Adjunctive resectional lung surgery for extensively drug-resistant tuberculosis.
Extensively drug-resistant (XDR) tuberculosis (TB) poses significant management challenges as there are limited pharmacological treatment options for cure. Adjunctive resectional lung surgery decreases case-fatality rates for some patients with multidrug-resistant tuberculosis (MDR-TB), but its use has not been well documented for patients with XDR-TB. We describe 17 XDR-TB patients treated with surgery as part of their case management in Latvia during 1999-2005. One patient had no previous TB treatment history, 10 were previously treated for drug-susceptible TB and six were previously treated for MDR-TB. Mycobacterium tuberculosis isolates from the 17 patients were resistant to a mean of 9.2 drugs. Due to failure of pharmacological therapy, one due to a large cavity and one due to pulmonary haemorrhage, 15 patients were treated with surgery. Despite failure of pharmacological treatment in 15 out of 17 patients, eight (47%) were cured with adjunctive surgical treatment. Surgery should be explored as a possible treatment option for patients with XDR-TB.
Dravniece
G
G
Latvia State Agency of Tuberculosis and Lung Diseases, Riga, Latvia. gdravniece@tuberculosis.lv
Cain
K P
KP
Holtz
T H
TH
Riekstina
V
V
Leimane
V
V
Zaleskis
R
R
D000328:Adult; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007844:Latvia; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000378:metabolism; D011159:Population Surveillance; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000601:surgery*