Outcome of TB

00:00 So what's the outcome? Well if you have non-resistant tuberculosis of a 100 cases you can expect 90 to 95% of patients can be cured, so it's a very good outcome in most patients. And people should not really die of tuberculosis, and that only really happens if they have resistant disease or if the diagnosis is made late because the patient presents very late, or they have the more severe forms such as Meningitis or miliary tuberculosis.

00:30 There is a problem with TB and that once you have had tuberculosis it can cause a lot of lung damage. Now this normally happens in people who have not been treated quickly or effectively. So this is not a common complication in the West but it's very common in people who are born abroad. And the extensive lung tuberculosis will leave extensive lung fibrosis and that can have quite marked complications. You get poor lung function because there will be extensive pleural thickening around the lung and also there seems to be a degree of airways obstruction associated with extensive tuberculosis. You can get cavities formed by the tuberculosis, and those persist after the bug has been killed and the patient is healed of TB, and those cavities have been colonized by fungi to cause mycetoma and that might cause hemoptysis, and sometimes it causes major hemoptysis. And often in the areas of lung which have been particularly affected by tuberculosis you get bronchiectasis, and in my bronchiectasis's clinic, about 5% of the patients had previous tuberculosis causing their disease and they present with recurrent bacterial infections of the lung.

01:38 So this is a chest X-ray of somebody who had tuberculosis when they were much younger.

01:44 And you can see there is an extensive scar occurring on the right hand side and the right hemi diaphragm is raised and that reflects, the fact that the right lung is much smaller than it should be.

01:53 And that's partly because of the scarring within the lung but it's also because there is a layer of pleural thickening around the outside the lung, gripping it, stopping it from being able to expand.

02:03 In addition, the right lung has quite a lot of scarring in the apices and if you do a CT scan you will see that there is quite a marked areas of bronchiectasis and the occasional small cavities in that area as well. And this is a very classic situation that occurs with people who have had an extensive case of pulmonary tuberculosis when they are younger, and leads to chronic lung disease and this patient has respiratory failure as a consequence of this, with type two restrictive failure even when he is well.