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Role of Surgery in Drug-Resistant Pulmonary Tuberculosis

Spain

The first 20% of the full text of this article appears below.

INTRODUCTION

The role of surgery in pulmonary tuberculosis (TB) has changed from collapse therapy. Before chemotherapy, pulmonary resection for TB had a prohibitive operative mortality rate of 20–40%. The efficacy of modern antimycobacterial chemotherapy drastically reduced the indications for pulmonary resection to the treatment of complications of TB or sequelae such as tracheal or bronchial stenosis, aspergillomas growing on cavitated lesions, bronchiectasis, destroyed lungs, massive hemoptysis, bronchopleural fistulas, empyema, and also to rule out lung cancer in patients with pulmonary masses. Currently, the prevalence of TB remains high in many areas of the world. Resistance to antituberculous drugs has been noticed since the drugs were first introduced. During the 1980s, the epidemic of AIDS, changes in immigration patterns throughout the world, intravenous drug abuse, delay in diagnosis, insufficient health care infrastructures, and inappropriate treatments led to an increased incidence of resistance to chemotherapy, thereby allowing the emergence of multidrug-resistant tuberculosis (MDR-TB) as the most frequent indication for surgery in patients with localized TB lesions and a sufficient expected cardiovascular function after resection.¹

MULTIDRUG-RESISTANT TUBERCULOSIS

MDR-TB is caused by Mycobacterium tuberculosis strains that are resistant to at least rifampin and isoniazid. Mutations can produce bacilli resistant to any of the currently used drugs against TB. Drug resistance may be primary or secondary. Primary . . . [Full Text of this Article]