Post-TB disease: a new topic for investigation-and why it matters

D Visca, L D Ambrosio, R Centis, E Pontali, S Tiberi, G B Migliori

Research output: Contribution to journalArticlepeer-review

Abstract

TRADITIONALLY, TB CONTROL (a term less used
now, as TB prevention, diagnosis and treatment are
preferred) is based on rapid diagnosis and effective
treatment of infectious cases.1,2 This was the core
concept inspiring the first ever strategy of TB control
by the WHO, known as the DOTS Strategy, launched
in 1995.3–6 The core activities implemented by
National TB Programmes (NTPs) worldwide were
rapid diagnosis (particularly, of infectious patients,
that is, those who were sputum smear-positive) and
effective treatment with regimens approved by the
WHO, to break the chain of transmission and rapidly
impact the curve of the epidemic.7 The last element of
the DOTS Strategy, adopted by the Stop TB Strategy
and End TB Strategy, was recording and reporting of
treatment success rate (e.g., the programmatic capacity to provide permanent protection against infection
to patients initiating treatment).8 The main effort of
NTPs has been, and still is, focused on ensuring that
as many patients as possible achieve treatment
success, defined by the WHO as those achieving
bacteriological conversion, i.e., those who are
‘‘cured’’ and those with ‘‘treatment completed’’.9
Unfortunately, historical underfunding has prevented NTPs from diverging from the initial
priorities of improving case finding and treatment
success rates.9–16 However, more recently, NTPs
have started to assess patient care beyond TB
prevention, diagnosis and treatment. After reaching
the status of ‘treatment completed’ and ‘cured’,
longer term follow-up has revealed that a proportion
of patients continue to suffer from health problems.9–16 This includes treatment sequelae with a
variety of radiological findings such as fibrosis,
cavities, pleural thickening, bronchiectasis, as well
as spirometry abnormalities with obstruction, restriction and mixed patterns.10,14,17 These sequelae
accompany a variety of signs and symptoms (residual cough, malaise, weakness, dyspnoea, difficulties
in climbing stairs or managing daily activities or
work) which affect the quality of life (QoL) of these
patients.13 Several scientific, clinical and, potentially, programmatic questions arise from these observations.
Original languageEnglish
Pages (from-to)258-261
Number of pages4
JournalThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Volume25
Issue number4
DOIs
Publication statusPublished - Apr 1 2021

Keywords

  • Humans
  • Lung
  • Treatment Outcome
  • Tuberculosis/diagnosis

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