Post-tuberculosis Patients Research Articles

The Incidence, Risk Factors, and Predictive Model of Obstructive Disease in Post-Tuberculosis Patients

The Incidence, Risk Factors, and Predictive Model of Obstructive Disease in Post-Tuberculosis Patients

Enhancing Anxiety Management in Post-Tuberculosis Patients through Psychoeducational Intervention in Baki Community Health Center

Background: Tuberculosis is an infectious disease caused by mycobacterium tuberculosis by air-borne transmission. TB patients are at risk of psychosocial disorders during treatment and post-treatment. This study aims to analyze the effect of psychoeducation on the level of anxiety experienced relapse in patients after Tuberculosis treatment.Subjects and Method: This study used a quasi-experimental design of a posttest pretest at the Baki Health Center, Sukoharjo Regency, Central Java, Indonesia from June to July 2023. The sample was 30 people in the treatment group, namely post-tuberculosis treatment patients, and 30 people in the control group by paying attention to the inclusion criteria, the sample was selected in total sampling. The dependent variable is anxiety and the independent variable is psychoeducation. Psychoeducation was provided with intervention for 3 sessions with a time of 25-30 minutes and anxiety was measured by the HALS questionnaire. The data was analyzed by the Mann-Whitney test.Results: After the intervention, the psychoeducational group had a decrease in anxiety scores (Mean = 7; SD= 4.68) than the control group (Mean= 4.07; SD= 3.14) with p=0.006.Conclusion: Psychoeducation for post-tuberculosis treatment patients can continue to be carried out to reduce the level of anxiety about tuberculosis recurrence and awareness of the impact of the disease.

Breath assessment at with post-tuberculosis patients suffered new coronavirus infection

BACKGROUND: The possibility of mutual aggravation of post-tuberculosis and post-COVID respiratory pathologies requires additional consideration. AIM: To study some subjective breathing parameters at patients with post-tuberculosis pulmonary residual changes after a new coronavirus infection recovering. MATERIALS AND METHODS: The study included two groups: the main group — 14 patients with cured pulmonary tuberculosis, who had recovered from a new coronavirus infection, a comparison group — 52 patients with post-tuberculosis changes non-sick new coronavirus infection who were admitted to the tuberculosis sanatorium “Glukhovskaya” in 2020–2021. The severity of shortness of breath using the Modified Medical Research Council (mMRC) and Borg scales was assessed upon admission to the sanatorium and a month later. Results: The mMRC scale was 1.5 ± 1.4 and 2.1 ± 0.2 and the Borg scale was 1.5 ± 1.4 and 2.9 ± 0.2 before treatment respectively in the main group and the comparison group. According to the mMRC scale initially 14.3 and 11.5% of patients with pulmonary tuberculosis and the comparison group did not complain of shortness of breath and 50% of pulmonary tuberculosis patients and 42.4% of the comparison group defined it as severe. After a month there were 3 or 4 points on the mMRC scale among pulmonary tuberculosis patients. In the comparison group 3-point shortness of breath decreased by 11.2 times most often indicated shortness of breath with 2 score. According to the Borg scale dyspnea was initially assessed as 3 points at 71.5% pulmonary tuberculosis patients. In the comparison group 67.3% patients had grade 3 dyspnea and 11.5% noted 4–6 grade shortness of breath. After a month the proportion of patients with mild shortness of breath at the pulmonary tuberculosis and comparison groups increased by 4.5 and 3.3 times, respectively, and the frequency of 3-grade shortness of breath decreased by 5 and 3.9 times. CONCLUSIONS: Major post-tuberculosis changes, smoking and chronic obstructive pulmonary disease determine the severity of breathing discomfort to a greater extent than the experience of new coronavirus infection but rehabilitation treatment are leveled out these differences. It is advisable to study the state of the respiratory system at patients cured of pulmonary tuberculosis.

Evaluation of Pulmonary Status of Post-Tuberculosis Patients with Spirometry and Chest X-Ray

In 2022, 7.5 million new cases of tuberculosis were reported worldwide. Mycobacterium tuberculosis results in tuberculosis, an infectious disease mostly affecting the lungs. However, many completely treated post-tubercular patients experience persistent changes in lung anatomy (bronchial and parenchymal structure), Increasing their risk of lung complications and early death. These changes affect the airway's size, leading to higher resistance and decreased airflow. Our study aimed to assess the overall clinical status and lung function of treated post tuberculosis patients using spirometry. The study constituted patients over the age of 18 who presented to the Outpatient department of the Pulmonary Medicine Department, Chettinad Hospital and research institute, Kelambakkam, after receiving complete treatment and being certified cured. Convenience sampling technique was used, 87 patients participated in this trial. The Institutional Ethical Committee approved the study, which lasted 18 months. A proforma was used to collect a complete socio-demographic history and clinical history, particularly in terms of pulmonary symptomatology, and information about previous anti-tb treatment. Each of these patients had chest radiography, smear microscopy, and lung function testing. Mean age was 44.1± 15.2 years, mean BMI was 22.27 ± 3.66 kg/m2. There were 66.2% men and 33.8% females. 42% employed and 52% literate. In the current study, 41(53.25%) of the individuals reported dyspnea and 22(28.57%) had dry cough, cough with expectoration 12(15.58%), Fever 8(10.4%), Haemoptysis 7(9%), chest pain 2(2.6%). Following Post tuberculosis treatment, 38(44%) had normal chest radiographs, 31(35.6%) of the patients had fibrosis/Fibrotic strand, 8(9.1%) had consolidation, 5(5.7%) had ectatic changes, 3(3.4%) had fibrocavity, 1(1%) had calcification and cicatricial collapse. In the current study, we found that 31(40.25%) had normal spirometry followed by 23(29.87%) had mixed pattern and 12(15.6%) had restrictive pattern findings, 11(14.28%) had obstructive pattern findings. In spite of appropriate suggestions, the majority of post-tb pulmonary impairment individuals suffer in quiet or undergo poor medical care. As a result, comprehensive recommendations for patient follow-up following tuberculosis treatment are required in order to monitor lung function and provide appropriate care to improve quality of life.

Clinical Performance of the Aspergillus Western Blot IgG Kit for Serodiagnosis of Chronic Pulmonary Aspergillosis in Post-Tuberculosis Patients

Background: Chronic pulmonary aspergillosis (CPA) by Aspergillus spp., which causes slowly progressive destruction to lung parenchyma, is a major complication of pulmonary tuberculosis (TB). Clinical and radiological features of CPA are not typical and might resemble TB. Therefore, detecting Aspergillus-specific IgG is critical for diagnosing CPA.Methods: This cross-sectional study was conducted to evaluate the performance of Aspergillus Western Blot (Asp-WB) IgG kit (LDBio Diagnostics, Lyon, France) for CPA diagnosis in 63 post-TB patients. The analysis was performed by comparing Asp-WB with Aspergillus ELISA IgG (Asp-ELISA) and fungal culture as standard method.Results: Of the 63 patients studied, twenty six (41%) met the probable CPA criteria. The Asp-WB results were positive in 13 probable CPA patients and 3 non-CPA patients, with the significant difference of 50% vs. 8% (p< 0.001). The sensitivity and specificity of Asp-WB were 50% and 93%. False negative results of Asp-WB were detected from non-fumigatus CPA that grew Aspergillus niger. CPA patients with mild symptoms (less than 3 months) indicated early progression of CPA might showed positive Asp-WB test result in low sensitivity of Asp-WB test.Conclusion: The Asp-WB has potential to use as confirmatory test to assist diagnosis of CPA in post-TB patients.

The Bidirectional Relationship between Pulmonary Tuberculosis and Lung Cancer.

Lung cancer and pulmonary tuberculosis are two significant public health problems that continue to take millions of lives each year. They may have similar symptoms and, in some cases, are diagnosed simultaneously or may have a causal relationship. In tuberculosis disease, the chronic inflammation, different produced molecules, genomic changes, and fibrosis are believed to be important factors that may promote carcinogenesis. As a reverse reaction, the development of carcinogenesis and the treatment may induce the reactivation of latent tuberculosis infection. Moreover, the recently used checkpoint inhibitors are a debatable subject since they help treat lung cancer but may lead to the reactivation of pulmonary tuberculosis and checkpoint-induced pneumonitis. Pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and lung cancer patients and should be recommended to improve outcomes in these pathologies.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Bronchial Hyper-responsiveness in Post-tubercular Patients: A Case-control Study

Introduction: Bronchial hyper-responsiveness is the manifestation of excessive bronchoconstriction in response to diverse types of stimuli both physical and chemical. It is the most characteristic feature of bronchial asthma; it also occurs in a spectrum of other diseases like Chronic Obstructive Pulmonary Disorders (COPD) and reactive airway syndrome and may be provoked by a variety of stimuli like histamine and methacholine. Patients of healed pulmonary Tuberculosis (TB) show varying extent of lung impairment such as fibrosis, collapse, emphysema and broncho alveolar destruction. Aim: To assess the incidence and severity of obstructive airway diseases in previously treated TB patients. Materials and Methods: This was a prospective case control study, carried out in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from September 2017 to September 2019, this study included 120 patients of previously treated TB, who were divided into two groups. The case group (71) included patients who completed treatment for TB and had dyspnoea. The control group (49) consisted of patients who completed the treatment but did not have dyspnoea. The patients were subjected to spirometry, histamine bronchial challenge test and computed chest tomogram along with routine investigations including sputum for Acid Fast Bacilli (AFB). Results: The present study showed significant histamine hypersensitivity among post TB patients. In the case group, 34 (56%) patients showed positive response to bronchial challenge test with histamine; while in control group only 7 (14%) showed a positive response (p-value=0.004). Pulmonary function test (spirometry) showed an obstructive pattern in 35 (49%) case group patients, while normal pattern was the most common finding seen in 23 (47%) in the control group followed by obstruction in 10 (21%) patients. Among the cases, the mean Forced Expiratory Volume in the first second (FEV1) was 65.77±15.98, while among the controls, it was 80.02±8.81. The case group had a mean Forced Expiratory Volume in the first second/Forced Vital Capacity (FEV1/FVC) of 78.09±15.75, as against 81.33±16.79 in the control group. Conclusion: Airway bronchial hyper-reactivity is a prominent feature in previously treated tubercular patients. This underlines the need for proper attention towards post-tubercular lung function impairment and proper treatment of such patients so as to lessen the impact of bronchial hyper-reactivity on patient symptoms and their quality of life.

Performance of LDBio Aspergillus WB and ICT Antibody Detection in Chronic Pulmonary Aspergillosis.

The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.

The Correlation between Levels of Transforming Growth Factor-β with Pulmonary Fibrosis in Post Pulmonary Tuberculosis in Medan, North Sumatera - Indonesia.

BACKGROUND:Untreated or undertreated, pulmonary tuberculosis could cause severe complications until death. After treatment, residual lesions might occur. The presence of residual lesions is varied, including fibrosis, cavity, bronchiectasis and calcification. Transforming growth factor-β (TGF-β) is a cytokine associated with lung inflammation, which plays a role in lung fibrosis. However, only a few studies have assessed the serum level of TGF-β in post-treatment tuberculosis patients.AIM:The main objective of this study was to determine the correlation between TGF-β levels and pulmonary fibrosis in patients with pulmonary tuberculosis.DESIGN:A group of 51 patients that had undergone anti-tuberculosis treatment were observed, consisting of 31 men, 20 women. Of all patients, there were 26 people with a smoking history, including 25 men and 1 woman. All patients had been recovered, confirmed by the clinical state, laboratory and radiology examination. The ELISA test was performed to measure TGF-β level, while the chest X-ray was used to look for the occurrence of pulmonary fibrosis.RESULTS:The mean level of TGF-β in patients with a lesion (+) was 7628.02 (SD: ± 4928.38) while the mean level of TGF-β in patients with a lesion (-) was 2315.11 (SD: ± 505.83). The statistical test showed a significant relationship between TGF-β level and fibrosis lesion (p < 0.001).CONCLUSION:TGF-β level was significantly higher in post-tuberculosis patients with pulmonary fibrosis.

Effect of Tiotropium on Post Pulmonary TB Patients With Obstructive Abnormalities to Lung Function and Quality of Life

Background: Post pulmonary tuberculosis (TB) patients could experience pulmonary function declines which affected their quality of life. Obstrucitve abnormalities were found the most after complete TB treatment and the therapeutic guidelines focused in bronchodilators. The use of bronchodilators could improve lung function and quality of life in post TB patients with obstructive abnormalities. Tiotropium is a bronchodilator that has been shown to be effective in chronic obstructive pulmonary disease (COPD) patients, while its use in post TB patients has not been widely studied.&#x0D; Methods: This study design was a clinical trial with pre and post test design in post TB patients in Dr.M.Djamil Padang General Hospital and Lubuk Alung Pulmonary Hospital conducted from November 2016 to June 2017.&#x0D; Results: Of 30 post TB patients, the mean age was 62.77±10.99 years, most were male (63.33%), non-smokers and former smokers (50% each), had interval from complete anti TB drugs to study ≥6 months (53.3%), and moderate level of obstruction (80%). Pulmonary function prior to tiotropium was generally in moderate obstruction (FEV1 68,85±15,77). The mean quality of life prior to tiotropium was 18.27±10.81. There was no improvement in pulmonary function of post TB patients after administration of tiotropium, P=0.920, however, there was an improvement in the quality of life, P=0.009. No adverse events were found in this study.&#x0D; Conclusions: Administration of 2 months tiotropium in post TB patients had no effects on the improvements of lung function but improved the quality of life. More studies were needed using more patients and longer duration of administration. (J Respir Indo. 2018; 38: 203-9)

Pulmonary Rehabilitation in Patients with Chronic Lung Impairment from Pulmonary Tuberculosis.

SettingOur study was conducted at a tertiary care center for respiratory illnesses (Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi, India). Patients were enrolled in the study from the outpatient clinic.ObjectiveTo assess the effects of pulmonary rehabilitation (PR) in patients with chronic lung impairment from previously treated tuberculosis (CLIPTB), on exercise capacity (six-minute walk distance), pulmonary function tests, quality of life and markers of systemic inflammation.DesignProspective cohort study including 29 patients who had finished anti-tubercular therapy and currently had symptoms of dyspnea with or without cough secondary to CLIPTB.ResultSignificant improvement in six-minute walk distance (488 meters at baseline vs 526 meters post PR intervention, p-value 0.033) and chronic respiratory questionnaire score (17.21 at baseline vs 18.96 post PR intervention, p-value 0.025) with pulmonary rehabilitation was noted. Pulmonary function tests, inflammatory markers and mid-thigh muscle mass trended towards improvement with pulmonary rehabilitation but were not statistically significant.ConclusionOur study shows that pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and should be recommended.

Lipoarabinomannan-Responsive Polycytotoxic T Cells Are Associated with Protection in Human Tuberculosis.

The development of host-targeted, prophylactic, and therapeutic interventions against tuberculosis requires a better understanding of the immune mechanisms that determine the outcome of infection with Mycobacterium tuberculosis. To identify T-cell-dependent mechanisms that are protective in tuberculosis. Multicolor flow cytometry, cell sorting and growth inhibition assays were employed to compare the frequency, phenotype and function of T lymphocytes from bronchoalveolar lavage or the peripheral blood. At two independent study sites, bronchoalveolar lavage cells from donors with latent tuberculosis infection limited the growth of virulent Mycobacterium tuberculosis more efficiently than those in patients who developed disease. Unconventional, glycolipid-responsive T cells contributed to reduced mycobacterial growth because antibodies to CD1b inhibited this effect by 55%. Lipoarabinomannan was the most potent mycobacterial lipid antigen (activation of 1.3% T lymphocytes) and activated CD1b-restricted T cells that limited bacterial growth. A subset of IFN-γ-producing lipoarabinomannan-responsive T cells coexpressed the cytotoxic molecules perforin, granulysin, and granzyme B, which we termed polycytotoxic T cells. Taking advantage of two well-defined cohorts of subjects latently infected with Mycobacterium tuberculosis or patients who developed active disease after infection, we found a correlation between the frequency of polycytotoxic T cells and the ability to control infection (latent tuberculosis infection, 62%; posttuberculosis patients, 26%). Our data define an unconventional CD8(+) T-cell subset (polycytotoxic T cells) that is based on antigen recognition and function. The results link clinical and mechanistic evidence that glycolipid-responsive, polycytotoxic T cells contribute to protection against tuberculosis.

Chronic symptoms and pulmonary dysfunction in post-tuberculosis Brazilian patients

BackgroundQuestionnaire and spirometry were applied to post-tuberculosis indigenous and non-indigenous individuals from Dourados, Brazil, to investigate the prevalence of chronic respiratory symptoms and pulmonary dysfunction. MethodsThis was a cross-sectional study in cured tuberculosis individuals as reported in the National System on Reportable Diseases (SINAN) from 2002 to 2012. ResultsOne hundred and twenty individuals were included in the study and the prevalence of chronic respiratory symptoms was 45% (95% CI, 34–59%). Respiratory symptoms included cough (28%), sputum (23%), wheezing (22%) and dyspnea (8%). These symptoms were associated with alcoholism, AOR: 3.1 (1.2–8.4); less than 4 years of schooling, AOR: 5.0 (1.4–17.7); and previous pulmonary diseases, AOR: 5.4 (1.7–17.3). Forty-one percent (95% CI, 29–56) had pulmonary disorders, of which the most prevalent were obstructive disorders (49%), followed by obstructive disorder with reduced forced vital capacity disorders (46%) and restrictive disorders (5%). The lifestyle difference could not explain differences in chronic symptoms and/or the prevalence of pulmonary dysfunction. ConclusionThe high prevalence of chronic respiratory symptoms and pulmonary dysfunction in post-tuberculosis patients indicates a need for further interventions to reduce social vulnerability of patients successfully treated for tuberculosis.

Importance of the PaCO 2 from 3 to 6 months after initiation of long-term non-invasive ventilation

The level at which arterial carbon dioxide tension (PaCO(2)) a few months after introduction of long-term non-invasive positive pressure ventilation (NPPV) is associated with a favorable prognosis remains uncertain. Data on 184 post-tuberculosis patients with chronic restrictive ventilatory failure who were receiving long-term domiciliary NPPV were examined retrospectively. Average PaCO(2) 3-6 months after NPPV (3- to 6-mo PaCO(2)) and potential confounders were analyzed with discontinuation of long-term NPPV as the primary outcome. The effects of 3- to 6-mo PaCO(2) on annual hospitalization rates due to respiratory deterioration from 1 year before to 3 years after the initiation of NPPV were examined. The effect of the difference between the PaCO(2) value at the start of NPPV (0-mo PaCO(2)) and the PaCO(2) value 3- to 6-mo later (d-PaCO(2)) on continuation rates for NPPV was also assessed in patients who initiated NPPV while in a chronic state. Patients with relatively low 3- to 6-mo PaCO(2) values maintained a relatively low PaCO(2) 6-36 months after NPPV (p<0.0001) and had significantly better continuation rates (p<0.03) and lower hospitalization rates from the 1st to 3rd year of NPPV (p=0.008, 0.049, 0.009, respectively) than those with higher levels. The 0-mo PaCO(2) (p=0.26) or d-PaCO(2) (p=0.86) had no predictive value. A relatively low 3- to 6-mo PaCO(2) value was predictive of long-term use of NPPV. The target values for 3- to 6-mo PaCO(2) may, therefore, be less than 60mmHg in post-tuberculosis patients, although more studies are needed.

Importance of ventilator mode in long-term noninvasive positive pressure ventilation

Long-term noninvasive positive pressure ventilation (NPPV) is associated with an excellent survival rate, especially in post-tuberculosis patients. Nothing is currently known on which method of ventilatory support is associated with a better continuation of long-term NPPV, which itself might lead to longer survival. One hundred and eighty four post-tuberculosis patients, who started NPPV at the Kyoto University Hospital group and the National Tokyo Hospital from June 1990 to August 2007, were examined retrospectively. Ventilator mode (an assisted mode or a pure controlled mode) and potential confounders were examined with the discontinuation of NPPV as the primary outcome. Patients treated with a pure controlled mode had significantly better continuation rates (hazard ratio, 3.09; 95% confidential interval, 1.75-5.47; p=0.0001) and better survival rates (Log-rank test; p=0.0031) than those treated with an assisted mode. Female gender and no pulmonary lesions were also associated with a significantly better probability of continuing NPPV. The five- and ten-year probabilities of continuing NPPV for 106 patients with a pure controlled mode were 68.3% and 41.4%, respectively, while those for 76 patients with an assisted mode were 46.7% and 12.7%, respectively. Patients treated with pure controlled ventilation had significantly better continuation rates and survival rates than those treated with assisted ventilation. Prospective randomized controlled trials are needed to verify the effectiveness of a pure controlled mode in patients with not only restrictive thoracic disease but also other diseases including chronic obstructive pulmonary disease.

Increased Survival With Mechanical Ventilation in Posttuberculosis Patients With the Combination of Respiratory Failure and Chest Wall Deformity

Patients who have had tuberculosis are at risk for respiratory failure with hypercapnea from chest wall deformity and hypoxia from pulmonary sequelae. The combination of hypercapnea and hypoxia justifies both mechanical ventilation and oxygen therapy as treatment options. We aimed to study which treatment mode is associated with the best survival in patients with the combination of respiratory failure and chest wall deformity from tuberculosis. Swedish patients starting oxygen therapy or mechanical ventilation between 1996 and 2004 due to the combination of respiratory failure and chest wall deformity from tuberculosis were eligible for conclusion. They were followed up prospectively until October 2006, with death as the primary outcome. A cohort of 188 patients was included. Eighty-five patients received mechanical ventilation, and 103 received oxygen therapy alone. No patients were excluded, and no patients were unavailable for follow-up. Mechanical ventilation was associated with a significantly better survival than oxygen therapy alone, even after adjustments for age, gender, concomitant respiratory disease, blood gas tensions, and vital capacity, with an adjusted hazard risk of death of 0.35 (95% confidence interval, 0.17 to 0.70). Patients with the combination of respiratory failure and chest wall deformity from tuberculosis had a significantly better survival when treated with home mechanical ventilation than with long-term oxygen therapy alone. We recommend home mechanical ventilation with or without supplementary oxygen as the first choice of treatment for these patients.

Using the St. George Respiratory Questionnaire To Ascertain Health Quality in Persons With Treated Pulmonary Tuberculosis

Pulmonary tuberculosis (PTB) can result in anatomic and functional changes that are associated with pulmonary impairment after tuberculosis that occurs frequently and varies in severity. We completed the St. George Respiratory Questionnaire (SGRQ), a health-related quality-of-life (HRQoL) instrument validated for several types of lung disease, for patients in whom PTB or latent tuberculosis infection (LTBI) has been diagnosed. We measured HRQoL pattern changes and the usefulness of the SGRQ in their ascertainment. Participants with known pulmonary function and a history of PTB or LTBI completed HRQoL questionnaires. The SGRQ was validated for content and construct using pulmonary function tests and the Medical Outcomes Study questionnaire. Internal consistency and test-retest methods assessed reliability. Significance of findings was determined with one-way analysis of variance with between-group comparisons. Over 15 months, 313 subjects completed the SGRQ. The SGRQ was valid and reliable in the study population (intraclass correlation, 0.927; p<0.01; Cronbach alpha, 0.93). The mean total score for posttuberculosis patients was significantly higher than for that for LTBI score (23.5 [SE, 2.2] vs 10.3 [SE, 1.0], respectively; p<0.001). We validated the SGRQ in a diverse population microbiologically cured of tuberculosis and found a mean 13.5-U difference in SGRQ score between these patients and a comparison group with similar risk factors (p<0.001). This difference indicates impairment after PTB has a substantial impact on human health worldwide. The microbiological cure of tuberculosis is not sufficient to avert chronic health loss. More aggressive treatment of LTBI and other case-preventing strategies is warranted worldwide.