5/11/07
Tuberculosis (tb) Part 4
Author: Ibrahim Machiwala
Complications:
• Late complications of pulmonary TB include relapse, aspergilloma, bronchiectasis, broncholithiasis, fibrothorax and possibly carcinoma. A copy of the chest radiograph at the time of completion of therapy should be provided to the patient to facilitate the diagnosis of late complications.
o The Relapse rate following appropriate completed therapy is only 0-4% and occurs within the first 2years after completion. Therefore re-treatment usually is not necessary, especially after DOT.
o Aspergilloma is a fungus ball that develops in a residual lung abnormality (e.g. pneumatocele, bulla, bleb, and cyst). It may appear as a crescent sign on chest radiographs. Other super infections may manifest with an air fluid level and often contain mixed bacteria, including anaerobes.
o Hemoptysis is the most common late complication. Broncholithiasis is the result of spontaneous lymph node migration into the bronchoial tree and may be associated with postobstructive pneumonia or esophageal perforation. Chronic bronchitis may develop from bronchiectasis; bleeding from submucosal bronchial veins usually is self-limited.
o Fibrothorax is the development of trapped lung due to pleural fibrosis and scarring.
o The risk for carcinoma is controversial but should be considered with newly developing clubbing.
Prognosis:
• The relapse rate following appropriate therapy is only 0-4% and occurs within the first 2 years after completion. Following successful completion of DT, most cases of recurrent TB probably are due to re-infection rather than endogenous reactivation.
Medical / Legal Pitfalls:
• Laws vary from state to state, but communicable disease laws typically empower public health officials to investigate suspected cases of TB, including patient's contacts. In addition, patients may be incarcerated for noncompliance with therapy. For example, in the Denver Metro Tuberculosis Clinic from 1984 – 1994, 5% who were lost incarcerated for noncompliance and an additional 5% who were lost to follow-up before completing therapy would have been candidates for incarceration.
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Author: Ibrahim Machiwala
Complications:
• Late complications of pulmonary TB include relapse, aspergilloma, bronchiectasis, broncholithiasis, fibrothorax and possibly carcinoma. A copy of the chest radiograph at the time of completion of therapy should be provided to the patient to facilitate the diagnosis of late complications.
o The Relapse rate following appropriate completed therapy is only 0-4% and occurs within the first 2years after completion. Therefore re-treatment usually is not necessary, especially after DOT.
o Aspergilloma is a fungus ball that develops in a residual lung abnormality (e.g. pneumatocele, bulla, bleb, and cyst). It may appear as a crescent sign on chest radiographs. Other super infections may manifest with an air fluid level and often contain mixed bacteria, including anaerobes.
o Hemoptysis is the most common late complication. Broncholithiasis is the result of spontaneous lymph node migration into the bronchoial tree and may be associated with postobstructive pneumonia or esophageal perforation. Chronic bronchitis may develop from bronchiectasis; bleeding from submucosal bronchial veins usually is self-limited.
o Fibrothorax is the development of trapped lung due to pleural fibrosis and scarring.
o The risk for carcinoma is controversial but should be considered with newly developing clubbing.
Prognosis:
• The relapse rate following appropriate therapy is only 0-4% and occurs within the first 2 years after completion. Following successful completion of DT, most cases of recurrent TB probably are due to re-infection rather than endogenous reactivation.
Medical / Legal Pitfalls:
• Laws vary from state to state, but communicable disease laws typically empower public health officials to investigate suspected cases of TB, including patient's contacts. In addition, patients may be incarcerated for noncompliance with therapy. For example, in the Denver Metro Tuberculosis Clinic from 1984 – 1994, 5% who were lost incarcerated for noncompliance and an additional 5% who were lost to follow-up before completing therapy would have been candidates for incarceration.
About the Author:
Dr. D.S. Merchant Resident Medicine AKUH
Gold Medalist (Anatomy & Histology)
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