Pulmonary Cavities Due to Infectious Causes
Abstract
Pulmonary cavities are an important radiological finding in various infectious and non‑infectious diseases. Infection‑related cavities are usually associated with tuberculosis (TB), non‑tuberculous mycobacterial (NTM) infection, chronic pulmonary aspergillosis, and echinococcosis, each with distinct mechanisms of formation and radiologic patterns. In TB and NTM, tissue necrosis and bronchiectasis lead to the formation of cavitary spaces that serve as reservoirs for organisms with a high burden and facilitate transmission. Residual cavities may then undergo secondary colonization by Aspergillus spp, resulting in a spectrum of chronic pulmonary aspergillosis with findings such as aspergilloma and thick‑walled cavities. Echinococcus forms cysts that, when ruptured, can appear as cavitary lesions with the “water lily” sign, adding yet another differential diagnosis for pulmonary cavities. Understanding radiologic patterns, pathogenesis, and microbiological correlations can be used as an important clue to distinguish etiologies and to select appropriate management for patients.
Full text article
References
Amin, S., Thywissen, A., Heinekamp, T., Saluz, H. P., & Brakhage, A. A. (2014). Melanin dependent survival of Apergillus fumigatus conidia in lung epithelial cells. International Journal of Medical Microbiology, 304(5–6), 626–636. https://doi.org/10.1016/j.ijmm.2014.04.009
Andreu, J., Cáceres, J., Pallisa, E., & Martinez-Rodriguez, M. (2004). Radiological manifestations of pulmonary tuberculosis. European Journal of Radiology, 51(2), 139–149. https://doi.org/10.1016/j.ejrad.2004.03.009
Ben Romdhane, H., Carette, M.-F., & Grenier, P. (1996). Pulmonary Tuberculosis: Comparison of CT Findings in HIV-Seropositive HIV-Seronegative Patients’. In Radiology (Vol. 198).
Canan, A., Batra, K., Saboo, S. S., Landay, M., & Kandathil, A. (2021). Radiological approach to cavitary lung lesions. In Postgraduate Medical Journal (Vol. 97, Issue 1150, pp. 521–531). BMJ Publishing Group. https://doi.org/10.1136/postgradmedj-2020-138694
Chakaya, J., Kirenga, B., & Getahun, H. (2016). Long term complications after completion of pulmonary tuberculosis treatment: A quest for a public health approach. In Journal of Clinical Tuberculosis and Other Mycobacterial Diseases (Vol. 3, pp. 10–12). Elsevier Ltd. https://doi.org/10.1016/j.jctube.2016.03.001
Chu, H.-Q., Li, B., Zhao, L., Huang, D.-D., Zhang, Z.-M., Xu, J.-F., Zhang, J.-B., Gui, T., Xu, L.-Y., & Sun, X.-W. (2015). Chest imaging comparison between non-tuberculous and tuberculosis mycobacteria in sputum acid fast bacilli smear-positive patients. European Review for Medical and Pharmacological Sciences, 19, 2429–2439.
Daley, C. L., & Winthrop, K. L. (2020). Mycobacterium avium complex: Addressing gaps in diagnosis and management. Journal of Infectious Diseases, 222(Supplement_4), S199–S211. https://doi.org/10.1093/infdis/jiaa354
Denning, D. W., Cadranel, J., Beigelman-Aubry, C., Ader, F., Chakrabarti, A., Blot, S., Ullmann, A. J., Dimopoulos, G., & Lange, C. (2015). Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J, 1–24. https://doi.org/10.1183/13993003.00583-2015
Denning, D. W., Page, I. D., Chakaya, J., Jabeen, K., Jude, C. M., Cornet, M., Alastruey-izquierdo, A., Bongomin, F., Bowyer, P., Chakrabarti, A., Gago, S., Guto, J., Hochhegger, B., Hoenigl, M., Irfan, M., Irurhe, N., Izumikawa, K., Kirenga, B., Manduku, V., … Getahun, H. (2018). Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings. Emerging Infectious Diseases, 24(8), e171312.
Denning, D. W., Pleuvry, A., & Cole, D. C. (2011). Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bulletin of the World Health Organization, 89, 864–872. https://doi.org/10.2471/BLT.11.089441
Duong, T. B., Ceglar, S., Reaume, M., & Lee, C. (2020). Imaging approach to cavitary lung disease. In Annals of the American Thoracic Society (Vol. 17, Issue 3, pp. 367–371). American Thoracic Society. https://doi.org/10.1513/AnnalsATS.201909-727CC
Elkington, P. T., D’Armiento, J. M., & Friedland, J. S. (2011). Tuberculosis immunopathology: The neglected role of extracellular matrix destruction. In Science Translational Medicine (Vol. 3, Issue 71). https://doi.org/10.1126/scitranslmed.3001847
Gadkowski, L. B., & Stout, J. E. (2008). Cavitary pulmonary disease. In Clinical Microbiology Reviews (Vol. 21, Issue 2, pp. 305–333). https://doi.org/10.1128/CMR.00060-07
Gafoor, K., Patel, S., Girvin, F., Gupta, N., Naidich, D., Machnicki, S., Brown, K. K., Mehta, A., Husta, B., Ryu, J. H., Sarosi, G. A., Franquet, T., Verschakelen, J., Johkoh, T., Travis, W., & Raoof, S. (2018). Cavitary Lung Diseases: A Clinical-Radiologic Algorithmic Approach. In Chest (Vol. 153, Issue 6, pp. 1443–1465). Elsevier Inc. https://doi.org/10.1016/j.chest.2018.02.026
Goodwin, R. A., & Des Prez, R. M. (1983). Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung. In Chest (Vol. 83, Issue 5, pp. 801–805). https://doi.org/10.1378/chest.83.5.801
Greene, R. (2005). The radiological spectrum of pulmonary aspergillosis. Medical Mycology, 43(SUPPL.1). https://doi.org/10.1080/13693780500064771
Griffith, D. E., Aksamit, T., Brown-Elliott, B. A., Catanzaro, A., Daley, C., Gordin, F., Holland, S. M., Horsburgh, R., Huitt, G., Iademarco, M. F., Iseman, M., Olivier, K., Ruoss, S., Von Reyn, C. F., Wallace, R. J., & Winthrop, K. (2007). An official ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. In American Journal of Respiratory and Critical Care Medicine (Vol. 175, Issue 4, pp. 367–416). https://doi.org/10.1164/rccm.200604-571ST
Grosset, J. (2003). Mycobacterium tuberculosis in the extracellular compartment: An underestimated adversary. In Antimicrobial Agents and Chemotherapy (Vol. 47, Issue 3, pp. 833–836). https://doi.org/10.1128/AAC.47.3.833-836.2003
Guo, H., Liu, W., Wang, J., & Xing, Y. (2021). Extrahepatic alveolar echinococcus on multi-slice computed tomography and magnetic resonance imaging. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-89101-x
Hales, C. M., Heilig, C. M., Chaisson, R., Leung, C. C., Chang, K. C., Goldberg, S. V., Gordin, F., Johnson, J. L., Muzanyi, G., Saukkonen, J., Vernon, A., Villarino, M. E., & Burman, W. J. (2013). The association between symptoms and microbiologically defined response to tuberculosis treatment. Annals of the American Thoracic Society, 10(1), 18–25. https://doi.org/10.1513/AnnalsATS.201207-038OC
Han, D. W., Jo, K. W., Kim, O. H., & Shim, T. S. (2021). Cavity formation and its predictors in noncavitary nodular bronchiectatic Mycobacterium avium complex pulmonary disease. Respiratory Medicine, 179. https://doi.org/10.1016/j.rmed.2021.106340
Hansell, D. M., Bankier, A. A., MacMahon, H., McLoud, T. C., Müller, N. L., & Remy, J. (2008). Fleischner Society: Glossary of terms for thoracic imaging. In Radiology (Vol. 246, Issue 3, pp. 697–722). https://doi.org/10.1148/radiol.2462070712
Hoefsloot, W., Van Ingen, J., Andrejak, C., Ängeby, K., Bauriaud, R., Bemer, P., Beylis, N., Boeree, M. J., Cacho, J., Chihota, V., Chimara, E., Churchyard, G., Cias, R., Daza, R., Daley, C. L., Dekhuijzen, P. N. R., Domingo, D., Drobniewski, F., Esteban, J., … Wagner, D. (2013). The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: An NTM-NET collaborative study. European Respiratory Journal, 42(6), 1604–1613. https://doi.org/10.1183/09031936.00149212
Honda, J. R., Knight, V., & Chan, E. D. (2015). Pathogenesis and risk factors for nontuberculous mycobacterial lung disease. In Clinics in Chest Medicine (Vol. 36, Issue 1, pp. 1–11). W.B. Saunders. https://doi.org/10.1016/j.ccm.2014.10.001
Howard, S. J., Pasqualotto, A. C., Anderson, M. J., Leatherbarrow, H., Albarrag, A. M., Harrison, E., Gregson, L., Bowyer, P., & Denning, D. W. (2013). Major variations in Aspergillus fumigatus arising within aspergillomas in chronic pulmonary aspergillosis. Mycoses, 56(4), 434–441. https://doi.org/10.1111/myc.12047
Izumikawa, K., Tashiro, T., Tashiro, M., Takazono, T., Kosai, K., Morinaga, Y., Kurihara, S., Nakamura, S., Imamura, Y., Miyazaki, T., Tsukamoto, M., Kakeya, H., Hayashi, T., Yanagihara, K., Nagayasu, T., & Kohno, S. (2014). Pathogenesis and clinical features of chronic pulmonary aspergillosis-Is it possible to distinguish CNPA and CCPA clinically? Journal of Infection and Chemotherapy, 20(3), 208–212. https://doi.org/10.1016/j.jiac.2013.10.016
Jeon, D. (2019). Infection source and epidemiology of nontuberculous mycobacterial lung disease. In Tuberculosis and Respiratory Diseases (Vol. 82, Issue 2, pp. 94–101). Korean National Tuberculosis Association. https://doi.org/10.4046/trd.2018.0026
Jeong, Y. J., Lee, K. S., Koh, W. J., Han, J., Kim, T. S., & Kwon, O. J. (2004). Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: Comparison of thin-section CT and histopathologic findings. Radiology, 231(3), 880–886. https://doi.org/10.1148/radiol.2313030833
Kartalija, M., Ovrutsky, A. R., Bryan, C. L., Pott, G. B., Fantuzzi, G., Thomas, J., Strand, M. J., Bai, X., Ramamoorthy, P., Rothman, M. S., Nagabhushanam, V., McDermott, M., Levin, A. R., Frazer-Abel, A., Giclas, P. C., Korner, J., Iseman, M. D., Shapiro, L., & Chan, E. D. (2013). Patients with nontuberculous mycobacterial lung disease exhibit unique body and immune phenotypes. American Journal of Respiratory and Critical Care Medicine, 187(2), 197–205. https://doi.org/10.1164/rccm.201206-1035OC
Kearney, S. E., Davies, C. W. H., Davies, R. J. O., & Gleeson, F. V. (2000). Computed tomography and ultrasound in parapneumonic effusions and empyema. Clinical Radiology, 55(7), 542–547. https://doi.org/10.1053/crad.1999.0480
Kementerian Kesehatan Republik Indonesia. (2024, April). Dashboard tuberkulosis Indonesia. https://tbindonesia.or.id/pustaka-tbc/dashboard/
Ketai, L., Currie, B. J., Holt, M. R., & Chan, E. D. (2018). Radiology of Chronic Cavitary Infections. Journal of Thoracic Imaging, 33(5), 334–343. https://doi.org/10.1097/RTI.0000000000000346
Kim, N. R., & Han, J. (2012). Pathologic review of cystic and cavitary lung diseases. In Korean Journal of Pathology (Vol. 46, Issue 5, pp. 407–414). https://doi.org/10.4132/KoreanJPathol.2012.46.5.407
Ko, J. M., Park, H. J., Cho, D. G., & Kim, C. H. (2015). CT differentiation of tuberculous and non-tuberculous pleural infection, with emphasis on pulmonary changes. International Journal of Tuberculosis and Lung Disease, 19(11), 1361–1368. https://doi.org/10.5588/ijtld.15.0092
Koh, W. J., Moon, S. M., Kim, S. Y., Woo, M. A., Kim, S., Jhun, B. W., Park, H. Y., Jeon, K., Huh, H. J., Ki, C. S., Lee, N. Y., Chung, M. J., Lee, K. S., Shin, S. J., Daley, C. L., Kim, H., & Kwon, O. J. (2017). Outcomes of Mycobacterium avium complex lung disease based on clinical phenotype. European Respiratory Journal, 50(3). https://doi.org/10.1183/13993003.02503-2016
Krutikov, M., Rahman, A., & Tiberi, S. (2019). Necrotizing pneumonia (aetiology, clinical features and management). In Current Opinion in Pulmonary Medicine (Vol. 25, Issue 3, pp. 225–232). Lippincott Williams and Wilkins. https://doi.org/10.1097/MCP.0000000000000571
Kunst, H., Mack, D., Kon, O. M., Banerjee, A. K., Chiodini, P., & Grant, A. (2011). Parasitic infections of the lung: A guide for the respiratory physician. In Thorax (Vol. 66, Issue 6, pp. 528–536). BMJ Publishing Group. https://doi.org/10.1136/thx.2009.132217
Kwon-Chung, K. J., & Sugui, J. A. (2013). Aspergillus fumigatus-What Makes the Species a Ubiquitous Human Fungal Pathogen? PLoS Pathogens, 9(12), 1–4. https://doi.org/10.1371/journal.ppat.1003743
Latgé, J. P., & Chamilos, G. (2020). Aspergillus fumigatus and aspergillosis in 2019. Clinical Microbiology Reviews, 33(1), e00140-18. https://doi.org/10.1128/CMR.00140-18
Lee, K. S., Hwang, J. W., Chung, M. P., Kim, H., & Kwon, O. J. (1996). Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS. Chest, 110(4).
Lynch, D. A., Simone, P. M., Fox, M. A., Bucher, B. L., & Heinig, M. J. (1995). CT Features of Pulmonary Mycobacterium avium Complex Infection. Journal of Computed Tomography, 19(3), 353–360.
Nin, C. S., de Souza, V. V. S., Alves, G. R. T., do Amaral, R. H., Irion, K. L., Marchiori, E., & Hochhegger, B. (2016). Solitary lung cavities: CT findings in malignant and non-malignant disease. Clinical Radiology, 71(11), 1132–1136. https://doi.org/10.1016/j.crad.2016.04.009
Oladele, R. O., Irurhe, N. K., Foden, P., Akanmu, A. S., Gbaja-Biamila, T., Nwosu, A., Ekundayo, H. A., Ogunsola, F. T., Richardson, M. D., & Denning, D. W. (2017). Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians. International Journal of Tuberculosis and Lung Disease, 21(9), 1056–1061. https://doi.org/10.5588/ijtld.17.0060
Ordonez, A. A., Wang, H., Magombedze, G., Ruiz-Bedoya, C. A., Srivastava, S., Chen, A., Tucker, E. W., Urbanowski, M. E., Pieterse, L., Cardozo, E. F., Lodge, M. A., Shah, M. R., Holt, D. P., Mathews, W. B., Dannals, R. F., Gobburu, J. V. S., Peloquin, C. A., Rowe, S. P., Gumbo, T., … Morgan, R. H. (2020). Dynamic imaging in patients with tuberculosis reveals heterogeneous drug exposures in pulmonary lesions performed the rabbit experiments HHS Public Access. Nat Med, 26(4), 529–534. https://doi.org/10.1038/s41591020-0770-2
Ors, F., Deniz, O., Bozlar, U., Gumus, S., Tasar, M., Tozkoparan, E., Tayfun, C., Bilgic, H., & Grant, B. J. B. (2007). High-resolution CT Findings in Patients With Pulmonary Tuberculosis Correlation With the Degree of Smear Positivity.
Oshitani, Y., Kitada, S., Edahiro, R., Tsujino, K., Kagawa, H., Yoshimura, K., Miki, K., Miki, M., & Kida, H. (2020). Characteristic chest CT findings for progressive cavities in Mycobacterium avium complex pulmonary disease: A retrospective cohort study. Respiratory Research, 21(1). https://doi.org/10.1186/s12931-020-1273-x
Page, I. D., Byanyima, R., Hosmane, S., Onyachi, N., Opira, C., Richardson, M., Sawyer, R., Sharman, A., & Denning, D. W. (2019). Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation. European Respiratory Journal, 53, 1–13.
Palaci, M., Dietze, R., Hadad, D. J., Ribeiro, F. K. C., Peres, R. L., Vinhas, S. A., Maciel, E. L. N., Dettoni, V. D. V., Horter, L., Boom, W. H., Johnson, J. L., & Eisenach, K. D. (2007). Cavitary disease and quantitative sputum bacillary load in cases of pulmonary tuberculosis. Journal of Clinical Microbiology, 45(12), 4064–4066. https://doi.org/10.1128/JCM.01780-07
Patterson, K. C., & Strek, M. E. (2014). Diagnosis and treatment of pulmonary aspergillosis syndromes. Chest, 146(5), 1358–1368. https://doi.org/10.1378/chest.14-0917
Proaño, A., Bui, D. P., López, J. W., Vu, N. M., Bravard, M. A., Lee, G. O., Tracey, B. H., Xu, Z., Comina, G., Ticona, E., Mollura, D. J., Friedland, J. S., Moore, D. A. J., Evans, C. A., Caligiuri, P., Gilman, R. H., Cabrera, L., Varela, M., Vigil-Romani, F., … Oren, E. (2018). Cough Frequency During Treatment Associated With Baseline Cavitary Volume and Proximity to the Airway in Pulmonary TB. Chest, 153(6), 1358–1367. https://doi.org/10.1016/j.chest.2018.03.006
Im, J.-G., Itoh, H., Shim, Y.-S., Lee, J. H., Ahn, J., Han, M. C., & Noma, S. (1993). Pulmonary Tuberculosis: CT Findings-Early Active Disease and Sequential Change with Antituberculous Therapy. Radiology, 186(3), 653–660.
Rai, D., Priyadarshi, R., & Karmaker, S. (2022). Study to assess aetiology, clinical and imaging characteristics of post Covid-19 pulmonary cavitation. Journal of Family Medicine and Primary Care, 11(2), 739. https://doi.org/10.4103/jfmpc.jfmpc_1425_21
Ravimohan, S., Kornfeld, H., Weissman, D., & Bisson, G. P. (2018). Tuberculosis and lung damage: from epidemiology to pathophysiology. European Respiratory Review , 27(170077), 1–20. https://doi.org/10.1183/16000617.0077
Rozaliyani, A., Rosianawati, H., Handayani, D., Agustin, H., Zaini, J., Syam, R., Adawiyah, R., Tugiran, M., Setianingrum, F., Burhan, E., Kosmidis, C., & Wahyuningsih, R. (2020). Chronic pulmonary aspergillosis in post tuberculosis patients in indonesia and the role of ldbio aspergillus ict as part of the diagnosis scheme. Journal of Fungi, 6(4), 1–10. https://doi.org/10.3390/jof6040318
Rozenshtein, A., Hao, F., Starc, M. T., & Pearson, G. D. N. (2015). Radiographic appearance of pulmonary tuberculosis: dogma disproved. American Journal of Roentgenology, 204(5), 974–978. https://doi.org/10.2214/AJR.14.13483
Ryu, J. H., & Swensen, S. J. (2003). Cystic and cavitary lung diseases: Focal and diffuse. In Mayo Clinic Proceedings (Vol. 78, Issue 6, pp. 744–752). Elsevier Ltd. https://doi.org/10.4065/78.6.744
Ryu, Y. J., Koh, W. J., & Daley, C. L. (2016). Diagnosis and treatment of nontuberculous mycobacterial lung disease: Clinicians’ perspectives. In Tuberculosis and Respiratory Diseases (Vol. 79, Issue 2, pp. 74–84). Korean National Tuberculosis Association. https://doi.org/10.4046/trd.2016.79.2.74
Setianingrum, F., Rozaliyani, A., Adawiyah, R., Syam, R., Tugiran, M., Sari, C. Y. I., Nandipinto, F., Ramnath, J., Arifin, A. R., Handayani, D., Burhan, E., Rumende, M., Wahyuningsih, R., Rautemaa-Richardson, R., & Denning, D. W. (2021). A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL). Thorax, thoraxjnl-2020-216464. https://doi.org/10.1136/thoraxjnl-2020-216464
Skoura, E., Zumla, A., & Bomanji, J. (2015). Imaging in tuberculosis. In International Journal of Infectious Diseases (Vol. 32, pp. 87–93). Elsevier. https://doi.org/10.1016/j.ijid.2014.12.007
Sung Kim, T., Koh, W.-J., Han, J., Jin Chung, M., Hyun Lee, J., Soo Lee, K., Jung Kwon, O., & W-j, K. (2005). Hypothesis on the Evolution of Cavitary Lesions in Nontuberculous Mycobacterial Pulmonary Infection: Thin-Section CT and Histopathologic Correlation. In AJR (Vol. 184).
Takahashi, M., Tsukamoto, H., Kawamura, T., Mochizuki, Y., Ouchi, M., Inoue, S., Nitta, N., & Murata, K. (2012). Mycobacterium kansasii pulmonary infection: CT findings in 29 cases. Japanese Journal of Radiology, 30(5), 398–406. https://doi.org/10.1007/s11604-012-0061-z
To, K., Cao, R., Yegiazaryan, A., Owens, J., & Venketaraman, V. (2020). General overview of nontuberculous mycobacteria opportunistic pathogens: Mycobacterium avium and mycobacterium abscessus. In Journal of Clinical Medicine (Vol. 9, Issue 8, pp. 1–24). MDPI. https://doi.org/10.3390/jcm9082541
Torgerson, P. R., Keller, K., Magnotta, M., & Ragland, N. (2010). The global burden of alveolar echinococcosis. In PLoS Neglected Tropical Diseases (Vol. 4, Issue 6). https://doi.org/10.1371/journal.pntd.0000722
Turner, R. D., Chiu, C., Churchyard, G. J., Esmail, H., Lewinsohn, D. M., Gandhi, N. R., & Fennelly, K. P. (2017). Tuberculosis Infectiousness and Host Susceptibility. Journal of Infectious Diseases, 216, S636–S643. https://doi.org/10.1093/infdis/jix361
Urbanowski, M. E., Ordonez, A. A., Ruiz-Bedoya, C. A., Jain, S. K., & Bishai, W. R. (2020). Cavitary tuberculosis: the gateway of disease transmission. In The Lancet Infectious Diseases (Vol. 20, Issue 6, pp. e117–e128). Lancet Publishing Group. https://doi.org/10.1016/S1473-3099(20)30148-1
World Health Organization. (2023). Global tuberculosis report 2023.
Xue, X. Y., Wang, P. L., Xue, Q. L., Wang, N., Zhang, L. N., Sun, J. P., Wang, K. F., Yang, B., & Wang, J. X. (2012). Comparative study of solitary thin-walled cavity lung cancer with computed tomography and pathological findings. Lung Cancer, 78(1), 45–50. https://doi.org/10.1016/j.lungcan.2012.06.004
Yamazoe, M., & Yanagi, M. (2023). Pulmonary Mycobacterium avium Complex Infection Showing Extensive Consolidation. Internal Medicine, 62(12), 1875–1876. https://doi.org/10.2169/internalmedicine.0817-22
Yeon, J. J., & Lee, K. S. (2008). Pulmonary tuberculosis: Up-to-date imaging and management. In American Journal of Roentgenology (Vol. 191, Issue 3, pp. 834–844). https://doi.org/10.2214/AJR.07.3896
Yuan, M. K., Chang, C. Y., Tsai, P. H., Lee, Y. M., Huang, J. W., & Chang, S. C. (2014). Comparative chest computed tomography findings of non-tuberculous mycobacterial lung diseases and pulmonary tuberculosis in patients with acid fast bacilli smear-positive sputum. BMC Pulmonary Medicine, 14(1). https://doi.org/10.1186/1471-2466-14-65
Authors
Copyright (c) 2026 Findra Setianingrum, Finny Nandipinto, Anna Rozaliyani
This work is licensed under a Creative Commons Attribution 4.0 International License.
Qanun Medika by FK UM Surabaya is liscence under Lisensi Creative Commons Atribusi 4.0 Internasional.