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Surgical treatment of drug-resistant tuberculosis.

Authors
  • Kempker, Russell R
  • Vashakidze, Sergo
  • Solomonia, Nelly
  • Dzidzikashvili, Nino
  • Blumberg, Henry M
Type
Published Article
Journal
The Lancet Infectious Diseases
Publisher
Elsevier
Publication Date
Feb 01, 2012
Volume
12
Issue
2
Pages
157–166
Identifiers
DOI: 10.1016/S1473-3099(11)70244-4
PMID: 22281142
Source
Medline
License
Unknown

Abstract

The global emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has led to the re-examination of surgery as a possible adjunctive treatment. We present the case of a 26-year-old HIV-seronegative patient with XDR pulmonary tuberculosis refractory to medical therapy. Surgical resection of the patient's solitary cavitary lesion was done as adjunctive treatment, and a successful outcome with a combination of surgery and drug therapy was achieved. We review the history of surgical therapy for tuberculosis and reports of its role in treatment of MDR and XDR tuberculosis. 26 case series and cohort studies were included, and together showed that surgical resection is beneficial in the treatment of drug-resistant tuberculosis. However, the results might not be applicable in all settings because investigations were observational and typically included patients with less severe disease, and all surgeries were done at specialised thoracic-surgery centres. Well designed studies are needed to establish the efficacy of surgery in treatment of drug-resistant tuberculosis.

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