TUBERCULOSIS USING AN ENDOBRONCHIAL VALVE OR LUNG RESECTION

Abstract

Intro: Background. The leading clinical form in people with disabilities due to pulmonary tuberculosis is fibrous-cavernous tuberculosis (FCPT). Treatment of patients with FCPT causes difficulties, especially in the presence of drug resistance of the pathogen. The aim was to analyze the efficacy of endobronchial valve (EBV) or surgical treatment (ST) in disabled patients with FCPT and drug resistance. Methods: 23 cases of people with disabilities with FCPT who received treatment at the National Medical Center in January-June 2021 were analyzed. EBV was installed in 17 patients, ST – lung resection of 1-2-3 segments underwent in 6 patients. All patients had TB drug resistance to 3 or more drugs. Findings: Males predominated - 88% (n=15) in patients using EBV in the treatment and 67% (n=4) in patients undergoing ST. The median age was 37 years (Q1-Q3: 35-50) in EBV group; 40 years (Q1-Q3: 35-50 years) in ST group. MDR-TB and XDR-TB were dominated in EBV group - 53% (n=9) and 17% (n=1); in patients with ST - 35% (n=6) and 50% (n=3) respectively. The median length of TB-related disability in group with EBV was 2 years (Q1-Q3: 2–4) and in patients with ST - 7 years (Q1-Q3: 5–8). When treated with EBV, 23.5% (n=4) achieved cavity healing. The median cavity healing time was 12 months (Q1-Q3: 10-15.5). In 2 patients (11%), bacterial excretion was stopped while maintaining the cavity in the lung. Among patients who underwent ST, the effectiveness of treatment was 100% (n=6); the median duration of a full course of effective treatment was 31 months (Q1-Q3: 30–33). Discussion: Treatment with both EBV and ST is possible in disabled patients with FCPT. This will reduce the reservoir of MDR/XDR-TB in the community. Conclusion: The use of EBV and ST in disabled patients due to pulmonary TB can improve the effectiveness of treatment for MDR/XDR-TB.