From the Guidelines
To diagnose a patient with post TB bronchiectasis, perform a thin section computed tomography scan (CT) to confirm the diagnosis when clinically suspected, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1. When evaluating a patient for post-TB bronchiectasis, it is essential to start with a thorough clinical history, focusing on previous tuberculosis infection, persistent cough with purulent sputum, recurrent respiratory infections, hemoptysis, and dyspnea.
- Key symptoms to look out for include:
- Persistent cough with purulent sputum
- Recurrent respiratory infections
- Hemoptysis
- Dyspnea Physical examination may reveal crackles, wheezing, or digital clubbing.
- The diagnostic workup should include:
- Baseline chest X-ray
- High-resolution computed tomography (HRCT) of the chest, which is the gold standard diagnostic test, showing characteristic bronchial dilation, bronchial wall thickening, and lack of tapering in areas previously affected by TB
- Pulmonary function tests to demonstrate obstructive patterns with decreased FEV1 and FEV1/FVC ratio
- Sputum cultures to identify current pathogens and rule out active TB infection
- Complete blood count to check for elevated white blood cells suggesting infection
- Sputum acid-fast bacilli (AFB) testing to exclude TB reactivation The diagnosis is confirmed when bronchiectasis is identified in areas with previous TB scarring, after excluding other causes of bronchiectasis such as cystic fibrosis, immunodeficiency disorders, or allergic bronchopulmonary aspergillosis, as per the British Thoracic Society guideline for bronchiectasis in adults 1.
- It is crucial to perform baseline imaging during clinically stable disease, as this is optimal for diagnostic and serial comparison purposes, according to the British Thoracic Society guideline for bronchiectasis in adults 1. Post-TB bronchiectasis occurs due to the destructive inflammatory response during TB infection, which damages bronchial walls and supporting structures, leading to permanent dilation and structural abnormalities of the airways.
- The British Thoracic Society guideline for bronchiectasis in adults recommends performing a thin section computed tomography scan (CT) to confirm a diagnosis of bronchiectasis when clinically suspected 1.
From the Research
Diagnosis of Post TB Bronchiectasis
To diagnose a patient with post TB bronchiectasis, the following steps can be taken:
- Evaluate the patient's medical history, including any previous diagnosis of tuberculosis (TB) and treatment received 2, 3, 4
- Perform a physical examination to assess for signs of bronchiectasis, such as crackles or wheezing 3
- Conduct imaging tests, such as chest X-rays or computed tomography (CT) scans, to visualize the lungs and detect any damage or abnormalities consistent with bronchiectasis 2, 4
- Assess lung function using tests such as spirometry or plethysmography to evaluate for any obstructive or restrictive patterns 2, 3
- Collect and analyze sputum samples to check for the presence of nontuberculous mycobacteria (NTM) or other pathogens 3
Clinical Characteristics
Patients with post TB bronchiectasis often exhibit certain clinical characteristics, including:
- Lower body mass index (BMI) compared to those with other types of bronchiectasis 2, 3
- Higher rates of chronic obstructive pulmonary disease (COPD) and lower rates of asthma 2
- More frequent upper lobe involvement and more severe radiological extent 2
- Worse lung function and higher rates of mucolytic use 2
- Higher rates of haemoptysis and NTM isolation 3
Quality of Life
Post TB bronchiectasis can significantly impact a patient's quality of life, with: