Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation

Abstract

Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.

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

“…A limited number of observational studies and reviews are available on the topic; the majority suggests that adjuvant surgery in selected patients may be useful to improve treatment outcomes [2,[15][16][17][18][19][20][21][22][23][24][25][26][27]. However, the strength of the conclusions from these studies is somewhat limited by the risk of bias related to the variability of the centres' procedures, patients' profiles, treatment regimens, timing and types of surgical procedures, and it is difficult, if not impossible, to identify homogenous patients to compare among studies.…”

The treatment of tuberculosis under current conditions

“…До середины XX в. действенных антибактериальных средств против туберкулеза не существовало, лечение основывалось на климатотерапии, лечебном питании и охранительном режиме и весьма рискованных хирургических методах [7][8][9][10]. После открытия в США З. Ваксманом и А. Шатцом в 1943 г. стрептомицина началась эра химиотерапии туберкулеза, появилась возможность излечения больных туберкулезом.…”

Pulmonary rehabilitation and tuberculosis: a new approach for an old disease

“…A very important part is represented by the education that aims to improve the long-term adherence to treatment and the participation in daily life activities and social reintegration. The palliative care should also be included in very severe patients with MDR-TB (32,34). An Indian research emphasized the benefits of a homebased care programme for patients with MDR-TB.…”

“…After 1 month, the rib expansion exercise can start asymmetrical suspension with the espalier, swimming (crawl) (36). Sometimes, there is poor healing with pleural fibrosis and consecutively restrictive syndrome (34). In these cases, the procedures used by physiotherapist used are breathing education, exercise training, muscle tonifying and hydrotherapy (37).…”