[Surgical aspects of mycobacterioses. Evolution during the last 20 years]

Tuberculosis remains one of the major infectious diseases. Its incidence has grown in immigrants and in immunosuppressed patients, and, moreover, cases of drug resistance are on the increase. The goal of this study was to analyze the implications of these new developments and surgical experience in our patients.

The cases of 104 patients with tuberculosis hospitalized between 1975 and 1995 were reviewed retrospectively.

22% of the patients (23/104) were immigrants. No HIV-positive patients were described but association with debilitating diseases was frequent. Diagnosis was chiefly by histology. The culture was positive in only 30/104 patients (29%). Drug resistance was seen in only one patient (1%). 72/104 patients (69.2%) presented with an infection of the pulmonary parenchyma, 21/104 (20.2%) with pleural tuberculosis including tuberculous empyema, 3/104 (2.9%) with tuberculosis of the chest wall and 8/104 (7.7%) with mediastinal tuberculosis. Surgery was performed in 84/104 patients (80.8%). The chief indications were suspected carcinoma in 39/84 cases (46.4%), destroyed lung in 11/84 (13.1%), empyema combined with bronchopleural fistula in 10/84 (11.9%), enlarged mediastinal lymph-nodes of unknown dignity in 7/84 (8.3%), recurrent pleural effusion in 5/84 (5.9%) and bronchial stenosis in 4/84 (4.8%).

The number of surgical patients with tuberculosis has remained fairly stable over the last 20 years, but the proportion of immigrants has grown since 1990. Thoracoscopy is playing an increasingly important role in the diagnosis and surgical treatment of tuberculosis (recurrent pleural effusion, resection of peripheral pulmonary nodules turning out to be tuberculoma).