Tuberculosis Sequelae Research Articles

Robot-assisted complex urinary tract reconstruction using intestinal segments: redefining the paradigm.

Complex urinary tract reconstruction has significantly advanced with the increasing use of robot-assisted procedures. Robotic surgery aims to achieve the same outcomes as open surgery while minimizing morbidity by causing less blood loss, faster postoperative recovery, and reducing complications.This article shares our technique, challenges encountered, and experience of robot-assisted complex urinary tract reconstruction using intestinal segments.Between January 2020 to March 2022, 6 patients who underwent robot-assisted complex urinary tract reconstruction using intestinal segments at our centre were retrospectively reviewed. Demographic, clinical, and operative data were recorded. Patients underwent renal function tests, blood gas analysis, and radiographic imaging in the follow-up. Symptomatic and radiologic relief were the criteria for success. Out of 6 cases, three patients underwent ileal ureter replacement, two combined ileal ureter with augmentation ileo-cystoplasty and one augmentation ileo-cystoplasty alone. The mean age, estimated blood loss, length of hospital stay, and follow-up period were 32.6years, 110 ± 13.1mL, 7.0 ± 1.1days, and 11.3months, respectively. The indications for surgery were either benign ureteral stricture following lithotripsy or sequelae of genitourinary tuberculosis. No intra-operative complications were found. Clavien-Dindo grade-II and Grade-IIIa were found in three and one patient, respectively. During follow-up, none had compromised renal function or acidosis. Robot-assisted complex urinary tract reconstruction using intestinal segments is safe and offers the advantages of minimally invasive techniques. Techniques demonstrated in this article make these reconstructions feasible with good surgical and clinical outcomes.

Roadblocks and resilience: A qualitative study of the impact of pediatric tuberculosis on Tanzanian households and solutions from caregivers

ABSTRACT Distinct from quantifying the economic sequelae of tuberculosis (TB) in adults, data are scarce regarding lived experiences of youth and their caregivers seeking and sustaining TB treatment in low income communities. Children ages 4–17 diagnosed with TB and their caregivers were recruited from rural and semi-urban northern Tanzania. Using a grounded theory approach, a qualitative interview guide was developed, informed by exploratory research. Twenty-four interviews were conducted in Kiswahili, audio-recorded and analyzed for emerging and consistent themes. Dominant themes found were socioemotional impacts of TB on households, including adverse effects on work productivity, and facilitators and obstacles to TB care, including general financial hardship and transportation challenges. The median percentage of household monthly income spent to attend a TB clinic visit was 34% (minimum: 1%, maximum: 220%). The most common solutions identified by caregivers to mitigate adverse impacts were transportation assistance and nutrition supplementation. To end TB, healthcare systems must acknowledge the total financial burden shouldered by low wealth families seeking pediatric TB care, provide consultations and medications locally, and increase access to TB-specific communal funds to mitigate burdens such as inadequate nutrition. Trial registration: planned sub-study of the registered prospective study, NCT05283967. Trial registration: ClinicalTrials.gov identifier: NCT05283967.

Total Unilateral Collapsed Lung- A Sequela of Pulmonary Tuberculosis- and Pregnancy Outcome

Lung tissue damage after pulmonary tuberculosis is common and can result in persistent pulmonary disability with negative influence on a patient’s quality of life. On the other hand, a COVID-19 infection in a previously treated tuberculosis patient with residual pulmonary abnormalities imposes an increased risk of death. On their own, both of these diseases can have a devastating effect on a patient’s pulmonary system and as such be the cause of disability or even death. In this case report of total atelectasis of the left lung due to obliteration of the left main bronchus after tuberculosis treatment, we present a pregnant patient, who despite a significant reduction in pulmonary function, managed to have a pregnancy with favorable outcome. Thereafter the patient even recovered from a COVID-19 infection, illustrating resilience of the human body.

Isolated chronic right heart failure due to tuberculosis sequelae: Experience of the Libreville University Hospital Center

Isolated chronic right heart failure due to tuberculosis sequelae: Experience of the Libreville University Hospital Center

Efficacy of Pulmonary Rehabilitation in Pulmonary Tuberculosis Sequelae with Cystic Bronchiectasis and Pulmonary Hypertension

Cystic bronchiectasis, also known as saccular bronchiectasis (a severe type of bronchiectasis), is a condition that occurs as a complication and sequelae after pulmonary Tuberculosis (TB). There is chronic permanent dilation of bronchi that occurs after destructive changes in elastic and muscular layers of bronchial walls which further leads to the ballooning of bronchi and difficulty in clearing secretions with recurrent infection of the respiratory tract. Pulmonary hypertension is another major complication after bronchiectasis which affects pulmonary circulation. A 44-year-old female reported to the physiotherapy department with cystic bronchiectasis and pulmonary hypertension. The positive symptoms were chronic cough with mucoid sputum, low-grade fever, chest pain, breathlessness (modified Medical Research Council (mMRC) grade III), and easy fatiguability. The goals were set and inpatient Pulmonary Rehabilitation (PR) started with the aim of reducing burdening of symptoms and promoting the Quality of Life (QoL). The therapeutic interventions were splinted coughing techniques, deep breathing exercises, thoracic expansions, postural correction exercises, dyspnoea relieving positions, strength training, and pacing techniques. After rehabilitation the ventilation along with strength improved, dyspnoea was reduced, and exercise tolerance was increased.

PD41 Role Of Artificial Intelligence In Improving Access To COVID-19 Diagnosis During Pandemic

IntroductionThe evolution of advances in informatics, technology in medicine, and artificial intelligence (AI) offers opportunities to enhance health care during the coronavirus disease 2019 (COVID-19) pandemic. The challenge for biomedical engineers is to implement these developments in clinical practice to improve global health. Populations living in low-income countries do not have access to specialist care and quality diagnostic services for COVID-19. Therefore, an AI system based on a telemedicine platform for diagnosing COVID-19 could help mitigate the lack of highly trained radiologists at regional hospitals and serve as a triage system for rationalizing the use of reverse transcription polymerase chain reaction (RT-PCR) testing and other health resources in low-income countries. Thus, the utility of an AI system for diagnosing COVID-19 in Paraguay was investigated.MethodsThis is a descriptive multicenter observational feasibility study of an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties who attended public hospitals across the country.ResultsBetween March 2020 and August 2021, 3,514 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of the patients was 48.6 years (52.8% were men); the most common age ranges were 27 to 59 years, followed by older than 60 years and 19 to 26 years. The most frequent findings on the CT images were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes. Overall, there was 93 percent agreement and 7 percent discordance between the AI system and the RT-PCR test results. Compared with RT-PCR testing, the AI system had a sensitivity of 93 percent and a specificity of 80 percent.ConclusionsParaguay has an AI-based telemedicine screening system for the rapid detection of COVID-19 that uses chest CT images of patients with respiratory conditions.

The Relationship among Splenomegaly, Lung Involvement Patterns, and Severity Score in COVID-19 Pneumonia.

The disease caused by the novel coronavirus (COVID -19) is a vital public health problem that has now affected approximately 68,037,473 people and caused 1,552,802 deaths around the world. We aimed to correlate the frequency of the lung involvement patterns, the segmental distribution of lung infiltration, and TLSS in COVID-19 pneumonia patients with and without splenomegaly. This retrospective study included patients admitted to Yunus Emre State Hospital Emergency, Internal Medicine and Infectious Disease Departments between March 11, 2020, and June 10, 2020, and diagnosed with COVID-19 by PCR test with a throat and nasal swab. The thoracic and upper abdomen CTs and the clinical and demographic features of the patients were analyzed at the time of initial diagnosis. Consolidation (group 1 - 18 (47%), group 2 - 69 (28.2%); P = 0017), crazy pavement pattern (15 (39.5%), 42 (17.1%); p = 0.001), pleural band formations (24 (63.2%), 87 (35.5%); p = 0.001), interlobular septal thickening (23 (60.5%), 79 (32.2%); p = 0.001), and sequelae of secondary tuberculosis (4 (10.5%), 8 (3.3%); p = 0.039) were more frequent in the patient with splemomegaly. The total lung severity score was high in the group with splenomegaly (7.32 ± 6.15, 3.69 ± 5.16; p = 0.001). Consolidation, interlobular septal thickening, tuberculosis sequela, pleural band, and crazy pavement patterns were frequent in the COVID-19 pneumonia patients with splenomegaly. The most frequently affected segment was the superior segment of the right lower lobe. TLSS was higher in the COVID-19 pneumonia patients with splenomegaly.

Destroyed left lung due to multidrug-resistant Mycobacterium tuberculosis

A 40-year-old man who was a Syrian refugee presented to the emergency department with a 2-month history of a productive cough and progressive nocturnal dyspnoea after arriving in the Netherlands 6 days before seeking treatment. Physical examination was notable for tachypnoea of 25 breaths/min, hypotension of 100/70 mmHg, and decreased breath sounds on auscultation of the left lung. Laboratory studies showed a C-reactive protein concentration of 51 mg/L (normal <5 mg/L), erythrocyte sedimentation rate of 81 mm/h (normal <15 mm/h), haemoglobin concentration of 11·4 g/dL (normal 13·7–17·7 g/dL), and mean corpuscular volume of 76·7 fL (normal 80–100 fL). One year before this presentation, the patient was admitted in Greece for an acute myocardial infarction. Chest radiography during the admission in Greece showed signs of tuberculosis, which sputum cultures confirmed to be multidrug-resistant Mycobacterium tuberculosis. The patient was treated for 6 months with tuberculostatic drugs and discharged following three consecutively negative sputum cultures. Monthly follow-ups were advised. However, before his first follow-up, the patient was lost to health services for 5 months as he migrated westward without antibiotic maintenance therapy. After presenting to the emergency department in the Netherlands, chest radiography showed opacification of the left hemithorax and right-sided hyperinflation, a chest CT, which included three-dimensional modelling, demonstrated unilateral atelectasis and leftward mediastinal shift (figure and video). Microbiological assessment confirmed relapsed multidrug-resistant tuberculosis, for which the patient received oral, directly observed therapy with 4 months of moxifloxacin (600 mg once a day), 7 months of cycloserine (750 mg once a day), 8 months of amikacin (400 mg once a day), 13 months of co-trimoxazole (960 mg once a day) and rifampicin (900 mg once a day), and 14 months of clofazimine (100 mg 5 times per week), linezolid (300 mg once a day), protionamide (750 mg once a day), and rifabutin (300 mg once a day). Within 3 months of treatment, the patient's sputum cultures became negative for M tuberculosis; and 6 months later, the patient underwent a pneumectomy of the destroyed left lung. During the past 5 years of follow-up, there has been no tuberculosis recurrence. Considering tuberculosis disproportionately impacts the global migrant population, clinicians should consider proactively screening the lungs of people who are migrants upon entry to the country to avert the debilitating sequelae of multidrug-resistant tuberculosis.

Point-of-care ultrasound for tuberculosis management in Sub-Saharan Africa—a balanced SWOT analysis

Point-of-care ultrasound (POCUS) is an increasingly accessible skill, allowing for the decentralization of its use to nonspecialist healthcare workers to guide routine clinical decision-making. The advent of ultrasound-on-a-chip has transformed the technology into a portable mobile health device. Because of its high sensitivity to detect small consolidations, pleural effusions, and subpleural nodules, POCUS has recently been proposed as a sputum-free likely triage tool for tuberculosis (TB). To make an objective assessment of the potential and limitations of POCUS in routine TB management, we present a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis based on a review of the relevant literature and focusing on Sub-Saharan Africa (SSA). We identified numerous strengths and opportunities of POCUS for TB management, e.g., accessible, affordable, easy to use and maintain, expedited diagnosis, extrapulmonary TB detection, safer pleural/pericardial puncture, use in children/pregnant women/people living with HIV, targeted screening of TB contacts, monitoring TB sequelae, and creating artificial intelligence decision support. Weaknesses and external threats such as operator dependency, lack of visualization of central lung pathology, poor specificity, lack of impact assessments and data from SSA must be taken into consideration to ensure that the potential of the technology can be fully realized in research as in practice.

Ascite chyleuse à Mycobacterium tuberculosis : un cas clinique

Chylous ascites is a rare manifestation of tuberculosis. We report the case of a 63-year-old man admitted with ascites and bilateral lower limb edema developed two years previously, with progressive increase. He had a history of microbiologically confirmed and properly treated pleuropulmonary tuberculosis, 20 years before. Although Mycobacterium tuberculosis could not be detected in the ascitic fluid, chest, abdominal and pelvic computed tomography showed findings very suggestive of tuberculosis sequelae. A lymphoscintigraphy was performed and also supported our diagnostic hypothesis of chylous ascites and lymphedema due to tuberculosis sequelae associated or not with active infection. The intention was to further investigate if any form of active tuberculosis was present due to reactivation of the infection. Unfortunately, the patient died before these assessments could be completed.

Rehabilitation of the patients with pulmonary tuberculosis and tuberculosis sequelae

Tuberculosis sequelae are very common after successful treatment of the disease. Airflow obstruction and restrictive impairment develop alongside with the changes. High prevalence of pulmonary impairment in patients with tuberculosis sequelae shows that lung function study and pulmonary rehabilitation should be performed. Malnutrition is very common among TB patients. The review deals with the methods of rehabilitation, which include physical training and nutritional status correction.

Complication and Sequelae of Pulmonary Tuberculosis: A Tertiary Care Center Experience

Complication and Sequelae of Pulmonary Tuberculosis: A Tertiary Care Center Experience

Mycobacterium tuberculosis and Pulmonary Rehabilitation: From Novel Pharmacotherapeutic Approaches to Management of Post-Tuberculosis Sequelae.

Tuberculosis (TB) is still a worldwide public health burden, as more than 1.3 million deaths are expected to be reported in 2021. Even though almost 20 million patients have completed specific anti-TB treatment and survived in 2020, little information is known regarding their pulmonary sequelae, quality of life, and their need to follow rehabilitation services as researchers shifted towards proper diagnosis and treatment rather than analyzing post-disease development. Understanding the underlying immunologic and pathogenic mechanisms during mycobacterial infection, which have been incompletely elucidated until now, and the development of novel anti-TB agents could lead to the proper application of rehabilitation care, as TB sequelae result from interaction between the host and Mycobacterium tuberculosis. This review addresses the importance of host immune responses in TB and novel potential anti-TB drugs’ mechanisms, as well as the assessment of risk factors for post-TB disease and usefulness of guidance and optimization of pulmonary rehabilitation. The use of rehabilitation programs for patients who successfully completed anti-tuberculotic treatment represents a potent multifaceted measure in preventing the increase of mortality rates, as researchers conclude that a patient with a TB diagnosis, even when properly completing pharmacotherapy, is threatened by a potential life loss of 4 years, in comparison to healthy individuals. Dissemination of pulmonary rehabilitation services and constant actualization of protocols could strengthen management of post-TB disease among under-resourced individuals.

Six Minute Walk Test in People with Tuberculosis Sequelae

Background: Tuberculosis often brings about diffuse fibrotic and other changes to lung tissue also consolidation of lung tissue prompting a decrease in generally lung tissue compliance. Following tuberculosis, the functional status of people is reduced e.g., impaired ventilation and gas exchanges leading to shortness of breath, muscular deconditioning, and a functional status decline is seen Objective: The purpose of this study was to evaluate and compare the six-meter walk distance and physical functional capacity (VO2 max) in 40 – 65 years people with pulmonary tuberculosis and healthy subjects. Methods: Forty healthy subjects (20 males and 20 females) and forty subjects with pulmonary tuberculosis (30 males and 10 females) took part in this study. All the subjects underwent a six min walk test. Walk-work was calculated and used for evaluating functional capacity. To examine for significant relationships Pearson product correlation was used Results: A significant difference was found between the groups in regards to 6MWT distance (p &lt; 0.05). For height and body mass index (BMI) Pearson product correlations with 6MWD were significant in normal individual and for the weight and BMI it was significant in the TB sequelae group. Conclusion: A significant difference was found in functional capacity in terms of VO2max between healthy and patients with TB was found. TB sequelae individuals’ group, 52.6% patients had a VO2 max under 21 milliliter per kilogram per minute that brought about an impressive effect of TB sequelae on endurance in regards to cardiorespiratory system. Keywords: functional capacity, hospital, six-minute walk test, tuberculosis

The unresolved issues in the management of mucormycosis

Mucormycosis represents the second most frequent invasive mold infection after invasive aspergillosis and its incidence tends to increase around the world [1]. The disease not only affects patients with severe immune defects (e.g. hematologic cancer patients, transplant recipients), but also apparently immunocompetent individuals, such as those with uncontrolled diabetes, sequela of tuberculosis, chronic kidney disease or following severe trauma [1,2]. For these reasons, the burden of mucormycosis is particularly high in low- and middle-income countries with limited access to healthcare structures.

Pulmonary Functions and Inflammatory Biomarkers in Post-Pulmonary Tuberculosis Sequelae.

Background Post-tuberculosis (TB) sequelae is a commonly encountered clinical entity, especially in high TB burden countries. This may represent chronic anatomic sequelae of previously treated TB, with frequent symptomatic presentation. This pilot study was aimed to investigate the pulmonary functions and systemic inflammatory markers in patients with post-TB sequelae (PTBS) and to compare them with post-TB without sequelae (PTBWS) participants and healthy controls.Methods A total of 30 participants were enrolled, PTBS (n=10), PTBWS (n=10), and healthy controls (n=10). Pulmonary function tests included spirometry and measurement of airway impedance by impulse oscillometry. Serum levels of matrix metalloproteinase (MMP)-1, transforming growth factor-β, and interferon-γ were estimated.Results Slow vital capacity (SVC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and peak expiratory flow were significantly lower in PTBS as compared to controls. SVC and FEV1 were significantly less in PTBS as compared to PTBWS. Total airway impedance (Z5), total airway resistance (R5), central airway resistance (R20), area of reactance (Ax), and resonant frequency (Fres) were significantly higher and respiratory reactance at 5 and 20 Hz (X5, X20) were significantly lower in PTBS as compared to PTBWS. Spirometry parameters correlated with impulse oscillometry parameters in PTBS. Serum MMP-1 level was significantly higher in PTBS as compared to other groups.Conclusion Significant pulmonary function impairment was observed in PTBS, and raised serum MMP-1 levels compared with PTBWS and healthy controls. Follow-up pulmonary function testing is recommended after treatment of TB for early diagnosis and treatment of PTBS.

Impacto de la rehabilitación pulmonar en pacientes con enfermedad pulmonar restrictiva

IntroductionRestrictive lung diseases present alterations in thoracic-pulmonary mechanics, reduced functional capacity and lung function. Intrinsic and extrinsic alterations can be found where the interstitium, thoracic expandability and even lung parenchymal conditions are altered. Pulmonary rehabilitation could benefit patients with the restrictive condition and improve their functional condition. ObjectiveEstablish the impact of pulmonary rehabilitation in patients with intrinsic and extrinsic restrictive respiratory compromise on dyspnea, functional capacity, anxiety/depression and health-related quality of life. MethodsLongitudinal descriptive study with 50 patients with restrictive lung disease who performed pulmonary rehabilitation in a clinic in the city of Cali, Colombia. The participants linked to the study were separated into two groups, the first with intrapulmonary restrictive disease (IRD) and the second group with extrapulmonary restrictive disease (ERD). ResultsThe mean age of the patients was 53.3years. Among the restrictive intrapulmonary diseases there were: diffuse interstitial lung disease (ILD), post-condition pneumonia and/or acute respiratory distress syndrome (ARDS) and sequelae of pulmonary tuberculosis. Extrapulmonary respiratory diseases: lung resection, pulmonary lobe resection, and wedge resection. At the end of pulmonary rehabilitation, the IRD group presented statistically significant improvements in distance covered, estimated oxygen consumption (VO2e), dyspnea, anxiety, and quality of life. The ERD group presented a significant increase in the distance traveled and VO2e. ConclusionPatients with restrictive lung disease improve the distance traveled, VO2e, dyspnea, anxiety and quality of life; patients with extrapulmonary respiratory disease show improvements in functional capacity.

History of prevention, diagnosis, treatment and rehabilitation of pulmonary sequelae of tuberculosis

Tuberculosis (TB), known as the White Plague’ is of great significance to humanity for the magnitude of morbidity and mortality it has generated over centuries from the very start of human civilization. In this Review, we will describe the history of prevention (vaccination and management of TB infection), diagnosis, treatment and pulmonary rehabilitation of post-treatment sequelae. The article leads the reader through the main discoveries which paved the way to the modern approach to TB prevention and care. The history of Bacille Calmette-Guérin (BCG) vaccine and of the diagnosis and treatment of TB infection are presented, together with that of diagnosis and treatment of TB disease. Pivotal was in 1882 the discovery by Robert Koch of the aetiological agent of TB, and his pioneering work in culturing the bacillus and developing tuberculin. Also of enormous importance was, in 1895, the discovery of the X-rays by Wilhelm Conrad Röntgen, discovery which paved the way to the development of the modern imaging technologies.To complement this, the more recent history of rehabilitation of post-treatment sequelae is summarized, given the importance this issue has on patients’ wellbeing and Quality of Life.

Bronchial Arteries Embolization in Tuberculosis-Related Recurrent Hemoptysis with Complete Right Lung Atelectasis: A Case Report

Introduction: Hemoptysis is an emergency condition with high morbidity and mortality which requires immediate treatment. Active tuberculosis (TB) and post-tubercular sequelae can result in hemoptysis with the most common source is from bronchial artery.Case: We reported a 22-year-old man who presented with shortness of breath and recurrent hemoptysis. A chest X-Ray showed total atelectasis right lung due to obstructive airway. After aspiration clotting blood in bronchus and instillation adrenalin with fiber optic bronchoscopy, the atelectasis totally disappeared. Computed tomography angiography (CTA) showed prominent vascular lesions from the apical right pulmonary artery, right brachialis artery, and branch of the posterior intercostal artery. The patient was referred to the interventional unit of the radiology department in Dr. Soetomo General Hospital and underwent bronchial artery embolization. After this procedure, his symptoms resolved completely and he was discharged after a week with 2nd category anti-tuberculosis drugs (ATD). 6 months of follow-up, he no longer experienced hemoptysis.Conclusion: Recurrent hemoptysis needs optimal management, including diagnostic with chest radiography, CT and bronchoscopy. Treatment with bronchoscopy and bronchial artery embolization will reduce mortality and morbidity in patients with hemoptysis.

Outcomes in patients of pulmonary tuberculosis treated under RNTCP &amp; follow up after 6 months

Tuberculosis (TB) is, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent.This Prospective study was conducted at Santosh medical college Ghaziabad from 1 April 2018 to 30 September 2019. All diagnosed PTB patients above 12yrs were taken. Patients with EPTB, HIV positive, MDR TB, XDR TB were excluded from the study. At the end of study treatment outcome was evaluated.Total of 208 patients diagnosed as tuberculosis were enrolled in the study. 6 patients died during course of study, 10 were treatment failure, 4 were lost to follow-up, 3 transferred out &amp; 1 shifted to private treatment. 184 patients completed treatment successfully. Out of 184, only 152 patients were available for interview at 6 months follow up after completion of treatment. 19 could not be traced, 11 patients refused and 2 died. Out of 152, 110 were asymptomatic, 1 relapsed &amp; rest 41 patients were symptomatic. All symptomatic patients were subjected to Chest X-Ray. Fibrosis was seen on CXR of 30 patients, bronchiectasis was seen in 3 patients, 1 patient had destroyed lung, nothing abnormal detected in 7 patients.Even after successful treatment under RNTCP, these patients need to be followed up as many of them relapse or suffer from sequelae of tuberculosis.