Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections

Between August 1983 and October 1990, 42 patients with resistant Mycobacterium tuberculosis underwent 44 pulmonary resections. During the same time, 38 patients with mycobacterial infections other than tuberculosis had 41 pulmonary resections. All patients either were poor candidates for medical therapy alone or had existing complications requiring surgical intervention. There was one operative death in each group, both from adult respiratory distress syndrome (postpneumonectomy pulmonary edema). Complications were high, with bronchopleural fistula most commonly occurring after right pneumonectomy in patients infected with Mycobacterium avium with superimposed infection with nonmycobacterial pathogens. In patients undergoing pneumonectomy for resistant Mycobacterium tuberculosis, the left lung was most often resected. It is recommended that if localized disease is present and medical treatment is likely to fail, pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection after 3 months of drug-specific therapy. Muscle flaps were used frequently to avoid residual space and bronchial stump problems. Earlier resection in patients with indolent nontuberculous mycobacterial pulmonary infections is advocated before extensive polymicrobial contamination and right lung destruction.     

Upper eyelid mycobacterial infection following Oriental blepharoplasty in a pulmonary tuberculosis patient

Bilateral upper blepharoplasty for the Oriental eyelid was performed in a 20-year-old female on antituberculous therapy for 3 months. The postoperative course was smooth and the patient was back to normal life. But unfortunately, at 3 months after the upper blepharoplasty, a spherical tumescence and red granuloma developed over the right upper eyelid. The granuloma was resected, and on pathological examination the specimen revealed epitheloid granuloma with Langhan's giant cells and a few acid-fast positive bacilli. The clinical events and pathological findings were suggestive of Mycobacterium tuberculosis rather than Mycobacterium chelonei as the possible cause of infection. Thus the patient was advised to continue antituberculous therapy and no antibiotic was prescribed. The eyelid swelling resolved gradually and was completely normal at the end of antituberculous therapy. Though it has been suggested that aesthetic surgery can be performed safely 3 months after antituberculous therapy in a patient with pulmonary tuberculosis, the remote risk of such a complication is always a possibility.     

Pulmonary Mycobacterium kansasii infection: comparison of the clinical features,treatment and outcome with pulmonary tuberculosis.

BACKGROUND: In the United Kingdom Mycobacterium kansasii is the most common pulmonary non-tuberculous mycobacteria to cause disease in the non-HIV positive population. METHODS: The clinical features, treatment, and outcome of 47 patients (13 women) of mean (SD) age 58 (17) years with culture positive pulmonary M kansasii infection were compared with those of 87 patients (23 women) of mean (SD) age 57 (16) years with culture positive pulmonary M tuberculosis infection by review of their clinical and laboratory records. Each patient with M kansasii infection was matched for age, sex, race and, where possible, year of diagnosis with two patients with M tuberculosis infection. RESULTS: All those with M kansasii infection were of white race. Haemoptysis was more common in patients infected with M kansasii but they were less likely to present as a result of an incidental chest radiograph or symptoms other than those due to mycobacterial infection. Patients with M kansasii were also less likely to have a history of diabetes, but the frequency of previous chest disease and tuberculosis was similar. An alcohol intake of > 14 units/week was less frequent in those with M kansasii, but there were no significant differences in drug history, past and present smoking habit, occupational exposures, social class, or marital status. Patients with M kansasii received a longer total course of antimycobacterial therapy and, in particular, extended treatment with ethambutol and rifampicin was given. There was no significant difference in outcome between pulmonary M kansasii or M tuberculosis infection. CONCLUSIONS: There are group differences between the clinical features of the two infections but, with the possible exception of diabetes and alcohol intake, these features are unlikely to be diagnostically helpful. Treatment of M kansasii infection with ethambutol, isoniazid, and rifampicin in these patients was as effective as standard regimens given to patients infected with M tuberculosis.     

Efficiency of surgical treatment of patients with pulmonary tuberculosis and diabetes mellitus in conditions of the mycobacterial tuberculosis resistant to pharmacotherapy

The peculiarities of surgical treatment of 32 patients with destructive pulmonary tuberculosis and diabetes mellitus, in whom the Mycobacterium tuberculosis resistance to chemopreparations was revealed, were enlighted. The measures of optimal preoperative preparation and postoperative patients management were substantiated. Postoperative complications occurred in 62.5% of patients. Clinical effect was achieved in 78.12% of patients.     

慢性肾脏病合并肺结核患者抗结核治疗转归相关因素分析

目的回顾性分析慢性肾脏病(CKD)合并肺结核患者的抗结核治疗转归相关因素。 方法纳入2017年1月至2021年6月我院收治的资料完整、CKD合并肺结核病患者84例,分析其一般情况、病史特点、化验指标、外周血淋巴细胞亚群、药物不良反应发生率,以及抗结核治疗转归相关因素。 结果84例患者中男性占76.54%,中位年龄53.5(41.25,63.00)岁。治疗有效组和无效组患者在性别、年龄、CKD分期、治疗史、吸烟史、糖尿病病史、高血压病史、γ干扰素(interferon-γ,IFN-γ)释放试验、结核抗体、白蛋白、肾功能、尿比重、尿蛋白、尿红细胞等方面比较无统计学差异。治疗无效组血红蛋白、总淋巴细胞计数、CD8⁺T细胞计数均低于有效组(P<0.05)。Logistic回归分析显示总淋巴细胞计数与治疗转归相关(P<0.05)。 结论CKD合并肺结核治疗无效组患者贫血重、CD8⁺T细胞计数及总淋巴细胞计数减少。总淋巴细胞计数减少与治疗转归差相关。     

Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess--a review of 46 cases.

OBJECTIVES: Spinal epidural abscess (SEA) is a rare disease and its early detection and appropriate treatment is essential to prevent high morbidity and mortality. There are only few single-institution series who report their experiences with the microsurgical management of SEA and treatment strategies are discussed controversially. Within the last 15 years the authors have treated 46 patients with SEA. This comparatively high number of cases encouraged us to review our experiences with SEA focussing on the clinical presentation, microsurgical management and outcome. METHODS: Clinical charts of 46 cases with a spinal epidural abscess treated between 1990 and 2004 were reviewed. There were 30 men and 16 women, the age ranged between 32 and 86 years (mean: 57 years). The clinical mean follow-up was 8.5 months (range: 2-84). The clinical presentation and severity of neurological deficits were measured by the Frankel grading system on admission and on follow-up visit. RESULTS: The abscess was located in the cervical spine in 8, the thoracic spine in 17 and the lumbar spine in 21 patients. On admission 8 patients were in Frankel grade A, 7 in B, 15 in C, 8 in D and 8 in E. During follow-up 1 patient was in Frankel grade A, 1 in B, 5 in C, 13 in D and 24 in E. 37 patients underwent primary microsurgery with abscess drainage or removal of chronic granulomatous tissue. The clinical symptoms in 4 patients worsened shortly after the operation due to a compression fracture of the vertebral body (n=2) or progress of the abscess (n=2) making re-operation necessary. 9 patients with severe critical illness or without neurological deficits had primarily a CT-guided puncture for assessment of the causative organism. 3 of them needed additional surgical therapy within the hospital stay because of a new neurological deficit. All patients were immobilised and treated with antibiotics for at least 6 weeks. The mortality was 6.5%. As for complications we noted septicaemia (n=5), meningitis (n=1) and a transient malresorptive hydrocephalus (n=1). CONCLUSION: Early diagnosis, microsurgical therapy with appropriate antibiotic therapy and careful observation of patients are the keys to successful management of SEA. The goal of surgical treatment is to isolate the causative organism and to perform a decompression at the site of maximal cord compression in cases of neurological deterioration or severe pain. Instrumentation with primary fixation does not seem to be imperative. In cases of post-operative worsening, a fracture of additionally infected bony elements has to be considered and a stabilisation should be discussed on an individual basis.     

Surgical treatment of pulmonary tuberculosis

The indications for the surgical treatment of pulmonary tuberculosis are mainly for multidrug-resistant tuberculosis (MDR-Tb). In Fukujuji Hospital there have been 91 pulmonary resections for 83 MDR-Tb cases during the past 20 years. Of those resections, upper lobectomies with or without partial resection of other lobes comprised 55%, segmentectomies 10%, and pneumonectomies 30%. The following major postoperative complications occurred: prolonged air leakages in 19%, empyema in 9%, and respiratory failure in 6%. However, there were no operative deaths. After pulmonary resection for MDR-Tb, immediate negative conversion rate of expectoration of tuberculous bacilli was 98%, reexpectoration rate of them was 12%, The final cure rate was 92%. Surgical treatment is worth consideration for the treatment of refractory pulmonary tuberculosis.     

Compliance predictors of patients with pulmonary tuberculosis needing phthisiological treatment

The factors predicting initial readiness of patients with infiltrative pulmonary tuberculosis to give their consent to transthoracic interventions were investigated. It was shown that initial readiness of patients to give their consent to phthisiological treatment directly depended on the indices of "social functioning" and lymphocyte percentage in leukogram. The total prognosis algorithm with 94.1% sensitivity and 75% specificity is presented as discriminative function estimated by "social functioning" data, lymphocyte percentage in leukogram and ordinal evaluation of complaints to sweating.