Details
Category: Volume 07 Issue 11 November 2019
Hits: 1121

Title: Post Tubercular Lung: Does it need A Relook?

Authors: Dr Gajendra Vikram Singh, Dr Santosh Kumar, Dr Komal Lohchab, Dr Parul Mittal, Dr Bhanu Pratap Pandey, Dr Amirul haqu

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.119

Abstract

Background: Long after completion of tuberculosis (TB) therapy, many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms, frequently resulting in Ventilatory defect, deterioration in quality of life and exercise capacity.

Objective: To describe the health of patients with a history of adequately treated microbiologically positive Pulmonary Tuberculosis Patients.

Methods: A cross-sectional study that was conducted in349 successfully treated Pulmonary tuberculosis patients of age >18 years who were put on ATT between 1stQ of 2016 TO 4th Q of 2016.  Patients with current culture and AFB-positive TB were excluded. Data was collected by demographic details, respiratory symptoms, comorbidities and chest radiography findings after TB treatment. Lung function impairment was defined by the presence of at least one of these three abnormalities. Radiographic abnormalities, effect on quality of life and exercise capacity were assessed by chest X-ray, St George’s questionnaire and 6 minute walk test.

Results: Of a total of 160 participants included in the study, 55.68% were male. The mean age of participants was 35.36 years. Radiological abnormality was detected in only 84% patients. Out of finally selected 160 successfully treated pulmonary tuberculosis patients pulmonary impairment was observed in 88(55%). Mixed pattern was the most common ventilatory defect (45.45%) followed by pure obstruction (30.68%).Mean 6 minute walk distance was 334.39(137.07) meter and total SGRO score was 53.34(21.56).

Conclusion: Post-tuberculous pulmonary function impairment is frequent phenomenon. After tuberculosis treatment, nearly half of all tuberculosis patients evolve to impaired pulmonary impairment, mainly mixed disorder. Sensitization of patient with symptoms of pulmonary impairment after tuberculosis for an earlier visit to healthcare facilities could reduce the impact of PTB on exercise capacity and health related quality of patients.

Keywords: Pulmonary Impairment, Tuberculosis, PIAT, Exercise Intolerance.

References

  1. World Health Organization. Global Tuberculosis Report 2019. http://www.who.int/tb/ publications/global_report/gtbr2019_executive_summary.pdf
  2. World Health Organization. Global Tuberculosis Report 2015. 2015. http://apps.who.int/iris/ bitstream/10665/191102/1/9789241565059_eng.pdf (accessed 25 January 2019).
  3. Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of drug-susceptible tuberculosis. Clin Infect Dis 2016;63(7):e147-e195. https://doi. org/10.1093/cid/ciw376
  4. Chakaya J, Kirenga B, Getahun H. Long term complications after completion of pulmonary tuberculosis treatment: A quest for a public health approach. J ClinTuberc Other Mycobact Dis 2016;3(May):10-12. https://doi.org/10.1016/j.jctube.2016.03.001
  5. Singla N, Singla R, Fernandes S, Behera D. Post treatment sequelae of multi-drug resistant tuberculosis patients. Indian J Tuberc 2009;56(4):206-212. http://medind.nic.in/ibr/t09/i4/ibrt09i4p206.pdf (accessed 5 February 2019).
  6. Muniyandi M, Rajeswari R, Balasubramanian R, et al. Evaluation of post-treatment health-related quality of life (HRQoL) among tuberculosis patients. Int J Tuberc Lung Dis 2007;11(8):887-892.
  7. Rajeswari R, Muniyandi M, Balasubramanian R, Narayanan PR. Perceptions of tuberculosis patients about their physical, mental and social well-being: A field report from south India. SocSci Med 2005;60(8):1845-1853. https://doi.org/10.1016/j.socscimed.2004.08.024
  8. Nihues S de S, Mancuzo EV, Sulmonetti N, et al. Chronic symptoms and pulmonary dysfunction in post-tuberculosis Brazilian patients. Braz J Infect Dis 2015;19(5):492-497. https://doi.org/10.1016/j. bjid.2015.06.005
  9. Ramos LMM, Sulmonett N, Ferreira CS, Henriques JF, de Miranda SS. Functional profile of patients with tuberculosis sequelae in a university hospital. J Bras Pneumol 2006;32(1):43-47. https://doi. org/10.1590/S1806-37132006000100010
  10. Musafiri S, Dusabejambo V, Munganyinka BC, Manzi O, Kalisa L, Rutayisire PC. The aftermath of pulmonary tuberculosis: Predictors of severe pulmonary sequelae and quality of life of patients visiting a tertiary level of care in Rwanda, East Africa. Austin J PulmRespir Med 2015;2(2):1027. http:// austinpublishinggroup.com/pulmonary-respiratory-medicine/fulltext/ajprm-v2-id1027.php#Title (accessed 4 February 2019).
  11. Menon B, Nima G, Dogra V, Jha S. Evaluation of the radiological sequelae after treatment completion in new cases of pulmonary, pleural, and mediastinal tuberculosis. Lung India 2015;32(3):241-245. https://doi.org/10.4103/0970-2113.156233
  12. Al-Hajjaj MS, Joharjy IA. Predictors of radiological sequelae of pulmonary tuberculosis. ActaRadiol 2000;41(6):533-537. https://doi.org/10.1080/028418500127346153
  13. R. Miller, J. Hankinson, V. Brusasco, F. Burgos, R. Casaburi, A. Coates, et al., Standardisation of spirometry, Eur. Respir. J. 26 (2) (2005 Aug) 319e338.
  14. Y. Kim, K.S. Song, J.M. Goo, J.S. Lee, K.S. Lee, T.H. Lim, Thoracic Sequelae and Complications of Tuberculosis, Radiographics 21 (2001) 839e860.
  15. L. Snider, L. Doctor, T.A. Demas, A.R. Shaw, Obstructive airway disease in patients with treated pulmonary tuberculosis, Am. Rev. Respir. Dis. 103 (5) (1971 May) 625e640.
  16. A. Willcox, A.D. Ferguson, Chronic obstructive airways disease following treated pulmonary tuberculosis, Respir. Med. 83 (3) (1989 May) 195e198.
  17. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic pulmonary disease (updated 2014). Available from: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf. Accessed June 22, 2015.
  18. Pellegrino, G. Viegi, V. Brusasco, R.O. Crapo, F. Burgos, R. Casaburi, et al., Interpretative strategies for lung function tests, Eur. Respir. J. 26 (5) (2005 Nov) 948e968
  19. Willcox PA, Ferguson AD. Chronic obstructive airways disease following treated pulmonary tuberculosis. Respir Med 1989;83(3):195-198. https://doi.org/10.1016/S0954-6111(89)80031-9
  20. Mbatchou Ngahane BH, Nouyep J, Nganda Motto M, et al. Post-tuberculous lung function impairment in a tuberculosis reference clinic in Cameroon. Respir Med 2016;114(May):67-71. https://doi. org/10.1016/j.rmed.2016.03.007
  21. Long R, Maycher B, Dhar A, Mafreda J, Hershfield E, Anthonisen N. Pulmonary tuberculosis treated with directly observed therapy: serial changes in lung structure and function. Chest 1998;113(April (4)):933—43.
  22. Menezes AM, Hallal PC, Perez-Padilla R, Jardin JRB, Muino A, Lopez MV, et al. Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America. EurRespir J 2007;30(December (6)):1180—5.
  23. Eva Hnizdo TSGC. Chronic pulmonary function impairment caused by initial and recurrent pulmonary tuberculosis following treatment. Thorax 2000;55:32—8.
  24. Plit ML, Anderson R, Van Rensburg CEJ, Page-Shipp L, Blott JA, Fresen JL, et al. Influence of antimicrobial chemotherapy on spirometric parameters and pro-inflammatory indices in severe pulmonary tuberculosis. EurRespir J1998;12:351—6.
  25. Singla N, Singla R, Fernandes S, Behera D. Post treatment sequelae of multi-drug resistant tuberculosis patients. Indian J Tuberc 2009;56(4):2006—12.
  26. Chung KP, Chen JY, Lee CH, Huey-Dong W, Jann-Yuan W, Li-Na L, et al. Trends and predictors of changes in pulmonary function after treatment for pulmonary tuberculosis. Clinics2011;66(4):549—56.
  27. Hnizdo E, Sircar K, Yan T, Harber P, Fleming J, Glindmeyer HW. Limits of longitudinal decline for the interpretation of annual changes in FEV1 in individuals. Occup Environ Med 2007;64(October (10)):701—7.
  28. Greenaway C, Menzies D, Fanning A, Grewal R, Yuan L, FitzGerald JM, et al. Delay in diagnosis among hospitalized patients with active tuberculosis — predictors and outcomes. Am J RespirCrit Care Med 2002;165:927—33.
  29. Vree M, Huong NT, Duong BD, Co NV, Sy DN, Cobelens FG,et al. High mortality during tuberculosis treatment does notindicate long diagnostic delays in Vietnam: a cohort study.BMC Public Health 2007;7:210.
  30. Mayosi BM, Wiysonge CS, Ntsekhe M. Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry. BMC Infect Dis 2006;6:2.
  31. Mayosi BM, Wiysonge CS, Ntsekhe M, Gumedze F, Volmink JA, Maartens G, et al. Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa. S Afr MedJ 2008;98(January (1)):36—40.
  32. Thwaites GE, Nguyen DB, Nguyen HD, Hoang TQ, Do TT,Nguyen TC, et al. Dexamethasone for the treatment oftuberculous meningitis in adolescents and adults. N Engl J Med 2004;351:1741—51.
  33. Pasipanodya J, Gumbo T. An oracle: antituberculosis pharmacokinetics-pharmacodynamics, clinical correlation, and clinical trial simulations to predict the future. Antimicrob Agent Chemother 2011;55(1):24—34.

Corresponding Author

Dr Komal Lohchab

Department of Pulmonary Medicine, S.N. Medical College, Agra UP, India