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Review
. 2012 Feb;12(2):157-66.
doi: 10.1016/S1473-3099(11)70244-4.

Surgical treatment of drug-resistant tuberculosis

Russell R Kempker  1 , Sergo Vashakidze, Nelly Solomonia, Nino Dzidzikashvili, Henry M Blumberg
Affiliations
Review

Surgical treatment of drug-resistant tuberculosis

Russell R Kempker et al. Lancet Infect Dis. 2012 Feb.

Abstract

The global emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has led to the re-examination of surgery as a possible adjunctive treatment. We present the case of a 26-year-old HIV-seronegative patient with XDR pulmonary tuberculosis refractory to medical therapy. Surgical resection of the patient's solitary cavitary lesion was done as adjunctive treatment, and a successful outcome with a combination of surgery and drug therapy was achieved. We review the history of surgical therapy for tuberculosis and reports of its role in treatment of MDR and XDR tuberculosis. 26 case series and cohort studies were included, and together showed that surgical resection is beneficial in the treatment of drug-resistant tuberculosis. However, the results might not be applicable in all settings because investigations were observational and typically included patients with less severe disease, and all surgeries were done at specialised thoracic-surgery centres. Well designed studies are needed to establish the efficacy of surgery in treatment of drug-resistant tuberculosis.

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Conflict of interest statement

Conflicts of interest

We declare that we have no conflicts of interest.

Figures

Figure 1
Figure 1. Chest radiography
(A) Preoperative image showing left lower lobe infiltrate (arrows). (B) One month postoperative image, showing clear lung fields.
Figure 2
Figure 2. Preoperative CT scan of the lung
Cross Sectional view showing 3 × 5 cm left lung cavitary lesion.
Figure 3
Figure 3. Gross pathology of resected lung lesion
The inside of the cavity shows caseous necrosis.
Figure 4
Figure 4
Clinical course, AFB culture results, and antibiotic regimens for our patient.
See this image and copyright information in PMC

References

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