Retrospective study of clinical and lesion characteristics of patients undergoing surgical treatment for Pulmonary Tuberculosis in Georgia

Sergo Vashakidze, Albert Despuig, Shota Gogishvili, Keti Nikolaishvili, Natalia Shubladze, Zaza Avaliani, Nestan Tukvadze, Martí Casals, Joan A Caylà, Pere-Joan Cardona, Cristina Vilaplana, Sergo Vashakidze, Albert Despuig, Shota Gogishvili, Keti Nikolaishvili, Natalia Shubladze, Zaza Avaliani, Nestan Tukvadze, Martí Casals, Joan A Caylà, Pere-Joan Cardona, Cristina Vilaplana

Abstract

Objectives: Our aim was to retrospectively compare clinical data and characteristics of removed lesions of the cohort of patients undergoing therapeutical surgery for their tuberculosis.

Design and methods: Demographic and epidemiological details, clinical data, data on the surgery performed, macroscopic characteristics of the TB lesions removed, and outcome were recorded retrospectively from the 137 patients who underwent therapeutical surgery for their TB in Tbilisi, Georgia during 2014 and 2015.

Results: Men represented 70% of the included patients, presented more comorbidities and underwent operation earlier in terms of days between diagnostic and surgery. Women underwent operation at younger ages, and in MDR/XDR-TB cases, showed higher percentages of sputum conversion at >2 months and of fresh necrosis in the surgical specimens, suggesting a worse evolution. Half of cases were MDR/XDR-TB cases. In spite of being considered microbiologically cured according to WHO, a non despricable percentage of cases showed viable bacilli in the surgical specimen. Even if no causality could be statistically demonstrated, differences could be encountered according to gender and drug susceptibility of the responsible strains.

Conclusions: According to our results, host factors such as gender, type of necrosis found in the lesions, size of lesions and presence of viable bacilli in the surgical specimen, should be included in future studies on therapeutical surgery of TB. As most of studies are done in MDR/XDR-TB, more data on DS-TB operated cases are needed. Our results also highlight that, in spite of achieving the microbiologically cured status, sterilization might not occur, and thus new biomarkers and new methods to evaluate the healing process of TB patients are urgently needed and radiological assays should be taken into account.

Keywords: DS-TB; Gender; MDR/XDR-TB; Necrosis; Surgery; Tuberculosis.

Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Time in sputum culture conversion. Time to sputum culture conversion (always negative, less than 2 months (≤2 months) and more than 2 months (>2 months)) is represented in percentages, for DS-TB and MDR/XDR-TB cases. Total values and results stratified by gender (males (of more or less than 43 years old) and females) are graphically represented.
Figure 2
Figure 2
Necrosis type found in lesions. Percentages of presence of the different type of necrosis (fresh, dry and both) are represented for DS-TB and MDR/XDR-TB cases. Total values and results stratified by gender (males (of more or less than 43 years old) and females) are graphically represented.
Figure 3
Figure 3
Types of necrosis in surgical specimens. Macroscopic photographs of removed surgical specimens showing fresh necrosis (A), both fresh and dry necrosis (B) and dry necrosis (C).

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