‘Destroyed lung’ as Post Tuberculosis Sequel: A Preventable Stigma of ‘disease of concern’ of Millennium!

Abstract

Pulmonary Tuberculosis is caused by bacilli mycobacterium tuberculosis and known to infect human race since the dawn of history and archaeological evidence has traced its association in neolithic times. Tuberculosis is the most common infectious lung diseases in India with significant mortality and morbidity. Tuberculosis can cause diverse thoracic presentations ranging from nodules, consolidations & cavitation, mediastinal adenopathy, pleural effusion to diffuse endobronchial disease presenting like bronchial asthma. Due to diverse presentations, diagnosis is many times delayed due to lack of suspicion by treating general physicians and rational treatment many not offered in time. In spite of awareness by government organizations and considered as ‘global health issue of concern’ by World Health organization, tuberculosis is still considered as social stigma. Destroyed lung is described in literature and known complication of pulmonary tuberculosis. Destroyed lung is defined as combination of pleural and parenchymal lung destruction with cavitation, bronchiectasis, loss of lung volume and mediastinal herniation to diseased side. In this case series, we have reported two cases with history of pulmonary tuberculosis in past and received adequate anti-tuberculosis treatment. Both were having residual chronic lung disease and symptoms causing significant impact on quality of life with recurrent hospitalization, hospital visits and cost of care. One patient has history of delayed diagnosis and ATT was started after maximum lung destruction due to tuberculous process has already occurred. In this patient tuberculosis was cured but residual lung damage or sequel presenting as destroyed lung. In second case, tuberculosis was diagnosed in adequate time but patient has defaulted due to adverse events of ATT and he has taken medications as per his own tolerance. Neither adherence nor compliance was acceptable in second case and resulted into partially treated case of pulmonary tuberculosis. Ongoing lung destruction inn second case would be cause for destroyed lung in absence of irrational medicines in today’s era of good quality ATT. Destroyed lung is preventable with early diagnosis, prompt evaluation with microscopy and nucleic acid amplification tests and treatment with universally available, acceptable and affordable free ATT as National guidelines. Destroyed lung is having significant impact on quality of life and health expenditure and considered as ‘radiological stigma’ of Tuberculosis.