:Among 2,027 patients, 1-year mortality rates were 19% (PMAC), 15% (EMAC), and 52% (DMAC), increasing to 68%, 22%, and 84% at 10 years, respectively. Mortality decreased over time, especially for EMAC and DMAC. The risk factors for higher mortality included older age (aHR 1.04), male sex (aHR 1.85), DMAC (aHR 2.66), and higher comorbidity (aHR 1.21). Over time, age-related mortality hazards increased (0.4%/year on average), while hazards related to EMAC (-9%/year), DMAC (-13%/year), and comorbidities (-1%/year) declined. Chronic respiratory disease and HIV were the leading causes of death. Conclusions:Despite improvements over nearly three decades, PMAC remains associated with substantial mortality. This study offers valuable insights into mortality trends and risk factors for MAC disease, providing findings that can assist clinicians in delivering more accurate prognoses for different patient groups.

BACKGROUND: Clinical characteristics of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) in Denmark are undescribed. This study investigated clinical characteristics and diagnostic practices in patients with pulmonary NTM isolates. METHODS: Patients in Central Region Denmark from 2016 to 2021 were identified using mycobacterial reference laboratory data, and hospital records were reviewed for demographics, comorbidities, risk factors, and diagnostic details. Diagnostic guideline criteria for NTM-PD were assessed, and clinical characteristics were compared between those who met the criteria and those who did not. RESULTS: Among 193 patients, M. avium complex (56 %), M. gordonae (15 %), and M. xenopi (11 %) were most common. Symptoms included cough (62 %), expectoration (51 %), dyspnea (43 %), and systemic symptoms (42 %), with 36 % experiencing symptoms for over 6 months. The median time from first hospital contact to receipt of the first sample yielding NTM was 14 days (IQR: 42). Forty-five percent (n = 87) of patients were initially seen in a fast-track pulmonary cancer referral pathway. Fifty-three percent (n = 103) met the diagnostic criteria for NTM-PD. This was associated with older age, lower BMI and FEV1, a higher comorbidity burden, longer time to diagnostic sampling, and higher bacterial loads. CONCLUSIONS: In Denmark, a high percentage of patients met the NTM-PD criteria compared to other studies, which may be attributed to a high prevalence of structural lung disease and delayed disease presentation and diagnosis. Many patients were initially seen in a fast-track pulmonary cancer pathway, which could be leveraged to improve the diagnostic pathway of NTM-PD.

INTRODUCTION:Correct use of tuberculosis (TB) diagnosis codes is essential for patient care, surveillance and resource allocation. We aimed to assess the positive predictive value (PPV) of TB diagnosis codes. METHODS:In this retrospective cohort study, we identified patients with International Classification of Diseases, tenth version (ICD-10) TB diagnosis codes from 1 July 2020 to 30 June 2023, at two TB centres in the Central Denmark Region. Confirmed TB was defined as microbiologically confirmed TB, prescription of ≥ 3 first- or second-line TB drugs, or TB notification. All patients who did not meet these criteria and those who received fewer than three TB drugs or lacked TB notification underwent manual hospital record review to verify or exclude the TB diagnosis. PPVs were calculated as the proportion of confirmed TB diagnoses among all patients with a TB diagnosis code. RESULTS:In total, 185/230 patients were confirmed to have TB, yielding a PPV of 80% (95% CI: 75; 85). The PPVs for TB microbiology, TB prescriptions and TB notification exceeded 95% individually. Excluding TB lupus codes increased the PPV to 89% (95% CI: 84; 93). Patients with more than one different type of TB diagnosis code had a PPV of 100% (95% CI: 93; 100). Additionally, PPVs were high when TB diagnosis codes appeared on multiple occasions, increasing with the number of occurrences (≥ 2: 85%, ≥ 3: 89%, ≥ 4: 93%). CONCLUSION:TB ICD-10 diagnosis codes demonstrate a moderately high PPV in Denmark, particularly when excluding TB lupus codes, highlighting the importance and complexities of diagnostic coding. FUNDING:None. TRIAL REGISTRATION:Not relevant.

OBJECTIVES:This nationwide retrospective cohort study estimates tuberculosis (TB) disease risk in adults and children with inflammatory bowel disease (IBD) and inflammatory rheumatic disease (IRD) treated with immunosuppressive biologics in Denmark, including temporal trends and risk stratification by TB infection status and country of birth. METHODS:Patients diagnosed with IBD or IRD from 1994 to 2018 were identified using the Danish National Patient Registry. Treatments with biologics and diagnoses of TB disease were determined through International Classification of Diseases, 10th Revision codes and microbiological records. Patient demographics, interferon-gamma release assay (IGRA) results, and drug use data were collected from national databases. Poisson regression was used to calculate TB incidence rates (IRs) and assess associations with biologic treatment, IGRA status, country of birth, age, and sex. RESULTS:During 553 551 person-years of follow-up, 117 patients with TB disease were identified, with 71 cases occurring in biologic-naïve patients and 46 in biologic-treated individuals. The crude IR was 39.3 of 100 000 person-years (95% CI, 29.4-52.4) for biologic-treated individuals, compared with 12.4 of 100 000 person-years (95% CI, 9.2-16.8) for naive patients, yielding an IR ratio (IRR) of 3.2 (95% CI, 2.0-4.9). The TB risk was higher in IGRA-positive patients (vs. negative, IRR 45.0, 95% CI, 12.0-168.2) and those born in intermediate (vs. low-incidence country, IRR 7.9, 95% CI, 3.3-18.9) or high TB incidence countries (vs. low-incidence country, IRR 7.5, 95% CI, 2.9-19.1). DISCUSSION:The elevated risk of TB disease in patients with IRD and IBD treated with biologics is strongly associated with IGRA positivity and country of birth. These findings highlight the importance of comprehensive baseline TB risk assessment and patient education in combination with personalized follow-up to guide preventive strategies in this population.

Objectives: The study aimed to investigate the association between quantitative T-SPOT.TB values and the risk of incident and prevalent tuberculosis disease (TBD), identify risk factors, and evaluate test accuracy. Methods: This retrospective cohort study followed patients tested consecutively with T-SPOT.TB at Aarhus University Hospital from 2010 to 2017, with follow-up for incident TBD through 2022. Data on demographics, comorbidities, medications, and TB status were collected from patient records and national registries. Cox proportional hazard models with restricted cubic splines assessed the risk of incident TBD (occurring >= 3 months post-test) by quantitative spot counts. Cox and log-binomial regressions identified risk factors for incident and prevalent TBD (occurring between 3 months before and after the test). Sensitivity, specificity, and predictive values assessed test accuracy. T-SPOT.TB was the index test, and microbiologically and/or clinically confirmed TBD was the reference standard. Results: Among 8542 individuals with complete follow-up, 59 developed incident TBD over 67 456 person-years. Among 9014 individuals tested once, 162 had prevalent TBD at the time of testing. The risk of incident TBD increased with higher spot counts, plateauing for tests with more than ten spots. The strongest risk factors for both incident and prevalent TBD were categorical T-SPOT.TB results: compared with negative tests (c4 spots), adjusted hazard ratios for incident TBD were 5.0 (95% CI: 1.9-13.1) for borderline (5-7 spots) and 8.0 (95% CI: 4.0-15.7) for positive tests (>= 8 spots). Adjusted risk ratios for prevalent TBD were 14.9 (95% CI: 7.7-28.9) for borderline and 35.6 (95% CI: 21.4-59.2) for positive tests. Sensitivities for incident and prevalent TBD were 54.0% (95% CI: 39.3-68.2%) and 78.4% (95% CI: 71.3 -84.5%), respectively. Specificities were 84.8 (84.0-85.4) and 83.7 (82.9-84.4), respectively. Discussion: Incident TBD risk increases with T-SPOT.TB values but plateaus beyond 10 spots. Borderline and positive T-SPOT.TB results are strongly linked to TBD risk. Ole Skouvig Pedersen, Clin Microbiol Infect 2025;31:808 (c) 2025 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background Addressing the disproportionate representation between sexes is essential for achieving universal health coverage. Studies on the association between sex and unsuccessful tuberculosis treatment outcomes have shown conflicting results. This study examines this association and analyses sex-stratified risk factors associated with unsuccessful outcomes. Methods This retrospective, observational cohort study analysed prospectively collected data from six Eastern European countries from 2020 to 2022. Treatment outcomes were defined using World Health Organization criteria. Uni- and multivariable logistic regression models were used to assess the association between sex and unsuccessful outcomes (‘treatment failure’, ‘lost to follow-up’, ‘died’, or any of these). After propensity score matching females and males, the multivariable analysis was repeated. Risk factors were analysed separately for each sex and compared using interaction terms. Findings Among females, 19·5% (n = 290/1490) (95% confidence interval [CI]: 18, 22) achieved an unsuccessful treatment outcome, compared with 30% (n = 1363/4553) (95% CI: 29, 31) among males. In the multivariable analyses, female sex was associated with 32% lower odds of any unsuccessful outcome (adjusted odds ratio [aOR] 0·68, 95% CI: 0·58, 0·80), 36% lower odds of dying (aOR 0·64, 95% CI: 0·51, 0·80), and 37% lower odds of treatment failure (aOR 0·63, 95% CI: 0·47, 0·85). The association between sex and being ‘lost to follow-up’ was not significant. In the propensity score-matched cohort, sex was not associated with unsuccessful outcomes. Risk factors for unsuccessful outcomes were similar for females and males, except that in females aged >65 years, the odds of death were 2·2 times higher (95% CI: 1·1, 4·4). Interpretation Male sex was associated with unsuccessful outcomes, including death and treatment failure, but adjusting for socio-demographic and clinical factors, and matching males to females, attenuated the association, suggesting that sex disparities in tuberculosis outcomes may be driven more by behavioural than biological factors. Longitudinal studies are needed to confirm these findings. Funding The publication fee was funded by the Civilian Research and Development Foundation (CRDF) under grant #G-202407-72538.

Mortality and causes of death in non-tuberculous mycobacterial pulmonary disease (NTM-PD) are not well-described over long follow-up periods, particularly in Europe. We investigated whether NTM-PD is associated with higher mortality rates and different causes of death than matched controls.Danish national registers were used to identify patients with NTM-PD from 2000–2017 and to match them 1:4 with controls based on age, sex, cohabitation status, and municipality.We identified 661 patients with NTM-PD (50.4% male, median age 66 years, interquartile range [IQR] 48–84). The 5-year mortality rate for NTM-PD was 51% (95% CI 47–55) compared to 15% (95% CI 14–17) for controls. The hazard ratio (HR) of death for NTM-PD was 3.1 (95% CI 2.7–3.5; P < 0.001) compared to controls, persisting after adjusting for Charlson Comorbidity Index with an adjusted HR of 1.9 (95% CI 1.63–2.22; P < 0.001). Median age at death was 72 years (IQR 58–86) for NTM-PD patients and 81 years (IQR 69–93) for controls. Deaths due to respiratory diseases were more frequent in NTM-PD patients (45.2%) than in controls (11.6%). Mycobacterial infection directly caused death in 5.8% of NTM-PD patients.NTM-PD is associated with significantly higher all-cause mortality than controls, particularly in the initial years following diagnosis. These findings highlight the need for increased attention to NTM-PD and related respiratory conditions.

Background:Extra-fine particle inhaled corticosteroids (ICS) improve peripheral airway distribution, but their effect on risk of exacerbations and all-cause mortality in patients with chronic obstructive pulmonary disease (COPD) is unclear. Methods:This observational cohort study compares patients with COPD who received extra-fine particle ICS to those who received standard particle size ICS from 2010 to 2017 while followed in outpatient clinics. The primary outcome was the time to a COPD exacerbation that required hospitalization, with all-cause mortality as a secondary outcome. Data were analyzed using an adjusted Cox proportional hazards model and a competing risk analysis. Two predefined subgroup analyses of patients treated with pressurised metered dose inhalers (pMDIs) and patients with a previous exacerbation history, was carried out. Lastly, we created a propensity score matched cohort as a sensitivity analysis. Results:Of the 40,489 patients included, 38,802 (95.8%) received stand particle size ICS and 1,687 (4.2%) received extra-fine particle ICS. In total 7,058 were hospitalized with a COPD exacerbation, and 4,346 died. No significant protective effect of extra-fine particle ICS against hospitalization due to COPD exacerbations (HR 0.93, 95% CI 0.82-1.05, p=0.23) or all-cause mortality (HR 1.00, 95% CI 0.85-1.17, p=0.99) was found when compared to standard particle size ICS. However, in the subgroup analysis of patients treated with pMDIs, extra-fine particle ICS was associated with reduction in risk of exacerbations (HR 0.72, 95% CI 0.63-0.82, p<0.001) and all-cause mortality (HR 0.72, 95% CI 0.61-0.86, p<0.001). Conclusion:The administration of extra-fine particle ICS was not associated with reduced risk of exacerbations or all-cause mortality in our primary analysis. A subgroup consisting of patients treated with pMDIs suggested potential protective benefits.

BACKGROUND:The epidemiology of nontuberculous mycobacteria (NTM) infections is not well described. In this study, we sought to determine the incidence and prevalence of NTM infections and focus on social risk factors. In addition, we describe people with pulmonary and extrapulmonary NTM. RESEARCH QUESTION:What are the incidence and prevalence of NTM in Denmark, and what are the characteristics of the affected patients? STUDY DESIGN AND METHODS:This is a nationwide retrospective register-based cohort study in Denmark. Adult patients in the Danish national registers who received a diagnosis of NTM disease from 2000 to 2017 were classified as having either pulmonary or extrapulmonary NTM disease. RESULTS:We identified 1,146 adults with an NTM diagnosis. Of these, 661 patients had pulmonary NTM, of whom 50.4% were male, whereas 485 had extrapulmonary NTM, of whom 59.6% were male. The median age (interquartile range) was 66 (18) years and 57 (32) years, respectively. The yearly incidence rate per 100,000 increased between 2000 and 2017 for both pulmonary NTM (0.4 to 1.3) and extrapulmonary NTM (0.3 to 0.6). The annual prevalence per 100,000 inhabitants increased from 0.4 to 3.5 for pulmonary NTM and from 0.3 to 1.0 for extrapulmonary NTM. The incidence rate increased with age. The incidence of pulmonary NTM was highest among those who were aged 70 years or older (19.3 per 100,000 inhabitants). Compared with patients with pulmonary NTM, patients with extrapulmonary NTM were more likely to be employed and had a higher educational level. INTERPRETATION:This study indicates that the prevalence of NTM disease in Denmark increased between 2000 and 2017. We found that patients with pulmonary NTM and patients with extrapulmonary NTM represent two distinct groups that differ in age, sex, education, and employment status. Increased suspicion of pulmonary NTM disease is warranted in older adults after exclusion of more common lung infections.

Evidence on mortality rates and causes of death associated with extrapulmonary nontuberculous mycobacteria (NTM) infection is limited. This nationwide register-based study in Denmark used diagnostic codes to match adult patients with extrapulmonary NTM infection 1:4 to controls. During 2000-2017, we identified 485 patients, who had significantly more comorbidities than controls. The 5-year mortality rate for patients was 26.8% (95% CI 23.1%-31.0%) and for controls, 10.9% (95% CI 9.6%-12.4%). The median age at death was 76 (interquartile range 63-85) years for patients and 84 (interquartile range 73-90) years for controls. The adjusted hazard rate of death for patients was 1.34 (95% CI 1.10-1.63; p = 0.004). Patients and controls mainly died of cardiovascular disease and solid malignant neoplasms. Hematologic malignancies and HIV were more frequently causes of death in patients. Mortality rates are substantial among patients with extrapulmonary NTM infection, predominantly caused by underlying conditions.

Chest X-ray (CXR) in combination with machine learning (ML)-based prediction models has been proposed as a promising tool to distinguish drug-susceptible from drug-resistant tuberculosis (DS-/DR-TB) [ 1 Jaeger S. Juarez-Espinosa O.H. Candemir S. et al. Detecting drug-resistant tuberculosis in chest radiographs. Int J Comput Assist Radiol Surg. 2018; 13: 1915-1925 Crossref PubMed Scopus (40) Google Scholar , 2 Yang F. Yu H. Kantipudi K. et al. Differentiating between drug-sensitive and drug-resistant tuberculosis with machine learning for clinical and radiological features. Quant Imaging Med Surg. 2022; 12: 675-687 Crossref PubMed Scopus (16) Google Scholar ]. This method builds on the idea that radiological abnormalities differ between patients with pulmonary DR- and DS-TB. Yet, previous studies have yielded conflicting results when comparing CXR findings in clinical practice [ 3 Wáng Y.X.J. Chung M.J. Skrahin A. et al. Radiological signs associated with pulmonary multi-drug resistant tuberculosis: an analysis of published evidences. Quant Imaging Med Surg. 2018; 8: 161-173 Crossref PubMed Scopus (54) Google Scholar , 4 Oriekot A. Sereke S.G. Bongomin F. et al. Chest X-ray findings in drug-sensitive and drug-resistant pulmonary tuberculosis patients in Uganda. J Clin Tuberc Other Mycobact Dis. 2022; 27100312 PubMed Google Scholar ]. These studies have, however, also been limited by relatively small sizes or by including few types of drug resistance. The aim of this study was to examine whether CXR findings differ across various types of Mycobacterium tuberculosis resistance.