Thoracic Sequelae and Complications of Tuberculosis

Abstract

established the temporality of the disease events, which was otherwise lacking in the study. The overall burden of disease (number, duration and severity of TB relapse) and respiratory morbidity in childhood [2] are other potential confounding factors that were not considered in the study. Radiologically, healed pulmonary TB can present with cicatrisation, fibro-cavitory disease, end-stage lung destruction, pulmonary calcification, bronchiectasis, trachea-bronchial stenosis etc. [3]. With such diverse and mixed presentations, combined obstructive and restrictive defects seem highly probable, but were not observed in the study. In general, asymptomatic lung function defects in patients with past TB do not require any treatment. The study would have been clinically more relevant if the authors had given the percentage of previously treated TB patients with symptomatic lung function defects, particularly airway obstruction, who were likely to utilise medical resources in future. @ERSpublications Healed pulmonary TB often presents with residual lung function defects which may require further treatment We are grateful to Aggarwal and colleagues for their interest in our paper [1]. They are correct to point out the limitations of cross-sectional studies, particularly when they rely on recalled information, and we discussed these at some length in the paper. However, evidence needs to be evaluated in the round. Not all error is biased; the outcomes (lung function) that we used were measured objectively and, as the results were not shared with the participants at the time, are unlikely to have influenced their answers to questions about a past history of tuberculosis. We agree, of course, that objective measures of tuberculosis would have been preferable, but it seems more likely that these would have reduced random error and so strengthened the current findings. We hope to add these to future investigations in the Burden of Obstructive Lung Disease (BOLD) cohort. We also discussed at some length the problem of inferring causality from cross-sectional studies when the order of events is unclear. In this case, reverse causation (low lung function causing tuberculosis) seems unlikely, but finding that the tuberculosis preceded the lung function decline would have only slightly reduced, and not excluded, the possibility of both being explained by a third, unmeasured, variable. The argument against this rests largely on the strength of the association and the failure to account for it by adjustment for other known factors. Having raised a concern over recall errors, Aggarwal and colleagues suggest we should have used time to "lung defects" after the occurrence of tuberculosis and "total burden" of disease as exposure variables. In the BOLD study, we do not have this information but it would likely be even less reliable than the information on history of tuberculosis itself. We did have information on childhood hospitalisation for respiratory disease. We did not report this in the paper, largely because of the strong possibi...

Tuberculosis-Associated Secondary Pneumothorax: A Retrospective Study of 53 Patients

“…In particular, when physicians encounter a remaining lesion after lung re-expansion following a spontaneous pneumothorax, they should consider pulmonary TB as a highly probable diagnosis. 12 In the report by Yagi et al, 18 23 patients (50%) had pneumothorax as their first presentation.…”

“…8,9 Pneumothorax is one of the important TB complications that requires surgery. [8][9][10][11] Pneumothorax secondary to TB usually occurs after extensive TB involvement of the lung, and the sudden onset of bronchopleural fistulization and empyema 12 with severe cavitary formations or occasionally with miliary TB. The TB organism invades the pleura and causes liquifactive necrosis, then pleural rupture.…”

“…The TB organism invades the pleura and causes liquifactive necrosis, then pleural rupture. 12 Therefore, a remaining apical lesion after lung re-expansion following a spontaneous pneumothorax should raise suspicion of pulmonary TB. 12 Although re-expansion occurs in some patients due to TB treatment, most of these patients require chest-tube insertion, which is the treatment of choice for complete drainage and resolution.…”

“…12 Therefore, a remaining apical lesion after lung re-expansion following a spontaneous pneumothorax should raise suspicion of pulmonary TB. 12 Although re-expansion occurs in some patients due to TB treatment, most of these patients require chest-tube insertion, which is the treatment of choice for complete drainage and resolution. 13,14 At Masih Daneshvari Hospital, Iran's sole TB-referral center and a specialized center for chest disease and thoracic surgery, we see numerous patients with TB-induced pneumothorax or hydropneumothorax.…”

A case of allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis

“…Whereas children infected in preadolescence or adolescence tend to developing severe adult-type pulmonary tuberculosis. 1,7 Almost half of the patients with ABPA are initially misdiagnosed as having pulmonary tuberculosis and many of them had received antitubercular therapy in the past. Fleeting pulmonary infiltrates, the characteristic radiological finding of ABPA, is often confused with pulmonary tuberculosis.…”