Cent Eur J Public Health 2020, 28(1):48-52 | DOI: 10.21101/cejph.a5789

Increasing incidence of tuberculosis diagnosed by surgery: a single centre analysis in low-incidence country

Radek Pohnán1,2, Vladislav Hytych2, Ivana Holmquist3,4, Vanda Boštíková4, Radek Doležel1, Miroslav Ryska1
1 Department of Surgery, Second Faculty of Medicine, Charles University and Central Military Hospital, Prague, Czech Republic
2 Thomayer Hospital, Prague, Czech Republic
3 Emory University Hospital Midtown, Atlanta, Georgia, USA
4 Department of Epidemiology, Faculty of Health Sciences, University of Defence, Hradec Králové, Czech Republic

Objective: The aim of this study was to assess the incidence of thoracic tuberculosis (TB) in patients who underwent surgery for indeterminate lung nodules, mass and pleural effusions.

Methods: A monocentric retrospective study was carried out from 2012 to 2018 in a high-volume thoracic surgery centre. All patients with finding of thoracic TB within surgery and/or confirmed post-surgery were studied. Demography, origin, TB related symptoms, immunosuppression, type of surgery, and complication of surgery were analyzed.

Results: During the seven-year period TB was diagnosed in 71 cases, 58% were men. The mean age was 50 years. 21% of the cases had family history of TB or were successfully treated for TB in the past. 14% of patients had prior history of treatment for malignancy. Five patients (7%) received immunosuppressive therapy. The indication for surgery was indeterminate lung nodules and mass in 55 patients (77.5%) and indeterminate recurrent or persistent pleural effusions in 21 patients (22.5%). In five patients (7%) a lung carcinoma and a concomitant TB infection was detected. 63 of the cases (88.7%) had positive real-time PCR TBC test. Direct microscopic detection of Mycobacterium tuberculosis detected TB in five cases (7%). The microbiological diagnosis by culture was achieved in 19 patients (26.8%). Two patients (2.8%) were diagnosed with multidrug-resistant TB. Surgical procedure complications occurred in nine cases (12.7%).

Conclusions: Although the overall incidence of TB in the Czech Republic is low and constantly continues to decrease, the number of TB detected by surgical procedures is increasing. Surgery still remains an important tool in diagnostics of nonobvious cases of TB, especially in patients with a potential risk of malignancy.

Keywords: tuberculosis, surgical procedures, epidemiology, incidence, diagnostics

Received: April 12, 2019; Revised: October 10, 2019; Accepted: October 10, 2019; Published: March 30, 2020  Show citation

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Pohnán R, Hytych V, Holmquist I, Boštíková V, Doležel R, Ryska M. Increasing incidence of tuberculosis diagnosed by surgery: a single centre analysis in low-incidence country. Cent Eur J Public Health. 2020;28(1):48-52. doi: 10.21101/cejph.a5789. PubMed PMID: 32228817.
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