Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden

Mkoko, Philasande; Naidoo, Senlika; Mbanga, Luyanda; Nomvete, F; Muloiwa, Rudzani; Dlamini, Sipho

doi:10.7196/samj.2019.v109i3.13366

Cited by 15 publications

(9 citation statements)

References 15 publications

(23 reference statements)

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“…This would account for roughly 50% of all participants who had previous TB (38/65, 58.5% – Tables 1 and 2). This value is much lower than in a South African and a Zimbabwean study, wherein 96% and 83% of the patients with post‐TB CLD to had abnormal CXRs, respectively [32,33]. A systematic review by Meghji et al in 2016 discovered a high prevalence of radiographic abnormalities in post‐TB lung disease, the commonest of which was fibrosis (prevalence 25.0–70.4%) [34].…”

Section: Discussionmentioning

confidence: 98%

Pattern of abnormalities amongst chest X‐rays of adults undergoing computer‐assisted digital chest X‐ray screening for tuberculosis in Peri‐Urban Blantyre, Malawi: A cross‐sectional study

Twabi

Semphere

Mukoka

et al. 2021

Tropical Med Int Health

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Background The prevalence of diseases other than tuberculosis (TB) detected during chest X‐ray screening is poorly described in sub‐Saharan Africa. Computer‐assisted digital chest X‐ray technology is available for TB screening and has the potential to be a screening tool for non‐communicable diseases as well. Low‐ and middle‐income countries are in a transition period where the burden of non‐communicable diseases is increasing, but health systems are mainly focused on addressing infectious diseases. Methods Participants were adults undergoing computer‐assisted chest X‐ray screening for tuberculosis in a community‐wide tuberculosis prevalence survey in Blantyre, Malawi. Adults with abnormal radiographs by field radiographer interpretation were evaluated by a physician in a community‐based clinic. X‐ray classifications were compared to classifications of a random sample of normal chest X‐rays by radiographer interpretation. Radiographic features were classified using WHO Integrated Management for Adult Illnesses (IMAI) guidelines. All radiographs taken at the screening tent were analysed by the Qure.ai qXR v2.0 software. Results 5% (648/13,490) of adults who underwent chest radiography were identified to have an abnormal chest X‐ray by the radiographer. 387 (59.7%) of the participants attended the X‐ray clinic, and another 387 randomly sampled normal X‐rays were available for comparison. Participants who were referred to the community clinic had a significantly higher HIV prevalence than those who had been identified to have a normal CXR by the field radiographer (90 [23.3%] vs. 43 [11.1%] p‐value < 0.001). The commonest radiographic finding was cardiomegaly (20.7%, 95% CI 18.0–23.7). One in five (81/387) chest X‐rays were misclassified by the radiographer. The overall mean Qure.ai qXR v2.0 score for all reviewed X‐rays was 0.23 (SD 0.20). There was a high concordance of cardiomegaly classification between the physician and the computer‐assisted software (109/118, 92.4%). Conclusion There is a high burden of cardiomegaly on a chest X‐ray at a community level, much of which is in patients with diabetes, heart disease and high blood pressure. Cardiomegaly on chest X‐ray may be a potential tool for screening for cardiovascular NCDs at the primary care level as well as in the community.

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Section: Discussionmentioning

confidence: 98%

Pattern of abnormalities amongst chest X‐rays of adults undergoing computer‐assisted digital chest X‐ray screening for tuberculosis in Peri‐Urban Blantyre, Malawi: A cross‐sectional study

Twabi

Semphere

Mukoka

et al. 2021

Tropical Med Int Health

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“…However, the management of TB is complicated by the increasing prevalence of MDR-TB, which requires prolonged and complex therapy, and is more likely to be associated with poor outcomes [12]. Even after successful treatment, patients may have ongoing lung disease and a decreased life expectancy [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

et al. 2022

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Background Although tuberculosis (TB) is a curable disease, treatment is complex and prolonged, requiring considerable commitment from patients. This study aimed to understand the common perspectives of TB patients across Brazil, Russia, India, China, and South Africa throughout their disease journey, including the emotional, psychological, and practical challenges that patients and their families face. Methods This qualitative market research study was conducted between July 2020 and February 2021. Eight TB patients from each country (n = 40) completed health questionnaires, video/telephone interviews, and diaries regarding their experiences of TB. Additionally, 52 household members were interviewed. Patients at different stages of their TB treatment journey, from a range of socioeconomic groups, with or without TB risk factors were sought. Anonymized data underwent triangulation and thematic analysis by iterative coding of statements. Results The sample included 23 men and 17 women aged 13–60 years old, with risk factors for TB reported by 23/40 patients. Although patients were from different countries and cultural backgrounds, experiencing diverse health system contexts, five themes emerged as common across the sample. 1) Economic hardship from loss of income and medical/travel expenses. 2) Widespread stigma, delaying presentation and deeply affecting patients’ emotional wellbeing. 3) TB and HIV co-infection was particularly challenging, but increased TB awareness and accelerated diagnosis. 4) Disruption to family life strained relationships and increased patients’ feelings of isolation and loneliness. 5) The COVID-19 pandemic made it easier for TB patients to keep their condition private, but disrupted access to services. Conclusions Despite disparate cultural, socio-economic, and systemic contexts across countries, TB patients experience common challenges. A robust examination of the needs of individual patients and their families is required to improve the patient experience, encourage adherence, and promote cure, given the limitations of current treatment.

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“…Although it was possible to locate households from the addresses stored in the register, a large proportion of FTB patients had moved away or they were otherwise unable to participate. Breathlessness and lung function loss after TB treatment are well documented (Ross et al, 2010;Allwood et al, 2013;van Kampen et al, 2019), and patients with chronic lung disease who have previously had TB have been shown to have chronic respiratory symptoms and recurrent hospital admissions (Mkoko et al, 2019). In the BOLD study, TB and smoking were associated with increased shortness of breath (Grønseth et al, 2014), and an earlier work showed that a chronic productive cough among South African adults was associated with previous TB, smoking occupational exposures, and domestic fuel exposure (Ehrlich et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: A pilot study

Osman

Welte

Dunbar

et al. 2019

International Journal of Infectious Diseases

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Background: A high risk of tuberculosis (TB), chronic lung disease, and mortality have been reported among people with a history of previous TB treatment, but data from high-incidence settings remain limited. The aim of this study was to characterize general morbidity and mortality among adults who had successfully completed TB treatment in the past 5 years in a high-incidence setting in South Africa. Methods: Adults (18 years) who had completed treatment for pulmonary TB between 2013 and 2017 were randomly selected from TB treatment registers. Household visits were conducted to locate and interview former TB (FTB) patients, and bacteriological testing for TB was offered. Additional data sources were used to ascertain the vitality status of FTB patients who could not be located. Results: Addresses were located for 200 of the 223 FTB patients sampled and 89 FTB patients were contacted of whom 51 agreed to be interviewed. Approximately half reported persistent respiratory symptoms, such as shortness of breath and wheezing, and repeated lung infections. One (3.6%) of 28 patients who provided a sputum sample had culture-positive TB and another two were currently on re-treatment for TB. Fifteen deaths post treatment were ascertained, resulting in a standardized mortality ratio of 3.8 (95% confidence interval 2.3-6.3) after successful TB treatment relative to the general population. Conclusions: In this high-incidence setting, locating and interviewing FTB patients was challenging. The study findings are consistent with a high rate of respiratory disease, including recurrent TB, and substantially elevated mortality among FTB patients.

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Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden

Cited by 15 publications

References 15 publications

Pattern of abnormalities amongst chest X‐rays of adults undergoing computer‐assisted digital chest X‐ray screening for tuberculosis in Peri‐Urban Blantyre, Malawi: A cross‐sectional study

Pattern of abnormalities amongst chest X‐rays of adults undergoing computer‐assisted digital chest X‐ray screening for tuberculosis in Peri‐Urban Blantyre, Malawi: A cross‐sectional study

Living with tuberculosis: a qualitative study of patients’ experiences with disease and treatment

Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: A pilot study

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