From the Guidelines
Post-tuberculosis sequelae can lead to significant morbidity and mortality, and thus, it is crucial to recognize and manage these complications promptly to improve the quality of life for patients. The sequelae of post-tuberculosis (TB) can be severe and long-lasting, affecting not only the lungs but also other organs. According to the American Thoracic Society guidelines 1, the objectives of tuberculosis therapy are to rapidly reduce the number of actively growing bacilli, eradicate populations of persisting bacilli, and prevent acquisition of drug resistance during therapy. However, even with successful treatment, patients can experience various sequelae due to tissue destruction and abnormal healing with fibrosis.
Pulmonary Sequelae
Pulmonary complications are common and can include:
- Bronchiectasis
- Fibrosis
- Cavitation
- Pleural thickening
- Hemoptysis
- Recurrent respiratory infections These complications can lead to chronic respiratory symptoms like cough, shortness of breath, and reduced lung function 1.
Extrapulmonary Sequelae
Extrapulmonary sequelae can involve:
- Spine (kyphosis or Pott's disease)
- Joints (arthritis)
- Heart (constrictive pericarditis)
- Kidneys (renal scarring) These complications can significantly impact the patient's quality of life and require prompt management.
Management
Management of post-TB sequelae typically involves:
- Regular follow-up with pulmonary function tests
- Chest imaging
- Symptom-based treatments including bronchodilators
- Pulmonary rehabilitation
- Prompt treatment of secondary infections Surgical interventions may be necessary for complications like severe bronchiectasis, aspergilloma, or bronchial stenosis 1.
Early recognition and management of these sequelae are essential to prevent further complications and improve the patient's quality of life. Therefore, it is crucial to prioritize regular follow-up and monitoring of patients after TB treatment to promptly address any potential sequelae.
From the Research
Sequelae of Post-Tuberculosis
The sequelae of post-tuberculosis (TB) can be severe and long-lasting, affecting the quality of life of individuals who have been treated for TB. Some of the common sequelae include:
- Parenchymal disorders such as thin-walled cavities, lung fibrosis, and structural destruction 2
- Airway disorders including subglottic stenosis, chronic obstructive air flow obstruction, bronchiectasis, tracheobronchial stenosis, anthracofibrosis, and broncholithiasis 2
- Vascular lesions like Rasmussen aneurysm 2
- Pleural lesions ranging from pleural thickening to severe fibrothorax 2
- General complications such as cor pulmonale, secondary amyloidosis, and chronic respiratory failure 2
Post-Tuberculosis Lung Disease
Post-tuberculosis lung disease (PTLD) is a significant clinical challenge, characterized by a spectrum of pathological changes, including fibrosis, bronchiectasis, and cavitation 3. The clinical presentation of PTLD can vary widely, from chronic cough and hemoptysis to recurrent respiratory infections 3. PTLD has been associated with adverse patient outcomes, including persistent symptoms and functional impairment, ongoing health seeking, and impacts on income and employment 4.
Risk Factors and Management
Risk factors for PTLD include multiple episodes of tuberculosis, drug-resistant tuberculosis, delays in diagnosis, and possibly smoking 5. Management strategies for PTLD involve pharmacological interventions to alleviate symptoms and prevent disease progression, rehabilitation programs, and surgical options for select cases 3. Prevention efforts through a TB control program and early detection are crucial in reducing the burden of PTLD 3.
Long-Term Outcomes
People affected by PTLD have shortened life expectancy and an increased risk of recurrent tuberculosis 5. However, predictors of long-term outcomes are not known, and no data are available on PTLD in children and on impact throughout the life course 5. Research is urgently needed to inform policy and guide clinical decision-making and preventative strategies for PTLD 5. The probability of tuberculosis recurrence must be balanced against other causes of symptom worsening in individuals with PTLD, and unnecessary courses of repeated empiric anti-tuberculosis chemotherapy should be avoided 5.