Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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The role of the Brazilian Tuberculosis Research Network in national and international efforts to eliminate tuberculosis

O papel da Rede Brasileira de Pesquisas em Tuberculose nos esforços nacionais e internacionais para a eliminação da tuberculose

Afranio Kritski1,a, Margareth Pretti Dalcolmo2,b, Fernanda Carvalho Queiroz Mello3,c, Anna Cristina Calçada Carvalho4,d, Denise Rossato Silva5,e, Martha Maria de Oliveira6,f, Julio Croda7,8,g

J Bras Pneumol.2018;44(2):77-81

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Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation

Tratamento da tuberculose grave e suas sequelas: da terapia intensiva à cirurgia e reabilitação

Simon Tiberi1,2,a, Marcela Muñoz Torrico3,b, Ananna Rahman1,c, Maria Krutikov1,d, Dina Visca4,e, Denise Rossato Silva5,f, Heinke Kunst2,g, Giovanni Battista Migliori4,h

J Bras Pneumol.2019;45(2):e20180324-e20180324

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Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.

 


Keywords: Extensively drug-resistant tuberculosis; Tuberculosis, multidrug-resistant; Critical care; Smoking cessation.

 


 

 


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Secretariat of the Brazilian Journal of Pulmonology
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E-mails: jbp@jbp.org.br
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