title: Surgical treatment of complications of pulmonary tuberculosis, including drug-resistant tuberculosis.
abstract: Surgery for drug-resistant tuberculosis has been shown to be safe and effective, with similar level of mortalities associated with surgical intervention observed with that for lung cancer. While surgery has been an option to treat TB in the pre-antibiotic era, it is now increasingly used to treat complications of pulmonary TB, particularly in patients with drug-resistant TB who do not respond to medical treatment. The two most frequent indications for lung resection in drug- resistant TB, are i) failed medical treatment with persistent sputum positivity or ii) patients who have had medical treatment and are sputum negative, but with persistent localized cavitary disease or bronchiectasis. Massive hemoptysis is a potentially life-threatening complication of TB. Lung resection is potentially curative in patients with massive hemoptysis and cavitary or bronchiectatic disease. Bronchial artery embolization in these patients has a high success rate but bears also the risk of recurrence. Lung resection can be safely undertaken in selected patients with HIV co-infection and pulmonary complications of TB. Ambulatory drainage is a novel, safe, affordable and effective method of draining a chronic TB associated empyema thoracis. We review here the current surgical treatment of the complications of pulmonary TB and discuss the experience from the Durban Cardiothoracic Surgery Unit for the surgical treatment of patients with complicated pulmonary TB.
authors: Department of Cardiothoracic Surgery, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team. Electronic address: rajhmun.madansein@ki.se.
authors: Rajhmun
authors: R
authors: Madansein
authors: Division of Therapeutic Immunology, TIM, Dept of Laboratory Medicine, Karolinska Institutet. Electronic address: Shreemanta.Parida@ki.se.
authors: Shreemanta
authors: S
authors: Parida
authors: MSC_Durban Team; Centre for AIDS Prevention Research in South Africa (CAPRISA), University of KwaZulu-Natal, SAMRC CAPRISA HIV - TB Pathogenesis and Treatment Research Unit, Durban, South Africa. Electronic address: Nesri.Padayatchi@caprisa.org.
authors: Nesri
authors: N
authors: Padayatchi
authors: DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team. Electronic address: nalini.singh@ki.se.
authors: Nalini
authors: N
authors: Singh
authors: DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team. Electronic address: iqbal.master@kznhealth.gov.za.
authors: Iqbal
authors: I
authors: Master
authors: DR-TB Department, King Dinuzulu Hospital, Dept of Health, KwaZulu-Natal Province, Durban, South Africa; MSC_Durban Team. Electronic address: Ruben.Naidu@kznhealth.gov.za.
authors: Kantharuben
authors: K
authors: Naidu
authors: Division of Infection and Immunity, University College London Medical School, London, UK. Electronic address: a.i.zumla@gmail.com.
authors: Alimuddin
authors: A
authors: Zumla
authors: Division of Therapeutic Immunology, TIM, Dept of Laboratory Medicine, Karolinska Institutet; Center for allogeneic stem cell transplantation (CAST), Karolinska Hospital, Stockholm, Sweden. Electronic address: markus.maeurer@ki.se.
authors: Markus
authors: M
authors: Maeurer
mesh_terms: D001987:Bronchiectasis / Q000150:complications / Q000601:surgery; D060085:Coinfection / Q000150:complications; D015658:HIV Infections / Q000150:complications; D006469:Hemoptysis / Q000150:complications / Q000601:surgery; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000601:surgery*; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000601:surgery; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000601:surgery
keywords: M. tuberculosis; Surgery; TB; empyema thoracis; hemoptysis; lung resection; tuberculosis