Etiological Factors causing Persistence of Symptoms in Treated Patients of Pulmonary Tuberculosis

Abstract

Objective To find out etiological factors causing persistence of symptoms in treated patients of pulmonary tuberculosis. Methods The study was carried out in the Department of Pulmonology, Military Hospital Rawalpindi. Diagnosed patients of tuberculosis having received at least six months of anti-tuberculosis treatment and presenting with persistence of symptoms i.e. weight loss, hemoptysis, productive cough and fever were included in the study. CT scan of the patients was done followed by fiberoptic bronchoscopy. Bronchial washings of each patient were taken and submitted for acid fast bacilli smear, Mycobacterium tuberculosis culture and sensitivity, bacterial and fungal cultures. Results Ninety patients fulfilling the criteria were included in the study. Mean age patients was 42 years (±17; ranged 15 to 80 years. 31 (35%) patients were males and 59 (65%) females. 37 (41%) patients showed no evidence of infection with any microbiological organism, 22 (24%) patients had bacterial infection and 8 (9%) patients fungal infection as detected by bacterial and fungal cultures respectively. Bronchial washings of 23 (25%) patients yielded growth of Mycobacterium tuberculosis. The Ziehl-Neelsen stained smears prepared from bronchial washings showed acid fast bacilli positivity in 15 (17%) of cases. CT scan revealed bronchiectasis in 34(38%) patients, cavitating lung lesion in 30(33%) patients and no significant structural abnormality in 26(29%) patients. Conclusion Patients of tuberculosis presenting with persistence of symptoms having received anti-tuberculosis treatment require a thorough diagnostic work up including radiological investigations to rule out secondary bacterial or fungal infections and drug resistance so that further management can be done accordingly.