パキスタンにおける結核の気管支拡張症への影響

タイトル: Post Tuberculosis (TB) Bronchiectasis versus Non-TB Bronchiectasis in Northern Pakistan: A single centre retrospective cohort study on frequency, demographics, microbiology, and complications

概要: IntroductionWhile Post Tuberculous (TB) Bronchiectasis is the most common cause of Bronchiectasis in South Asia, there has been little research into its microbiology and clinical characteristics in Pakistan. This single centre retrospective cohort study at Bach Christian Hospital (BCH) in rural Northern Pakistan seeks to address this issue. MethodsDemographic, Imaging, Aetiological and Microbiological data were obtained from 32 patients with Bronchiectasis at BCH from between January 2023 and December 2023(1-3). Results76% (25/32) of all cases of Bronchiectasis were Post TB. TB infection was seen in 5 cases of Post TB Bronchiectasis, TB with bacterial or fungal co infections in 4, and single bacterial infections in 4. In post TB Bronchiectasis 4 patients had growth of a single bacterium. Drug sensitivities were obtained for bacterial isolates. One patient each with Post TB and Non-TB Bronchiectasis died from Type 2 Respiratory failure despite appropriate treatment. 2 patients with Post TB Bronchiectasis and destroyed lung syndrome improved but with ongoing significant respiratory impairment(4). All other patients improved with treatment. DiscussionO_LIThe frequency of Post TB Bronchiectasis is very high even for South Asia(5-8). C_LIO_LIA significant number (8/24) of Post TB Bronchiectasis had re-infection or failure to improve despite appropriate drug treatment. TB PCR (Polymerase Chain Reaction) on Bronchoalveolar lavage (BAL) was key in the management of these patients(9). C_LIO_LIAmong patients with Post TB Bronchiectasis, those with co-infection present a difficult treatment challenge. C_LIO_LISome patients with Post TB Bronchiectasis have significant complications such as destroyed lung syndrome which is difficult to manage. C_LIO_LIDrug susceptible bacteria and NTM were less commonly isolated than in other studies(10-12). C_LI ConclusionFurther research is needed particularly to manage Post TB Bronchiectasis patients with co-infections or complications such as significant structural lung disease. Key MessagesO_ST_ABSWhat is known about this topicC_ST_ABSTuberculosis (TB) is the most common cause of bronchiectasis in South Asia, but little is known about microbiology or clinical characteristics of post-TB Bronchiectasis. What this study addsPost TB Bronchiectasis has a very high prevalence in our region, with TB PCR key for diagnosis of TB re-infection in some cases. Mycobacterial, Bacterial and Fungal co-infections form a treatment challenge, as does significant structural lung disease such as destroyed lung. How this study might affect research, practice, or policyTB PCR testing is a valuable tool in Post TB Bronchiectasis and further research and larger-scale studies are needed to determine optimal treatment for co-infections and significant structural lung disease.