TB - before and after treatment

A fairly recently published review of TB patients found that even after completion of the medication many did not return to full health. The assessment is of health-related quality of life (HRQL)

HRQL broadly describes how well individuals function in daily lives and their own perception of well-being in physical, psychological, and social aspects

and the evidence suggests that TB diminishes a patients HRQL. Whether the cause is psychological, physiological or social, or a combination of, remains unclear. One method to measuring overall health is the SF-36 or short-form health survey of 36 questions.

One aspect that does not seem to be properly addressed in current literature is the psychological impact of TB therapy

The knowledge of a deadly and stigmatized disease lying dormant in his/her body may also induce anxiety and fear..

..after receiving 6 months of preventive therapy with isoniazid, the mental well-being of people with LTBI decreased significantly.

The outcomes can be worse for active TB therapy

after the 6 month of treatment, active TB patients scored significantly lower at SF-36 PCS and MCS (mental component) summary scores compared to people with LTBI.

Poor health persisted after completion of TB treatment;

Muniyandi et. al. assessed the HRQL in a sample of previous TB patients one year after successful completion of treatment. 40% of these people reported persistent symptoms, such as breathlessness, cough, chest pain, and occasional fever. 

The authors conclude by unequivocally stating that TB does have a negative impact on HQRL but uncertainty exists in determining the most correct method of assessment.

This study generated the following response from the University of Texas, dated 19 January 2010 and the following is extracted from the full article - my bold.

Measurement of health is contentious because of the complexity and abstract nature of health itself. Despite these controversies data on health outcomes, especially among populations affected by illnesses that cause low mortality rates, are crucial for shaping health care policy. Tuberculosis in low tuberculosis-burden areas is an example of such an illness. Mortality is rare but as the authors analysis demonstrates poor health persists despite microbiological cure of tuberculosis disease. As a result tuberculosis has a greater effect on population health than is apparent from incidence and mortality data. We appreciate the author's review of this topic and find from their analysis convincing support for expanding LTBI treatment guidelines. Currently only treatment of latent tuberculosis infection (LTBI) can prevent pulmonary impairment after tuberculosis.