Magnitude and factors associated with post-tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-analysis

Abstract

Background Emerging evidence suggests that after completion of treatment for tuberculosis (TB) a significant proportion of patients experience sequelae. However, there is limited synthesized evidence on this from low-income countries, from Sub-Saharan Africa, and in HIV infected individuals. We seek to provide an updated comprehensive systematic review and meta-analysis on the magnitude and factors associated with post-TB lung disease (PTLD) in low- and middle-income countries (LMICs). Methods We searched PubMed, Embase and CINAHL for studies from LMICs with data on post-TB lung health in patients who had previously completed treatment for pulmonary TB. Data on study characteristics, prevalence of PTLD–specifically abnormal lung function (spirometry), persisting respiratory symptoms and radiologic abnormalities were abstracted. Statistical analysis was performed using Microsoft Excel and R version 4.1 software, and random effects meta-analysis conducted to compute pooled prevalence of PTLD, evaluate heterogeneity, and assess factors associated with PTLD. Results We identified 32 eligible studies with 6225 participants. Twenty-one studies were from Africa, 16 included HIV infected participants, spirometry was conducted in 20 studies, symptom assessment in 16 and chest imaging in eight. Pooled prevalence of abnormal lung function was 46.7%, persistent respiratory symptoms 41.0%, and radiologic abnormalities 64.6%. Magnitude of any type of PTLD varied by HIV status (HIV- 66.9%, HIV+ 32.8%, p = 0.0013), across geographic setting (SE Asia 57.5%, Southern America 50.8%, and Africa 38.2%, p = 0.0118), and across urban-rural settings (symptom prevalence: rural 68.8%, urban 39.1%, mixed settings 27.9%, p = 0.0035), but not by income settings, sex or age-group. Conclusions There is high burden of post-TB persistent respiratory symptoms, functional lung impairment and radiologic structural abnormalities in individuals living in LMICs. Burden varies across settings and by HIV status. This evidence may be valuable to advocate for and inform implementation of structured health care specific to the needs of this vulnerable population of individuals.

Paediatric pulmonary disease—are we diagnosing it right?

“…Past history of TB was found in 7 among 33 patients, which could partially explain the colonization of other bacteria post TB disease in these 7 patients. Since there is documented evidence of post TB lung disease (PTLD) in children ( 38 , 39 ), although low in number, diagnosis of bacterial pathogens in patients with past history of TB in our study warrants the necessity for continuous monitoring of the menaces and key interventions to prevent and reduce the outcome of TB on child health. For the other TST-positive children, although they did not turn out to be positive by any MTB diagnostic test and had normal chest x-rays (except one), the symptoms listed out and the presence of other bacterial pathogens implicate the need for further research.…”

Chronic Pulmonary Aspergillosis as a Considerable Complication in Post-Tuberculosis Lung Disease

“…2). 27,[31][32][33] Nevertheless, the prevalence of imaging abnormalities is highly variable between these patterns and chest imaging techniques. 32 The availability of thin-section computed tomography (CT) scans is often limited, especially in LMICs, which may lead to an underestimation of structural damage on chest radiographs.…”

“…25 Recent data suggest that up to 50% of TB patients are left with PTLD-related impairment after completion of anti-TB treatment, with a considerable variation across geographic settings, HIV status, and population assessed. 26,27 In patients with a history of multidrug-resistant TB (MDR-TB), up to 70% or more are affected by PTLD. 15 With an overall standardized mortality ratio of around 2.91 after TB treatment, there is growing evidence for a relevant excess mortality.…”

Pediatric Post-TB Lung Disease: Ready for Prime Time?

“…A recent systematic review and meta-analysis of evidence from 30 studies, including over 6,000 participants from low- and middle-income countries, estimated the pooled prevalence of PTLD to be 42.69% (95% confidence interval, 34.64–51.14) in TB survivors; PTLD was defined as 1 ) chronic respiratory symptoms, 2 ) radiology abnormalities, and 3 ) pulmonary function abnormalities ( 11 ). Of the 30 studies analyzed, only one small pediatric, hospital-based study was considered that included 33 children ( 11 , 12 ).…”

“…A recent systematic review and meta-analysis of evidence from 30 studies, including over 6,000 participants from low- and middle-income countries, estimated the pooled prevalence of PTLD to be 42.69% (95% confidence interval, 34.64–51.14) in TB survivors; PTLD was defined as 1 ) chronic respiratory symptoms, 2 ) radiology abnormalities, and 3 ) pulmonary function abnormalities ( 11 ). Of the 30 studies analyzed, only one small pediatric, hospital-based study was considered that included 33 children ( 11 , 12 ). Recently, published clinical standards for the management of PTLD have highlighted the limited evidence available from longitudinal and pediatric studies, emphasizing an abysmal lack of pulmonary function testing data, specifically in participants younger than 6 years old ( 13 ).…”