Background
Tuberculosis (TB), the disease caused by Mycobacterium tuberculosis, remains a major public health problem globally. In 2014,
more than 9.6 million people are estimated to have fallen ill with
TB while 1.5 million people died of the disease [1]. The disease
is closely associated with poverty, which explains the high rates
of TB in countries or in geographic areas within countries where
poverty rates are high. The disease is also closely linked with HIV
which has been the major driver for the high rates of TB in many
countries of Sub Saharan Africa [25]. TB is also associated with
other immunosuppressive states such as diabetes mellitus and tobacco smoking and it is currently postulated that the next wave
of the global TB epidemic will be driven by these emerging health
threats [68].
Over the last two decades treatment of TB has signicantly improved and 61 million patients were successfully treated for TB
globally since 1995 [1]. However such successful treatment of TB
based on either documentation of bacteriological clearance of Mycobacterium tuberculosis bacilli from the involved site or completion of the prescribed drug dose does not assess structural and
functional effects on the involved organ which is the hallmark
of the pathology of TB [9]. While any part of the body may be
affected by TB, pulmonary TB is the most common site of disease primarily because the Mycobacterium tuberculosis transmits
through the respiratory route. Thus TB is a major contributor to
the overall burden of lung disease in the world. It may be that the
majority of patients with pulmonary TB, the resulting structural
and functional damage is small and will not pose any signicant
long term lung health risk, however, for some patients an episode
of pulmonary TB may herald the beginning of chronic respiratory
disease and pose a signicant risk of reduced longevity despite the
successful treatment of their disease [10]. In this paper we argue on the importance of a programmatic approach to address the
long term complications of PTB and suggest mechanisms to prevent, rapidly identify and provide appropriate long term care for
patients with post TB chronic lung disease.
Long term complications of pulmonary TB
Of the 6.3 million notied cases of TB that occurred in 2014,
81% had lung TB [1]. Based on recent trends in treatment outcomes, about 86% of the new and relapse PTB cases notied
in 2014 were successfully treated. However, several studies have
http://dx.doi.org/10.1016/j.jctube.2016.03.001
2405-5794
11
12
Conclusion
Exploring mechanisms to address the long term complications
that follow treatment of pulmonary TB is long overdue and will
signicantly contribute to the quality of care for TB patients. In
many PTB patients successful completion of TB treatment or bacteriological cure is not the end of the need for care. Systematic
generation of data is needed to develop approaches for the prevention, care and treatment of patients with post TB chronic lung
disease. The global TB community cannot afford to continue ignoring this facet of TB care and control and needs to act with urgency
to address what is likely to be a huge public health burden.
Jeremiah Chakaya
Department of Medicine, Therapeutics, Dermatology and Psychiatry,
Kenyatta University, Nairobi, Kenya
Bruce Kirenga
Division of pulmonary medicine & lung institute Makerere
University, Kampala, Uganda
Haileyesus Getahun
Global TB Programme, WHO, Geneva, Switzerland.
Corresponding author:
E-mail address: chakaya.jm@gmail.com (J. Chakaya)
[10] Hoger S, Miller T, Katz D, Beavers S, et al. Longevity loss among cured tuberculosis patients and the potential value of prevention. Int J Tuberc Lung Dis
2014;18:134752.
[11] Rajeswari R, Muniyandi M, Balasubramanian R, Naryanan PR. Perceptions of
tuberculosis patients about their physical, menal and social wellbeing: a eld
report from South India. Soc Sci Med 2005;60:184553.
[12] Rekha BVV, Ramachandran R, Rao KVK, Rahman F, Adhilakshmi AR, Kalaiselvi D, et al. Assessment of long term status of sputum positive pulmonary
tb patients successfully treated with short course chemotherapy. Indian J Tuberc 2009;56:13240.
[13] Lam KH, Jiang CQ, Jordan R, Miller MR, Zhang WS, Cheng KK, et al. Prior tuberculosis, smoking, and airow obstruction: a cross-sectional analysis of the
Guangzhou Biobank Cohort study. Chest 2010;137:593600.
[14] Ross J, Ehlrich R, Hnizdo E. Excess lung function decline in gold miners following pulmonary tuberculosis. Thorax 2010;65:101015.
[15] Shah M, Reed C. Complications of tuberculosis. Curr Opin Infect Dis
2014;27(5):40310.
[16] Liang HuiYing, Li XueLian, Yu XiaoSong, Guan Peng, Yin Zhi-Hua,
He QinCheng, et al. Facts and Fiction of the relationship between pre-existing tuberculosis and lung cancer risk: a systematic review. Int J Cancer
2009;125:293644.
[17] Singla Neeta, Singla Rupak, Fernandes Sheron, Behera Digamber. Post treatment sequelae of multidrug resistant tuberculosis patients. Indian J Tuberc
2009;56(4):20612.
[18] Long R, Maycher B, Manfreda J, et al. Pulmonary tuberculosis treated with directly observed therapy: serial changes in lung structure and function. Chest
1998;113:93343.
[19] Gordon LSnider, Leroy Doctor, Theodore A Demas, Allan R Shaw. Am Rev
Respir Dis 1971;103(5):62540.
[20] Wilcox PA, Ferguson AD. chronic obstructive airways disease following treated
pulmonary TB. Respir Med 1989;83:1958.
[21] Hnzido E, Singh T, Churchyard G. Chronic Pulmonary function impairment
by initial and recurrent pulmonary tuberculosis following treatment. Thorax
20 0 0;55:328.
[22] Pasipanodya JG, Miller TL, Vecino M, Munguia G, Garmon R, Bae S,
Drewyer G, Weis SE. Pulmonary impairment after tuberculosis. Chest
2007;131(6):181724.
[23] Menezes AM, Perez Padilla R, Jardim JR, et al. Chronic obstructive pulmonary disease in ve Latin American cities (the Platino study): a prevalence
study. Lancet 2005;366:187581.
[24] Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic
respiratory disease: a systematic review. Int J Infect Dis 2015;32:13846.
[25] Amaral Andr FS, Coton Sonia, Kato Bernet, Tan Wan C, Studnicka Michael,
Janson Christer, et al. For the BOLD collaborative research group lung
function defects in treated pulmonary tuberculosis patients. Eur Respir J
2016;47(1):3523.
[26] Amaral AF, Coton S, Kato B, Tan WC, Studnicka M, Janson C. Eur Respir J
2016;47(1):3523.
[27] Jordan Toni S, Spencer Elspeth M, Davies Peter. Tuberculosis, bronchiectasis
and chronic airow obstruction. Respirology 2010;15:6238.
[28] Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ
2011;89(12):86472.
[29] Agarwal R, Vishwanath G, Aggarwal AN, Garg M, Gupta Chakrabarti A. Itraconazole in chronic cavitary aspergillosis: a randomized controlled trial and
systematic review of literature. Mycoses 2013;56(5):55970.
[30] Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias HM,
et al. WHOs GlobalTB programme. WHOs end TB strategy. Lancet
2015;385(9979):1799801.
[31] Practical Approach to Lung Health (PAL). A primary health care strategy
for the integrated management of respiratory conditions in people ve
years of age and over. WHO/HTM/TB/2005.351. www.who.int/tb/publications/
pal- primary- strategy/en/