Post-tuberculosis Sequelae in Children.

Tuberculosis (TB) is a global health problem especially in the Indian subcontinent imposing significant physical, psychosocial and economic burden on the society. Most national programs define TB cure as completion of treatment with improvement in clinical symptoms, microbiological and radiological clearance. However, follow up these patients for long-term sequelae or complications has not got adequate attention. Post-TB lung disease, neurological deficits and spinal deformities are some of the post-TB sequelae reported in adults, with scanty data available for children. With this review authors attempt to discuss various post-TB disease manifestations and the risk factors associated with their development in children. They address the need to create awareness amongst physicians involved in managing children with TB and obtain more scientific data in this field.

Consequences of Irregular Tuberculosis Treatment: A Case Report of Destroyed Lung Syndrome.

Destroyed lung syndrome (DLS) refers to the irreversible and complete destruction of lung tissue, often due to chronic or recurrent lung infections. Pulmonary tuberculosis (PTB) is a prominent cause of this condition, particularly prevalent in regions burdened by high PTB rates. This report delineates the case of a 60-year-old Indian male who presented with DLS as a consequence of a history of irregular PTB treatment. The patient complained of a productive cough, hemoptysis, fever, and dyspnea. A comprehensive evaluation confirmed the diagnosis, prompting the re-initiation of antitubercular therapy. This case report highlights the challenges and consequences of irregular PTB therapy leading to severe lung damage, emphasizing the significance of prompt and consistent treatment in preventing such debilitating outcomes.

Multiple tracheobronchial diverticula in a post-TB patient: A case report.

The presence of multiple tracheal and bronchial diverticula is a rare condition. We present a case of a 22-years old non-smoker male with a history of pulmonary tuberculosis, having multiple tracheal and bronchial diverticula along with other common sequelae such as stenosed and collapsed upper lobe bronchi.

Aftermath of pulmonary tuberculosis: computed tomography assessment.

PURPOSE: Pulmonary tuberculosis (PTB) has clinically significant sequelae, even after recommended treatment completion. It is important to recognise these sequelae for accurate assessment of severity and treatment planning, if indicated. MATERIAL AND METHODS: We retrospectively analysed contrast-enhanced computed tomography (CT) scans of chest of 100 patients with previous history of treated pulmonary tuberculosis, excluding those with active pulmonary disease. CT findings were analysed based on parenchymal, airway, pleural, mediastinal, and vascular sequelae of PTB. RESULTS: Parenchymal sequelae included fibrosis with architectural distortion and volume loss (90%), cavities (21%) (with aspergillomas noted in 19% of these cases), and tuberculomas (54%). Airway involvement was noted as bronchiectasis (77%) and bronchial stenosis (4%) but none with broncholithiasis. Mediastinal sequelae included lymph node calcification (74%), fibrosing mediastinitis (1%), and pericardial tuberculosis (2%). Pleural sequelae included pleural thickening (22%), with 40.9% of these patients showing calcifications, and one patient with chronic chylous pleural effusion. Vascular sequelae included Rasmussen aneurysms (4%), enlarged bronchial arteries (3%), and systemic bronchial collaterals in 1% of our patients. CONCLUSIONS: PTB has multiple appalling sequelae, which require due attention and appropriate treatment in symptomatic cases. Radiological evaluation forms an integral part in patient assessment and decision making.

Standard factors predicting success of Non-invasive ventilation are useful in treating Patients with POST Tuberculosis sequel.

OBJECTIVE: The aim was to access the effectiveness of Bilevel Positive Airway Pressure (BiPAP) in patients with type II respiratory failure secondary to Post Tuberculosis (TB) sequelae and determine the factors that can predict its success. PostTB pulmonary sequelae are complications after healing of TB and type II respiratory failure is frequently encountered in this group. . METHODS: This prospective study was carried out in the department of Chest Medicine, Jinnah Postgraduate Medical Center Karachi. (JPMC) Total 78 patients, between 20-80 years of age having hypercapnic respiratory failure, were included. Patients were given BiPAP along with standard treatment. RESULTS: Among 78 patients, 45 (56.3%) were males and 33 (43.7%) were females. Patients mean age was 50.6 } 15.76 years. The BiPAP success rate was 70.5% (55/78). There is significant difference in age (p=0.008), duration of disease (p=0.021), baseline pH (p=0.00), PaCO2 (p=0.004), Glasgow Coma Score (p=0.031), Chest X-ray (p<0.05) and systolic blood pressure (p=0.007) between responders and non-responders. Improvement in Abgs and vitals was observed among responders following 3 hours of therapy while pH drops significantly at 3 hours in non-responders. CONCLUSIONS: This study reveals that BiPAP is also efficacious method in patients with Type II respiratory failure post TB sequelae. Potential non responders can be identified relatively early in course of treatment and considered for ventilator.

Analysis of the relationship between health status and mortality in hypercapnic patients with noninvasive ventilation.

BACKGROUND: Health status and mortality are important outcomes in patients with advanced pulmonary diseases receiving noninvasive ventilation (NIV). However, their relationship has not been thoroughly investigated. METHODS: The present study prospectively recruited 56 stable outpatients treated with NIV for chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease and/or pulmonary tuberculosis sequelae. At baseline, health status was measured by the Medical Outcomes Study 36-item short form, a generic questionnaire; the St. George's Respiratory Questionnaire (SGRQ), a respiratory-specific questionnaire; and two respiratory failure-specific questionnaires, the Maugeri Respiratory Failure questionnaire and the Severe Respiratory Insufficiency (SRI) questionnaire. Arterial blood gas, pulmonary function, dyspnea and psychological status were also measured. RESULTS: In cross-sectional comparisons of the four health status questionnaires, the SGRQ and SRI questionnaire had lower floor and ceiling effects. During the 3-year follow-up, 16 patients (29%) died. Health status shown by the SGRQ and SRI was significantly predictive of mortality, independently of the physiological measures of low body mass index (BMI), hypercapnia, and low pulmonary function. Stepwise multivariate analyses indicated that the SRI summary score was the most significant predictor of mortality (P = 0.0006) followed by BMI (P = 0.012). CONCLUSION: There was a significant relationship between health status and 3-year mortality in patients with NIV, independently of under-nutrition, hypercapnia and low pulmonary function. Health status measurement is important not only to comprehensively evaluate disease severity in relation to its close association with mortality, but also to elucidate factors that improve the survival of patients with advanced respiratory diseases.

Colonização intracavitária pulmonar por Aspergillus: análise de 190 casos / Pulmonary intracavitary colonization by Aspergillus: analysis of 190 cases

A colonização intracavitária pulmonar aspergilar (CIPA) é caracterizada pela presença de massa miceliana de crescimento endocavitário. O agente mais frequente é o Aspergillus fumigatus, e a lesão cavitária é geralmente sequela de tuberculose e curada com história de hemoptise de repetição e baciloscopia negativa. Os autores analisaram retrospectivamente 190 casos de CIPA, entre abril de 1978 e março de 2008, no Serviço de Arquivo Médico do Hospital Universitário Lauro Wanderley e no Complexo Hospitalar Clementino Fraga, enfatizando a incidência, forma de apresentação clínica, enfermidades associadas, métodos, diagnósticos e conduta terapêutica.

The colonized intrapulmonary aspergilloma (CIPA) is characterized by the mass fungal in a existing pulmonary cavity, where the most commonly agent is the Aspergillus fumigatus. The pulmonary cavity is often result cured pulmonary tuberculosis with hemoptisis repletion history and bacilloscopy negative. The authors analyzed retrospectively 190 cases of CIPA from April 1978 to March 2008 in the University Hospital Lauro Wanderley and Hospital Complex Clementino Fraga emphasizing the incidence, clinical evolution, illness association, diagnosis method and treatment.

Motivos de hospitalización en pacientes con tuberculosis pulmonar en un hospital de referencia / Reasons for medical admission in patients with pulmonary tuberculosis in a referral institute

Objetivo: Determinar la prevaíencia de complicaciones torácicas en pacientes con tuberculosis pulmonar hospitalizados en el Instituto Nacional de Enfermedades Respiratorias (INER). Lugar del estudio: INER, centro de tercer nivel y referencia dedicado a la atención médica especializada, docencia e investigación de enfermedades respiratorias. Material y métodos: Se realizó un estudio retrospectivo con la revisión de los expedientes clínicos de pacientes con tuberculosis pulmonar ingresados al INER, en un período que comprendió del 1 de julio al 31 de diciembre de 2003. Resultados: De los 124 pacientes con tuberculosis pulmonar que acudieron al INER durante el período de estudio, 62.9% (78/124) fueron hospitalizados; 44.9% (35/78) del sexo masculino; mediana de edad, 44.5 años (rango 16-78); el diagnóstico bacteriológico se hizo por baciloscopía en 51.3% (40/78); sólo por cultivo, 5.1% (4/78) y por baciloscopía y cultivo, 43.6% (34/78). Del total de pacientes, 66.6% (52/78) se clasificaron en la categoría I de la Organización Mundial de la Salud. La prevaíencia de diabetes mellitus fue 43.7% (31/78). Los motivos de hospitalización fueron: 46.2% (36/78) para diagnóstico; hemoptisis, 34.6% (27/78); infecciones, 5.2% (4/78) y otros motivos, 14.0% (11/78). Presentaron bronquiectasias, 85.7% (66/78); neumonía, 6.4% (5/78); neumonía por Mycobacterium tuberculosis, 5.1% (4/78); empierna, 5.1% (4/78); fístula broncopleural, 3.9% (3/78); aspergiloma, 2.6% (2/78); compresión tráqueo-bronquial, 1.3% (l/78) y fibrotórax, 12.8% (10/78). Conclusiones: Los pacientes hospitalizados en el INER por tuberculosis pulmonar manifestaron una elevada frecuencia de complicaciones, especialmente de bronquiectasias y hemoptisis. Casi 44% de los pacientes presentó diabetes mellitus; uno de cada dos fue hospitalizado para diagnóstico.

Purpose: To determine the prevalence of thoracic complications in hospitalized patients with pulmonary tuberculosis. Setting: National referral hospital for the care, teaching and investigation of respiratory diseases. Material and methods: This study is based on the retrospective analysis of pulmonary tuberculosis patients admitted from July 1 to December 31, 2003 and was conducted at The National Institute of Respiratory Diseases (INER), Mexico. Results: Seventy eight patients with pulmonary tuberculosis were included in the six month period; 35 (44.9%) were male; the bacteriological diagnosis was done by sputum smear in 51.3% (40/78), culture in 5.1% (4/78) and sputum smear and culture in 43.6% (34/78). Patients were classified as WHO category I in 66.7% (52/78); 43.7% had diabetes mellitus (31/78). Admission causes: for diagnosis in 46.2% (36/78); hemoptysis in 34.6% (27/78); infection in 5.2% (4/78); other causes in 14.0% (11/78); bronchiectasis were present in 85.7% (66/ 77); pneumonia in 6.4% (5/78); Mycobacterium tuberculosis pneumonia in 5.1% (4/78); empyema in 5.1% (4/78); bronchopleural fistula in 3.9% (3/ 78); aspergilloma in 2.6% (2/78); tracheobronchial obstruction in 1.3% (1/78); fibrothorax in 12.8% (10/78). Conclusions: Hospitalized pulmonary tuberculosis patients show an elevated rate of pulmonary complications. Almost half had diabetes mellitus; almost half were hospitalized for diagnosis.