Infection prevention Dr. Ratnakumar and colleagues carried out
a systematic review and meta-analysis, which included data on 75,631 individuals from 15 studies conducted in 17 countries with varying TB incidence and income levels. Four measures of lung function were included in the analysis: forced expiratory volume in 1 second (FEV1, the volume of air can be forcefully exhaled in one second); forced vital capacity (FVC, the volume of air that can be forcefully exhaled in a single breath); FEV1/FVC ratio; FVC as a percentage of the predicted value (compares the volume to the average of a healthy person of the same age, sex and height). The study, which was supported by the charity,
Breathing Matters, found that, compared to the healthy controls, the participants with prior TB had significantly lower results on all four measures of lung function, with FEV1 more affected than FVC. Dr. Ratnakumar said: “FEV1 was 230 millilitres
lower compared to healthy controls and FVC was 140 millilitres lower. A decrease in FEV1 of 100 millilitres is considered clinically significant and is associated with an increased risk of cardiovascular and respiratory disease.” The results as a whole point to the TB survivors having smaller lungs (restrictive disease) and narrower airways with slower air flow (obstructive disease). This means that the breaths they take are smaller and take longer; breathing is less efficient and less able to respond to increased ventilatory demands such as during exercise. Analysis of the data showed the TB survivors
to have 65% higher odds of airflow obstruction (AFO) than the healthy controls. The results suggest TB can leave a lasting and widespread impact on the lungs, especially in terms of how the airways are structured. This valuable insight can help guide rehabilitation strategies and, in the longer term, aid in the development of new therapies, the researchers explained. Dr. Ratnakumar commented: “The focus, until
now, has been on the treatment of acute TB, but even when treatment is successful, individuals can be left with significant lung damage. This can cause breathlessness that can affect their ability to work and go about their day-to-day lives and reduces their quality of life. This legacy of TB has been overlooked for too long and it is vital it is recognised. “With an estimated 74 million lives saved
through tuberculosis treatment between 2000 and 2020 and a rising life expectancy, there is an urgent need for evidence-based recommendations on the diagnosis, treatment and management of post-tuberculosis lung disease. Our study also provides compelling evidence that the long-term care of individuals
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with post-tuberculosis lung disease should be an explicit component of the WHO’s ‘End TB strategy’.” Another study presented at ECCMID 2024 found an association between TB and cancer, with those with current or previous TB more likely to have a diagnosis of a variety of cancers, including lung, blood, gynaecological and colorectal cancers. The study was conducted by Dr. Jiwon Kim, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea, and Dr. Jinnam Kim, Hanyang University College of Medicine, Seoul, South Korea, and colleagues. Despite successful cure of TB being possible, complications can occur at various anatomical sites due to structural or vascular damage, metabolic abnormalities and host inflammatory response. These complications may include an increased risk of cancer, which may be influenced by host tissue and DNA damage, and/ or interruption of normal gene repair processes and growth factors present in the blood. In this study, the authors investigated the association between cancer incidence and TB compared with the general population. They found that, compared with the general population, the incidence of cancer was significantly higher in TB patients: 80% higher for all cancers combined; 3.6 times higher for lung cancer, 2.4 times higher for blood (haematological) cancers); 2.2 times higher for gynaecological cancer; 57% higher for colorectal cancer; 56% higher for thyroid cancer and 55% higher for oesophagus and stomach cancer. After adjustment, current smoking (40%
increased risk versus non-smokers), heavy alcohol consumption (15% increased risk versus regular alcohol consumption) chronic liver disease (42% increased risk versus no liver
diseases) and chronic obstructive pulmonary disease (COPD) (8% increased risk) were also identified as independent risk factors for cancer in people with TB. The authors commented: “TB is an independent risk factor for cancer, not only lung cancer, but also various site-specific cancers, after adjusting for confounders. Screening and management for cancer should be warranted in patients with TB.”
Conclusion Ultimately, intensified research and innovation will be critical to break the trajectory of the TB epidemic and reach global targets. As the latest research shows, there is also a need to address the impacts of TB in those who have been successfully treated. Going forward, this must form a key part of the global strategy and requires investment in further research and screening. To find out more about World TB Day visit
https://www.stoptb.org/
CSJ
References 1. Accesed at:
https://www.who.int/news/ item/22-09-2023-world-leaders-commit-to- new-targets-to-end-tb
2. WHO End TB strategy. Acessed at:
https://www.who.int/teams/global- tuberculosis-programme/the-end-tb-strategy
3.
https://www.southamptonbrc.nihr.ac.uk/post/ scientists-close-in-on-blood-test-to-stop- spread-of-tuberculosis
4. Schiff, H, et al. Integrated plasma proteomics identifies tuberculosis-specific diagnostic biomarkers, JCI Insight. 2024;9(8):e173273.
https://doi.org/10.1172/jci.insight.173273.
5. Boston University School of Public Health. ‘Who should receive preventive treatment for TB? Individuals of all ages with positive skin or blood test.’ ScienceDaily, 8 May 2024.
www.sciencedaily.com/ releases/2024/05/
240508190418.htm
6. Cazzola, M, et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers, Eur Respir J 2008; 31: 416–468
7.
https://www.eurekalert.org/news- releases/1039521
Useful websites
https://www.stoptb.org https://www.gov.uk/government/collections/ tuberculosis-and-other-mycobacterial- diseases-diagnosis-screening-management- and-data
https://www.who.int/campaigns/world-tb- day/2025
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