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

Abstract

Even though the majority of tuberculosis (TB) programmes consider their work completed when a patient is ‘successfully’ cured, patients often continue to suffer with post-treatment or surgical sequelae. This review focuses on describing the available evidence with regard to the diagnosis and management of post-treatment and surgical sequelae (pulmonary rehabilitation). We carried out a non-systematic literature review based on a PubMed search using specific key-words, including various combinations of ‘TB’, ‘MDR-TB’, ‘XDR-TB’, ‘surgery’, ‘functional evaluation’, ‘sequelae’ and ‘pulmonary rehabilitation’. References of the most important papers were retrieved to improve the search accuracy. We identified the main areas of interest to describe the topic as follows: 1) ‘Surgery’, described through observational studies and reviews, systematic reviews and meta-analyses, IPD (individual data meta-analyses), and official guidelines (GRADE (Grading of Recommendations Assessment, Development and Evaluation) or not GRADE-based); 2) Post-TB treatment functional evaluation; and 3) Pulmonary rehabilitation interventions. We also highlighted the priority areas for research for the three main areas of interest. The collection of high-quality standardized variables would allow advances in the understanding of the need for, and effectiveness of, pulmonary rehabilitation at both the individual and the programmatic level. The initial evidence supports the importance of the adequate functional evaluation of these patients, which is necessary to identify those who will benefit from pulmonary rehabilitation.

Tuberculosis in the time of COVID-19: quality of life and digital innovation

“…Among the different QoL tools reported in the literature [24], there are generic questionnaires such as the 36-item Short-Form Health Survey (SF-36) and its shortened version with 12 questions, or specific tools such as the St Georges's Respiratory Questionnaire that are specifically used to investigate QoL in chronic respiratory diseases (tables 2 and 3).…”

Current morbimortality and one-year survival after pneumonectomy for infectious diseases

“…However, recent data contrast this information, and several authors believe that for good candidates pneumonectomy can be a safe and effective adjuvant treatment for TB, leading to good results. 24 …”

Editorial on Special Issue “Tuberculosis Drug Discovery and Development 2019”

“…In addition, Gries et al report on the most recent advances in host-directed therapies and anti-virulence compounds, which could represent a helpful complement to current anti-TB approaches [14]. In the context of additional approaches to standard antibiotic treatment, an article by Visca et al reviews the importance of post-TB treatment with the roles of surgery and rehabilitation [15]. Two candidate compounds which are in the advanced stages of development complete the section dedicated to novel medications: macozinone [16] and delpazolid [17].…”