Andrew Speaker, the lawyer from Atlanta who has extreme drug resistant tuberculosis (XDR TB) and has been in the international spotlight these past weeks because he took a trip to Europe while infected with the disease, is scheduled to have a part of his lung removed at the University of Colorado Hospital next month.
The infected area is about the size of a tennis ball and the plan is to remove Mr Speaker’s upper right lobe. Exactly how much tissue will be removed depends on what the surgeon, Dr John D. Mitchell, Chief of General Thoracic Surgery at the University of Colorado Hospital, finds when he does the operation.
Since a collaboration was set up 25 years ago between the University and the National Jewish Medical Center in Denver, where Mr Speaker is currently in isolation, hundreds of patients with similar pulmonary mycobacterial diseases have been been treated at the Hospital.
According to a statement released yesterday by the National Jewish, Mr Speaker will pose no risk to other patients in the hospital when he has his operation.
Dr Charles Daley, Head of the Infectious Disease Division at National Jewish, said that:
“Andrew Speaker is an excellent candidate for surgery. The infected area of his lung is relatively small and well contained. He is also young and otherwise healthy.” Mr Speaker is 31 years old.
Dr Mitchell will be using a technique called video-assisted thoracic surgery (VATS) which is minimally invasive requiring only three small incisions to the chest to give access to the affected area, allow the insertion of a fibre optic camera and surgical instruments. Patients who undergo VATS recover more quickly than those who have more conventional, invasive surgery.
However, if the VATS procedure does not give enough access or is found not to be viable, then the surgeon will enlarge one of the incisions and do a standard thoracotomy where the ribs have to be spread open.
As Dr Mitchell explained in the prepared statement:
“This type of surgery requires that we take special care to contain any infected tissue I remove, and that we identify and completely resect any spread of the infection to the chest wall.”
“Given the localized nature of the disease, I am optimistic about the chances for a successful surgery,” he added.
The surgical team is optimistic that this procedure, which takes about 2 hours, will remove most of the TB organisms in Mr Speaker’s lungs, giving the post- operative medication more opportunity to kill off the rest. It also removes damaged tissue that TB bacteria thrive on.
The decision to do the surgery in July is not an arbitrary one, but a result of careful timing by the physicians attending Mr Speaker. The antibiotics that Mr Speaker is being treated with need several weeks to attack the TB and reduce the number of organisms. However, the wait cannot be indefinite because the benefit of organism reduction has to be weighed against the risk that the TB (which is already an extremely drug resistant type) will mutate further and be even more difficult to treat with antibiotics.
The National Jewish has extensive experience in treating multi-drug resistant tuberculosis (MDR TB) patients with similar procedures and they are normally able to go home four weeks later, when their sputum cultures are negative.
Mr Speaker’s recovery may or may not follow a similar pattern. The decision to release him from hospital will depend on how well he recovers from the procedure, tolerance to medication and the status of sputum cultures.
Surgeons are not able to say how the operation will affect his breathing, but many patients make a good recovery and go back to active lives.
In the meantime, Mr Speaker is in isolation at the National Jewish and is able to carry on working through his Atlanta office on some client cases.
Last month Mr Speaker captured the headlines when he flew to Greece for his wedding and then to Rome for his honeymoon. He eventually returned to the US via Canada.
The US Centers for Disease Control and Prevention (CDC) ordered Mr Speaker to be isolated and tracked down passengers and air crew who may have been exposed to TB while on the plane with Mr Speaker.
According to health officials, before Mr Speaker left the US he was advised not to travel but was told they could not stop him. At that time he did not know the type of TB he was infected with was XDR. He found out when he was in Europe, after the sample he gave had been tested.
Mr Speaker’s case has led to a debate among health officials about how to handle people who intend to leave the country when they are infected with potentially serious diseases.
At the moment the restrictions on entering the US with a serious infection far exceed those that stop people going from the US to other countries.
The World Health Organization (WHO) said the CDC should have been quicker to inform authorities in other countries about Mr Speaker’s illness.
Officials don’t know how Mr Speaker contracted XDR TB, but an investigation is under way.
Written by: Catharine Paddock
Writer: Medical News Today