Mycobacterial non-tuberculosis infection in patients operated on for pulmonary tuberculosis

Abstract

Introduction: Non-tuberculous mycobacteriosis (NTM) can be accompanied by the formation of focal lesions and destructive cavities in the lungs. In the absence of bacterial excretion, these patients require differential diagnosis with pulmonary tuberculosis.

Aim: Study of the effectiveness of surgery for the differential diagnosis and treatment of patients with NTM.

Methods: A retrospective analysis of 68 cases of detection of NTM in patients underwent surgery for suspected tuberculosis in the 5 years period was performed. The features of the clinical course of the disease, the X-ray pattern, perioperative management, as well as the characteristic of the morphological picture of NTM in the pulmonary parenchyma was studied.

Results: All patients were admitted to the hospital due to ineffective TB therapy or for verification of the diagnosis. According to X-ray pattern before surgery, these processes were regarded as fibro-cavernous - 20, cavernous - 13, tuberculomas - 29, cirrhotic tuberculosis - 6. Surgical interventions of the following volume were performed: pneumonectomy - 3, lobectomy - 12, lung resection - 54. In the lung resection material of patients, mainly slowly growing NTM were revealed. A hysthological study showed high active processes of fibrotization in the background of granulomas without necrosis. No recurrences of mycobacterial infection were reveled after surgery during the observation period.

Conclusion: The introduced cases demonstrate the difficulty of differential diagnosis for pulmonary tuberculosis and non-tuberculous mycobacteriosis, and determine indications for surgery.