Chronic tuberculous empyema with bronchopleural fistula resulting in treatment failure and progressive drug resistance.

Abstract:

:We treated five patients with a past history of tuberculous pleural infection that led to chronic, quiescent, loculated empyema. Reactivation of TB was associated with formation of BPF and recovery of drug-susceptible Mycobacterium tuberculosis from sputum. All patients had recurrence of positive sputum cultures that yielded tubercle bacilli resistant to drugs they were receiving. The lungs demonstrated gross thickening with calcification of both visceral and parietal pleura. Two patients underwent retreatment chemotherapy followed by decortication-empyemectomy and lung resection surgery; both are now culture-negative for TB. One patient received retreatment chemotherapy but refused surgery; he remains clinically stable with negative sputum cultures. Two other patients' organisms became drug-resistant and they remain sputum-culture positive. We believe that thick, calcified pleural walls limit penetration of drugs into the infected empyema space, resulting in suboptimal drug concentrations and drug resistance. Intensified chemotherapy and surgical intervention should be considered in these cases.

journal_name

Chest

journal_title

Chest

authors

Iseman MD,Madsen LA

doi

10.1378/chest.100.1.124

subject

Has Abstract

pub_date

1991-07-01 00:00:00

pages

124-7

issue

1

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(16)37387-1

journal_volume

100

pub_type

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