The bacteria may show resistance to only one of the 1st line drugs or could be multi-drug resistant. When this is suspected, sputum analysis is done and then treatment is commenced. Three or more drugs from the 2nd line drugs are added to the failing regimen. The duration of such a therapy is 18-24 and follow-up for at least 2 years after cure. 15
Those patients who have radiological findings but no manifestations may also need treatment. Patients who qualify for the treatment are those above 2 years with high risk of progression.
The drugs used are isoniazid or rifampicin or isoniazid and rifapentine.
Recommended for high risk groups – post exposure, living in area with high incidence of tuberculosis, immunosuppressed patients.
BCG vaccine helps in reducing incidences of military tuberculosis and meningitis more than the pulmonary tuberculosis 14
Bed rest in acute cases, proper nutrition and symptomatic treatment.
TB disease can lead to significant short-and long-term health consequences. Current or prior Tuberculosis disease can lead to metabolic, structural, systemic or infectious derangements in the body, and hence lead to complications. The reemergence of TB has led to drug resistance which leads to complications that are more severe and which makes treatment challenging.16
? Acute complications
1. Tuberculosis sepsis and acute respiratory failure: Cause of high mortality rate in individuals presenting with sepsis and septic shock even with adequate treatment.
2. Paradoxical reaction: Worsening of symptoms while treating Tb sepsis happens as a result of an exaggerated immune response to the antigens of the dying organism.17
3. Massive Hemoptysis: Pulmonary Tb can lead to hemoptysis by erosion into the bronchial and pulmonary circulation leading to deleterious gas exchange impairment or hemodynamic collapse.
4. Pleural Effusion: Presents as one of the leading inflammatory diseases in Tb endemic areas, occurring more commonly in middle-aged and elderly people.18
? Long-term complications
1. Lung scarring or fibrosis
2. Bronchiectasis: Mainly atelectasis and pulmonary fibrosis cause the abnormal and permanent dilatation of bronchi.
3. Chronic Pulmonary Aspergillosis: Colonisation of TB cavity by Aspergillus fumigatus and formation of a fungal ball.
4. Chronic Obstructive Pulmonary Disease
Extra pulmonary Complications
1. Tuberculosis pericarditis: Tuberculous pericarditis develops from contiguous spread from mediastinal nodes or heamatogenous seeding during dissemination with mycobacteremia. In endemic countries, TB is among the most common causes of pericardial disease.
2. TB uveitis: Leading to residual blindness
3. Spinal TB: Resulting in loss of structural integrity and neurological deficit.
4. The Peritoneal disease can cause intestinal obstruction
5. Genitourinary TB: Can result in ureteral strictures, and hydronephrosis
HIV associated Tb complications
HIV is famous for increasing the mortality and morbidity rates among Tuberculosis infected people. Extrapulmonary Tb and disseminated Tb prevalence are increased in HIV- infected individuals.19 Also, infection with atypical Mycobacterium has unexpected progression and poor response to conventional treatment regimen. All of these lead to bad prognosis.