Cavitated pulmonary tuberculosis: A long-term follow-up of 283 patients with special reference to the significance of the persistent cavity

Arblaster, Paul; Cross, K. W.; McWhinney, I.R.; Yates, J. K.

doi:10.1016/s0041-3879(61)80132-3

Cited by 2 publications

(1 citation statement)

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“…Death was the only certain marker of the epidemiology and outcome of TB. Spontaneous healing of TB was possible, as Laennec recognized ("healing of phthisis is possible for the nature but impossible for medicine" [9]), but was probably equivalent to a protracted course with persistence of mycobacteria, as observed in some long-term survivor [10]. In a Swiss sanatorium, between 1921 and 1941, 49% of patients hospitalized for TB were still alive 6 years after entry, with a clear correlation between mortality and (i) the extension of pulmonary involvement (28% in patients with unilateral in-volvement without cavity, 42% in patients with unilateral cavitary disease, and 72% in patients with bilateral cavitary disease) and (ii) the smear status (60% in patients with smear positivity at entry and 79% in patients with smear positivity 1 year after entry) [11].…”

Section: Historical Development Of Treatment Outcome Definitionsmentioning

confidence: 99%

Defining Outcomes of Tuberculosis (Treatment): From the Past to the Future

Günther

Heyckendorf

Zellweger³

et al. 2021

Respiration

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Untreated active tuberculosis (TB) has a very high long-term mortality. Treatment of TB reduces mortality dramatically and should maximize cure, preventing ongoing transmission and TB sequelae. However, predicting the risk of failure and relapse is crucial for the management of individual patients and for the evaluation of effectiveness of programs. Various outcome definitions for drug-sensitive and drug-resistant TB were developed, implemented, and endorsed since introduction of TB chemotherapy by the World Health Organization (WHO), mostly based on culture and smear results. They should be applicable for individual patient care, surveillance, and research. Definitions with focus on program evaluation differ from definitions to evaluate the efficacy and effectiveness of regimens. Lack of sputum production at the later stage of treatment reduces the easy applicability of current definitions. Definitions of failure and cure are sometimes difficult to apply. Alternative approaches suggest culture positivity at 6 months or more of treatment as an indicator for failure. New definitions for cure including a relapse-free period posttreatment and reduced number of culture and smear results are considered. Increasing variation and individualization of treatment and its duration urgently require new approaches using pathogen- or host-specific biomarkers, which indicate risk of failure and define cure. Such biomarkers are under evaluation but still far from translation in clinical routine practice.

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Section: Historical Development Of Treatment Outcome Definitionsmentioning

confidence: 99%