Pulmonary impairment after tuberculosis and its contribution to TB burden

Abstract

BackgroundThe health impacts of pulmonary impairment after tuberculosis (TB) treatment have not been included in assessments of TB burden. Therefore, previous global and national TB burden estimates do not reflect the full consequences of surviving TB. We assessed the burden of TB including pulmonary impairment after tuberculosis in Tarrant County, Texas using Disability-adjusted Life Years (DALYs).MethodsTB burden was calculated for all culture-confirmed TB patients treated at Tarrant County Public Health between January 2005 and December 2006 using identical methods and life tables as the Global Burden of Disease Study. Years of life-lost were calculated as the difference between life expectancy using standardized life tables and age-at-death from TB. Years lived-with-disability were calculated from age and gender-specific TB disease incidence using published disability weights. Non-fatal health impacts of TB were divided into years lived-with-disability-acute and years lived-with-disability-chronic. Years lived-with-disability-acute was defined as TB burden resulting from illness prior to completion of treatment including the burden from treatment-related side effects. Years lived-with-disability-chronic was defined as TB burden from disability resulting from pulmonary impairment after tuberculosis.ResultsThere were 224 TB cases in the time period, of these 177 were culture confirmed. These 177 subjects lost a total of 1189 DALYs. Of these 1189 DALYs 23% were from years of life-lost, 2% were from years lived-with-disability-acute and 75% were from years lived-with-disability-chronic.ConclusionsOur findings demonstrate that the disease burden from TB is greater than previously estimated. Pulmonary impairment after tuberculosis was responsible for the majority of the burden. These data demonstrate that successful TB control efforts may reduce the health burden more than previously recognized.

Allopatric tuberculosis host–pathogen relationships are associated with greater pulmonary impairment

“…Patients with disease with a sympatric host-pathogen relationship were more likely to have no impairment. Previously, we showed that PIAT is more frequent and severe in certain risk groups and racial/ethnic populations and also demonstrated that PIAT could be life-long (Pasipanodya et al, 2010(Pasipanodya et al, , 2012bVecino et al, 2011). In these studies, self-reported non-Hispanic white was associated with PIAT, while various measures of socio-economic status were not.…”

“…Non-Hispanic Whites suffer more frequent and severe PIAT relative to other racial groups. Increased risk for PIAT remained after controlling for cigarette smoking, healthcare access, treatment, and socioeconomic status, suggesting that other factors contributed to PIAT (Pasipanodya et al, 2010). However, pathogen factors including M. tuberculosis phylogenetic differences were not included in these studies.…”

“…PIAT may vary by race/ethnicity (Pasipanodya et al, 2010). Non-Hispanic Whites suffer more frequent and severe PIAT relative to other racial groups.…”

“…Approximately 2 million persons die annually from tuberculosis (TB) and among those that survive, at least half will experience pulmonary impairment after TB (PIAT) that can be debilitating (Pasipanodya et al, 2007(Pasipanodya et al, , 2010Vecino et al, 2011;World Health Organization, 2010). Previous studies have described host, pathogen, environmental, and lifestyle factors associated with outcomes after TB exposure, after latent Mycobacterium tuberculosis infection, or after TB disease (Blaser and Kirschner, 2007;Caws et al, 2008;Coscolla and Gagneux, 2010;Kato-Maeda et al, 2001;Malik and Godfrey-Faussett, 2005;Pasipanodya et al, 2012b;van Crevel et al, 2009).…”

An Oracle: Antituberculosis Pharmacokinetics-Pharmacodynamics, Clinical Correlation, and Clinical Trial Simulations To Predict the Future

“…"Short-course chemotherapy" is actually long. Longterm mortality, morbidity, relapse, and resistance emergence are still problems even after "successful" therapy (20,77,78,93). Indeed, while it often said that the therapy has a 95% success rate under directly observed therapy (DOTS) programs, a look at high-TB-burden countries with good DOTS programs reveals cure rates for pulmonary TB of only 34 to 76%, and those are under study conditions (1,103).…”