Rehabilitation, optimized nutritional care, and boosting host internal milieu to improve long-term treatment outcomes in tuberculosis patients.

Onno W Akkerman, Lies Ter Beek, Rosella Centis, Markus Maeurer, Dina Visca, Marcela Muñoz-Torrico, Simon Tiberi, Giovanni Battista Migliori

Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2020;92S():S10-S14

PMID: 31982628

Abstract

BACKGROUND

The holistic management of tuberculosis (TB) patients can improve life expectancy and lost organ function.

REHABILITATION

Chronic sequelae are very common among patients who survive TB, which can lead to a further decline in lung function. There is still no guidance for 'cured' patients with impaired lung function who need pulmonary rehabilitation. Additional tests for evaluation should be given after the end of treatment, as recent studies have shown the good effect of pulmonary rehabilitation for TB patients.

OPTIMIZED NUTRITIONAL CARE

Malnutrition is very common among TB patients and is related to malabsorption. The latter can cause lower drug exposure, which may result in treatment failure, increasing the risk of death, and can lead to acquired drug resistance. Malnutrition should be assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the diagnosis should lead to an individualized treatment plan, including sufficient proteins and preferably in combination with adequate training.

PROTECTIVE IMMUNE RESPONSES

Under normal circumstances, most immune cells use a glucose-based mechanism to generate energy. Therefore the patient's nutritional status is a key factor in shaping immune responses. Disease-related malnutrition leads to proteolysis and lipolysis. In the end, the identification of individuals who will benefit from immune-modulatory strategies may lead to clinically relevant markers.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Address: University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, TB Centre Beatrixoord, Haren, The Netherlands. Electronic address: [email protected].; University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, TB Centre Beatrixoord, Haren, The Netherlands. Electronic address: [email protected].; Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy. Electronic address: [email protected].; Champamalimaud Foundation, Immunosurgery, Avenida Brasilia, Lisbon, Portugal. Electronic address: [email protected].; Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy. Electronic address: [email protected].; Tuberculosis Clinic, Instituto Nacional De Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad De Mexico, Mexico. Electronic address: [email protected].; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Department of Infection, Royal London and Newham Hospitals, Barts Health NHS Trust, London, United Kingdom. Electronic address: [email protected].; Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy. Electronic address: [email protected].

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