Post-tuberculosis morbidities and their associated mortality: moving from challenges to solutions

Area of Science:

• Pulmonology and Infectious Diseases
• Public Health Epidemiology

Background:

• Tuberculosis (TB) treatment has decreased case fatality, but 155 million survivors remain, with 58 million disability-adjusted life years (DALYs) linked to post-TB phase.
• TB survivors experience persistent lung damage, reduced function, and inflammation, increasing susceptibility to conditions like COPD, aspergillosis, bronchiectasis, and COVID-19.
• Beyond respiratory issues, TB survivors have elevated risks for cancers and cardiovascular diseases, compounded by poorer psychological and socioeconomic status, resulting in significantly higher mortality.

Purpose of the Study:

• To review the current knowledge on the prevalence, risk factors, and management of post-tuberculosis morbidities.
• To identify major post-TB morbidities and associated mortality.
• To inform intervention and research priorities for mitigating the public health impact of post-TB conditions.

Main Methods:

• Narrative review of existing evidence on post-tuberculosis morbidities.
• Identification of key risk factors contributing to long-term health consequences.
• Synthesis of information on management strategies and research gaps.

Main Results:

• Significant portion of TB-related DALYs occur post-treatment.
• Key risk factors include delayed/incomplete treatment, residual lung damage, and prolonged inflammation.
• Post-TB morbidities encompass a range of pulmonary and non-pulmonary diseases, alongside psychological and socioeconomic challenges.

Conclusions:

• Post-TB morbidities represent a substantial and ongoing public health challenge.
• Targeted interventions like host-directed therapies, smoking cessation, pulmonary rehabilitation, and screening protocols are needed.
• Further research is warranted to optimize management and reduce mortality in TB survivors.