Effectiveness of lung surgery in MDR TB patients with diabetes mellitus

Abstract

Background: Recently despite decreasing TB incidence we observe increasing numbers of drug resistant TB cases, among them those with immunosuppression including diabetes mellitus cases. Surgery greatly contributes to treatment of patients with drug resistant pulmonary TB and diabetes mellitus. Pre-operational procedures, surgical tactics and post-operation management of pulmonary TB patients with diabetes mellitus remains discussable. Aim: To increase effectiveness of lung surgery in drug resistant TB patients with diabetes mellitus by improving pre-operational procedures and optimizing surgical tactics. Methods: We studied 70 pulmonary TB patients with diabetes mellitus, aged 14-66. Out of them 26 had fibrocavitary TB, 2 – cavitary TB, 2 – TB empyema, one – cirrhotic TB, 39 –tuberculoma. 28 patients had type 1 diabetes mellitus, 42 patients had type 2 diabetes mellitus. Results: 1. 70 patients underwent surgery. No post-operative complications or relapses were observed. 2. Considering presence of micro- and macroangiopathy and poor tolerance of antibacterial therapy, pre-operational procedures included plasmapheresis, intravenous laser irradiation of blood, detoxication therapy. Conclusion: Currently diabetes mellitus is not a contraindication to surgical treatment of drug resistant pulmonary TB patients; it is rather an additional argument for radical surgery.