Abstract
There is an increased awareness of the long-term physical, psychological and socioeconomic consequences that can follow apparently successful treatment for tuberculosis (TB). In this chapter, we describe the high burden of residual lung damage post-treatment for pulmonary tuberculosis, as well as the common associated respiratory infections.
Patterns of post-TB lung disease (PTLD) are heterogenous, with no standardised tools for diagnosis or measurement. However, it is clear that the condition includes pleural, parenchymal and airway pathology, which may be particularly severe after multidrug resistant disease.
Prospective data describing the long-term sequelae of PTLD are limited, but given the high burden of bronchiectasis, residual cavities and parenchymal destruction, these likely include infective exacerbations with bacterial or viral pathogens, and superimposed infection with aspergillus and non-tuberculous mycobacteria.
There are few data reporting the incidence of post-TB infections amongst (an increasing number of) TB survivors in high- or low-income settings, but basic approaches to their diagnosis and management are described here.
The importance of broad respiratory care, including tobacco cessation, and the need for further evidence for interventions to improve long-term respiratory outcomes after completing treatment for TB are highlighted.
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References
Brown J, Capocci S, Smith C, Morris S, Abubakar I, Lipman M. Health status and quality of life in tuberculosis. Int J Infect Dis. 2015;32:68–75. https://doi.org/10.1016/j.ijid.2014.12.045.
Amaral AF, Coton S, Kato B, Tan WC, Studnicka M, Janson C, et al. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J. 2015;46(4):1104–12. PubMed PMID: 26113680; PubMed Central PMCID: PMCPMC4594762. https://doi.org/10.1183/13993003.02325-2014.
Meghji J, Lesosky M, Joekes E, Banda P, Rylance J, Gordon S, et al. Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study. Thorax. 2020;75(3):269–78. PubMed PMID: 32102951; PubMed Central PMCID: PMCPMC7063395. https://doi.org/10.1136/thoraxjnl-2019-213808.
Ravimohan S, Kornfeld H, Weissman D, Bisson GP. Tuberculosis and lung damage: from epidemiology to pathophysiology. Eur Resp Review. 2018;27(147). Epub 2018/03/02. PubMed PMID: 29491034; PubMed Central PMCID: PMCPMC6019552. https://doi.org/10.1183/16000617.0077-2017.
Meghji J, Simpson H, Squire SB, Mortimer KA. Systematic review of the prevalence and pattern of imaging defined post-TB lung disease. PLoS One. 2016;11(8):e0161176. PubMed PMID: 27518438; PubMed Central PMCID: PMCPMC4982669. https://doi.org/10.1371/journal.pone.0161176.
Dhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health. 2019;7(9):e1269–e79. https://doi.org/10.1016/s2214-109x(19)30327-4.
de Vallière S, Barker RD. Residual lung damage after completion of treatment for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2004;8(6):767–71.
Datta S, Evans CA. Healthy survival after tuberculosis. Lancet Infect Dis. 2019;19(10):1045–7. https://doi.org/10.1016/s1473-3099(19)30387-1.
Ranzani OT, Rodrigues LC, Bombarda S, Minto CM, Waldman EA, Carvalho CRR. Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in Sao Paulo state, Brazil, 2010–15: a population-based, longitudinal study. Lancet Infect Dis. 2020;20(1):123–32. PubMed PMID: 31676242; PubMed Central PMCID: PMCPMC6928568. https://doi.org/10.1016/s1473-3099(19)30518-3.
Stek C, Allwood B, Walker NF, Wilkinson RJ, Lynen L, Meintjes G. The immune mechanisms of lung parenchymal damage in tuberculosis and the role of host-directed therapy. Front Microbiol. 2018;9:2603. PubMed PMID: 30425706; PubMed Central PMCID: PMCPMC6218626. https://doi.org/10.3389/fmicb.2018.02603.
Munoz G, de Gracia J, Buxo M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1). Epub 2018/01/13. https://doi.org/10.1183/13993003.01926-2017.
Page ID, Byanyima R, Hosmane S, Onyachi N, Opira C, Richardson M, et al. Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation. Eur Respir J. 2019;53(3).
Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016;47(1):45–68. https://doi.org/10.1183/13993003.00583-2015.
Cowman S, van Ingen J, Griffith DE, Loebinger MR. Non-tuberculous mycobacterial pulmonary disease. Eur Respir J. 2019;54(1). Epub 2019/06/22. https://doi.org/10.1183/13993003.00250-2019.
Harries AD, Dlodlo RA, Brigden G, Mortimer K, Jensen P, Fujiwara PI, et al. Should we consider a ‘fourth 90’ for tuberculosis? Int J Tuberc Lung Dis. 2019;23(12):1253–6. https://doi.org/10.5588/ijtld.19.0471.
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Meghji, J., Brown, J., Lipman, M. (2021). Post-Tuberculosis Infections and Chronic Lung Disease. In: Migliori, G.B., Raviglione, M.C. (eds) Essential Tuberculosis. Springer, Cham. https://doi.org/10.1007/978-3-030-66703-0_32
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