Post-tuberculosis lung disease (PTLD) is ongoing lung disease that is caused by tuberculosis (TB) but persists after the infection is cured.[1] PTLD can affect the airways, lung parenchyma, pulmonary vasculature, and pleura.[2]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/f/f3/Aspergilloma_complicating_tuberculosis_%285390382021%29.jpg/220px-Aspergilloma_complicating_tuberculosis_%285390382021%29.jpg)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/a/a2/Tuberculous_cavity%2C_healed_%286570246189%29.jpg/220px-Tuberculous_cavity%2C_healed_%286570246189%29.jpg)
Epidemiology
editPTLD affects a substantial proportion of TB survivors[3] (of whom there were an estimated 155 million globally in 2020), estimated as much as 50 percent overall and more than 70 percent in survivors of multi-drug-resistant tuberculosis.[4] Around 10 percent have lost more than half of their lung function.[4] Delayed diagnosis of TB, multidrug-resistant tuberculosis, and repeated TB infections are correlated with greater incidence of PTLD.[2] People who have HIV are less likely to have PTLD, possibly because of their impaired immune response.[2][3] Cigarette smokers are more likely to have lung damage, and more severe damage, after cure of a TB infection.[5] Co-infection may make lung damage worse, and thus vaccination is recommended to prevent PTLD.[1][2] Many studies have found a link between TB and later diagnosis with chronic obstructive pulmonary disease.[6]
Signs and symptoms
editA large number of people who survived tuberculosis still experience symptoms such as breathlessness and coughing. Although the severity is not well understood, some people have reduced quality of life and exercise capacity.[4][2] In severe cases, people may experience hospitalizations and death related to respiratory causes.[2]
There is no accepted diagnosis criteria for PTLD, and existing research does not use a clearly defined study population.[6][7]
Findings
editCommon radiological findings after TB include lesions to the airway, such as obstructive lung disease and bronchiectasis, lesions to the parenchyma, such as calcification, fibrosis, and Aspergillosis, chronic pleural disease, pulmonary hypertension, and other findings.[5] Radiological findings are distinct from chronic obstructive pulmonary disease (COPD) associated with cigarette smoking, although symptoms are similar.[5]
Effects
editAlthough prospective data is not available, it is believed that people with PTLD have a lower life expectancy and higher risk of TB recurrence compared to those not affected.[2] Besides PTLD, tuberculosis survivors may be afflicted with "cardiovascular and pericardial disorders, neurological impairments, as well as psychological and socioeconomic effects".[4]
Society and culture
editPTLD is not mentioned in most TB treatment guidelines, or in the World Health Organization (WHO)'s End TB strategy.[8]
References
edit- ^ a b Hsu, Desmond; Irfan, Muhammad; Jabeen, Kauser; Iqbal, Nousheen; Hasan, Rumina; Migliori, Giovanni Battista; Zumla, Alimuddin; Visca, Dina; Centis, Rosella; Tiberi, Simon (1 March 2020). "Post tuberculosis treatment infectious complications". International Journal of Infectious Diseases. 92: S41–S45. doi:10.1016/j.ijid.2020.02.032. ISSN 1201-9712. PMID 32114203.
- ^ a b c d e f g Allwood, Brian W.; Byrne, Anthony; Meghji, Jamilah; Rachow, Andrea; van der Zalm, Marieke M.; Schoch, Otto Dagobert (5 January 2021). "Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge". Respiration. 100 (8): 751–763. doi:10.1159/000512531. ISSN 0025-7931. PMID 33401266.
- ^ a b Maleche-Obimbo, Elizabeth; Odhiambo, Mercy Atieno; Njeri, Lynette; Mburu, Moses; Jaoko, Walter; Were, Fredrick; Graham, Stephen M. (20 December 2022). "Magnitude and factors associated with post-tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-analysis". PLOS Global Public Health. 2 (12): e0000805. doi:10.1371/journal.pgph.0000805. ISSN 2767-3375. PMC 10021795. PMID 36962784.
- ^ a b c d Silva, Denise Rossato; Mello, Fernanda Carvalho de Queiroz; Migliori, Giovanni Battista. "Diagnosis and management of post-tuberculosis lung disease". Jornal Brasileiro de Pneumologia. 49 (2): e20230055. doi:10.36416/1806-3756/e20230055. ISSN 1806-3713. PMC 10171303.
- ^ a b c Gai, Xiaoyan; Allwood, Brian; Sun, Yongchang (20 August 2023). "Post-tuberculosis lung disease and chronic obstructive pulmonary disease". Chinese Medical Journal. 136 (16): 1923–1928. doi:10.1097/CM9.0000000000002771. ISSN 0366-6999. PMC 10431356. PMID 37455331.
- ^ a b Ivanova, Olena; Hoffmann, Verena Sophia; Lange, Christoph; Hoelscher, Michael; Rachow, Andrea (30 June 2023). "Post-tuberculosis lung impairment: systematic review and meta-analysis of spirometry data from 14 621 people". European Respiratory Review. 32 (168). doi:10.1183/16000617.0221-2022. ISSN 0905-9180. PMC 10113954. PMID 37076175.
- ^ van Kampen, Sanne C; Wanner, Amanda; Edwards, Miles; Harries, Anthony D; Kirenga, Bruce J; Chakaya, Jeremiah; Jones, Rupert (2018). "International research and guidelines on post-tuberculosis chronic lung disorders: a systematic scoping review". BMJ Global Health. 3 (4). BMJ: e000745. doi:10.1136/bmjgh-2018-000745. hdl:10026.1/12220. ISSN 2059-7908.
- ^ Singh, S.; Allwood, B.W.; Chiyaka, T.L.; Kleyhans, L.; Naidoo, C.C.; Moodley, S.; Theron, G.; Segal, L.N. (September 2022). "Immunologic and imaging signatures in post tuberculosis lung disease". Tuberculosis. 136: 102244. doi:10.1016/j.tube.2022.102244. PMC 10061373.