Scoping review of post-TB pulmonary vascular disease: Proceedings from the 2nd International Post-Tuberculosis Symposium.
Elizabeth H Louw, Jennifer A Van Heerden, Ismail S Kalla, Gerald J Maarman, Zoliswa Nxumalo, Friedrich Thienemann, Moises A Huaman, Matthew Magee, Brian A Allwood
Author Information
Elizabeth H Louw: Department of Medicine, Division of Pulmonology Stellenbosch University & Tygerberg Hospital Cape Town South Africa. ORCID
Jennifer A Van Heerden: Nuffield Department of Surgical Sciences, Medical Sciences Division University of Oxford Oxford UK. ORCID
Ismail S Kalla: Department of Medicine, Division of Pulmonology University of Witwatersrand Johannesburg South Africa. ORCID
Gerald J Maarman: Department of Biomedical Sciences, Centre for Cardio-Metabolic Research in Africa (CARMA), Division of Medical Physiology, Faculty of Medicine & Health Sciences Stellenbosch University Cape Town South Africa. ORCID
Zoliswa Nxumalo: Department of Medicine Stellenbosch University & Tygerberg Hospital Cape Town South Africa. ORCID
Friedrich Thienemann: Department of Medicine and Cape Heart Institute, General Medicine & Global Health Research Unit, Faculty of Health Science University of Cape Town Cape Town South Africa. ORCID
Moises A Huaman: Hubert Department of Global Health, Rollins School of Public Health Emory University Atlanta Georgia USA. ORCID
Matthew Magee: Infectious Diseases Research Unit, CCTST K Scholars Program University of Cincinnati College of Medicine Cincinnati Ohio USA. ORCID
Brian A Allwood: Department of Medicine, Division of Pulmonology Stellenbosch University & Tygerberg Hospital Cape Town South Africa. ORCID
Tuberculosis (TB) may cause significant long-term cardiorespiratory complications, of which pulmonary vascular disease is most under-recognized. TB is rarely listed as a cause of pulmonary hypertension (PH) in most PH guidelines, yet PH may develop at various stages in the time course of TB, from active infection through to the post-TB period. Predisposing risk factors for the development of PH are likely multifactorial, involving active TB disease and post-TB lung disease (PTLD), host-related and environment-related factors. Moreover, post-TB PH should likely be classified in Group 3 PH, with the pathogenesis similarly complex and multifactorial as other Group 3 PH causes. Identifying risk factors that predispose to post-TB PH may aid in developing risk stratification criteria for early identification and referral for confirmatory diagnostic tests. Given that universal screening for PH in TB survivors may be impractical and unfeasible, a targeted screening approach for high-risk individuals would be sensible. In this scoping review of post-TB PH, resulting from the proceedings of the 2nd International Post-Tuberculosis Symposium, we aim to describe the epidemiology, risk factors, and pathophysiology of post-TB PH. We emphasize diagnosing PH with an alternative set of diagnostic guidelines in resource-constrained settings where right heart catheterization may not be feasible. Research to describe the burden and distribution of post-TB PH should be prioritized as there is a current gap in knowledge regarding the prevalence and incidence of post-TB PH among persons with TB.
