Cardiac Dysfunction in Active Pulmonary Tuberculosis: Underestimated, Missed Routinely and Have Impact on Clinical Outcome!; Prospective Study of 600 Cases in Tertiary Care Setting in India

Patil, Shekhar; Patil, Rajesh; Gondhali, Gajanan

doi:10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a5435

Cited by 2 publications

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“…Tuberculosis in advanced stage may cause cardiac dysfunction and systemic effects which will have poor outcome if timely treatment not received [15][16][17]. Final outcome in delayed treatment initiation may lead to destroyed lung as post tuberculosis sequel and proportionate number of cases may have lung function abnormalities irrespective of radiological outcome [18][19][20]. Tuberculosis may be misdiagnosed due to confusing or overlapping clinical and radiological features in high burden setting like India [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Patil¹,

Gondhali²,

Choudhari³

et al. 2023

SAR J Med

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Tuberculosis is a more prevalent disease and the leading cause of death from an infectious agent in India. Tuberculosis in India accounts for the highest number of cases and deaths annually in the world. In spite of an efficient National tuberculosis control program for five decades, Tuberculosis is still the number one cause of death due to infectious agents in India and one third of total global deaths occurs in India due to this disease. Burden of drug sensitive and drug resistant cases is highest in the south east Asian region with maximum cases in India and China. India has launched a National strategic plan to end TB in 2017 with a target to eliminate TB by 2025. Main theme of the national strategic plan is ‘TB Free India’ with the vision of zero TB disease, zero deaths due to TB and decreasing poverty due to TB. Tuberculosis is an ancient disease and history traced before the evolution of mankind on this planet. Tuberculosis primarily affects the lung and is classified pathologically as primary, post-primary and progressive primary tuberculosis. In this case report, a 62-year male, presented with constitutional symptoms for six-month duration with partial response to medical treatment. He was having low grade fever, cough, shortness of breath, weight loss and anorexia for 6 months. His symptoms were progressive and empirically treated as enteric or typhoid fever for four to five occasions with oral and intravenous antibiotics with steroids with general physicians and family physicians. Additionally, he received empirical treatment as jaundice, viral fever, bronchitis, asthma, and generalised debilitating disease. Relatives brought to our center worsened general health with increased shortness of breath. Clinically he was having bilateral crepitations with decreased breath sounds right lower axillary and infrascapular area. Chest x-ray showed right pleural effusion with miliary opacities bilateral lung field. HRCT thorax showed typical miliary opacities with conglomerated pattern and pleural effusion on the right side of thorax. Pleural fluid analysis revealed exudative effusion with raised ADA level. He was unable to produce sputum, we have done bronchoscopy and BAL evaluation confirmed pulmonary tuberculosis and sensitivity pattern. BAL cytology documented acid-fast bacilli in smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. More awareness is required regarding symptoms, diagnosis and treatment of tuberculosis to family physicians and general practitioners as the majority of the rural population receives treatment from these health professionals.

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Section: Introductionmentioning

confidence: 99%

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Patil¹,

Gondhali²,

Choudhari³

et al. 2023

SAR J Med

View full text Add to dashboard Cite

show abstract

“…Tuberculosis in advanced stage may cause cardiac dysfunction and systemic effects which will have poor outcome if timely treatment not received [15][16][17]. Final outcome in delayed treatment initiation may lead to destroyed lung as post tuberculosis sequel and proportionate number of cases may have lung function abnormalities irrespective of radiological outcome [18][19][20][21][22][23][24]. Tuberculosis may be misdiagnosed due to confusing or overlapping clinical and radiological features in high burden setting like India [25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

Patil,

Patil

2023

SAR J Med

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Pleural effusion secondary to tuberculosis is second most common manifestation of extrapulmonary tuberculosis. Tuberculous pleural effusion is more frequently documented in India due to high TB burden setting and usually cured with universally available ATT as per NTEP program. Very few cases showed inadequate treatment response and these cases require addition of steroids to relive symptoms. Addition of steroids in management of TB pleural effusion is not routinely indicated and not recommended by NTEP as well. Clinical deterioration during antituberculosis therapy in patients whose cases have initially improved is known as a “paradoxical reaction.” In this case report, a 54-year teacher male presented with constitutional symptoms with right upper lobe nodular opacity with infiltrates treated empirically for community acquired pneumonia and progressed to left massive pleural effusion with respiratory distress diagnosed as case of Tuberculous pleural effusion by reporting raised ADA level and CBNAAT test results with MTB genome and negative Rifampicin (rpo-b) mutation. He is treated according to NTEP guided ATT schedule as per weight band in line with drug sensitive tuberculosis. He has shown good clinical and radiological response in first six weeks to ATT and later showed clinical and radiological worsening. We further reassessed and confirmed drug sensitive tuberculosis and continued same regimen. We have further evaluated for possibility of immune dysregulation in present case by doing TH1 and TH2 markers and observed TH1-TH2 dysregulation and also significantly raised IgE level. We have started oral steroids which were contoured till six weeks in tapering order along with ATT and documented significant improvement in clinical and radiological response. We have observed near complete resolution of pleural effusion after seven months and documented clinical and radiological cure after eight months of ATT. Paradoxical reaction is not uncommon, but needs prompt workup to rule out underlying drug resistant tuberculosis. Short course of steroids will give symptomatic relief in drug sensitive tuberculosis along with ATT. We recommend to rule out immune dysregulation in cases with drug sensitive recurrent pleural effusion in spite of acceptable adherence with good quality drugs for adequate duration which have showed excellent initial response to ATT.

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Cardiac Dysfunction in Active Pulmonary Tuberculosis: Underestimated, Missed Routinely and Have Impact on Clinical Outcome!; Prospective Study of 600 Cases in Tertiary Care Setting in India

Cited by 2 publications

References 0 publications

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Progressive Primary Pulmonary Tuberculosis in Current Times: Are we really heading Towards ‘End of TB’ or Still, Many Miles to go for ‘Dream Come True’?

Recurrent Pleural Effusion in Drug Sensitive Extrapulmonary Tuberculosis: Marker of Immune Dysregulation!

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