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. 2023 Apr 1;27(4):248-283.
doi: 10.5588/ijtld.22.0514.

Post-TB health and wellbeing

R Nightingale  1 , F Carlin  2 , J Meghji  3 , K McMullen  4 , D Evans  5 , M M van der Zalm  6 , M G Anthony  6 , M Bittencourt  7 , A Byrne  8 , K du Preez  6 , M Coetzee  9 , C Feris  10 , P Goussard  11 , K Hirasen  12 , J Bouwer  13 , G Hoddinott  6 , M A Huaman  14 , G Inglis-Jassiem  9 , O Ivanova  15 , F Karmadwala  16 , H S Schaaf  6 , I Schoeman  17 , J A Seddon  18 , T Sineke  5 , R Solomons  19 , M Thiart  20 , R van Toorn  19 , P I Fujiwara  21 , K Romanowski  22 , S Marais  23 , A C Hesseling  6 , J Johnston  22 , B Allwood  24 , J C Muhwa  25 , K Mortimer  26
Affiliations

Post-TB health and wellbeing

R Nightingale et al. Int J Tuberc Lung Dis. .

Abstract
in English, French

TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.

La TB touche environ 10 millions de personnes chaque année et il y a aujourd’hui environ 155 millions de survivants de la TB. La TB et ses traitements peuvent entraîner des dommages permanents à la santé et au bien-être. En 2019, les représentants des communautés touchées par la TB participant au « 1er Symposium international post-tuberculose » ont appelé à l’élaboration des directives cliniques sur ces questions. Cette déclaration clinique sur la santé et le bien-être post-TB répond à cet appel et s’appuie sur le travail du symposium, qui a réuni des survivants de la TB, des professionnels de la santé et des chercheurs. Notre document offre une opinion d’expert et, dans la mesure du possible, une orientation fondée sur des données probantes pour aider les cliniciens dans le diagnostic et la prise en charge des pathologies post-TB et la recherche dans ce domaine. Il couvre tous les aspects post-TB, y compris le bien-être économique, social et psychologique, la maladie pulmonaire post-TB (PTLD), la maladie cardiaque et péricardique, la déficience neurologique, les effets chez les adolescents et les enfants, et les besoins futurs de recherche.

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Figures

Figure 1
Figure 1
Post-TB: visual abstract of the clinical statement.
Figure 2
Figure 2
Foreword – a TB survivor’s perspective, Ingrid Schoeman, TB Proof. TB Proof is a TB advocacy group based in South Africa. Ingrid Schoeman is a TB survivor and co-author of this Clinical Statement.
Figure 3
Figure 3
Rate of publications on post-TB health and well-being, 1965–2021.
Figure 4
Figure 4
Modelling and measuring post-TB wellbeing: schematic showing some of the psychological and socio-economic consequences that lead to a poor perception of HRQoL and the tools used to measure these. HRQoL = health-related quality of life; SF = Short Form (Health Survey); YLD = years lived with a disability.
Figure 5
Figure 5
Images and case descriptions corresponding to clinical patterns in post-TB lung disease (see Table 2): A) TOPD in 58-year-old male with three previous episodes of TB, a 10 pack-year history of smoking, and a FEV1/FVC of 28%. B) Focal bronchiectasis of the left lower lobe (arrow) in a 38-year-old female with two previous episodes of TB. C) Complete destruction of the left lung in a 31-year-old female, after two episodes of TB. D) Residual fibrotic band in the right upper lobe of a 46-year-old male, with one episode of TB 5 years prior. E) Right upper lobe cavity containing an aspergilloma in a 40-year-old female with recurrent haemoptysis after four previous episodes of TB. Note the dilated bronchial arteries (arrowhead). F) Chest X-ray of a 29-year-old female with pulmonary hypertension after two episodes of drug-resistant TB. Her mean pulmonary artery pressure was 65 mmHg at right heart catheterisation, and she had features of both TOPD and bronchiectasis. Images courtesy of B. Allwood. TOPD = TB-associated obstructive lung disease; FEV1 = forced expiratory volume in 1 sec; FVC = forced vital capacity.
Figure 6
Figure 6
Recommendations for assessment and care planning for TB treatment. A systematic approach to post-TB follow-up is recommended, including a baseline assessment (ideally recorded at, or just before, the end of TB treatment) to allow objective comparison of change over time. *Can be initiated at any time during or after TB treatment. mMRC = Modified Medical Research Council Dyspnoea Scale; 6MWT = 6-minute walk test; BMI = body mass index; CXR = chest X-ray; CPExT =cardiopulmonary exercise test; CT =computed tomography; DLCO = diffusion capacity of lungs for carbon monoxide measurement; PTLD = post-TB lung disease; QoL = quality of life.
Figure 7
Figure 7
Proposed approach to clinical assessment of symptomatic exacerbations of PTLD. *Lung function tests are generally not required at every clinical assessment or during an acute exacerbation but should be used as a diagnostic investigation and repeated to compare with baseline values when clinical deterioration is observed. †Based on a comparison of assessment findings with baseline assessment at end of TB treatment, and on results of current investigations. ‡Can be initiated at any time during treatment or follow-up. mMRC = Modified Medical Research Council; 6MWT = 6-min walk test; ABG = arterial blood gas; BMI = body mass index; CXR = chest X-ray; ZN = Ziehl-Neelsen; NAAT = nucleic acid amplification test; FBC = full blood count; CRP = C-reactive protein; IgG = immunoglobulin G; PCR = polymerase chain reaction; PTLD = post-TB lung disease.
Figure 8
Figure 8
Multidisciplinary team care for people with post-TB neurological disability. VP = ventriculoperitoneal; CBT = cognitive-behavioural therapy.
Figure 9
Figure 9
Future research needs. DR-TB = drug-resistant TB; PTLD = post-TB lung disease; TBM = TB meningitis; HRQoL = health-related QoL; QoL = quality of life; CVD = cardiovascular disease.
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Comment in

References

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