Pulmonary Hypertension in Patients with Treated Pulmonary Tuberculosis: Analysis of 14 Consecutive Cases

Abstract

Background:Pulmonary tuberculosis (PTB) is an increasing global health problem that continues to cause significant morbidity and mortality. The impact of PTB has been measured in terms morbidity and mortality and little attention has been paid to continuing respiratory disability in those who were cured. Pulmonary hypertension (PHT) is a serious respiratory disability that results from structural lung damage and chronic hypoxia. This study was conducted to investigate the presence of PHT in a cohort of treated PTB patients who presented with shortness of breath.Methods:This is a cross-sectional study that included 14 consecutive patients who were cured of PTB and presented with shortness of breath. Demographic and clinical data were recorded for all patients. PHT was diagnosed using Doppler echocardiography.Results:Fourteen patients who were treated for PTB and were found to have PHT were studied. All patients were sputum smear negative at the time of the study. The mean age (SD) was 43.1 (13.6) and half of the patients were males. The mean number of years since PTB was diagnosed (SD) was 9.4 (10.9). All patients had abnormal chest x-rays. The commonest radiological abnormality was fibrocavitation which occurred in 50% of patients. Estimated pulmonary artery systolic pressure (PASP) of 51 to 80 mm/Hg was found in 9 patients (64.3%) whereas PASP of 40 to 50 mm/Hg was found in 4 patients (28.6%) and one patient had PASP more than 80 mm/Hg.Conclusions:Different grades of PHT occurred in this cohort of treated PTB patients on average about 9 years after cure. The findings of this study support implementation of strategies for early detection and prevention of PTB. For those who were cured from PTB, longer periods of disability should be implemented in assessment of disease burden.

Rationale and design of the Pan African Pulmonary hypertension Cohort (PAPUCO) study: implementing a contemporary registry on pulmonary hypertension in Africa

“…Another study from Egypt found a PH prevalence of 9% in patients seropositive for schistosomal antibodies. Ahmed et al 18 from Sudan described 14 consecutive cases of PH with previously treated pulmonary TB and concluded that PH can even occur after resolution of TB, most likely due to persistent lung destruction. These data suggest that left heart disease, chronic lung disease, RHD, HIV, schistosomiasis and SCD might be the most common underlying diseases to cause PH within the spectrum of aetiologies of PH that we will find within the Pan African Pulmonary hypertension Cohort (PAPUCO)…”

Correlation of chest computed tomography findings with dyspnea and lung functions in post-tubercular sequelae

“…This is comparable to the median age of 43 years in a study on PAH in patients with post-TB-sequelae by Ahmed et al . [25] Thus, patients developing PAH as sequelae of TB are younger than patients developing PAH secondary to chronic obstructive airway disease (median age 66 years). [26] In our study, there were significant differences in the median TMS and TLS in patients with or without pulmonary artery dilatation.…”

“…This is in agreement with the study by Ahmed et al . [25] in which fibrocavitary disease was seen in 50% of patients with PAH due to PTB sequelae. Development of PAH in post-TB sequelae has been attributed to both structural lung damage and repeated secondary infections.…”

Pulmonary Hypertension Is a Probable NO/ONOO−Cycle Disease: A Review

“…For example, pulmonary tuberculosis oen leads to PAH [122][123][124] and not to, surprisingly, tuberculosis produces substantial elevation of much of the in�amma-tory cascade, including elevation of NF-B in�ammatory cytokines, iNOS induction, NO, and the marker of peroxynitrite (ONOO − ), 3-nitrotyrosine [125].…”