Tuberculosis associated pulmonary hypertension: The revelation of a clinical observation

Bhattacharyya, Parthasarathi; Saha, Debasri; Bhattacherjee, Pratyaya Deep; Das, Soumen; Bhattacharyya, Pinak Pani; Dey, Ranjan Kumar

doi:10.4103/0970-2113.177433

Cited by 18 publications

(16 citation statements)

References 14 publications

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“…Another study by Bhattacharya et al has also reported PH in patients with tuberculosis. 19 Patel et al have described 12% cases of PH to develop from tuberculosis. 20 Tuberculosis is the dominant etiology of PH in (66.21%) this study.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Tuberculosis; A Dominant Etiology of Pulmonary Hypertension in Endemic Areas

2020

APMC

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Background: Many patients with chronic lung disorders like infections, COPD, ILD, OSA & Thrombo-embolism, present with dyspnea, not showing adequate improvement by conventional treatment. Most of these were diagnosed as pulmonary hypertension by further multidisciplinary work-up. Such patients show reduced life expectancy due to late diagnosis and insufficient treatment. Many TB patients often remain undiagnosed in this context. The understanding of etiology and risk factors is essential for a high index of suspicion. Objective: To explore the etiology of Pulmonary Hypertension in chronic respiratory patients. Study Design: A Retrospective Observational Study. Settings: Male pulmonology ward, Gulab Devi Chest Hospital, Lahore Pakistan. Duration: 37 months from January 2014 to February 2017. Methodology: 231, consecutive cases, having Age >14 years with clinical and radiological suspicion of pulmonary hypertension were included. Patients having Age >90 years and <14years, not willing for further investigations were excluded. Detailed history, physical examination, radiological, hematological, bacteriological biochemical and immunologic findings were recorded. PH was diagnosed by ECG, Echocardiography, CT-Angiography. HRCT thorax & PFTs, were employed to recognize the underlying lung disorders. Risk factors were identified. Data tabulated, analyzed statistically and conclusions were drawn. Results: 69/231 (29.87%) cases with active and 76/231(32.90%) with old-treated TB, 50(21.64%) COPD, 10(4.32%) pneumonia, 5(2.16%) CLD, six bronchiectasis and three cases of chest deformities were diagnosed PH. Cigarette smoking, DM and obesity were major risk factors. Conclusion: Pulmonary Tuberculosis can be the dominant etiology of PH in high prevalence populations.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Tuberculosis; A Dominant Etiology of Pulmonary Hypertension in Endemic Areas

2020

APMC

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“…Echocardiography revealed pressure gradient ≥40 mmHg in pulmonary artery and considered to be pulmonary hypertension. 26,27 However, the gold standard diagnostic modality of pulmonary hypertension is right heart catheterization (RHC). But a study comparing RHC and echocardiography reported that echocardiography is a reliable and valid diagnostic method for pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

Long term follow-up of multidrug resistant tuberculosis in a pubertal child

Kurniawan

Setyoningrum

Suryawan

2018

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Increasing awareness of the rising global rates of multidrug-resistant tuberculosis (MDR-TB) has led to a concerted international effort to confront this disease. Nonetheless, despite cure rates >80% in some programs, MDR-TB patients tend to have chronic disease and require prolonged therapy.1-3 Little is known about the long-term results and follow-up of patients with MDR-TB, include the recurrence rate and chronic disability in patients who have recovered from TB.4 There are many side effects and adverse reactions to drugs can occur during MDR-TB treatment. These could be physical and or psychological, as well as reversible or irreversible. Treatment of MDR-TB requires a combination regimen, consists of second and third-line anti-tuberculosis drugs which more toxic than first-line drugs. Additionally, MDR-TB treatment requires a long duration of treatment (18-24 months) and causes discomfort in the patient.5 In a cohort of 60 patients treated for MDR-TB, the most common side effects included gastritis (100%), dermatological disorders (43%), and peripheral neuropathy (16.7).6 While in a cohort of 75 patients, the incidence of depression, anxiety, and psychosis for MDR-TB treatments was 13.3%, 12.0%, and 12.0%, respectively.7 Aggressive and effective management are needed so the patient can tolerate the treatment and remain adhere the treatment.8 Long-term follow-up is required for the rehabilitation of disorders due to psychosocial sequelae. As such, psychosocial support can be benefit pediatric MDR-TB patients. Here, we present a case report on a two-year follow-up of a pubertal child with MDR-TB, focusing on medical aspects and her development.

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“…The possible association between PTB and PH has been suggested by several authors. [1 , 2] To date, however, there has been a paucity of data confirming this suspicion, with a study [3] from India showing that 15% of patients with PH had evidence of previous PTB.…”

Section: Editorialmentioning

confidence: 99%

Screening for pulmonary hypertension secondary to pulmonary tuberculosis

Raine

2020

Afr J Thorac Crit Care Med

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It is likely that some patients who have had pulmonary tuberculosis (PTB) will go on to develop pulmonary hypertension (PH). PTB affects many compartments of the lung with injury to airways, parenchyma and loss of pulmonary vascular bed. The possible association between PTB and PH has been suggested by several authors. [1,2] To date, however, there has been a paucity of data confirming this suspicion, with a study [3] from India showing that 15% of patients with PH had evidence of previous PTB. This issue of the AJTCCM contains the results of a pilot study of patients with previously treated PTB who were evaluated for the presence of PH. [4] The 20 patients included were screened for many other recognised causes of PH, and subjected to clinical, electrocardiographical, radiological, pulmonary function and echocardiographical testing. None of the patients had symptoms of dyspnoea, and there were no clinical findings suggestive of PH. Approximately one-third had electrocardiographical changes, and 85% had at least one chest radiographical feature compatible with PH. Pulmonary function was within normal limits. All patients underwent echocardiography and none of them were found to have elevated pulmonary artery pressures. This small pilot study does not exclude the possibility of PH as a consequence of PTB, but raises the question of which patients, of the many who have had PTB, should undergo further evaluation. Most algorithms for screening for PH approach this issue by suggesting clinical suspicion, followed by echocardiography. [5-7] Dyspnoea is the most prominent symptom in PH [8] and the absence of this, perhaps, explains the results of this pilot study. Clinical examination, electrocardiography and chest radiology are likely to be helpful in more severe disease. Chest radiology with enlargement of the pulmonary artery associated with right ventricular enlargement, or peripheral pruning, had a high sensitivity and specificity for PH in patients with a 50% pre-test probability of PH. [9] Kalla et al. [4] describe enlarged pulmonary arteries in 75% and pruning in 25% of patients, but do not mention whether these were combined. Echocardiography remains the most helpful screening tool, with chest computed tomography, ventilation-perfusion scans and right heart catheterisation remaining essential investigations once the diagnosis of PH is likely. [5] PH secondary to PTB is likely to be multifactorial in origin. The prevalence remains unknown, and further studies to ascertain the true prevalence remain important. As a start, future studies should use symptoms, particularly dyspnoea, as an initial screening test to enhance detection.

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Tuberculosis associated pulmonary hypertension: The revelation of a clinical observation

Cited by 18 publications

References 14 publications

Pulmonary Tuberculosis; A Dominant Etiology of Pulmonary Hypertension in Endemic Areas

Pulmonary Tuberculosis; A Dominant Etiology of Pulmonary Hypertension in Endemic Areas

Long term follow-up of multidrug resistant tuberculosis in a pubertal child

Screening for pulmonary hypertension secondary to pulmonary tuberculosis

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