Radiological Outcome in Pulmonary, Pleural Tuberculosis and the Associated Pretreatment Factors

Abstract Background: Even after successful treatment of pulmonary or pleural tuberculosis (TB), many individuals are left with considerable lung damage. This study aims to evaluate these posttreatment radiological sequelae and to identify people at greatest risk. Objectives: The objectives were to study the various radiological sequelae at the end of treatment in patients taking antitubercular therapy (ATT); to estimate the proportion of participants showing radiological sequelae at treatment completion; and additionally, to determine the association between demographic factors, clinical factors, initial radiological extent, and other laboratory parameters with residual radiological abnormalities at the end of treatment. Methodology: Participants included smear-positive or smear-negative pulmonary or pleural TB (intrathoracic TB) patients aged more than 18 years who were initiating ATT and registered under the National Tuberculosis Elimination Program (NTEP), Government T. D. Medical College, Alappuzha. Selection was based on the study’s inclusion and exclusion criteria. Biodata were collected and recorded in the study pro forma. Routine blood investigations were performed, and a baseline chest X-ray was taken. Patients were followed up after 6 months of ATT. A repeat chest X-ray was taken at the end of treatment to reassess the extent and pattern of involvement. The collected data were entered into an Excel worksheet and analyzed using SPSS software version 16. To identify factors associated with radiological outcomes, the Chi-square test was used for qualitative variables and the t -test for quantitative variables. Results: In this study, the overall residual radiological sequelae – including both pulmonary and pleural TB – among the 110 patients were 78.18%. Of these, 82 (89.1%) pulmonary TB cases and 4 (22.22%) pleural TB cases had residual radiological sequelae. Among pulmonary TB patients with post-TB sequelae, the most common finding was fibrosis (81; 98.78%) on chest radiograph, followed by bronchiectatic changes (22; 26.87%), persistent cavitation (4; 4.87%), and calcification (3; 3.6%). Among pleural TB cases, four had residual sequelae, which consisted of pleural thickening (22.22%). Among the pretreatment factors, those found to have a statistically significant association with residual radiological sequelae were age >60 years, male gender, diabetes mellitus, smoking index >200, duration of symptoms before initiating antitubercular treatment >30 days, and microbiologically confirmed disease. Conclusion: A large proportion of patients completing ATT exhibit radiological sequelae. Pulmonary rehabilitation programs can significantly enhance patient well-being and quality of life, thereby improving the prognosis of post-TB lung damage.