PROLONGED FEVER DURING THE TREATMENT OF PULMONARY TUBERCULOSIS

Area of Science:

• Pulmonology
• Infectious Diseases
• Clinical Medicine

Background:

• Fever onset or persistence after initiating anti-tubercular treatment (ATT) is a clinical challenge in tuberculosis (TB) management.
• Differentiating causes of fever is critical for appropriate patient care, especially in sputum smear-positive, HIV-negative individuals.

Purpose of the Study:

• To investigate the diverse causes of prolonged or new-onset fever in patients undergoing ATT.
• To identify the etiological spectrum of fever in hospitalized TB patients receiving directly observed therapy (DOT).

Main Methods:

• A cohort of 40 male patients with sputum smear-positive, HIV-negative TB were studied.
• Patients were admitted to a sanatorium for directly observed therapy (DOT).
• Clinical, radiological, and etiological investigations were performed to determine fever causes.

Main Results:

• Direct TB complications (22.5%), TB hypersensitivity (12.5%), drug resistance (10%), and drug reactions (22.5%) were identified as causes of fever.
• Other diseases accounted for 32.5% of fevers, including superadded lung infections (15%), malaria (7.5%), and anemia (5%).
• Extensive disease and extrapulmonary dissemination were noted in a significant proportion of patients.

Conclusions:

• Fever during ATT requires comprehensive investigation beyond attributing it solely to drug resistance or TB toxemia.
• A systematic approach is essential to uncover underlying causes, including co-infections and treatment-related adverse events.
• Identifying the specific cause of fever is vital for optimizing TB treatment regimens and patient outcomes.