1
|
Senhaji L, Alami B, Amara B, El Biaze M, Benjelloun MC, Serraj M. [Endobronchial mass of unusual etiology]. Rev Mal Respir 2024; 41:508-511. [PMID: 38937205 DOI: 10.1016/j.rmr.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Affiliation(s)
- L Senhaji
- Service de pneumologie, centre hospitalier universitaire Hassan II, 4, route d'Immouzar, appartement 1, Fès, Maroc; Faculté de médecine, de pharmacie et de médecine dentaire de Fès, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc.
| | - B Alami
- Service de radiologie, centre hospitalier universitaire Hassan II, Fès, Maroc; Faculté de médecine, de pharmacie et de médecine dentaire de Fès, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - B Amara
- Service de pneumologie, centre hospitalier universitaire Hassan II, 4, route d'Immouzar, appartement 1, Fès, Maroc; Faculté de médecine, de pharmacie et de médecine dentaire de Fès, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - M El Biaze
- Service de pneumologie, centre hospitalier universitaire Hassan II, 4, route d'Immouzar, appartement 1, Fès, Maroc; Faculté de médecine, de pharmacie et de médecine dentaire de Fès, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - M C Benjelloun
- Service de pneumologie, centre hospitalier universitaire Hassan II, 4, route d'Immouzar, appartement 1, Fès, Maroc; Faculté de médecine, de pharmacie et de médecine dentaire de Fès, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| | - M Serraj
- Service de pneumologie, centre hospitalier universitaire Hassan II, 4, route d'Immouzar, appartement 1, Fès, Maroc; Faculté de médecine, de pharmacie et de médecine dentaire de Fès, université Sidi-Mohamed-Ben-Abdellah, Fès, Maroc
| |
Collapse
|
2
|
Chen Q, Huang T, Zou L, Tang X, Shi Z, Wang X, Wu H, Sun J, Lu X, Liang L, Jiang L, Liu D, Tang S, Wu G, He W. Clinical outcomes of multidrug-resistant tracheobronchial tuberculosis receiving anti-tuberculosis regimens containing bedaquiline or delamanid. Sci Rep 2024; 14:17347. [PMID: 39069547 PMCID: PMC11284204 DOI: 10.1038/s41598-024-68550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 07/24/2024] [Indexed: 07/30/2024] Open
Abstract
The treatment of multidrug-resistant tracheobronchial tuberculosis poses challenges, and research investigating the efficacy of bedaquiline or delamanid as treatment for this condition is limited. This retrospective cohort study was conducted from 2017 to 2021. The study extracted data of patients with multidrug-resistant tracheobronchial tuberculosis from medical records and followed up on prognoses. Participants were divided into three groups: the bedaquiline, delamanid, and control group. Clinical outcomes and the risk factors associated with early culture conversion were analyzed. This study included 101 patients, with 32, 25, and 44 patients in the bedaquiline, delamanid, and control groups respectively. The differences in the treatment success rates among the three groups did not show statistical significance. Both the bedaquiline and delamanid groups had significantly higher culture conversion rates compared to the control after 2 or 6 months of treatment, with significantly shorter median times to culture conversion (bedaquiline group: 2 weeks, delamanid group: 2 weeks, control group: 12 weeks, P < 0.001). Treatment with bedaquiline or delamanid were identified as independent predictors of culture conversion at 2 months (bedaquiline group: aOR = 13.417, 95% CI 4.067-44.260, delamanid group: aOR = 9.333, 95% CI 2.498-34.878) or 6 months (bedaquiline group: aOR = 13.333, 95% CI 3.379-52.610, delamanid group: aOR = 5.000, 95% CI 1.357-18.426) of treatment through multivariable logistic regression analyses. The delamanid group showed better improvement in lumen stenosis compared to bedaquiline. Regimens containing bedaquiline or delamanid may accelerate the culture conversion during the early treatment phase in multidrug-resistant tracheobronchial tuberculosis, and delamanid appears to have the potential to effectively improve airway stenosis.
Collapse
Affiliation(s)
- Qing Chen
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Tao Huang
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Liping Zou
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Xianzhen Tang
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Zhengyu Shi
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Xinwei Wang
- Department of Imaging, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Huaige Wu
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Jiying Sun
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Xiaoli Lu
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Li Liang
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China
| | - Liangshuang Jiang
- Department of Thoracic Surgery, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Dafeng Liu
- Department of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Shenjie Tang
- Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, China.
| | - Guihui Wu
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China.
| | - Wei He
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China.
| |
Collapse
|
3
|
Thiet TT, Trung NT, Phat KT, Lan NH, Dung LT, Anh LV, Nam NH, Vuong NL. Long-term outcomes of surgical reconstruction for post-tuberculosis tracheobronchial stenosis: a 7-year follow-up in a tuberculosis-endemic region. J Thorac Dis 2024; 16:3563-3573. [PMID: 38983138 PMCID: PMC11228715 DOI: 10.21037/jtd-24-230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/26/2024] [Indexed: 07/11/2024]
Abstract
Background Surgical reconstruction is often necessary for severe tracheobronchial stenosis resulting from tuberculosis (TB). However, the long-term efficacy of this approach remains unclear. This study investigated the safety and long-term outcomes of surgery for severe post-TB tracheobronchial stenosis. Methods We conducted a retrospective study of 48 patients with severe post-TB tracheobronchial stenosis who underwent surgical reconstruction between 2015 and 2018 in a TB-endemic region. Pre- and postoperative evaluations included Karnofsky performance status, modified Medical Research Council (mMRC) dyspnea scale, spirometry, chest computed tomography (CT) scan, and bronchoscopy. The primary outcome was intervention-requiring restenosis over the long term. Results The mean patient age was 30.6±9.9 years, with 91.7% females. Airway fibrosis was the predominant lesion (93.8%), affecting the bronchi (93.8%) and trachea (6.2%). All the patients underwent resection and anastomosis, and 56.2% required lobectomy. Postoperative complications occurred in 13 patients (27.1%), with prolonged air leaks being the most prevalent (12.5%). All complications resolved with conservative management. Significant improvements in performance status, dyspnea, and lung function were observed postoperatively and sustained for over 5 years. Within a median follow-up of 69 months, five cases of intervention-requiring restenosis occurred within the first year. The freedom from restenosis rate was 90% from 1 year onwards. Conclusions Surgical reconstruction is safe and effective in treating severe post-TB tracheobronchial stenosis. Larger studies are required to validate these findings.
Collapse
Affiliation(s)
- Truong Thanh Thiet
- Department of Thoracic Surgery No. 1, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Trung
- Department of Thoracic Surgery No. 1, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Khuu Tan Phat
- Department of Thoracic Surgery No. 1, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Huu Lan
- Board of Directors, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Le Tien Dung
- Board of Directors, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Le Viet Anh
- Department of Thoracic Surgery, Military Hospital No. 103, Ha Noi, Vietnam
| | - Nguyen Hoai Nam
- Department of Cardiovascular and Thoracic Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| |
Collapse
|
4
|
Chen Q, Huang T, Zou L, Jiang L, Sun J, Lu X, Huang X, Wu G, He W. Differences in epidemiological and clinical features between adult and pediatric tracheobronchial tuberculosis patients in Southwest China. Front Public Health 2023; 11:1225267. [PMID: 37538277 PMCID: PMC10395115 DOI: 10.3389/fpubh.2023.1225267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
Background Tracheobronchial tuberculosis (TBTB) is a common form of extrapulmonary tuberculosis that affects the tracheobronchial tree. However, the mechanism has not been fully elucidated. Comparisons of clinical characteristics in various age groups can aid in the understanding of TBTB. Methods This retrospective study was conducted at the Public Health Clinical Center of Chengdu between July 2017 and December 2021, including adults and children with TBTB. Clinical data were extracted from medical records. T/T' test, Mann-Whitney U test, Chi-square test, or Fisher's exact test were used in this study. Results This study enrolled 347 patients with TBTB (175 adults and 172 children). Adult females were more susceptible to TBTB, whereas gender-based differences were not observed in children. Children had a higher occurrence of irritant dry cough and fever, and acute hematogenous disseminated PTB, and specific types of EPTB, but a shorter interval before diagnosis, and lower diagnostic yields compared to adults (P < 0.05). Adults presented more extensive lung lesions and cavitations as compared to children. Granulation hyperplasia and lymph fistula were more frequently observed in children, as well as airway stenosis, but less severe. Conclusions The study revealed important variations exist in multiple respects between adults and children with TBTB.
Collapse
Affiliation(s)
- Qing Chen
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Tao Huang
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Liping Zou
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Liangshuang Jiang
- Department of Thoracic Surgery, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Jiying Sun
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Xiaoli Lu
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Xiaoqiu Huang
- Department of Health Information, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Guihui Wu
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Wei He
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, China
| |
Collapse
|
5
|
Chen G, Qin CJ, Wu MZ, Wu BB, Luo WR, Zhuang H, He XY, Liu SS. CLINICAL APPLICATION OF RT-PCR IN TUBERCULOSIS DNA DETECTION COMBINED WITH TB-IGRA IN THE DIAGNOSIS OF SPUTUM SMEAR-NEGATIVE PULMONARY TUBERCULOSIS. Acta Clin Croat 2022; 61:193-197. [PMID: 36818924 PMCID: PMC9934030 DOI: 10.20471/acc.2022.61.02.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/26/2020] [Indexed: 02/10/2023] Open
Abstract
The aim was to investigate detection of pulmonary alveolar lavage fluid tuberculosis DNA by real-time fluorescent polymerase chain reaction (RT-PCR) combined with clinical application of the sputum smear-negative pulmonary tuberculosis diagnosis with TB interferon-γ release assay (TB-IGRA). From October 2014 to October 2015, 632 outpatients and inpatients treated in our hospital were randomly selected, of which 459 patients as the research group managed with RT-PCR detection combined with TB-IGRA and 173 patients as the control group undergoing electronic bronchoscopy alveolar lavage fluid detection, with detection results statistically evaluated. The positive rate in the research group was 96.51%, i.e. significantly higher than that in the control group (66.47%), yielding a statistically significant difference (χ2=109.68, p=0.00). The true positive rate was 97.7% in the research group and 67.92% in the control group; the true positive rate was significantly higher in the research group patients as compared with the control group, yielding a statistically significant difference (χ2=112.04, p=0.00). The sensitivity and specificity, as well as Youden index were significantly higher in the research group as compared with the control group. In conclusion, TB DNA detection by RT-PCR combined with TB-IGRA is a very good method of diagnosing tuberculosis, and it can be implemented in clinical diagnosis of pulmonary tuberculosis.
Collapse
Affiliation(s)
- Gao Chen
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| | - Chun-Jun Qin
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| | - Meng-Zheng Wu
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| | - Bi-Bo Wu
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| | - Wan-Rong Luo
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| | - Han Zhuang
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| | - Xian-Ya He
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| | - Shu-Shu Liu
- Department of Infectious Diseases, Deyang People's Hospital, Deyang Sichuan, People's Republic of China
| |
Collapse
|
6
|
Wongtanasarasin W, Boonyaprapa S, Euathrongchit J. A woman with wheezing and stridor. J Am Coll Emerg Physicians Open 2021; 2:e12333. [PMID: 33521784 PMCID: PMC7819261 DOI: 10.1002/emp2.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Somkamon Boonyaprapa
- Department of OtolaryngologyFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | | |
Collapse
|
7
|
Jenson M, Forshee WA, Padilla RM, Wynn G. Endobronchial Tuberculosis and Bronchostenosis: A Rare Case of Bronchial Occlusion in a Patient With History of Tuberculosis. Cureus 2021; 13:e12717. [PMID: 33614322 PMCID: PMC7883571 DOI: 10.7759/cureus.12717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary tuberculosis is common worldwide, and many of these patients develop endobronchial tuberculosis (EBTB). Bronchostenosis is a known complication of EBTB though most patients with endobronchial stenosis do not develop severe bronchostenosis or occlusion. We present a rare case of a patient with a right upper lobe bronchus occlusion and a history of tuberculosis.
Collapse
Affiliation(s)
- Matthew Jenson
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - William A Forshee
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Rebekah M Padilla
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Gregory Wynn
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| |
Collapse
|
8
|
Peng AZ, Yang A, Li SJ, Qiu Q, Yang S, Chen Y. Incidence, laboratory diagnosis and predictors of tracheobronchial tuberculosis in patients with pulmonary tuberculosis in Chongqing, China. Exp Ther Med 2020; 20:174. [PMID: 33093909 PMCID: PMC7571346 DOI: 10.3892/etm.2020.9304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
Tracheobronchial tuberculosis (TBTB) is reported in 10-40% of patients with pulmonary tuberculosis (PTB). Due to its non-specific presentation, the diagnosis and management are frequently delayed. The aim of the present study was to investigate the incidence, predictors and laboratory diagnosis of concomitant TBTB and PTB in Chongqing, China. Bronchoscopy was performed in all patients with newly diagnosed or relapsed PTB in order to detect TBTB between January 2018 and April 2019 in a sub-tertiary hospital in Chongqing, China. The clinical characteristics and laboratory data were analyzed to identify predictors and determine the diagnostic yield of TBTB. A total of 341 (31.4%) of the 1,085 patients with PTB who underwent the bronchoscopic examination presented with concomitant TBTB. The parameters of female sex [odds ratio (OR)=2.57], clinical symptoms (OR=6.26) and atelectasis (OR=4.3) were independent predictors of TBTB. Cough (OR=32.48) and atelectasis (OR=3.14) were independent predictors of TBTB-associated tracheobronchial stenosis. The diagnostic yields of sputum smear, bronchial brush smear, sputum culture, GeneXpert Mycobacterium tuberculosis/rifampicin resistance (GX) using sputum, GX using brushings and in bronchial brush culture used for the diagnosis of TBTB were 44.2, 44.2, 63.5, 57.7, 71.2 and 75%, respectively. GX brushings had higher diagnostic yields compared with sputum or brush smears; however, there was no significant difference between sputum/brushings cultures and GX with sputum. The incidence of TBTB in PTB was 31.4% in Chongqing, China. The parameters of female sex, atelectasis and cough were the major predictors of concomitant TBTB and associated tracheobronchial stenosis. Although GX is an accurate and rapid test to detect TBTB, additional laboratory techniques should also be adopted to improve diagnostic yields in the detection of TBTB in patients with PTB.
Collapse
Affiliation(s)
- An-Zhou Peng
- Department of Tuberculosis Laboratory, Public Health Medical Center, Chongqing 400036, P.R. China
| | - Ao Yang
- Department of Traffic Injury Prevention Research Office, Daping Hospital, Army Medical Center of The PLA, Chongqing 400042, P.R. China
| | - Si-Ju Li
- Department of Tuberculosis Laboratory, Public Health Medical Center, Chongqing 400036, P.R. China
| | - Qian Qiu
- Department of Tuberculosis Laboratory, Public Health Medical Center, Chongqing 400036, P.R. China
| | - Song Yang
- Department of Tuberculosis Laboratory, Public Health Medical Center, Chongqing 400036, P.R. China
| | - Yong Chen
- Department of Tuberculosis Laboratory, Public Health Medical Center, Chongqing 400036, P.R. China.,Department of Endocrinology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| |
Collapse
|
9
|
Song YH, Li Q, Ma LP, Liu RM, Jiang GL, Li Q, Gao MQ. Performance of the Xpert® MTB/RIF assay in the rapid diagnosis of tracheobronchial tuberculosis using bronchial washing fluid. J Int Med Res 2020; 48:300060520921640. [PMID: 33045875 PMCID: PMC7557701 DOI: 10.1177/0300060520921640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the diagnostic value of the Xpert® MTB/RIF (GeneXpert) assay for tracheobronchial tuberculosis (TBTB) using bronchial washing fluid (BWF). Methods This retrospective study enrolled patients suspected of having TBTB and patients with non-TB pulmonary disease as controls. BWF were used to undertake acid-fast bacillus (AFB) smears, the GeneXpert assay and the Lӧwenstein–Jensen (LJ) culture method. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared among BWF AFB smears, BWF GeneXpert and the BWF LJ culture method. Results A total of 130 patients with TBTB and 102 patients with non-TB pulmonary disease were enrolled in the study. Sputum AFB smears were positive in 62 of 130 patients (47.7%) with TBTB. Using the clinical diagnosis of TBTB as the gold standard, the sensitivity, specificity, PPV and NPV of the three methods using BWF were as follows: 93.1%, 99.0%, 99.2% and 91.8% for BWF GeneXpert; 73.1%, 100.0%, 100.0% and 74.5% for BWF LJ cultures; 53.8%, 99.0%, 98.6% and 62.7% for BWF AFB smears. The diagnostic yield of BWF GeneXpert was significantly higher compared with BWF cultures for type III and IV TBTB. Conclusion The Xpert® MTB/RIF assay using BWF exhibited higher sensitivity than bacteriological diagnostic methods and was particularly useful for the early diagnosis of smear-negative TBTB.
Collapse
Affiliation(s)
- Yan-Hua Song
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Qiang Li
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Ma
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Rong-Mei Liu
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Guang-Lu Jiang
- Tuberculosis Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Qi Li
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Meng-Qiu Gao
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
10
|
Avula A, Ngu S, Mansour W, Gurala D, Maroun R. A Case of Laryngeal Tuberculosis, Endobronchial Tuberculosis and Pulmonary Tuberculosis Coexistent in an Immunocompetent Host. Cureus 2020; 12:e10713. [PMID: 33133876 PMCID: PMC7594666 DOI: 10.7759/cureus.10713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Historically associated with poor prognosis seen in advanced disease, laryngeal tuberculosis (LTB) now represents only 1% of all cases of tuberculosis (TB). The incidence of LTB has decreased drastically with the introduction of anti-tubercular drugs. LTB can be primary or secondary to pulmonary tuberculosis. LTB can mimic laryngeal cancer. We present a case of primary laryngeal TB with descending tracheobronchial spread in an immunocompetent 71-year-old female who developed progressive dysphonia over several months with unintentional weight loss and non-productive cough. Non-contrast enhanced computed tomography (CT) revealed clustering of subcentimeter stellate nodules in the right upper lung field with an enlarging ground-glass opacity in the right lower lung but did not show structural abnormalities within the neck. Positron emission tomography (PET) showed pathologic fluorodeoxyglucose (FDG) uptake within the larynx and trachea with extension into the left mainstream bronchus as well as the proximal left upper and lower lobe bronchi. Diffuse standardized uptake value (SUV) was greatest in the larynx (20.5). Polymerase chain reaction (PCR) on bronchoscope sputum specimen confirmed Mycobacterium tuberculosis. Findings were consistent with primary laryngeal TB with endobronchial extension. She was started on a four-drug regimen comprising of isoniazid, rifampin, ethambutol, and pyrazinamide with a good response. Her close contacts were treated as well. This case highlights the unusual spread of primary laryngeal TB in an immunocompetent host. Early diagnosis can limit adverse complications and unnecessary exposure to healthcare workers. To our knowledge, this is the first case of primary LTB with proximal spread to the tracheobronchial and pulmonary tuberculosis.
Collapse
Affiliation(s)
- Akshay Avula
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Sam Ngu
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Wissam Mansour
- Pulmonary and Critical Care Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Dhineshreddy Gurala
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| | - Rabih Maroun
- Pulmonary and Critical Care Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
| |
Collapse
|
11
|
Mondoni M, Rinaldo RF, Carlucci P, Terraneo S, Saderi L, Centanni S, Sotgiu G. Bronchoscopic sampling techniques in the era of technological bronchoscopy. Pulmonology 2020; 28:461-471. [PMID: 32624385 DOI: 10.1016/j.pulmoe.2020.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Flexible bronchoscopy is a key diagnostic and therapeutic tool. New endoscopes and technologically advanced navigational modalities have been recently introduced on the market and in clinical practice, mainly for the diagnosis of mediastinal lymph adenopathies and peripheral lung nodules. Bronchoscopic sampling tools have not changed significantly in the last three decades, with the sole exception of cryobiopsy. We carried out a non-systematic, narrative literature review aimed at summarizing the scientific evidence on the main indications/contraindications, diagnostic yield, and safety of the available bronchoscopic sampling techniques. Performance of bronchoalveolar lavage, bronchial washing, brushing, forceps biopsy, cryobiopsy and needle aspiration techniques are described, focusing on indications and diagnostic accuracy in the work-up of endobronchial lesions, peripheral pulmonary abnormalities, interstitial lung diseases, and/or hilar-mediastinal lymph adenopathies. Main factors affecting the diagnostic yield and the navigational methods are evaluated. Preliminary data on the utility of the newest sampling techniques (i.e., new needles, triple cytology needle brush, core biopsy system, and cautery-assisted transbronchial forceps biopsy) are shown. TAKE HOME MESSAGE: A deep knowledge of bronchoscopic sampling techniques is crucial in the era of technological bronchoscopy for an optimal management of respiratory diseases.
Collapse
Affiliation(s)
- M Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - R F Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - P Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - S Terraneo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - L Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - S Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy.
| |
Collapse
|
12
|
Lee KCH, Tan S, Goh JK, Hsu AAL, Low SY. Long-term outcomes of tracheobronchial stenosis due to tuberculosis (TSTB) in symptomatic patients: airway intervention vs. conservative management. J Thorac Dis 2020; 12:3640-3650. [PMID: 32802443 PMCID: PMC7399429 DOI: 10.21037/jtd-20-670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Patients with tracheobronchial stenosis due to tuberculosis (TSTB) have a variable clinical course and response to treatment including airway intervention. There are no clear guidelines on the best approach to manage such patients. This study examines long-term outcomes of patients with TSTB and factors associated with recurrent symptoms or need for repeat airway intervention following initial bronchoscopic intervention. Methods This is a retrospective analysis of patients with TSTB over an 18-year period. Symptoms, radiological, bronchoscopic findings, airway interventions and complications were obtained. Multivariate logistic regression analysis was performed to identify factors predictive of recurrence of symptoms or need for repeat airway intervention. Results A total of 131 patients with mean age 50±18 years and median follow-up 5 (interquartile range, 2–10) years were included. Nineteen (29.7%) patients underwent balloon dilatation alone, 22 (34.4%) had additional resection or stenting, and 19 (29.7%) underwent all 3 procedures. Among patients conservatively managed, a larger proportion (55.6%) of patients with no recurrence of symptoms had active TB. Patients who developed recurrent symptoms had longer symptom duration (12 vs. 3 months, P=0.025), and more had recurrent lower respiratory tract infections (50% vs. 5.6%, P=0.003), lung collapse (90.0% vs. 41.7%, P=0.011) or linear fibrosis (70.0% vs. 30.6%, P=0.033) compared to those without recurrent symptoms. Bronchomalacia (OR =17.18; 95% CI, 3.43–86.18) and prior bronchoscopic airway resection (OR =4.97; 95% CI, 1.20–20.60) were strongly associated with the recurrence of symptoms or need for repeat airway intervention on multivariate logistic regression analysis. Conclusions Bronchomalacia and prior bronchoscopic airway resection are associated with the recurrence of symptoms despite airway intervention. Patients who are diagnosed with TSTB early in the course of active TB may be conservatively managed.
Collapse
Affiliation(s)
- Ken Cheah Hooi Lee
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.,Lung Center, Duke-National University Singapore SingHealth, Singapore, Singapore
| | - Shera Tan
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore, Singapore
| | - Junyang Ken Goh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.,Lung Center, Duke-National University Singapore SingHealth, Singapore, Singapore
| | - Anne Ann Ling Hsu
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.,Lung Center, Duke-National University Singapore SingHealth, Singapore, Singapore
| | - Su Ying Low
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.,Lung Center, Duke-National University Singapore SingHealth, Singapore, Singapore
| |
Collapse
|
13
|
Kim SB, Lee WY, Lee JH, Lee SJ, Lee MK, Kim SH, Uh Y, Jung SH, Shin B. A variety of bacterial aetiologies in the lower respiratory tract at patients with endobronchial tuberculosis. PLoS One 2020; 15:e0234558. [PMID: 32584852 PMCID: PMC7316277 DOI: 10.1371/journal.pone.0234558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022] Open
Abstract
Recently, our understanding of the elusive bacterial communities in the lower respiratory tract and their role in chronic lung disease has increased significantly. However, little is known about the respiratory microorganisms in patients with endobronchial tuberculosis (EBTB), which is a chronic inflammatory disease characterized by destruction of the tracheobronchial tree due to Mycobacterium tuberculosis (MTB) infection. We retrospectively reviewed data for histopathologically and microbiologically confirmed EBTB patients diagnosed at a tertiary referral hospital in South Korea between January 2013 and January 2019. Bacterial cultures were performed on bronchial washing from these patients at the time of EBTB diagnosis. A total of 216 patients with EBTB were included in the study. The median age was 73 years and 142 (65.7%) patients were female. Bacteria were detected in 42 (19.4%) patients. Additionally, bacterial co-infection was present in 6 (2.8%) patients. Apart from MTB, the most common microorganisms identified were Staphylococcus aureus (n = 14, 33.3%) followed by Klebsiella species (n = 12, 28.6%; 10 Klebsiella pneumoniae, 2 Klebsiella oxytoca), Streptococcus species (n = 5, 11.9%), Enterobacter species (n = 4, 9.5%), and Pseudomonas aeruginosa (n = 3, 7.1%). A variety of microorganisms were isolated from the bronchial washing indicating that changes in microorganism composition occur in the airways of patients with EBTB. Further studies are needed to investigate the clinical significance of this finding.
Collapse
Affiliation(s)
- Sae Byol Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Soon-Hee Jung
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Beomsu Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- * E-mail:
| |
Collapse
|
14
|
Abstract
Endobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree by Mycobacterium tuberculosis. It is common among young females. Patient can present with fever, cough, wheeze, with or without any constitutional symptoms. It presents as a diagnostic dilemma, as patient sputum smear can be false negative. CT scan may or may not show any abnormality, or any endobronchial lesion. Bronchoscopy with bronchoalveolar lavage and biopsy offers the diagnostic choice. We hereby report a case of a young immunocompetent Asian female who was found to have endobronchial pathology, leading to diagnosis and timely therapy.
Collapse
Affiliation(s)
- Nadeem M Kassam
- Internal Medicine, Aga Khan University Medical College, Dar es Salaam, TZA
| | - Omar M Aziz
- Internal Medicine, Aga Khan Hospital, Dar es Salaam, TZA
| | - Samina Somji
- Internal Medicine, Aga Khan University Medical College, Dar es Salaam, TZA
| | - Grace Shayo
- Internal Medicine, Muhim Bili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
| |
Collapse
|
15
|
Yaguchi D, Kimura H, Inoue N, Ichikawa M. Tuberculous bronchial stenosis treated with balloon dilatation. QJM 2019; 112:539-540. [PMID: 30605545 DOI: 10.1093/qjmed/hcy307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Yaguchi
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Maehata-cho, Tajimi, Gifu 507-8522, Japan
| | - H Kimura
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Maehata-cho, Tajimi, Gifu 507-8522, Japan
| | - N Inoue
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Maehata-cho, Tajimi, Gifu 507-8522, Japan
| | - M Ichikawa
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Maehata-cho, Tajimi, Gifu 507-8522, Japan
| |
Collapse
|
16
|
Endobronchial tuberculosis with primary multi-drug resistance: An under-recognized entity in Nepal. J Clin Tuberc Other Mycobact Dis 2019; 15:100096. [PMID: 31720423 PMCID: PMC6830167 DOI: 10.1016/j.jctube.2019.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
17
|
Liu X, Xu L, Jiang G, Huang S. Pleural effusion resulting from bronchial tuberculosis: A case report. Medicine (Baltimore) 2018; 97:e12713. [PMID: 30290674 PMCID: PMC6200503 DOI: 10.1097/md.0000000000012713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The clinical manifestations in patients with bronchial tuberculosis (BTB) are nonspecific and may pose a great diagnostic challenge. PATIENT CONCERNS Here we describe the case of a 57-year-old man presented with right chest pain, chest tightness, and discomfort for 2 days. DIAGNOSIS Bronchoscopic biopsy was performed which revealed subepithelial and epithelioid cell granuloma of Langerhans cell structure. The definitive diagnosis was BTB with pleural effusion. INTERVENTIONS Treatment with a quadruple combinational antituberculous therapy was initiated. OUTCOMES Two months later, the patient's chest distress and discomfort significantly decreased. Repeat chest radiograph revealed that the pleural fluid had been absorbed. The patient recovered after 15 months of antituberculosis treatment. LESSONS The patient exemplifies the difficulty of diagnosing BTB, particularly the low reliability of imaging modalities. The diagnosis of BTB currently relies on bronchoscopy as well as bacteriological or pathological evidence. This report will help to lower the incidences of misdiagnosis of this disease.
Collapse
Affiliation(s)
- Xuchun Liu
- Department of Respiratory Medicine, Chizhou People's Hospital
| | - Litao Xu
- Department of Respiratory Medicine, Chizhou People's Hospital
| | - Guohua Jiang
- Department of Respiratory Medicine, Chizhou People's Hospital
| | - Shubin Huang
- Department of Pathology, Chizhou People's Hospital, Chizhou, Anhui, China
| |
Collapse
|
18
|
Zhao L, Guan R, Yu H, Lin J, Peng C, Yao H, Zhang X, Ye X. Endobronchial anthracofibrosis: possibly a new indication of aggressive treatment for active endobronchial tuberculosis. J Thorac Dis 2018; 10:E511-E515. [PMID: 30174922 DOI: 10.21037/jtd.2018.07.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anthracofibrosis, which was defined as a luminal narrowing associated with overlying anthracotic mucosa on bronchoscopy, has been infrequently reported. Recently, we have identified a case of patient who had a history of pulmonary tuberculosis (TB), manifested left main bronchial stenosis and hyperpigmentation. Despite repeated and multiple cryotherapy, the condition was still progressing. Given to the potential relationship between active endobronchial tuberculosis (EBTB) and anthracofibrosis, the patient received a diagnostic anti-tuberculosis (anti-TB) treatment due to initial failed cryotherapy, resulting in improvement of hyperpigmentation and stenosis of the left main bronchus. Eventually, the patient recovered well with regular anti-TB combined with intermittent cryotherapy. Our study suggests that even without etiological evidence, there might be an indication of therapeutic trial of anti-TB medication in case of repeated bronchial stenosis due to anthracofibrosis in patients with past history of TB and other causes are excluded. Yet, the recommendation of aggressive treatment should reply on the effect of diagnostic treatment and further research.
Collapse
Affiliation(s)
- Li Zhao
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China.,State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510030, China
| | - Ruijuan Guan
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510030, China
| | - Hong Yu
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Jieru Lin
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Chunhong Peng
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Hongmei Yao
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Xiangyan Zhang
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Xianwei Ye
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China
| |
Collapse
|
19
|
Yaguchi D, Ichikawa M, Shizu M, Inoue N, Kobayashi D, Imai N. Bronchoscopic local steroid spray to prevent bronchial tuberculosis-induced cicatricial bronchial stenosis: A case series. Medicine (Baltimore) 2018; 97:e11464. [PMID: 29995804 PMCID: PMC6076191 DOI: 10.1097/md.0000000000011464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATONALE Cicatricial bronchial stenosis or obstruction occurring in the healing process of endobronchial tuberculosis (ET) is a problematic complication of tuberculous airway lesions. Prevention by internal medical treatment is desired. PATIENT CONCERNS This case series describes four patients who diagnosed ET with Type IIIb (protruding ulcer-type) based on Arai's classification of bronchoscopic findings of bronchial tuberculosis. DIAGNOSES Endobronchial tuberculosis. INTERVENTIONS A local steroid spray was applied bronchoscopically to active protruding ulcer-type lesions (which are likely to cause cicatricial stenosis) that extended in the transverse direction and occupied one-half or more of the circumference on bronchoscopy. OUTCOMES Cicatricial stenosis was prevented in two of four patients. Treatment was discontinued in athird patient because tolerance could not be achieved, although the patient's condition had improved. In the fourth patient, treatment was switched to systemic steroid administration because of a problem with tolerance and the broad range of the lesion; however, stenosis remained. LESSONS Local steroid spray-applied bronchoscopically to bronchial tuberculosis lesions in the ulcer formation and granulation periods may help prevent stenosis.
Collapse
|
20
|
Zhang Q, Zhang Q, Sun BQ, Liu C, Su AN, Wang XH, Liu N, Zhang J, Kang J, Hou G. GeneXpert MTB/RIF for rapid diagnosis and rifampin resistance detection of endobronchial tuberculosis. Respirology 2018; 23:950-955. [PMID: 29691960 DOI: 10.1111/resp.13316] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/14/2018] [Accepted: 03/29/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Delayed diagnosis and treatment of tuberculosis (TB) contribute to poor outcomes, especially for endobronchial TB (EBTB), which typically leads to tracheobronchial stenosis. Finding rapid and accurate diagnostic tools for EBTB is crucial. GeneXpert Mycobacterium tuberculosis (MTB)/rifampin (RIF) was recommended by the World Health Organization (WHO) as a standard molecular biological diagnostic technique for MTB. The aim of this study was to evaluate the efficacy of GeneXpert MTB/RIF for diagnosing EBTB and for evaluating RIF resistance. METHODS Biopsy tissue and bronchial brushings from EBTB patients were prospectively assessed with GeneXpert MTB/RIF. The diagnostic yields of auramine O-stained sputum smears and bronchial brush smears were obtained, and the results were compared with the cultures of sputum and biopsy tissues for MTB. RESULTS In 61 confirmed cases of EBTB, the sensitivities of sputum smear, bronchial brush smear, sputum culture and tissue culture to diagnose EBTB were 13.1%, 32.8%, 36.1% and 68.9%, respectively. For bronchial brushings and biopsies, our data showed sensitivities of 57.4% and 63.9%, respectively, and a specificity of 100% for GeneXpert MTB/RIF, and these results were superior to those of sputum smears, bronchial brush smears and sputum culture. GeneXpert MTB/RIF for bronchial brushings and biopsies showed complementarity in its diagnostic performance. Resistance to RIF was identified in 17.4% (8/46) of GeneXpert MTB-positive cases. CONCLUSION GeneXpert MTB/RIF may enable more rapid EBTB diagnosis and determination of RIF resistance, which are crucial for timely treatment.
Collapse
Affiliation(s)
- Qin Zhang
- Institute of Respiratory Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Qing Zhang
- Department of Endoscopy, Shenyang Thoracic Hospital, Shenyang, China
| | - Bing-Qi Sun
- Department of Laboratory, Shenyang Thoracic Hospital, Shenyang, China
| | - Chang Liu
- Department of Endoscopy, Shenyang Thoracic Hospital, Shenyang, China
| | - An-Na Su
- Department of Endoscopy, Shenyang Thoracic Hospital, Shenyang, China
| | - Xiao-Han Wang
- Department of Endoscopy, Shenyang Thoracic Hospital, Shenyang, China
| | - Na Liu
- Department of Endoscopy, Shenyang Thoracic Hospital, Shenyang, China
| | - Juan Zhang
- Department of Laboratory, Shenyang Thoracic Hospital, Shenyang, China
| | - Jian Kang
- Institute of Respiratory Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Gang Hou
- Institute of Respiratory Diseases, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
21
|
Mondoni M, Repossi A, Carlucci P, Centanni S, Sotgiu G. Bronchoscopic techniques in the management of patients with tuberculosis. Int J Infect Dis 2017; 64:27-37. [PMID: 28864395 DOI: 10.1016/j.ijid.2017.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/28/2017] [Accepted: 08/15/2017] [Indexed: 12/27/2022] Open
Abstract
Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis. We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB. We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting) and ablative procedures (both heat and cold therapies).
Collapse
Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Alice Repossi
- Respiratory Unit, Humanitas Gavazzeni Institute, Bergamo, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.
| |
Collapse
|
22
|
Abdullah H, Quek CZ. Undiagnosed acute phase endobronchial tuberculosis with progression to irreversible tracheobronchial stenosis. BMJ Case Rep 2017; 2017:bcr-2017-219877. [DOI: 10.1136/bcr-2017-219877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
23
|
Şimşek A, Yapıcı İ, Babalık M, Şimşek Z, Kolsuz M. Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis. J Bras Pneumol 2017; 42:191-5. [PMID: 27383932 PMCID: PMC5569611 DOI: 10.1590/s1806-37562015000000134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 03/14/2016] [Indexed: 02/05/2023] Open
Abstract
Objective: To determine the proportional distribution of endobronchial tuberculosis (EBTB) subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. Methods: This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. Results: The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both). Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%). Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%). Smear microscopy of BAL fluid (BALF) was performed in 16 patients and was positive for AFB in 10 (62.5%). Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%). Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%); bronchial brushing, in 7 (38.8%); fine-needle aspiration biopsy, in 2 (11.1%); and BAL, in 2 (11.1%). Bronchial anthracofibrosis was observed in 5 (27.7%) of the 18 cases evaluated. Conclusions: In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB.
Collapse
Affiliation(s)
- Abdullah Şimşek
- Department of Chest Diseases, Prof. Dr. Türkan Akyol Chest Diseases Hospital, Bursa, Turkey
| | - İlhami Yapıcı
- Department of Chest Diseases, Prof. Dr. Türkan Akyol Chest Diseases Hospital, Bursa, Turkey
| | - Mesiha Babalık
- Department of Chest Diseases, Prof. Dr. Türkan Akyol Chest Diseases Hospital, Bursa, Turkey
| | - Zekiye Şimşek
- Department of Radiology, Bursa Çekirge Public Hospital, Bursa, Turkey
| | - Mustafa Kolsuz
- Department of Chest Diseases, Prof. Dr. Türkan Akyol Chest Diseases Hospital, Bursa, Turkey
| |
Collapse
|
24
|
Manal E, Nahid Z, Hanane B, Najiba Y. [Endobronchial tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:55-60. [PMID: 28162798 DOI: 10.1016/j.pneumo.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM The endobronchial tuberculosis (EBTB) is an uncommon type of tuberculosis. The respiratory symptoms in EBTB are usually nonspecific and misleading. The aim of the study is to determine the clinical features and diagnostic aspects of EBTB. PATIENTS AND METHODS Twenty-eight cases of endobronchial tuberculosis collected from January 2009 to October 2015. RESULTS EBTB was found in 16 females and 12 males. The mean age was 48 years. The history of tuberculosis and tuberculosis contagion were not found in any case. The respiratory symptoms were dominated by cough and dyspnea. Hemoptysis was found in 7 cases. The chest X-ray showed associated pulmonary lesions in 26 cases. Bronchoscopy finded an endobronchial granular lesion in 15 cases, a tumorous pattern in 7 cases; a thickening spurs in 4 cases and ganglio-bronchial fistula in two cases. Bronchial biopsies had found a caseo-follicular tuberculosis in 27 cases. Pleural biopsy confirmed associated pleural tuberculosis in one case. The research of Koch bacillus in the sputum was positive in 13 cases and culture in 6 cases. The antituberculosis treatment was started in all patients and an oral corticosteroids treatment was associated in 5 cases. The evolution was good in 26 cases. CONCLUSION This study showed clinical, radiological and endoscopic bronchial tuberculosis polymorphism making its diagnosis difficult and the importance of a bacteriological and/or histological confirmation.
Collapse
Affiliation(s)
- E Manal
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc.
| | - Z Nahid
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - B Hanane
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - Y Najiba
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| |
Collapse
|
25
|
Abstract
Endobronchial tuberculosis (EBTB) is defined as tuberculous infection of the tracheobronchial tree. The exact pathogenesis is unclear, and it has a heterogenous clinical course. Its diagnosis requires the clinician to have a high index of suspicion based on clinical symptoms and radiological features. Computed tomography and bronchoscopy are useful tools in its evaluation. The goal of treatment is in the eradication of tuberculous bacilli with appropriate anti-tuberculous therapy. Use of corticosteroids is controversial for the prevention of tracheobronchial stenosis. Interventional bronchoscopy or surgical intervention is employed to restore airway patency once significant stenosis occurs.
Collapse
Affiliation(s)
- Wen Ting Siow
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System Tower Block, Singapore 119228, Singapore
| | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System Tower Block, Singapore 119228, Singapore
| |
Collapse
|
26
|
Abstract
Endobronchial tuberculosis (EBTB) is a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence. Patients may present with symptoms secondary to disease itself or from the complication of disease like endobronchial obstruction. Diagnosis requires a high index of suspicion. Computed tomography (CT) and bronchoscopy along with microbiological investigations are the most useful diagnostic tools for the confirmation as well as for the evaluation of the tracheobronchial stenosis. The goals of treatment are eradication of tubercle bacilli with anti-tubercular medications and the prevention of airway stenosis. Interventional Bronchoscopic techniques and surgery is required for those patients who develop severe tracheobronchial stenosis that causing significant symptoms including dyspnea, repeated post obstructive pneumonia or bronchiectasis.
Collapse
Affiliation(s)
- Talha Shahzad
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
27
|
Abstract
Tracheobronchial tuberculosis (TBTB) is reported in approximately 10% to 39% of the patients with pulmonary tuberculosis. It is defined as the tubercle infection of the trachea and or bronchi. Due to its non-specific presentation, insidious onset and normal chest radiography in about 10-20% of the patients, the diagnosis is delayed. Bronchoscopy is the most definite method of diagnosis which provides adequate specimens for microbiological and histopathological diagnosis. Tracheobronchial stenosis is one of the most common long term complications of TBTB resulting in significant morbidity. It is estimated that 90% of patients with TBTB have some degree of tracheal and or bronchial stenosis. In this review article, we will discuss the pathogenesis, symptoms, imaging, bronchoscopic findings, and treatment of TBTB and management of tracheobronchial stenosis.
Collapse
Affiliation(s)
- Vikas Pathak
- Departments of Pulmonary Disease and Critical Care Medicine, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Ray W Shepherd
- Departments of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Samira Shojaee
- Departments of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| |
Collapse
|
28
|
Mohammad Y, Haffar L, Adib A, Hamdan Z, Dubaybo B. [Two cases of endobronchial tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:155-160. [PMID: 26776869 DOI: 10.1016/j.pneumo.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 06/29/2015] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Y Mohammad
- Damascus University Hospital, 17th April, Damascus, Syria; Lattakia University Hospital, Tishreen University POB1479, Lattakia, Syria.
| | - L Haffar
- Damascus University Hospital, 17th April, Damascus, Syria
| | - A Adib
- Damascus University Hospital, 17th April, Damascus, Syria
| | - Z Hamdan
- Damascus University Hospital, 17th April, Damascus, Syria
| | - B Dubaybo
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
29
|
Mechanical complication of endobronchial tuberculosis. Respir Med Case Rep 2016; 16:128-30. [PMID: 26744678 PMCID: PMC4681979 DOI: 10.1016/j.rmcr.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022] Open
Abstract
A 19-year-old Vietnamese lady was diagnosed with culture positive, left upper lobe pulmonary tuberculosis for which medical treatment was initiated. Four months into treatment, she developed a 'rubber-band-like' stretching sensation in her left chest with wheezing and shortness of breath. Decreased respiratory excursion over the left lung was present on physical-examination. Chest-Xray revealed left-upper-lobe collapse with leftward deviation of the trachea and mediastinum. CT thorax revealed a long segment of stenosis in the left mainstem bronchus. FEV1 was 1.26 L (45% predicted), FVC 1.53 L (49% predicted), FEV1/FVC 82% (95% predicted) indicating airway limitation. Ventilation-perfusion scan noted 9.8% ventilation to the left lung and 92.8% to the right lung and 7.6% perfusion to the left lung and 92.4% to the right lung. Bronchoscopy was notable for pin point stenosis of the left mainstem bronchus beyond which was inflamed mucosa and abnormal cartilage rings in the left upper and middle lobe bronchi. Nine months of medical therapy for tuberculosis along with oral steroid taper was completed successfully; however the patient has required six serial bronchscopies with dilatations without stent placement at four to six week intervals due to partial restenosis, with the last bronchoscopy at four months after completion of tuberculosis therapy.
Collapse
|
30
|
Manca S, Fois AG, Santoru L, Trisolini R, Polo MF, Ostera S, Patelli M, Pirina P. Unusual clinical presentation of thoracic tuberculosis: the need for a better knowledge of illness. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:240-4. [PMID: 25907152 PMCID: PMC4423172 DOI: 10.12659/ajcr.892546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Male, 73 Final Diagnosis: Bronchoesophageal fistula in endobronchial tuberculosis and mediastinal lymphadenopathy Symptoms: Nonproductive cough • weight loss Medication: Isoniazid • rifampin • pyrazinamide • ethambutol Clinical Procedure: Laser treatment Specialty: Pulmonology
Collapse
Affiliation(s)
- Sandra Manca
- Department of Respiratory Disease, University of Sassari, Sassari, Italy
| | | | - Luigi Santoru
- Department of Respiratory Disease, University of Sassari, Sassari, Italy
| | - Rocco Trisolini
- Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy
| | | | - Salvatore Ostera
- Department of Respiratory Disease, University of Sassari, Sassari, Italy
| | - Marco Patelli
- Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy
| | - Pietro Pirina
- Department of Respiratory Disease, University of Sassari, Sassari, Italy
| |
Collapse
|
31
|
Idrees F, Kamal S, Irfan M, Ahmed R. Endobronchial tuberculosis presented as multiple endobronchial vesicular lesions. Int J Mycobacteriol 2015; 4:154-7. [PMID: 26972885 DOI: 10.1016/j.ijmyco.2015.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/20/2022] Open
Abstract
Endobronchial tuberculosis (EBTB) is a tuberculous infection of the tracheobronchial tree with microbiological and histopathological evidence, with or without parenchymal involvement. EBTB commonly presents as acute or insidious onset cough, wheeze, low grade fever, and constitutional symptoms. In elderly patients, other differentials like malignancy and pneumonia may lead to misdiagnosis. Hence, bronchoscopy is essential for confirmation of EBTB. Here we report a rare presentation of EBTB in a 65 year old patient who presented with 3 months history of fever and cough and have multiple endobronchial vesicular lesions on bronchoscopy.
Collapse
Affiliation(s)
- Farah Idrees
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saima Kamal
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Irfan
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
| | - Rashida Ahmed
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
32
|
Jung SS, Park HS, Kim JO, Kim SY. Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis. Respirology 2015; 20:488-95. [PMID: 25620110 PMCID: PMC4409824 DOI: 10.1111/resp.12474] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/05/2014] [Accepted: 12/03/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Incidence and predictors of endobronchial tuberculosis (EBTB) remain unknown because of the lack of prospective studies. Our objective was to assess the incidence and predictors of concomitant EBTB in patients with active pulmonary tuberculosis (PTB). METHODS We prospectively performed routine bronchoscopic examination in all patients with PTB to detect EBTB. Clinical and bronchoscopic findings were analyzed to elucidate predictors of EBTB. RESULTS Bronchoscopies of 429 PTB patients were performed at a tertiary referral hospital in Korea. Among those, 233 patients (54.3%) had EBTB. Female gender (odds ratio (OR) 4.35, 95% confidence interval (CI) 1.78-10.63), longer symptom duration (>4 weeks; OR 1.86, 95% CI 1.05-5.46), and no previous history of tuberculosis (OR 4.16, 95% CI 1.22-14.18) were found to be the independent predictors of concomitant EBTB in patients with active PTB. Most of the EBTB/PTB patients had mild stenosis, and more than 20% of them had severe stenosis at the time of diagnosis. Patients with EBTB had follow-up bronchoscopy to evaluate persistent airway stenosis. Persistent bronchostenosis with the lumen narrowed by more than one third occurred in 20.7% (30/145) of patients. The involvement length and decreased forced expiratory volume in 1 s were the risk factors for persistent bronchostenosis. CONCLUSIONS In patients with active PTB, 50% or more have EBTB. Female gender and longer duration of symptoms are the main predictors of concomitant EBTB. Immediate diagnostic bronchoscopy in patients with active PTB should be considered in selected patients for detection of brocnhostenosis.
Collapse
Affiliation(s)
- Sung-Soo Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Chungnam National University HospitalDaejeon, South Korea
| | - Hee-Sun Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Chungnam National University HospitalDaejeon, South Korea
| | - Ju-Ock Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Chungnam National University HospitalDaejeon, South Korea
| | - Sun-Young Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Chungnam National University HospitalDaejeon, South Korea
| |
Collapse
|
33
|
Kilani T, Boudaya MS, Zribi H, Ouerghi S, Marghli A, Mestiri T, Mezni F. [Surgery for thoracic tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:140-158. [PMID: 24894967 DOI: 10.1016/j.pneumo.2014.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery.
Collapse
Affiliation(s)
- T Kilani
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie.
| | - M S Boudaya
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - H Zribi
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - S Ouerghi
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - A Marghli
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - T Mestiri
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| | - F Mezni
- Hôpital Abderrahmane Mami, université Tunis El Manar, Ariana, Tunisie
| |
Collapse
|
34
|
Balloon Dilatation of a Case of Tuberculous Tracheobronchial Stenoses during the Course of Antituberculous Treatment. Case Rep Med 2015; 2015:618394. [PMID: 25873975 PMCID: PMC4383301 DOI: 10.1155/2015/618394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of posttuberculosis (TB) tracheobronchial stenoses presented with progressive exertional dyspnea during the course of anti-TB treatment. An 83-year-old Japanese man was admitted for progressive dyspnea; chest X-ray and CT showed stenosis of distal trachea and left main bronchus. Pulmonary function test revealed reduction of FEV1. Balloon dilatation without stent insertion was the choice for this patient for multiple reasons with marked improvement of symptoms.
Collapse
|
35
|
Hou G, Zhang T, Kang DH, Wang W, Hu XJ, Wang QY, Kang J. Efficacy of real-time polymerase chain reaction for rapid diagnosis of endobronchial tuberculosis. Int J Infect Dis 2014; 27:13-7. [DOI: 10.1016/j.ijid.2014.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 12/28/2022] Open
|
36
|
Challenges in endobronchial tuberculosis: from diagnosis to management. Pulm Med 2014; 2014:594806. [PMID: 25197570 PMCID: PMC4147266 DOI: 10.1155/2014/594806] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 12/13/2022] Open
Abstract
Despite the rapid advancement in diagnostic and therapeutic modalities, endobronchial tuberculosis (EBTB), defined as tuberculous infection of the tracheobronchial tree, continues to remain challenging for clinicians. Nonspecific respiratory symptoms along with normal chest radiograph in 10–20% of cases may be alleged for the diagnostic delay. Variable diagnostic yield with sputum microscopy might further compound the problem. In such cases, high resolution computed tomography (HRCT) works as a more sensitive tool and demonstrates involvement of tracheobronchial tree described classically as “tree-in-bud” appearance. Bronchoscopic biopsy is considered the most reliable method for confirmation of the diagnosis with 30% to 84% positivity in different series. Evolution of the disease is also unpredictable with frequent progression to bronchostenosis, therefore requiring regular follow-up and early intervention to halt the natural course. This review article elaborates various aspects of the disease with specific focus on diagnostic dilemma and recent advances in interventional bronchoscopy. In addition, this discussion evokes optimism for further research and introduction of innovative therapeutic modalities.
Collapse
|
37
|
Masukume G, Sengurayi E, Moyo P, Feliu J, Gandanhamo D, Ndebele W, Ngwenya S, Gwini R. Massive hemoptysis and complete unilateral lung collapse in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome: a case report. BMC Res Notes 2013; 6:335. [PMID: 23968230 PMCID: PMC3765411 DOI: 10.1186/1756-0500-6-335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 08/21/2013] [Indexed: 11/23/2022] Open
Abstract
Background We report an extremely rare case of massive hemoptysis and complete left-sided lung collapse in pregnancy due to pulmonary tuberculosis in a health care worker with good maternal and fetal outcome. Case presentation A 33-year-old human immuno deficiency virus seronegative African health care worker in her fourth pregnancy with two previous second trimester miscarriages and an apparently healthy daughter from her third pregnancy presented coughing up copious amounts of blood at 18 weeks and two days of gestation. She had a cervical suture in situ for presumed cervical weakness. Computed tomography of her chest showed complete collapse of the left lung; subsequent bronchoscopy was apparently normal. Her serum β-human chorionic gonadotropin, tests for autoimmune disease and echocardiography were all normal. Her lung re-inflated spontaneously. Sputum for acid alcohol fast bacilli was positive; our patient was commenced on anti-tuberculosis medication and pyridoxine. At 41 weeks and three days of pregnancy our patient went into spontaneous labor and delivered a live born female baby weighing 2.6 kg with APGAR scores of nine and 10 at one and five minutes respectively. She and her baby are apparently doing well about 10 months after delivery. Conclusion It is possible to have massive hemoptysis and complete unilateral lung collapse with spontaneous resolution in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome.
Collapse
Affiliation(s)
- Gwinyai Masukume
- Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Bulawayo, Zimbabwe.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Casali L, Crapa ME. Endobronchial Tubercolosis: a peculiar feature of TB often underdiagnosed. Multidiscip Respir Med 2012; 7:35. [PMID: 23088226 PMCID: PMC3529703 DOI: 10.1186/2049-6958-7-35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 10/18/2012] [Indexed: 01/19/2023] Open
Affiliation(s)
- Lucio Casali
- Respiratory Diseases, University of Perugia, Perugia, Italy.
| | | |
Collapse
|