Abstract
BackgroundTuberculosis is an important risk factor for chronic respiratory disease in resource poor settings. The persistence of abnormal spirometry and symptoms after treatment are well described, but the structural abnormalities underlying these changes remain poorly defined, limiting our ability to phenotype post-TB lung disease in to meaningful categories for clinical management, prognostication, and ongoing research. The relationship between post-TB lung damage and patient-centred outcomes including functional impairment, respiratory symptoms, and health related quality of life also remains unclear.MethodsWe performed a systematic literature review to determine the prevalence and pattern of imaging-defined lung pathology in adults after medical treatment for pleural, miliary, or pulmonary TB disease. Data were collected on study characteristics, and the modality, timing, and findings of thoracic imaging. The proportion of studies relating imaging findings to spirometry results and patient morbidity was recorded. Study quality was assessed using a modified Newcastle-Ottowa score. (Prospero Registration number CRD42015027958)ResultsWe identified 37 eligible studies. The principle features seen on CXR were cavitation (8.3–83.7%), bronchiectasis (4.3–11.2%), and fibrosis (25.0–70.4%), but prevalence was highly variable. CT imaging identified a wider range of residual abnormalities than CXR, including nodules (25.0–55.8%), consolidation (3.7–19.2%), and emphysema (15.0–45.0%). The prevalence of cavitation was generally lower (7.4–34.6%) and bronchiectasis higher (35.0–86.0%) on CT vs. CXR imaging. A paucity of prospective data, and data from HIV-infected adults and sub-Saharan Africa (sSA) was noted. Few studies related structural damage to physiological impairment, respiratory symptoms, or patient morbidity.ConclusionsPost-TB structural lung pathology is common. Prospective data are required to determine the evolution of this lung damage and its associated morbidity over time. Further data are required from HIV-infected groups and those living in sSA.
Highlights
Chronic respiratory diseases (CRDs) are the fourth leading cause of non-communicable disease (NCD) deaths globally, and pose a particular challenge to low and middle-income countries (LMICs) where risk factors for respiratory damage including poverty-related in-utero and early childhood exposures[1], exposure to acute respiratory infections[2], indoor biomass fuel exposure[3, 4], a rising prevalence of smoking[5], chronic HIV-infection[6], and pulmonary tuberculosis (PTB) intersect
The principle features seen on CXR were cavitation (8.3– 83.7%), bronchiectasis (4.3–11.2%), and fibrosis (25.0–70.4%), but prevalence was highly variable
Further data are required from HIV-infected groups and those living in sub-Saharan Africa (sSA)
Summary
Chronic respiratory diseases (CRDs) are the fourth leading cause of non-communicable disease (NCD) deaths globally, and pose a particular challenge to low and middle-income countries (LMICs) where risk factors for respiratory damage including poverty-related in-utero and early childhood exposures[1], exposure to acute respiratory infections[2], indoor biomass fuel exposure[3, 4], a rising prevalence of smoking[5], chronic HIV-infection[6], and pulmonary tuberculosis (PTB) intersect. The persistence of abnormal airway physiology after treatment has been documented in large population-based cross-sectional studies which show 1.37–2.94 higher odds of fixed airways obstruction in those with a history of PTB, compared to those without[15, 18,19,20,21]. Previous TB has been associated with chronic respiratory symptoms in LMICS: previous TB was the strongest predictor of chronic bronchitis within the 1996 South African Demographic & Health Survey [22] and the odds of a medical diagnosis of bronchiectasis were over 3-fold higher in those who had a history of TB, compared to those who had not, in a population based study of 10,811 adults in China [23]. The relationship between post-TB lung damage and patient-centred outcomes including functional impairment, respiratory symptoms, and health related quality of life remains unclear.
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