Drug Resistant TB Traveler Has Surgery

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Main Category: Tuberculosis
Also Included In: Respiratory / Asthma;  MRSA / Drug Resistance
Article Date: 18 Jul 2007 - 6:00 PDT

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Andrew Speaker, the American lawyer from Atlanta who traveled to, from and within Europe on commercial airlines while infected with drug-resistant TB earlier this year, had surgery yesterday to remove infected lung tissue.

According to several media reports the surgery took about 2 hours and surgeons successfully removed the diseased tissue which is now being tested by pathologists and microbiologists.

Speaker's operation was performed at the University of Colorado Hospital at the Anschutz Medical Campus in Aurora, Colorado. Leading surgeon was John D Mitchell, Chief of General Thoracic Surgery at the hospital.

Dr Sanjay Gupta, neurosurgeon and Senior Medical Correspondent of CNN watched the operation and said everyone who observed the operation as well as the medical team had to wear special air-tight masks to avoid infection. He also gave an account of the procedure to remove the infected tissue safely.

Apparently the team of three surgeons worked cheerfully for 2 hours, while listening to rock and roll music.

Gupta said the most difficult part of the operation was the delicate separation of the diseased tissue, located in the upper lobe of the right lung, from the the blood vessels and airway. The surgeons had to look carefully into the diseased tissue to find and tease out buried blood vessels; a risky process because if you accidentally cut in the wrong place, blood can fill the chest cavity very quickly.

The surgeons sealed the separated diseased tissue in a bag, inside a tube, while it was still inside the chest cavity. This was to cut the risk of infecting other parts of Speaker's body.

Gupta said it was easy to spot the diseased tissue because it was dark and bumpy, with pockets of white where the TB bacterial infection had set in, while the healthy parts of the lung glistened with a reddish tinge.

According to information provided by the National Jewish Medical and Research Center, Denver, Colorado, where Speaker is being treated, Dr Mitchell used a minimally invasive approach called video-assisted thoracic surgery (VATS), where small holes are made in the side of the chest through which the surgeon inserts a fibreoptic camera and surgical instruments. VATS patients have less pain and recover more quickly than those who undergo a standard thoracotomy where a larger incision is made and the ribs are spread.

The surgery is expected to maximise Speaker's chances of a full recovery by removing most of the TB bacteria in his lungs and leaving behind only a minute amount that can be killed by medication. Removing damaged tissue also denies the bacteria anything to feed on and the chance to develop further drug resistance.

Speaker traveled to Europe in May, after being advised not to do so by health officials. While in Europe he was told he had XDR-TB, an extensively drug resistant form, and was advised again not to travel on a commercial flight, and either admit himself into a local hospital or return on a private plane. It was only after he returned to the US via Canada that a further test showed he did not have XDR-TB but MDR-TB, multidrug-resistant TB which can be treated by a wider range of antibiotics.

Several people who traveled on the plane with Speaker have since taken out law suits against him.

Nobody can say how soon Speaker will be able to leave hospital, the final decision depends on how quickly he recovers from the surgery, how well he tolerates the medication, and how soon sputum cultures test negative for TB. His breathing could also be affected by the surgery, but many patients who have had the operation return to active lives, according a statement released by the National Jewish.

Also, many patients who have had similar surgical treatment for MDR-TB have become culture-negative soon after surgery and were able to go home about a month later, they said.

According to Gupta of CNN, about 124 people were diagnosed with MDR-TB in the US in the last year, about half of whom elected to have surgery to remove infected lung tissue.

Click here for Dr Gupta's account in full (CNN).

Click here for Frequently Asked Questions and Answers about TB (CDC).

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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