Tuberculosis pneumothorax: Prognostic factors for unfavorable outcome

<bold>Introduction:</bold> Tuberculosis (TB) is a major public health problem in the world and in Tunisia. Tuberculosis pneumothorax (PT) is a rare but serious complication of active pulmonary tuberculosis. The objective of this study is to analyze clinical features, the treatment and the prognostic factors for unfavorable outcome of tuberculosis pneumothorax. <bold>Methods:</bold> We performed a multicentre retrospective cohort study of 56 patients with tuberculosis pneumothorax between 2004 and 2019. Unfavourable outcome was defined as: a Persistent chronic PT, chronic respiratory failure or death. <bold>Results:</bold> The mean age was 36.37 years. The sex ratio was 4. Smoking history and incarceration were noted respectively in 81.81% and 18.18% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 67.85% of cases. Duration of antituberculous treatment ranged from 6 to 15 months and was at least 12 months for resistant TB (4 cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47 days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6 cases and pleural infection in 5 of cases. Surgery treatment was necessary in 7cases. Persistent chronic tuberculous pneumothorax was noted in 8.9%, chronic respiratory failure in 1.8% and death in 10.7%. Patients with unfavourable outcomes had a significant trend toward higher radiological cavitary lesions (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. <bold>Conclusion:</bold> Tuberculosis pneumothorax is a severe form of tuberculosis that is difficult to manage, it can be life-threatening, and can cause severe complications in the long term