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.
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-TBpatients 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.
Authors: K F Laserson; L E Thorpe; V Leimane; K Weyer; C D Mitnick; V Riekstina; E Zarovska; M L Rich; H S F Fraser; E Alarcón; J P Cegielski; M Grzemska; R Gupta; M Espinal Journal: Int J Tuberc Lung Dis Date: 2005-06 Impact factor: 2.373
Authors: Neel R Gandhi; N Sarita Shah; Jason R Andrews; Venanzio Vella; Anthony P Moll; Michelle Scott; Darren Weissman; Claudio Marra; Umesh G Lalloo; Gerald H Friedland Journal: Am J Respir Crit Care Med Date: 2009-10-15 Impact factor: 21.405
Authors: D S Jeon; D H Kim; H S Kang; S H Hwang; J H Min; J H Kim; N M Sung; M W Carroll; S K Park Journal: Int J Tuberc Lung Dis Date: 2009-05 Impact factor: 2.373
Authors: Carole D Mitnick; Sonya S Shin; Kwonjune J Seung; Michael L Rich; Sidney S Atwood; Jennifer J Furin; Garrett M Fitzmaurice; Felix A Alcantara Viru; Sasha C Appleton; Jaime N Bayona; Cesar A Bonilla; Katiuska Chalco; Sharon Choi; Molly F Franke; Hamish S F Fraser; Dalia Guerra; Rocio M Hurtado; Darius Jazayeri; Keith Joseph; Karim Llaro; Lorena Mestanza; Joia S Mukherjee; Maribel Muñoz; Eda Palacios; Epifanio Sanchez; Alexander Sloutsky; Mercedes C Becerra Journal: N Engl J Med Date: 2008-08-07 Impact factor: 91.245
Authors: Satria A Prabowo; Matthias I Gröschel; Ed D L Schmidt; Alena Skrahina; Traian Mihaescu; Serap Hastürk; Rotislav Mitrofanov; Edita Pimkina; Ildikó Visontai; Bouke de Jong; John L Stanford; Père-Joan Cardona; Stefan H E Kaufmann; Tjip S van der Werf Journal: Med Microbiol Immunol Date: 2012-11-10 Impact factor: 3.402