Diagnosis and management of tuberculosis (TB) remains challenging and complex because of the heterogeneity of disease presentations. Despite effective treatment, TB disease can lead to significant short-and long-term health consequences. We review potential acute and chronic complications of TB disease and current management approaches.
Acute and subacute complications of TB disease are attributable to structural damage or vascular compromise caused by Mycobacterium tuberculosis, as well as metabolic abnormalities and host inflammatory responses. TB-related sepsis is a life-threatening acute complication for which current diagnostic and management approaches are likely inadequate. Therapeutic intensification and usage of immunomodulators are areas of ongoing research. Paradoxical reaction or symptom worsening during TB treatment may benefit from corticosteroids. Despite successful cure of TB, chronic complications can arise from anatomic alterations at disease sites. Examples include mycetomas developing within residual TB cavities, impaired pulmonary function, or focal neurologic deficits from tuberculomas.
Effective management of TB requires attention to potential structural, metabolic, vascular, and infectious complications. In some instances, individualizing treatment regimens may be necessary. Imunosuppression and other host factors predispose to complications; others occur despite adequate treatment. Public health TB programs and health systems require additional resources to provide comprehensive TB and post-TB care.
aJohns Hopkins University School of Medicine, Baltimore, Maryland
bInpatient Tuberculosis Unit, Olive View-UCLA Medical Center, Sylmar
cDavid Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
Correspondence to Maunank Shah, MD, Johns Hopkins University, School of Medicine, 725 N. Wolfe St. PCTB building-224, Baltimore, MD 21205, USA. Tel: +1 443 287 0401; fax: +1 410 955 0740; e-mail: firstname.lastname@example.org