Rehabilitation, optimized nutritional care, and boosting host internal milieu to improve long-term treatment outcomes in tuberculosis patients

Abstract

Background: The holistic management of tuberculosis (TB) patients can improve life expectancy and lost organ function. Rehabilitation: Chronic sequelae are very common among patients who survive TB, which can lead to a further decline in lung function. There is still no guidance for 'cured' patients with impaired lung function who need pulmonary rehabilitation. Additional tests for evaluation should be given after the end of treatment, as recent studies have shown the good effect of pulmonary rehabilitation for TB patients. Optimized nutritional care: Malnutrition is very common among TB patients and is related to malabsorption. The latter can cause lower drug exposure, which may result in treatment failure, increasing the risk of death, and can lead to acquired drug resistance. Malnutrition should be assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the diagnosis should lead to an individualized treatment plan, including sufficient proteins and preferably in combination with adequate training. Protective immune responses: Under normal circumstances, most immune cells use a glucose-based mechanism to generate energy. Therefore the patient's nutritional status is a key factor in shaping immune responses. Disease-related malnutrition leads to proteolysis and lipolysis. In the end, the identification of individuals who will benefit from immune-modulatory strategies may lead to clinically relevant markers.

Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function

“…Given the significant symptoms and functional impairment in this young population, urgent prognostic assessments for PTLD are needed, and pulmonary rehabilitation programmes may play a significant role in its treatment. 32 – 35 More work is required on the long-term evolution of PTLD to identify individuals at risk of chronic PTLD and to investigate effective prevention and treatment strategies.…”

Nano short peptide nutrition intervention on the prognosis of patients with COVID-19

“…The microvasculature under the small intestinal mucosa of patients with COVID-19 has serious inflammation and impaired digestion and absorption function, 5,6 which can not provide adequate nutrition for intestinal lymphocytes.Malnutrition can cause the decrease of systemic immune function. [34][35][36][37][38][39][40][41][42][43][44][45] More than 60% of patients with COVID-19 have lymphocytopenia,and almost all patients with COVID-19 have a decrease in the absolute number of T lymphocytes,CD4 + T cells and CD8 + T cells. [21][22][23][24][25][26][27][28][29][30][31][32][33] The negative nitrogen balance of patients with COVID-19 was 99.34%, and the proportion was consistent with the proportion of absolute number decrease of T lymphocytes,CD4 + T cells and CD8 + T cells in the literature.…”

“…In the later period of treatment the incidence of lymphocytopenia in the treatment group was significantly lower than that in the control group and literature reports.60% of human lymphocytes are distributed in the intestinal system.dipeptides and tripeptides can be actively absorbed,directly providing nutrition for intestinal lymphocytes,and improving the immune function of patients. [34][35][36][37][38][39][40][41][42][43][44][45] These changes of prealbumin and lymphocytopenia in the treatment group may be the reason that the rehabilitation speed of the treatment group is significantly faster than that of the control group.…”

Post-Tuberculosis (TB) Treatment: The Role of Surgery and Rehabilitation

“…As new evidence is made available and more is known about drugs and regimens, more patients are surviving [9][10][11][12], and it is emerging that other aspects require attention: the importance of preventing transmission [13], ensuring adequate nutrition, considering adjuvant surgery, and post-treatment sequelae [2,3,14]. These were emphasised in a comprehensive review of the Global Tuberculosis Network (GTN) based on the consensus of about 100 global experts [2].…”