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Salahuddin M, Khan DA, Ayub S, Shahzad T, Irfan M. Biomass Smoke–Associated Lung Diseases. CURRENT PULMONOLOGY REPORTS 2023; 12:151-161. [DOI: 10.1007/s13665-023-00318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 09/01/2023]
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The Atypical Manifestation of Pulmonary Tuberculosis in Patients with Bronchial Anthracofibrosis. J Clin Med 2022; 11:jcm11195646. [PMID: 36233513 PMCID: PMC9571957 DOI: 10.3390/jcm11195646] [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: 08/11/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
It has been stated that bronchial anthracofibrosis (BAF) has an important relationship with pulmonary tuberculosis (TB), and the coexistence of TB and BAF is high. The purpose of this study was to compare the differences in computed tomography (CT) characteristics of pulmonary TB according to the presence of underlying BAF. Total of 202 consecutive patients who were diagnosed with pulmonary TB and underwent bronchoscopy and CT in our institution were retrospectively reviewed. We classified the patients into two groups according to the presence of BAF and compared the clinicoradiological findings between the two groups (anthracofibrosis group vs. nonanthracofibrosis group). Elderly and female patients were significantly higher in anthracofibrosis group (mean age 79 ± 7 (64−94) vs. 56 ± 17 (16−95), p < 0.001; female 89% vs. 29%, p < 0.001). The frequency of internal low-density area or focal contour bulge within atelectasis (64% vs. 1%, p < 0.001), lower lobe predominance (43% vs. 9%, p < 0.001), endobronchial involvement (46% vs. 15%, p < 0.001), and lymphadenopathy (57% vs. 28%, p = 0.002) were significantly higher in anthracofibrosis group. In contrast, the anthracofibrosis group showed lower frequency of upper lobe predominance (32% vs. 81%, p < 0.001) and cavitation (14% vs. 51%, p = 0.001). In conclusion, being aware of these atypical manifestations of pulmonary TB in the presence of BAF will be of great help in early detection of TB.
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Shah A, Kunal S, Gothi R. Bronchial anthracofibrosis: The spectrum of radiological appearances. Indian J Radiol Imaging 2021; 28:333-341. [PMID: 30319212 PMCID: PMC6176667 DOI: 10.4103/ijri.ijri_339_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Bronchial anthracofibrosis (BAF), caused by long-standing exposure to biomass fuel smoke, has emerged as a distinct pulmonary disease. It is usually seen in elderly females who have worked long hours in poorly ventilated kitchen full of smoke due to incomplete combustion of biomass fuel. The diagnosis is confirmed on bronchoscopic visualization of bluish-black anthracotic pigmentation along with narrowing/distortion of the affected bronchus. BAF has been associated with clinical conditions such as pulmonary tuberculosis, chronic obstructive pulmonary disease, pneumonia, and malignancy. Tuberculosis, once thought to be the causative agent for BAF, is now considered to be an association. BAF has a diverse radiological presentation and the presence of associated clinical conditions often confound the radiological picture. The imaging features of BAF include primary imaging characteristics, which pertains to the disease entity directly, and secondary features based on the presence of associated conditions. High-resolution computed tomography findings of multifocal bronchial narrowing and peribronchial cuffing are considered to be specific diagnostic features of BAF. In addition, the diagnostic probability is increased in the presence of mediastinal adenopathy and collapse/atelectasis with middle lobe syndrome being the most common presentation. This pictorial essay highlights the range of imaging appearances in patients with BAF.
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Affiliation(s)
- Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.,Senior Consultant, Department of Pulmonary and Sleep Medicine, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
| | - Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Rajesh Gothi
- Department of Imaging, Max Super Speciality Hospital, Saket, New Delhi, India
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Samet M, Rahimian M, Meshkat S, Zand S. Evaluation of the Agreement Between the Tissue Sample and Bronchoalveolar Lavage (BAL) Fluid in the Diagnosis of Tuberculosis in Patients with Anthracosis. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x15666190719162914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Black dust deposited in the lungs is called anthracosis. By damaging
bronchial mucosa, anthracosis can affect the mucociliary cleaning function. Initial reports indicate
that there is a relationship between anthracosis and pulmonary tuberculosis. Due to obstructive
effects of anthracosis on distal airways and disruption in a proper sampling of bronchoalveolar
lavage (BAL), other diagnostic methods are necessary for estimating the tuberculosis prevalence in
these patients. The aims of this study was to evaluate tissue samples adjacent to an anthracotic plaque
for acid-fast bacilli smear and culture.
Methods:
his is a cross-sectional analysis study on 100 patients referred to Shahid Sadoughi
Hospital who required bronchoscopy and anthracotic plaque based on bronchoscopy results.
Bronchial fluid lavage, two biopsy samples for culture, and a smear of Mycobacterium tuberculosis
from the surrounding of these plaques were prepared. Data analyses were carried out using SPSS
(version 18).
Results:
One-hundred patients og the age range 46-91years were studied. The patients with
tuberculosis diagnosis based on the smear of BAL and bronchial tissue samples and culture of BAL
and bronchial tissue samples were 7%, 13%, 6% and 8% respectively. The presence of granuloma in
histopathology was seen in 15 patients infected with tuberculosis. (κ > 0.04, p-value <0.05). In
patients with positive tuberculosis, culture of bronchoalveolar lavage was superior to other methods.
Conclusions:
Diagnostic value of BAL method and tissue biopsy in anthracosis patients with
tuberculosis did not show a statistically significant difference. As compared with other methods,
BAL culture was more positive. Therefore, tissue biopsy is not a good alternative to BAL.
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Affiliation(s)
- Mohammad Samet
- Internal Medicine Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Rahimian
- Internal Medicine Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Samaneh Meshkat
- Internal Medicine Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sanaz Zand
- Internal Medicine Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Gao WW, Zhang X, Fu ZH, Hu WY, Zhang XR, Dai GC, Zeng Y. Tuberculosis mediastinal fibrosis misdiagnosed as chronic bronchitis for 10 years: a case report. Quant Imaging Med Surg 2019; 9:1179-1183. [PMID: 31367572 DOI: 10.21037/qims.2019.06.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Wei-Wei Gao
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Xia Zhang
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Zhi-Hao Fu
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Wei-Yi Hu
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Xiang-Rong Zhang
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Guang-Chuan Dai
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
| | - Yi Zeng
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 211132, China
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Hasani S, Andisheh N, Afrasiabian S, Mohammadi A. The incidence of pulmonary tuberculosis in patients with anthracosis. AIMS MEDICAL SCIENCE 2019. [DOI: 10.3934/medsci.2019.3.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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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.
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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
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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.
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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
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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.
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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
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Park TY, Heo EY, Chung HS, Jin KN, Kim DK. Prediction of Anthracofibrosis Based on Clinico-Radiographic Findings. Yonsei Med J 2017; 58:355-361. [PMID: 28120566 PMCID: PMC5290015 DOI: 10.3349/ymj.2017.58.2.355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/25/2016] [Accepted: 09/05/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Because anthracofibrosis (AF) is associated with tuberculosis (TB), detection of AF is clinically relevant in Korea, a TB endemic region. We thus sought to develop and validate a predictive model for AF using clinical radiographic data. MATERIALS AND METHODS Between January 1, 2008 and March 31, 2014, 3849 adult patients who underwent bronchoscopies were retrospectively included from an observational registry. We dichotomized patients based on the presence (n=167) or absence (n=242) of AF. After analyzing their clinico-radiographic characteristics, a logistic prediction model was developed. An area under the curve (AUC) was drawn using the weighted score in logistic regression model. To evaluate the degree of overfitting of the predictive model, a 5-fold cross-validation procedure was performed. RESULTS In multivariate logistic regression, clinical findings such as age >70 years, female gender, active TB, and computed tomography findings including atelectasis, stenosis, bronchial wall thickening, enlarged and calcified lymph nodes were significant diagnostic predictors for AF. The weighed score had an AUC of 0.939 [95% confidence interval (CI)=0.911-0.960], similar to the AUC obtained from internal validation (AUC=0.926, 95% CI=0.896-0.949). CONCLUSION The prediction model may be helpful for predicting AF based only on clinical and radiographic findings. However, further external validation is necessary.
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Affiliation(s)
- Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hee Soon Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
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Hu Y, Qiu JX, Liao JP, Zhang H, Jin Z, Wang GF. Clinical Manifestations of Fibrosing Mediastinitis in Chinese Patients. Chin Med J (Engl) 2017; 129:2697-2702. [PMID: 27824002 PMCID: PMC5126161 DOI: 10.4103/0366-6999.193457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Fibrosing mediastinitis (FM) is a rare disease. FM is thought to be related to prior granulomatous mediastinal infection, such as histoplasmosis or tuberculosis. The majority of cases have been reported in endemic regions for histoplasmosis. The characteristics of cases of FM in China, where the prevalence of tuberculosis is high, have not been reported. We analyzed the clinical, imaging, and bronchoscopic features of Chinese patients with FM to promote awareness of this disease. Methods: Between January 2005 and June 2015, twenty patients were diagnosed with FM in our hospital. Medical records and follow-up data were collected. Imaging and biopsy findings were reviewed by radiologists and pathologists. Results: A total of 20 patients were analyzed (8 males and 12 females). The age ranged from 43 to 88 years with a mean age of 69.5 years. Previous or latent tuberculosis was found in 12 cases. Clinical symptoms included dyspnea (18/20), cough (17/20), expectoration (7/20), and recurrent pneumonia (3/20). Chest computed tomography scans showed a diffuse, homogeneous, soft tissue process throughout the mediastinum and hila with compression of bronchial and pulmonary vessels. Calcification was common (15/20). Pulmonary hypertension was present in 9 of 20 cases. Diffuse black pigmentation in the bronchial mucosa was frequently seen on bronchoscopy (12/13). The patients’ response to antituberculosis treatment was inconsistent. Conclusions: FM in Chinese patients is most likely associated with tuberculosis. Some characteristics of FM are different from cases caused by histoplasmosis.
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Affiliation(s)
- Yan Hu
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Jian-Xing Qiu
- Department of Medical Imaging, Peking University First Hospital, Beijing 100034, China
| | - Ji-Ping Liao
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Hong Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Zhe Jin
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
| | - Guang-Fa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
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Kunal S, Shah A. The concomitant occurrence of pulmonary tuberculosis with bronchial anthracofibrosis. Indian J Tuberc 2016; 64:5-9. [PMID: 28166918 DOI: 10.1016/j.ijtb.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bronchial anthracofibrosis (BAF), diagnosed bronchoscopically, is a clinical entity which is now beginning to emerge from obscurity. This is commonly encountered in elderly females with history of long-standing exposure to biomass fuel smoke in poorly ventilated kitchens. As awareness of BAF has increased in recent times, distinct clinicoradiological and bronchoscopic features of the disease have emerged. Diagnosis is achieved by visualisation of bluish-black mucosal hyperpigmentation along with narrowing/distortion of the affected bronchus on fibreoptic bronchoscopy (FOB). BAF was first recognised nearly a decade ago in India, when a 65-year-old female who presented with a middle lobe syndrome (MLS) was diagnosed with concomitant pulmonary tuberculosis and BAF. Pulmonary tuberculosis, seen in up to one-third of patients with BAF, is now considered to be an associated condition rather than a causative agent, as was initially postulated. METHODS Respiratory symptomatics with a history of biomass fuel smoke exposure underwent high-resolution computed tomography (HRCT) of chest as well as FOB to establish a diagnosis of BAF. In patients who were diagnosed with BAF, an association with tuberculosis was also sought for. RESULTS Of the 31 patients diagnosed with BAF in one unit, four had an associated diagnosis of tuberculosis. Cough was the most common presenting symptom seen in all four patients. Imaging revealed consolidation in 3/4 subjects, nodular lesions in one and in another one multifocal narrowing on HRCT, a feature characteristic of BAF. One patient had a diagnosis of MLS. FOB, in all four subjects, visualised anthracotic pigmentation along with narrowing/distortion of the affected bronchi with the left upper lobe bronchus being most commonly affected. Stains and cultures of the bronchial aspirate for Mycobacterium tuberculosis were positive in all four patients while GeneXpert performed in three was positive in all. Rifampicin resistance was not detected. One patient had an actively caseating form of endobronchial tuberculosis as evidenced by oedematous, hyperemic mucosa along with whitish cheese-like material affecting the right middle lobe as was seen on FOB. CONCLUSION Once a diagnosis of tuberculosis is established in a patient with long-standing exposure to biomass fuel smoke, invasive procedure required for the diagnosis of BAF is usually not considered and the diagnosis would remain confined to pulmonary tuberculosis. This study highlights the need to recognise BAF and to exclude pulmonary tuberculosis in such patients.
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Affiliation(s)
- Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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Exposure to Mycobacterium tuberculosis during Flexible Bronchoscopy in Patients with Unexpected Pulmonary Tuberculosis. PLoS One 2016; 11:e0156385. [PMID: 27227408 PMCID: PMC4882062 DOI: 10.1371/journal.pone.0156385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/15/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Recent guidelines recommend the use by healthcare personnel of a fit-tested N95 particulate respirator or higher-grade respiratory precaution in a patient undergoing bronchoscopy when pulmonary tuberculosis (PTB) is suspected. However, PTB may be unexpectedly diagnosed in this setting and therefore not evaluated, resulting in the unexpected exposure to Mycobacterium tuberculosis (MTB) of healthcare workers in the bronchoscopy suite. Here, we examined the incidence of unexpected exposure to MTB during flexible bronchoscopy and determined the exposure-related factors. METHODS Between 2011 and 2013, a retrospective study was conducted to evaluate unexpected diagnoses of PTB in the bronchoscopy suite. During the study period, 1650 consecutive patients for whom previous CT scans were available and who underwent bronchoscopy for respiratory disease other than PTB were included. The results of bronchial washing, bronchoalveolar lavage, and post-bronchoscopic sputum were reviewed. RESULTS PTB was unexpectedly diagnosed in 76 patients (4.6%). The presence of anthracofibrosis [odds ratio (OR), 3.878; 95% confidence interval (CI), 1.291-11.650; P = 0.016), bronchiectasis (OR, 1.974; 95% CI, 1.095-3.557; P = 0.024), or atelectasis (OR, 1.740; 95% CI, 1.010-2.903; P = 0.046) as seen on chest CT scan was independently associated with unexpected PTB. Patients with both anthracofibrosis and atelectasis were at much higher risk of unexpected PTB (OR, 4.606; 95% CI, 1.383-15.342; P = 0.013). CONCLUSIONS The risk of MTB exposure by healthcare personnel in the bronchoscopy suite due to patients with undiagnosed PTB has been underestimated. Therefore, in geographic regions with an intermediate PTB prevalence, such as South Korea (97/100,000 persons per year), higher-grade respiratory precaution, such as a fit-tested N95 particulate respirator, should be considered to prevent occupational exposure to MTB during routine bronchoscopy, especially in patients with CT-confirmed anthracofibrosis, bronchiectasis, or atelectasis.
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Cho Y, Choi M, Myong JP, Kim HR, Lee H, Jang TW, Koo JW. The association between bronchial anthracofibrosis and pneumoconiosis: A retrospective cross-sectional study. J Occup Health 2014; 57:110-7. [PMID: 25519805 DOI: 10.1539/joh.14-0177-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Bronchial anthracofibrosis (BAF) is associated with occupational hazardous dust exposure. The aim of the present study was to determine the prevalence of BAF and BAC without fibrosis in patients with pneumoconiosis, and to evaluate the associations between BAC/BAF and occupational dust exposure and clinical manifestations among patients with pneumoconiosis. METHODS A retrospective cross-sectional study (n=170) among individuals who were diagnosed with pneumoconiosis or suspicious pneumoconiosis and underwent bronchoscopy between January 2000 and February 2013 was performed. Multiple logistic regression analysis was performed to estimate associations. RESULTS In total, 153 eligible subjects were included in the study because their records contained all the required information. Of these, 81 (53%) and 63 (41%) had BAC and BAF, respectively. Occupational coal dust exposure increased the risk of BAF and BAC (odds ratio [OR]=2.980, 95% confidence interval [CI]=1.184-8.128; OR=2.840, 95% CI=1.092-7.926, respectively). Profusion category 3 pneumoconiosis also increased the risk of BAC (OR=33.887, 95% CI=5.317-394.729). CONCLUSIONS BAF and BAC are associated with occupational exposure to coal dust. Therefore, clinicians should consider occupational history when they investigate the association between BAC/BAF and risk factors such as tuberculosis, lung cancer, and biomass fuel exposure.
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Affiliation(s)
- Younmo Cho
- Seoul St. Mary's Hospital; Department of Occupational and Environmental Medicine, College of Medicine, Catholic University of Korea, Republic of Korea
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