The role of surgery in pulmonary tuberculosis infected by tubercle bacilli with multiple drug resistance]

The first, definition of pulmonary tuberculosis bacilli with multiple drug resistance was decided as "bacilli completely resistant to RFP 50 mcg + SM 20 mcg and/or INH 1 mcg + KM 100 mcg and/or EB 5 mcg and/or another antituberculosis drug" based on 118 cases examined for drug resistance pre-operatively in 35 institutions belonging to the Tuberculosis Research Committee, during the 6 years period 1984 to 1989. Next, 48 pulmonary tuberculous cases with multiple drug resistance were analysed, and the following conclusions were obtained: 1) Pulmonary tuberculosis cases with multiple drug resistance were 36% of 133 cases of positive tuberculosis bacilli before operation. 2) 52% were more than 50 years old. One third showed less than 40 in respiratory index. 3) Most of them did not have effective anti-tuberculosis drug to be used after operation. 4) There was a high rate of pneumonectomy and collapse therapy such as thoracoplasty. 5) Successful rate of treatment was 72.9%, which is rather good for multiple drug resistant tuberculous cases. But bacilli positive rate after operation and mortality were 12.5% and severe complications such as bronchial or pulmonary fistula, thoracic empyema and worsening of tuberculosis after operation was 25%. Therefore surgical treatment for pulmonary tuberculosis with multiple drug resistance needed careful application considering sensitive drug to be used after testing of resistance for all anti-tuberculosis drugs. Surgical treatment should be considered especially if pulmonary tuberculosis cases have complete resistance to RFP and to one drug among SM, INH, KM and EB.     

Changes in the number and virulence of tubercle bacilli isolated form pulmonary tuberculosis during short course chemotherapy

The virulence of these tubercle bacilli was compared with the mice. The sputum specimens were collected on the 0, 3, 7, 14th day and then at 2 weeks intervals up to 12th week form 20 patients on chemotherapy. 25 mice were infected intravenously with each strain. We took the mean survival time of these mice as index of virulence. The results were shown that the numbers of bacilli were rapidly reduced with a stable logarithm within 4-6 weeks after chemotherapy. But the virulence of tubercle bacilli secreted from the same patients was stable and had no significant difference statistically (P greater than 0.05) from pretreatment to 12 weeks after chemotherapy.