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Adjunctive resectional lung surgery for extensively drug-resistant tuberculosis

¹ Latvia State Agency of Tuberculosis and Lung Diseases, Riga, Latvia. ² Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA. ³ World Health Organization, European Regional Office, Copenhagen, Denmark.

CORRESPONDENCE: G. Dravniece, State Agency of Tuberculosis and Lung Diseases p/o Cekule, Stopini, Riga District, Latvia, LV2118. E-mail: gdravniece{at}tuberculosis.lv

Keywords: Epidemiology, extensively drug-resistant tuberculosis, mortality, multidrug-resistant, surgery, tuberculosis

Received: March 26, 2008
Accepted January 6, 2009

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.