Clinical and Imaging Features of Adults with Recurrent Pulmonary Tuberculosis - A Prospective Case-Controlled Study

Abstract

Background: Recurrent pulmonary tuberculosis (RPTB) is a growing, important and neglected problem affecting treated TB patients and TB health services across the world, particularly in sub-Saharan Africa. Analyses and identification of differences in clinical features between recurrent PTB and newly diagnosed PTB may lead to improved management recommendations. Methods: Between September 1 st 2019 and January 31 st 2020, we performed a prospective case controlled study of clinical and imaging features of patients with recurrent pulmonary tuberculosis and compared them with those of newly diagnosed PTB cases. Recurrent PTB was defined as a patient with bacteriologically confirmed active PTB who was previously successfully treated for PTB and was cured. A control was defined as a patient who presents for the first time with bacteriologically confirmed PTB. Clinical and radiological features were assessed and documented. Chi-square and t-test were used to test the difference between proportion and continuous data, respectively. Logistic regression analysis was done to determine factors associated with RPTB using SPSS version 23 software. Results: A total of 312 patients with PTB were enrolled (104 RPTB cases and 208 newly diagnosed controls). Clinically hemoptysis was more common in RPTB compared to controls 28/104 (26.9%) vs 35/208 (16.8%), P = 0.036. Chest pain was significantly less common among patients with RPTB compared to controls 33 (31.7%) vs 92 (44.2%), P = 0.034. A higher proportion of RPTB presented with cavitation 34/104 (32.7%) compared to control 44/208 (21.2%) P = 0.027. The median score for lung pathology was higher among patients with RPTB (50) compared to controls (30); P = 0.001. Lung function of patients with RPTB at diagnosis of index TB were more likely to show mixed restrictive and obstructive pattern 36/104 (34.6%) compared to controls 31/208 (14.9%). p<0.001. Multivariate analysis showed that patients older than 45 years of age (adjusted odds ratio [aOR]: 3.59, 95% CI: 1.38-9.32), those with hemoptysis (aOR 1.96, 95% CI: 1.04-3.69) p=0.04) and fibrosis on chest x rays (aOR 2.18, 95% CI: 1.16-4.10) were significantly associated with recurrent PTB.

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

“…This finding may apparently contradict other studies that have reported TBDM comorbidity to be associated with greater TB severity and a more severe clinical presentation of TB in individuals with TBDM compared to those with APTB alone [ 64 , 65 ]. However, we consider that this can be explained by the absence of relapse TB cases in the TBDM group, which generally predisposes patients to greater lung injury [ 66 ]. The fact that approximately 56% of individuals with TBDM had a good glycemic control at the start of standard TB treatment (A1c <7%), influenced mycobacterial load, improved metabolism, and enhanced immunity against the causative agent of TB in individuals with TBDM [ 67 - 69 ].…”

Factors affecting the treatment outcome of injection based shorter MDR-TB regimen at a referral centre in India

“…This may be due to previously treated patients had a higher proportion of smear-positive cases or extensive cavitation on chest radiograph as compared to new patients [24], Increased duration of exposure of ATT in the past also increases the risk of the development of mutation.…”

Tuberkulosis Paru Berulang: Sebuah Review Narasi

“…Meskipun penyembuhan mikrobiologis, setiap episode TB Paru (PTB) dikaitkan dengan ketakutan dan gejala sisa jangka panjang yang tidak sepenuhnya dan sistematis ditangani dengan pengobatan anti-tuberkulosis. (Nagu et al, 2021) Dengan demikian, episode PTB yang berulang menjadi predisposisi pasien untuk cedera paru lebih lanjut. Analisis dan identifikasi perbedaan fitur klinis antara kasus TB baru dan berulang dapat mengidentifikasi perbedaan mendasar yang dapat mengarah pada rekomendasi manajemen yang lebih baik…”