Pulmonary nodules in patients with drug-resistant tuberculosis who have undergone adjuvant lung resection in a high-HIV-burden setting
Introduction. Radiological findings of drug-resistant tuberculosis (DR-TB) have been described; however, results were focused on HIVnegative patients.
Objectives. To describe the radiological distribution of pulmonary nodules in patients who have undergone lung resection. Furthermore, the study establishes the association between perioperative nodules and sputum culture conversion in HIV-positive and -negative patients.
Methods. A retrospective review was conducted of clinical and radiological records of adult patients who had undergone lung resections for DR-TB, between 1 January 2011 and 31 December 2013, at a hospital in Durban, South Africa.
Results. Lung resections were undertaken in 47 patients with drug-resistant tuberculosis (DR-TB.) Among patient infections, 74.5% were multidrug-resistant TB (MDR-TB) and 25.5% were extensively drug-resistant TB (XDR-TB). The prevalence of HIV was 54.3% in patients with MDR-TB and 66.7% in XDR-TB. Pre-operative radiological studies showed a similar distribution of pulmonary nodules in HIV-positive and -negative patients. Positive pre-operative sputum cultures were noted in 34% of patients, but were not associated with pulmonary nodules on pre-operative radiological evaluation (p=0.81). At 1 month postoperatively, 81.3% of patients with a positive pre-operative sputum culture converted to negative sputum culture. The cumulative culture conversion rate was 87.5% at 2 months postoperatively. Using composite sputum culture outcomes, a good outcome was defined as consistently negative postoperative sputum cultures. There was no association between poor outcomes and the presence of nodules, either pre-operatively (p=0.73) or postoperatively (p=0.52), irrespective of HIV status.
Conclusion. The presence of pulmonary nodules on pre-operative images was not associated with perioperative positive sputum results or poor outcomes. The clinical significance of residual pulmonary nodules in DR-TB, following lung resection, remains uncertain.
K Maharaj, Department of Cardiothoracic Surgery, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
R Perumal, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; MRC HIV-TB Pathogenesis and Treatment Research Unit at CAPRISA, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
G Alexander, Department of Cardiothoracic Surgery, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Greg Calligaro, University of Cape Town
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Date published: 2017-08-11
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African Journal of Thoracic and Critical Care Medicine| Online ISSN: 2617-0205
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