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(A) Thorax CT showing right middle lobe partial atelectasia; (B) Bronchoscopy revealing granular lesion in the medial wall of the right middle lobe entrance and partial fibrostenosis.
Source publication
Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence, with or without parenchymal involvement. In this study, clinical, radiological and bronchoscopic characteristics of cases diagnosed to have EBTB were evaluated.
Sixteen patients with at least three nega...
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Background:
Few data relate interferon-γ-release-assay results in children to source case sputum status, the best predictor of infectiousness of tuberculosis (TB) patients. We evaluated the QuantiFERON-Gold-in-tube assay (QFT) and tuberculin skin test (TST) in children with different types of TB exposure.
Methods:
The TST and QFT were performed...
Citations
... It is suggested that five potential mechanisms are responsible for the development of the disease: (i) direct invasion from an adjacent parenchymal focus; (ii) implantation of the organisms from infected sputum; (iii) hematogenous spread; (iv) erosion of a lymph node inside a bronchus; and (v) lymphatic drainage from the parenchyma toward the peribronchial region. [6] Clinical features of the EBTB are nonspecific and they differ between various types and stages of EBTB. [7] Common symptoms are cough, hemoptysis, sputum production, wheezing, chest pain, fever, and dyspnea. ...
In the present case report, a 12-year-old girl with recurrent cough and wheeze being treated outside as bronchial asthma for 3 years with inhaled medicines had shown partial response. Due to recurrent disease with clinical deterioration, chest radiology was performed and showed right paratracheal widening. Clinically, she was having tubular bronchial breathing in the right infraclavicular area, and wheezing was also predominantly on the right side. Bronchoscopy was a very useful test in documenting endobronchial abnormality, and microbiological workup was positive for tuberculosis. The girl showed complete resolution of her symptom after the completion of antitubercular therapy.
... In addition, the clinical diagnosis of TBTB mainly relies on bronchoscopic examination, 8 and it is classified into six types based on bronchoscopic findings, including inflammatory infiltration (type I), ulceration necrosis (type II), granulation hyperplasia (type III), cicatrices stricture (type IV), tracheobronchial malacia (type V), and lymph fistula (type VI). 24 Lymph fistula type is a very rare type among the Chinese population. 25 A retrospective study in Wuhan demonstrated that the incidence of VI type was higher in young adults and in male patients, where the prevalence of lymph fistula was significantly higher in male patients than in female patients. ...
Purpose
Tracheobronchial tuberculosis (TBTB) has been proposed to occur more commonly in female patients. However, to date, studies that systematically delineate differences between female and male patients with TB infection are lacking. We aimed to comprehensively assess the sex-specific differences in clinical manifestation, bronchoscopy performance, bacteriological examination, and imaging of TBTB in Shenzhen, China.
Methods
All patients with diagnosed TBTB from August 1, 2018 to July 31, 2021 at The Third People’s Hospital of Shenzhen were enrolled in the present study. Demographic information, clinical manifestations, blood tests, chest computed tomography, and bronchoscopic findings were collected, and assessed their sex-specific differences.
Results
Of these 331 patients, 238 patients (71.9%) were female, and 93 patients (28.1%) were male, with an overall average age of 37.3 years. The average age of male patients with TBTB was more than 5 years older than that of female patients. The prevalence of lymph fistula and diabetes mellitus was significantly higher in male patients than female patients (8.6% vs 1.7%, P = 0.005; 17.2% vs 2.1%, P < 0.001). The positive proportion of sputum smear was higher in male patients (27.9%) than in female patients (16.7%, P = 0.026). Moreover, the mean monocyte-to-lymphocyte ratio, serum CRP, and IL-6 levels were significantly higher in male patients than in female patients (P < 0.05).
Conclusion
In summary, in patients with TBTB diagnosis, male sex was associated with a high prevalence of diabetes mellitus, lymph fistula, and smear-positive ratio, as well as high inflammation levels. The management of young female and male patients with diabetes mellitus and high inflammation levels should be strengthened. Furthermore, to reduce the burden of TBTB, we must pay attention to the risk of TBTB in past tuberculosis patients, especially male patients under 45 years old and female patients over 45 years old.
... Bronchoscopy is the main method to diagnose TBTB (8). In a multicenter study, Su et al. performed bronchoscopy on 1,441 patients with PTB and found that 23.9% of them were diagnosed with TBTB (5). ...
... Early diagnosis and treatment are key to prevent the transmission of Mycobacterium tuberculosis. Bronchoscopy plays an important role in the diagnosis of TBTB, especially in suspicious patients with negative sputum smears and endobronchial diseases (8,(11)(12)(13). Since bronchoscopy is not routinely performed in patients with PTB, the incidence of TBTB is uncertain, ranging from 10 to 40%, and even higher (4)(5)(6)(7). ...
Background
Bronchoscopy is the main method for the diagnosis of tracheobronchial tuberculosis (TBTB). However, it is not well-used in patients with pulmonary tuberculosis (PTB), leading to misdiagnosis. The aim of this study is to verify the value and feasibility of bronchoscopy for an early diagnosis and treatment of TBTB.
Materials and Methods
A prospective observational study was performed in patients with active PTB. The ratios of TBTB and tracheobronchial stenosis were analyzed with propensity score matching (PSM) for baseline characteristics, and a Cox regression model was further employed to adjust for residual confounding factors.
Results
A total of 656 patients with active PTB were enrolled in the study that included 307 patients in the active group and 349 patients in the non-active group. The ratio of TBTB was significantly higher in the active group than that in the non-active group [hazard ratio ( HR ), 2.31; 95% CI , 1.70–3.14; p < 0.001]. With PSM, the proportion of tracheobronchial stenosis in the non-active group was significantly higher than that in the active group ( HR , 1.84; 95% CI , 1.15–2.95; p = 0.011). Moreover, the number of patients with moderate to severe stenosis were significantly higher than that in the active group ( HR , 4.13; 95% CI , 2.25–7.63; p < 0.001). Similar results were obtained with multivariate analysis. With 12 months of treatment, both therapeutic effective rate (84.7 vs. 68.2%; p = 0.009) and improvement rate of non-fibrotic tracheobronchial stenosis (79.1 vs. 47.4%; p = 0.022) were higher in the active group than that in the non-active group.
Conclusion
Active and regular bronchoscopy is conducive to early diagnosis of TBTB, combined with prompt anti-tuberculosis therapy, greatly reducing the occurrence of tracheobronchial stenosis and improving prognosis.
... Steroids, on the other hand, are no longer useful in more advanced cases where significant fibrosis is present. Close monitoring is advised since stenosis can occur later despite anti-tuberculosis treatment with or without corticosteroids [21,[29][30][31][32][33][34][35][36][37]. There were 17 patients in the trial. ...
The diagnosis of endobronchial tuberculosis (EBTB) is difficult as it is not well visualized radiologically, and bronchoscopy is not routinely performed for tuberculosis (TB) patients. Bronchoscopic characterization via endoscopic macroscopic features can speed up the diagnosis of EBTB and prompt immediate treatment. In this study, we identified the clinical and bronchoscopic morphology of 17 patients who were diagnosed with EBTB from 2018 to 2020. Demographics, radiological, microbiological and histopathological data were recorded. Endobronchial lesions were classified according to Chung classification. The diagnosis was made based on a histopathological examination (HPE) of endobronchial biopsy, and/or positive ‘Acid-fast bacilli’ (AFB) microscopy/Mycobacterium tuberculosis (MTB) culture on microbiological examination of bronchial alveolar lavage (BAL) and/or positive MTB culture on endobronchial biopsy specimens. Furthermore, EBTB was predominant in young women, age 20 to 49 years old, with a male to female ratio of 1 to 2. Underlying comorbidities were found in 53% of the patients. Cough, fever and weight loss were the main symptoms (23.5%). The indications for bronchoscopy are smear-negative TB and persistent consolidation on chest radiographs. Consolidation was the main radiological finding (53%). An active caseating lesion was the main EBTB endobronchial subtype (53%). The leading HPE finding was caseating granulomatous inflammation (47%). All patients showed good clinical response to TB treatment. Repeated bronchoscopy in six patients post TB treatment showed a complete resolution of the endobronchial lesion. EBTB bronchoscopic characterization is paramount to ensure correct diagnosis, immediate treatment and to prevent complication.
... To date, sputum smear examination for AFB is considered to be a popular and rapid bacteriological examination method for diagnosing TBTB. However, it is worth noting that more than one-third of TBTB patients have negative sputum smears (21,22), which is similar to the result of our present study (the negative smear rate was 63.1%). The bronchial brush smear also did not show satisfactory results; the detection rate was 35.2% for TBTB, similar to that reported in previous studies (23), which indicated the limited improvement in diagnosis efficacy. ...
Background: The Xpert Mycobacterium tuberculosis /rifampin (MTB/RIF) assay has shown good diagnostic efficacy in brushing and biopsy tissue samples from patients with tracheobronchial tuberculosis (TBTB). However, its diagnostic value in bronchoalveolar lavage fluid (BALF) is still unclear. Therefore, the present retrospective study aimed to evaluate the diagnostic value of the Xpert MTB/RIF assay in BALF.
Methods: The clinical data of 266 patients with suspected TBTB from January 2018 to October 2020 were pooled with complete details of bronchial brush and bronchoalveolar lavage samples. Smears of the bronchial brushings were stained with Auramine O stain to detect acid-fast bacilli (AFB), and BALF samples were used for culturing MTB with the BACTEC MGIT 960 system and the Xpert MTB/RIF assay. The diagnostic performance of these methods was assessed and compared.
Results: A total of 266 patients suspected to have TBTB were enrolled in the final analysis. Of these patients, 179 patients were confirmed to have TBTB and 87 patients were non-TBTB. The sensitivity of the Xpert MTB/RIF assay in BALF (87.2%) was significantly higher than that of the brush smear for AFB (35.2%, p < 0.001). No significant difference was observed between the sensitivities of the Xpert MTB/RIF assay in BALF and MTB culture in BALF (87.2 vs. 84.9%, p = 0.542). The specificities of the Xpert MTB/RIF assay in BALF, MTB culture in BALF, and the bronchial brush smear were 97.7, 97.7, and 98.9%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of the Xpert MTB/RIF assay in BALF, MTB culture in BALF, and the bronchial brush smear were 98.7 and 78.7%, 98.7 and 75.9%, and 98.4 and 42.6%, respectively. Among the MTB culture-positive patients with TBTB detected by the Xpert assay, 27.0% (20/74) were identified to be resistant to RIF.
Conclusions: The Xpert MTB/RIF assay in BALF enables a rapid and accurate diagnosis of TBTB and identification of RIF resistance, which is crucial for timely and proper treatment. Moreover, in patients with TBTB, BALF could be used as an alternative to bronchial brushing and biopsy tissues for the Xpert MTB/RIF assay.
... Previously published studies revealed that EBTB was common in young patients and predominant in females. [3,7,8] Kim et al. recorded that EBTB could develop in elderly patients due to tuberculous reactivation following decrease in immunity status through aging processes or reinfection by exogenous M. tuberculosis. [9] Our case series also showed similar results with a median age of 36 years, ranging from 18 to 81 years old, indicating that EBTB could occur in adult patients at any age. ...
... [19] The positive AFB smear and positive M. tuberculosis culture for bronchial lavage in the study of Sahin and Yıldız were 25.0% and 62.5%, respectively. [8] In our case series, they were 21.4% and 87.1%. This implies that a low load of tubercle bacilli might still exist in the pathogenesis of EBTB. ...
Background:
Clinical characteristics of endobronchial tuberculosis (EBTB) patients whose sputum smears were negative have not been elucidated yet.
Method:
EBTB patients with negative sputum smears were documented retrospectively at the outpatient pulmonary clinic from late 2015 to early 2019.
Results:
We described the characteristics of 31 EBTB patients with negative sputum smears. The median age was 36 years (range 18-81 years). The male-to-female ratio is 1:1.58. The "peripheral" lesion group included 16 cases with opacity/consolidation, 2 cases with atelectasis, 1 case with cavitary lesion, and 1 case with pleural effusion. The "central" lesion group included four cases with normal chest X-ray and seven cases with only unilateral hilar enlargement. EBTB patients with "central" lesion were more common the presence of cough, the positive rate of bronchial lavage acid-fast bacilli smear, and the rate of misdiagnosis as pharyngitis, bronchitis, or asthma than that with "peripheral" lesion.
Conclusions:
EBTB with negative sputum smears was found in adult patients at any age and predominant in females. The diagnosis of EBTB with "central" lesion was more difficult than that with "peripheral" lesion. The location of the lesion could play a role in inducing cough among EBTB patients.
... Sumnja na EBTB se u ovom slučaju ne postavlja na osnovu endoskopskog izgleda lezije već isključivo nalazom biopsije sluznice bronha. Prognoza je odlična jer se posle medikamentoznog antituberkuloznog lečenja promene povlače bez posledica.Kashyap et al. 2003) Slika 5. Edematozno-hiperemični oblik bolesti, lumen bronha je uvek sužen zbog izraženog edema sluzokože i hiperemije(Şahin, Yıldız 2013) Slika 6. Izraženo suženje lumena bronha usled razvoja fibroznog tkiva -fibrostenotični oblik(Şahin, Yıldız 2013) Slika 7. Hiperemična, vulnerabilna sluznica bronha, posuta sitnim beličastim čvorićima u donjem delu slike -granulacione promene(Kashyap et al. 2003) Slika 8. Endobronhijalna tuberkuloza tipa endobronhijalne tumorske mase (a) i polipoidne tvorevine (b)(Şahin, Yıldız 2013) Slika 9. Multiple ulceracije koje prodiru duboko u zid bronha kod ulceroznog tipa EBTB(Kashyap et al. 2003) Slika 10. Antrakofibroza bronha u EBTB(Ozkaya et al. 2012) ...
... Sumnja na EBTB se u ovom slučaju ne postavlja na osnovu endoskopskog izgleda lezije već isključivo nalazom biopsije sluznice bronha. Prognoza je odlična jer se posle medikamentoznog antituberkuloznog lečenja promene povlače bez posledica.Kashyap et al. 2003) Slika 5. Edematozno-hiperemični oblik bolesti, lumen bronha je uvek sužen zbog izraženog edema sluzokože i hiperemije(Şahin, Yıldız 2013) Slika 6. Izraženo suženje lumena bronha usled razvoja fibroznog tkiva -fibrostenotični oblik(Şahin, Yıldız 2013) Slika 7. Hiperemična, vulnerabilna sluznica bronha, posuta sitnim beličastim čvorićima u donjem delu slike -granulacione promene(Kashyap et al. 2003) Slika 8. Endobronhijalna tuberkuloza tipa endobronhijalne tumorske mase (a) i polipoidne tvorevine (b)(Şahin, Yıldız 2013) Slika 9. Multiple ulceracije koje prodiru duboko u zid bronha kod ulceroznog tipa EBTB(Kashyap et al. 2003) Slika 10. Antrakofibroza bronha u EBTB(Ozkaya et al. 2012) ...
... Sumnja na EBTB se u ovom slučaju ne postavlja na osnovu endoskopskog izgleda lezije već isključivo nalazom biopsije sluznice bronha. Prognoza je odlična jer se posle medikamentoznog antituberkuloznog lečenja promene povlače bez posledica.Kashyap et al. 2003) Slika 5. Edematozno-hiperemični oblik bolesti, lumen bronha je uvek sužen zbog izraženog edema sluzokože i hiperemije(Şahin, Yıldız 2013) Slika 6. Izraženo suženje lumena bronha usled razvoja fibroznog tkiva -fibrostenotični oblik(Şahin, Yıldız 2013) Slika 7. Hiperemična, vulnerabilna sluznica bronha, posuta sitnim beličastim čvorićima u donjem delu slike -granulacione promene(Kashyap et al. 2003) Slika 8. Endobronhijalna tuberkuloza tipa endobronhijalne tumorske mase (a) i polipoidne tvorevine (b)(Şahin, Yıldız 2013) Slika 9. Multiple ulceracije koje prodiru duboko u zid bronha kod ulceroznog tipa EBTB(Kashyap et al. 2003) Slika 10. Antrakofibroza bronha u EBTB(Ozkaya et al. 2012) ...
For the first time in Serbia medical doctors of different specialties combine the knowledge of medical science in prevention, diagnosis and treatment of tuberculosis (TB) of various types and localization.
... A tuberculose endobrônquica consiste na infecção tuberculosa da árvore traqueobrônquica, com ou sem o envolvimento do parênquima pulmonar. 1,2 Apesar de sua importância, a doença permanece subdiagnosticada. [2][3][4] Estudo prévio, no qual todos pacientes com tuberculose pulmonar ativa foram submetidos à broncoscopia, observou tuberculose endobrônquica em 54,3% dos casos. ...
... 1,2 Apesar de sua importância, a doença permanece subdiagnosticada. [2][3][4] Estudo prévio, no qual todos pacientes com tuberculose pulmonar ativa foram submetidos à broncoscopia, observou tuberculose endobrônquica em 54,3% dos casos. 5 Acredita-se que a implantação direta do bacilo da tuberculose oriundo da lesão parenquimatosa no brônquio, a infiltração ou erosão com protrusão luminal de linfonodos mediastinais e a disseminação hematogênica e/ou linfática originem essa forma de tuberculose. ...
... 5 Acredita-se que a implantação direta do bacilo da tuberculose oriundo da lesão parenquimatosa no brônquio, a infiltração ou erosão com protrusão luminal de linfonodos mediastinais e a disseminação hematogênica e/ou linfática originem essa forma de tuberculose. 2,3 O padrão ouro para o diagnóstico da tuberculose endobrônquica consiste na visualização por broncoscopia de lesões endobrônquicas associado à confirmação histológica e/ou microbiológica de amostras coletadas por endoscopia. 3,4,6 As lesões endobrônquicas podem ser classificadas conforme Chung-Lee em: caseosa ativa, granular, tumoral, fibroestenótica, bronquite inespecífica, edematosahiperêmica e ulcerativa. ...
... Pulmonary hila are composed of large bronchi, pulmonary vessels, and lymph nodes (Sarkar et al., 2013). Endobronchial tuberculosis (EBTB) is a tuberculous infection of the tracheobronchial tree in which endobronchial lesions can occur in large central bronchi with hilar abnormalities (widening or asymmetric density) on chest radiograph (CXR) (Sahin and Yıldız, 2013). However, identifying these abnormalities may be challenging for both radiologists and clinicians because the pulmonary hilar structures are poorly defined on CXR. ...
Background
Endobronchial tuberculosis (EBTB) is a challenging diagnosis because of its varied clinical and radiologic manifestation. Hilar asymmetry on chest radiograph (CXR) may be found in patient with EBTB but is often overlooked, which may lead to delayed diagnosis.
Case report
We present five cases with EBTB. Clinicians failed to identify unilateral hilar abnormalities on CXR, and these patients were treated initially for pharyngitis, bronchitis or pneumonia with no improvement. Subsequently, they visited to the pulmonary clinic and bronchoscopy revealed endobronchial lesions and microbial/histopathological evidence of tuberculous infection consistent with EBTB. Anti-tuberculosis (TB) therapy resulted in complete clinical resolution in four cases out of five, one case with persistent bronchial stenosis.
Conclusion
Hilar asymmetry on CXR may occur with EBTB and may suggest this diagnosis in the appropriate clinical setting. Bronchoscopy has an important role in establishing the final diagnosis.
Keywords
Bronchoscopy
chest radiograph
endobronchial tuberculosis
hilar asymmetry
... Five potential mechanisms are believed to be responsible for the development of endobronchial infections caused by M. tuberculosis: (i) direct invasion from an adjacent paren- chymal focus, (ii) implantation of organisms from infected sputum, (iii) hematogenous spread, (iv) erosion of a lymph node inside a bronchus and (v) lymphatic drainage from the parenchyma towards the peribronchial region (10,11). ...
The author reports the case of a patient with a tuberculosis-associated endobronchial inflammatory polyp. Acid-fast bacillus (AFB) staining and culturing of sputum and bronchial washing fluid specimens were negative on three occasions. Biopsy results twice showed chronic inflammation. The patient was finally diagnosed with Mycobacterium tuberculosis based on a polymerase chain reaction (PCR) of a biopsy tissue specimen, along with the finding of chronic granulomatous inflammation. The author herein reports a rare case of a tuberculosis-associated endobronchial inflammatory polyp that was AFB smear- and culture-negative and the patient's clinical course after treatment.
