Bilateral Radiological Involvement

On x-ray finding (Table 5), bilateral radiological involvement, 16.7% of non-converted cases had unilateral lesions versus to 83.3% had bilateral ones with (P value 0.03) and could be consider a predictor of sputum non-conversion. Bouti et al.10 revealed that bilateral radiological involvement was independent risk factors for delayed smear conversion, due to the high baseline bacillary burden of those patients which delay time for conversion. Also, the study showed that 92.9% of the converted cases had localized lesions versus7.1% of converted were of diffuse lesions with (p value 0.

02). Vora et al.7 reported that the more the involving part of the lung the more aggressive, more infectious, with more clinical symptoms and bacillary load this is the cause of the delay of sputum conversion in bilateral lung tuberculosis than unilateral involvement and in localized than diffuse lesions. There was statistically significant difference between presence of cavitation and delayed sputum conversion (P value >.001). This is in agreement with Mlotshwa et al.11 as their research found that there was a direct association between the presence of lung cavitation in TB patients and high bacillary load in their sputum and the high bacillary load at the start of treatment could possibly reflect severity of disease, which has been shown to be associated with TB treatment failure and relapse, and the development of TB drug resistance.

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Regarding smoking status in relation to treatment response, after 2nd month of treatment, there were about 65.1% of converted cases non-smokers versus 34.9% smokers and at 6th month all non-converted cases were smokers (P value 0.04) (Table 6).

Liew et al.15 reported in their study that smoking was associated with delayed sputum conversion but not death. Latorre, et al18 explains this as smoking affects the T- cell regulatory function which affects host defense mechanisms in the lung increase non-compliance to drugs. Regarding alcoholism, 93.0% of converted cases were alcohol non-consumers versus 7% alcohol consumer after 2nd month (P value 0.02) and after 6Th month, 66.7% of the non-converted cases alcohol consumers and 33.3% alcohol non-consumers (P value 0.03).This disagree with Bouti et al.10 and Saffari et al.19 Rehm et al.20 agree with the current study reported that alcohol affects the pharmacokinetics of the drugs by decreasing the absorption or increasing the metabolism which alter the efficacy of the anti-tuberculosis drugs so the consumers have big chance for delayed conversion even failure.

Regarding sputum positivity grading, 3 patients remained sputum positive at the end of treatment, those patients has a high sputum grading on their initial assessment; 2 patients had +3, and one patient had +4 sputum grading (P value 0.001) (Table 6). Bouti et al.10, Saffari et al.19 agree with current work. Singla et al.21 also found in their studies that the presence of large numbers of bacilli on pretreatment sputum smears was a main cause of delay conversion increasing the risk of persistent positivity because the greater the bacterial load the longer the time taken to eliminate the bacilli and eradicate the infection.