Post-Tuberculosis Infections and Chronic Lung Disease

There is an increased awareness of the long-term physical, psychological and socioeconomic consequences that can follow apparently successful treatment for tuberculosis (TB). In this chapter, we describe the high burden of residual lung damage post-treatment for pulmonary tuberculosis, as well as the common associated respiratory infections. Patterns of post-TB lung disease (PTLD) are heterogenous, with no standardised tools for diagnosis or measurement. However, it is clear that the condition includes pleural, parenchymal and airway pathology, which may be particularly severe after multidrug resistant disease. Prospective data describing the long-term sequelae of PTLD are limited, but given the high burden of bronchiectasis, residual cavities and parenchymal destruction, these likely include infective exacerbations with bacterial or viral pathogens, and superimposed infection with aspergillus and non-tuberculous mycobacteria. There are few data reporting the incidence of post-TB infections amongst (an increasing number of) TB survivors in high-or low-income settings, but basic approaches to their diagnosis and management are described here. The importance of broad respiratory care, including tobacco cessation, and the need for further evidence for interventions to improve long-term respiratory outcomes after completing treatment for TB are highlighted.