Tuberculosis is an infectious disease which has affected millions of people around the world. Ten million new TB cases were identified globally in 2018, with an estimated 1.2 million deaths. Lung function impairment often occurs due to the destruction of the lung parenchyma. This causes ventilatory abnormalities, often of obstructive type. Radiological lesions are also a common consequence of pulmonary tuberculosis. This study aims to analyse the various clinical features and assess the spirometric and radiological findings in post TB patients. This is a prospective observational study. All patients visiting the Chest Medicine OPD of Saveetha Medical College and Hospital who had a history of treated pulmonary tuberculosis and were above 18 years of age were included in this study. Patients who had no signs of active Tuberculosis underwent spirometry, and a chest x-ray was taken. Clinical presentation, spirometric parameters and radiological lesion were analysed. Among the 76 patients included in this study, 73.7% were male with most patients aged between 51 to 60 years. 64.5% of the study population were smokers. Dyspnoea (94.73%) was found to be the most common presenting complaint. Obstructive pattern (49%) was found to be the most common type of spirometric pattern with 68.42% having small airway disease. Based on the Wilcox classification, Degree II (47.37%) was the most common extent of the radiological lesion. It was found that there is a statistically significant difference between smokers and non-smokers in post-bronchodilator FEV1 (p=0.037) and FEF25-75 values (p=0.010). This study reveals the presence of post tuberculosis lung impairment in the population with varying presentations and severity. Hence, further studies and interventions are required to improve the quality of life of post tuberculosis patients.
Tuberculosis has stood the test of time over the millennia and still wreaks havoc on human life all over the world. We have studied the role of bronchoscopy in smear negative PTB suspects and have compared the results of BAL Gene Xpert with BAL AFB staining among the study population. We have also determined the microbiological profile in cases who are MTB negative. We retrospectively reviewed the respiratory samples (sputum and BAL) of 82 sputum negative PTB suspects from july 2018 – july 2019 for ZN stain and Gene Xpert. 25 cases were detected by Gene Xpert additionally to the 11 cases detected by BAL afb staining alone. Out of the 36 cases detected on gene Xpert 3(8%) were RIF resistant. These 5 samples which were positive on BAL AFB and negative on Gene Xpert,are suspected to be NON TB mycobacteria. Out of the remaining 41 samples, non TB culture results showed 8 Acinetobacter, 10 pseudomonas, 12 klebsiella, 2 e.coli,2 candida, 7 no growth on culture. According to our study, the bronchoscopic samples when subjected to Gene Xpert detect a higher number of cases which would go undetected otherwise compared to BAL AFB staining. Hence, bronchoscopy must be performed on such smear negative suspects and Gene Xpert could replace smear microscopy as initial diagnostic testing. It also helps in detecting first line drug resistance in addition.
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