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Case Reports
. 2012 Aug;94(2):381-6.
doi: 10.1016/j.athoracsur.2012.03.072. Epub 2012 May 24.

Pulmonary resection for extensively drug resistant tuberculosis in Kwazulu-Natal, South Africa

Adam Iddriss  1 , Nesri Padayatchi, Darshan Reddy, Anu Reddi
Affiliations
Case Reports

Pulmonary resection for extensively drug resistant tuberculosis in Kwazulu-Natal, South Africa

Adam Iddriss et al. Ann Thorac Surg. 2012 Aug.

Abstract

Background: Extensively drug resistant tuberculosis (XDR-TB) has been reported in 58 countries around the world and has emerged as a major public health challenge. Our objective was to determine the impact of pulmonary resection on XDR-TB treatment outcomes in a resource-constrained setting.

Methods: We conducted a retrospective case review of 11 patients with XDR-TB who were referred for pulmonary resection between January 2007 and June 2010 at a tertiary care referral hospital in South Africa. Two pneumonectomies and three upper lobectomies were performed. Occurrence of surgical complications and TB treatment outcome were assessed.

Results: No perioperative mortality or major morbidity was noted. All patients achieved sputum conversion, with 4 regarded as "cured." One patient defaulted on treatment, but subsequently returned and is regarded as a probable cure.

Conclusions: We describe pulmonary resection for XDR-TB management in Africa. Although the initial cohort of XDR-TB patients from Tugela Ferry demonstrated nearly complete mortality, our results demonstrate the potential of adjuvant surgical methods in XDR-TB treatment. With appropriate chemotherapy and timely adjuvant surgery, patients with XDR-TB localized to lobe or lung may achieve a "cure" with low morbidity and mortality. Consequently, this approach may be the most cost effective treatment for patients suitable for lung resection.

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Figures

Figure 1
Figure 1
Chest radiograph of patient 4, demonstrating shrinkage and cavitation of the left upper and lower lobe.
Figure 2
Figure 2
High resolution computed axial tomography scan of Patient 4 confirming bronchiectasis and cavitation of the left upper lobe, with a cavity in the apical segment of the left lower lobe is further illustrated.
See this image and copyright information in PMC

Comment in

  • Invited commentary.
    Odell JA. Odell JA. Ann Thorac Surg. 2012 Aug;94(2):386. doi: 10.1016/j.athoracsur.2012.05.001. Ann Thorac Surg. 2012. PMID: 22818300 No abstract available.

References

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