★Doctor Lalit Anande★
★Mumbai★
♂÷In a rare feat in a public hospital, a 50-year-old patient with dual infection of drug-resistant pulmonary tuberculosis and HIV was operated at civic-run TB Hospital in Sewri on Friday. HIV and TB, both highly infectious, need special arrangements and the use of extra disposable material that add to the cost of surgery in the private sector.
This is the second time a patient with HIV and TB was operated at the hospital. “Our honorary surgeons regularly operate on TB patients, but such a supra-major surgery is rare,’’ said Dr Lalit Anande, medical superintendent of the hospital. Surgery on the earlier co-infection patient was done over three years back.
The present patient, on anti-retroviral therapy for HIV\AIDS since 2009, was diagnosed with multi-drug resistant TB in October 2018. “He came with severe breathing difficulty about 10 days back,’’ said Dr Anande.
Doctors realized the TB infection affected his respiratory system so severely that only an operation could provide immediate relief. The surgical team performed decortication, a medical procedure involving surgical removal of the surface layer covering of an organ.The procedure is usually performed when the lung is covered by a thick, inelastic pleural peel restricting lung expansion.
“The lungs are covered by a thin membrane called pleura that is thinner than tissue paper. The TB infection makes this pleura thicker,’’ said cardiothroracic and vascular surgeon Dr Amol Bhanushali, who was in the team that operated on the patient.
Dr Amol Bhanusali said the patient’s pleura had became thick with consistency of curd, preventing the lungs from expanding during breathing. “It took us three hours to open up his chest and remove the pleura,’’ he added. The patient’s lungs were not severely affected by the TB bacterium and medicines should now help him recover. The patient is recovering and had his meals on Monday but as his immune system is weak, he will need 15 more days of hospitalization, said Dr Anande.
TB activist Ganesh Acharya said this was a positive development as many patients with HIV-MDR TB co-infection find it difficult to access healthcare. “Surgery is an option for patients in whom recovery with drugs alone is not possible. The government must provide modern operating theatres so doctors can operate on such patients safely,’’ he added.