Abstract
BackgroundPulmonary tuberculosis (PTB) often results in residual anatomical and functional changes despite microbiological cure and may be complicated by chronic pulmonary aspergillosis (CPA). In this study, we determined the perceived health-related quality of life (HRQoL) of patients during and after PTB therapy and compared it with their quantitative Aspergillus-specific IgG positivity rates.MethodologyWe conducted a longitudinal study among TB patients attending two directly observed therapy short-course (DOTS) clinics in Lagos, Nigeria. Two hundred and four confirmed TB patients were recruited over 9 months, with five visits at baseline and 3, 6, 9, and 12 months. They were all acid-fast bacilli smear, GeneXpert, or culture positive for Mycobacterium tuberculosis. Two HRQoL questionnaires translated into Yoruba were self-administered. Chest X-ray and Aspergillus IgG were collected at each visit.ResultsA total of 204 participants were recruited into this study. Most (70.6%) were age 18–39 years, and only 3.9% were above 60 years; 66.7% of all participants were males. A total of 189 (92.6%) participated in the 3-month assessment, 174 (85.3%) at 6 months, 139 (68.1%) at 9 months, and 99 (48.5%) at 12 months. At baseline, only 60.9% scored “good” or “very good” QoL and health on the WHOQOL-Bref, which improved to 77% at 6 months. At baseline, 10.4% had positive Aspergillus IgG levels, 15.1% at 3 months, 11.5% at 6 months, 16.7% at 9 months, and 19.3% at 12 months. Those with a positive Aspergillus IgG at 6 months had worse physical health (p = 0.001), psychological state (p = 0.002), social relationships (p = 0.006), and environmental QoL (p = 0.001) domains of the WHOQOL-Bref. Probable CPA was 10.4% at baseline and 19.3% at 6 months post-PTB therapy. Thirty-eight (18.6%) relocated after 6 months of treatment, 16 (7.8%) were lost to follow-up, and 11 (5.4%) died.ConclusionOur findings reveal a significant relationship between the QoL and Aspergillus IgG levels of TB patients. Further follow-up studies and additional imaging are required to determine when patients develop CPA and its clinical impact.
Highlights
Tuberculosis (TB) is a major public health problem and remains one of the world’s deadliest communicable diseases
pulmonary tuberculosis (PTB) patients often have pulmonary cavities, which can become colonized and infected by inhaled Aspergillus spores resulting in chronic pulmonary aspergillosis (CPA) (Denning et al, 2018)
Other structural sequelae include fibrosis, chronic obstructive pulmonary disease (COPD) (Denning et al, 2018), and bronchiectasis, as well as sensitization to Aspergillus (IgE response), itself linked to worse lung function, independently of CPA (Dhooria et al, 2014)
Summary
Tuberculosis (TB) is a major public health problem and remains one of the world’s deadliest communicable diseases. Nigeria is on the list of 14 countries with the triple burden of TB, HIV-associated TB, and multidrugresistant (MDR) TB with a population incidence of MDR-TB of 11/100,000 (World Health Organization, 2020). Tuberculosis patients face various challenges such as physical restrictions, psychological and emotional issues, and economic and social problems. These known challenges impact on the quality of life of the patients (Hansel et al, 2004; Guo et al, 2009). PTB results in residual anatomical and functional changes, despite microbiological cure (Pasipanodya et al, 2007) These changes are associated with post-TB lung disease (Pasipanodya et al, 2007). Pulmonary tuberculosis (PTB) often results in residual anatomical and functional changes despite microbiological cure and may be complicated by chronic pulmonary aspergillosis (CPA). We determined the perceived health-related quality of life (HRQoL) of patients during and after PTB therapy and compared it with their quantitative Aspergillus-specific IgG positivity rates
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