Life after Pulmonary Tuberculosis

Surviving a condition like tuberculosis may come with dangerous repercussions that need caution
For representational purposes
For representational purposes

KOCHI: Tuberculosis is a chronic multisystem disease caused by mycobacterium tuberculosis. It spreads through droplet infection, meaning germs expelled from the patient’s mouth while speaking, coughing or sneezing. It enters the lungs of whoever inhales it. A person may recover to full health almost completely after finishing antitubercular chemotherapy. But some are bound to suffer complications and relapse. 

Bronchiectasis:

Chronic condition where the walls of the bronchi are thickened from inflammation and infection. Tuberculosis can cause Bronchiectasis. A person with permanent damage to the lungs is more prone to develop recurrent cough, breathlessness, blood-tinged expectoration and fever because the lungs can no longer effectively expel infectious germs and potentially toxic substances. The most common way to diagnose post-TB bronchiectasis is with a chest X-ray or a CT scan.

The goal of bronchiectasis treatment is to prevent recurrent infections. This is done by giving adequate antibiotic coverage for the identified pathogen in sputum or bronchoscopic lavage sample. Once the acute phase settles patient should continue mucous thinning medications and chest physiotherapy for postural drainage of secretions. In case of any life-threatening situations like coughing out blood, patient should consider the option of surgical removal of the affected portion of lung or else a temporary closure of the bleeding vessel by Bronchial artery embolization.

Pulmonary Aspergilloma
Aspergillosis is an infection caused by the fungus aspergillus. Aspergillomas are formed when the fungus grows in clump inside a lung cavity. The cavity is often created by tuberculosis or any other chronic infection. Most often you may be asymptomatic and notice symptoms like recurrent cough and haemoptysis. Similar to bronchiectasis, aspergilloma is often diagnosed during imaging studies. Many people never develop symptoms. Often, no treatment is needed unless you are coughing up blood.

Post-TB obstructive airway disease (OAD)
Although post-TB OAD is well-documented, TB patients are not routinely counselled or followed up for post-tuberculous breathing difficulty which mimics asthma. Often such patients are wrongly treated for TB on multiple occasions on the basis of chronic cough, expectoration or haemoptysis. The exact pathogenesis of post-TB OAD is not clear but an immunological phenomenon might be contributing to it due to extensive destruction of the lung leading to fibrosis of the airways. OAD should be considered when a patient reports of new-onset of breathlessness mainly on exertion after completion of anti TB treatment. A periodic pulmonary function test (PFT) may be beneficial to detect pulmonary impairment early in its course. Often these cases are managed with inhalational medications and respiratory muscle strengthening exercises.

Tracheal/Bronchial stenosis
Tracheobronchial stenosis is often the result of endobronchial tuberculosis which is often missed in people who suffer from pulmonary TB. The affected group suffers from progressive breathlessness and recurrent respiratory infections especially due to collapse of the lung beyond the stenotic segments. It exists in 10-40% of patients with pulmonary involvement. Often a CT scan of the chest and bronchoscopic evaluation is required to diagnose this disorder and a bronchoscopic or surgical treatment is the only way to correct it. Proper counselling to people who suffer from pulmonary tuberculosis and a regular follow up even after completion of anti-TB therapy is absolutely essential to detect most of these complications as they may develop anytime during or after TB treatment.

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