Post-tuberculosis treatment paradoxical reactions

Paradoxical reactions (PR) to tuberculosis (TB) treatment are common during treatment, but have also been described after treatment. A presentation with recurrent signs or symptoms of TB after cure or completion of prior treatment needs to be differentiated between microbiological relapse and a para...

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Bibliographic Details
Published in:Infection Vol. 52; no. 5; pp. 2083 - 2095
Main Authors: Hermans, Sabine M., Akkerman, Onno W., Meintjes, Graeme, Grobusch, Martin P.
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2024
Springer Nature B.V
Subjects:
Antitubercular Agents - therapeutic use
Central nervous system
Chemical synthesis
Diagnosis
Epidemiology
Family Medicine
Female
General Practice
Humans
Incidence
Infectious Diseases
Inflammation
Internal Medicine
Lymph nodes
Male
Medicine
Medicine & Public Health
Recurrence
Review
Signs and symptoms
Tuberculosis
Tuberculosis - diagnosis
Tuberculosis - drug therapy
Tuberculosis - epidemiology
Tuberculosis, Lymph Node - diagnosis
Tuberculosis, Lymph Node - drug therapy
Recurrence
Paradoxical reaction
Tuberculosis
Lymph node
Paradoxical upgrading
Paradoxical response
ISSN:0300-8126, 1439-0973, 1439-0973
Online Access:Get full text
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Summary:Paradoxical reactions (PR) to tuberculosis (TB) treatment are common during treatment, but have also been described after treatment. A presentation with recurrent signs or symptoms of TB after cure or completion of prior treatment needs to be differentiated between microbiological relapse and a paradoxical reaction. We searched all published literature on post-treatment PR, and present a synthesis of 30 studies, focusing on the epidemiology, diagnosis and management of this phenomenon. We report an additional case vignette. The majority of studies were of lymph node TB (LN-TB), followed by central nervous system TB (CNS-TB). A total of 112 confirmed and 42 possible post-treatment PR cases were reported. The incidence ranged between 3 and 14% in LN-TB and was more frequent than relapses, and between 0 and 2% in all TB. We found four reports of pulmonary or pleural TB post-treatment PR cases. The incidence did not differ by length of treatment, but was associated with younger age at initial diagnosis, and having had a PR (later) during treatment. Post-treatment PR developed mainly within the first 6 months after the end of TB treatment but has been reported many years later (longest report 10 years). The mainstays of diagnosis and management are negative mycobacterial cultures and anti-inflammatory treatment, respectively. Due to the favourable prognosis in LN-TB recurrent symptoms, a short period of observation is warranted to assess for spontaneous regression. In CNS-TB with recurrent symptoms, immediate investigation and anti-inflammatory treatment with the possibility of TB retreatment should be undertaken.
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ISSN:0300-8126
1439-0973
1439-0973
DOI:10.1007/s15010-024-02310-0