STUDY OF THE CLINICAL AND DIAGNOSTIC PROFILE OF PATIENTS WITH RECURRENT PULMONARY TUBERCULOSIS

Abstract

Background: Recurrent pulmonary tuberculosis (RPTB) remains a major challenge to global tuberculosis control despite the widespread availability of effective anti-tubercular therapy. Patients who develop recurrent disease contribute significantly to ongoing transmission, increased healthcare utilization, poor treatment outcomes, and the emergence of drug-resistant tuberculosis. The recurrence of pulmonary tuberculosis may occur due to relapse of the original infection or reinfection with a new strain of Mycobacterium tuberculosis. Several demographic, behavioural, clinical, and treatment-related factors have been implicated in disease recurrence; however, regional data remain limited. Understanding these risk factors is essential for developing targeted preventive strategies and improving long-term treatment outcomes. Primary Objectives: To study various clinical features of patients with recurrent pulmonary tuberculosis. Secondary Objectives: To study associated predisposing factors for recurrent pulmonary tuberculosis. To study laboratory profile of recurrence in patients with recurrent pulmonary tuberculosis. To study prevalence of drug-resistant pulmonary tuberculosis in patients with recurrent pulmonary tuberculosis. Materials and Methods: A prospective observational study was conducted in the Department of Respiratory Medicine, Dr. Shankarrao Chavan Government Medical College and Hospital, Nanded, Maharashtra, India. A total of 200 patients diagnosed with recurrent pulmonary tuberculosis were included after obtaining written informed consent. Detailed demographic characteristics, clinical history, behavioural risk factors, previous tuberculosis treatment history, associated comorbidities, microbiological investigations, and radiological findings were recorded using a structured case record form. Sputum smear microscopy and molecular diagnostic tests (CBNAAT/GeneXpert or Truenat) were performed according to the National Tuberculosis Elimination Programme (NTEP) guidelines. Chest radiography was performed in all patients, while additional investigations were carried out whenever clinically indicated. Data were analyzed using appropriate statistical methods, and a p-value <0.05 was considered statistically significant. Results: Among the 200 patients included in the study, the majority belonged to the 45–54-year age group (28.5%), and 67% were males. Most participants were from rural areas (72%) and belonged to the lower socioeconomic class (60%). The most common presenting symptoms were cough, fever, weight loss, expectoration, and hemoptysis. Smoking and alcohol consumption were the predominant behavioral risk factors, while diabetes mellitus and undernutrition were the most frequent associated comorbidities. A history of previous treatment interruption and poor adherence to anti-tubercular therapy was observed in a significant proportion of patients. Radiological evaluation commonly demonstrated cavitary lesions and fibrotic changes, whereas microbiological investigations confirmed recurrent pulmonary tuberculosis, with a subset of patients showing evidence of drug resistance. Conclusion: Recurrent pulmonary tuberculosis predominantly affects middle-