Medicine - Medicine
Pulmonary and functional status of patients after treatment for pulmonary tuberculosis
Mycobacterium tuberculosis (TB) represents the second largest infectious cause of death, with the developing world carrying a disproportionate burden of disease.1 The challenge of curbing the global TB epidemic is compounded by the recent proliferation of multidrug resistant (MDR) strains.2 Evidence suggests that pulmonary TB may cause long-term respiratory sequelae after patients are cleared of bacteriologic infection, especially among patients treated for MDR-TB.3 However, few longitudinal studies have been conducted to characterize long-term respiratory sequelae in TB patients and to compare outcomes between MDR versus drug-sensitive cases. In addition, the biologic mechanism underlying the association between past TB infection and subsequent impairment of lung function has not been elucidated. We hypothesize that pulmonary function and functional status decline at a greater rate among individuals previously treated for pulmonary TB compared to controls with no TB history and that this rate is greatest among participants previously treated for MDR-TB. Further, we hypothesize that these differences in rate of decline arise from prolonged low-grade local and systemic inflammation, the extent of which varies by disease status. We propose a 2-year, longitudinal study of participants with and without history of TB in resource-poor, peri-urban sector of Lima, Peru. Ultimately, we aim to characterize the relationship between history of TB and pulmonary and functional status, correlating longitudinal trends in lung function with biomarkers of inflammation. This work will allow us to obtain preliminary data for an R01 proposing a large, prospective cohort study to establish a causal relationship between TB and chronic lung disease.
Robert Gilman, SPH, International Health; William Checkley, Medicine