Bronchoscopic assessment of airway involvement in children presenting with clinically significant airway obstruction due to tuberculosis

Goussard, Pierre; Gie, Robert P.; Kling, Sharon; Andronikou, Savvas; Lucas, Susan; Janson, Jacques; Roussouw, G.J.

doi:10.1002/ppul.22747

Cited by 32 publications

(31 citation statements)

References 9 publications

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“…The diagnostic value of mycobacterial culture from BAL is generally accepted to be limited in children with uncomplicated TB with reported culture yields lower or equivalent to gastric aspirate. Higher BAL culture yield (44%) has recently been reported in children with significant airway obstruction, reflecting the higher bacillary load typically associated with severe disease …”

Section: Discussionmentioning

confidence: 98%

“…After the procedure, children were transferred back to the pulmonology ward for further observation. Bronchoscopy was systematically performed according to a standard protocol . Observations made under direct bronchoscopic visualization were recorded in a standard data form.…”

Section: Methodsmentioning

confidence: 99%

“…With intensive sampling, culture confirmation is possible in up to 78% of children with complicated intrathoracic disease, compared to <30% in children with uncomplicated pulmonary TB . Bronchoscopy can be used both as a diagnostic and therapeutic procedure, with bronchoalveolar lavage (BAL) samples contributing up to 44% of total culture yield in severe cases . However, culture has long turnaround time, and empiric treatment is frequently necessary to prevent further progression of disease in children.…”

Section: Introductionmentioning

confidence: 99%

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GeneXpert MTB/RIF on bronchoalveolar lavage samples in children with suspected complicated intrathoracic tuberculosis: A pilot study

et al. 2013

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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GeneXpert MTB/RIF on bronchoalveolar lavage samples in children with suspected complicated intrathoracic tuberculosis: A pilot study

et al. 2013

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“…For children with complicated pulmonary diseases, fiberoptic bronchoscopy can assist in diagnosing clinically; also Goussard et al reported that the BALF culture yield was high in children with severe airway obstruction [19], although MTB culture from BALF has limitations to diagnose in children with uncomplicated pulmonary TB because taking BALF is much more invasive [20]. In our setting, all children need to do routine fiberoptic bronchoscopy according to their chest radiograph, and 28.9% of children who suffered from PTB had positive MTB culture, while 8.4% had positive AFB microscopy.…”

Section: Discussionmentioning

confidence: 99%

Rapid Diagnosis of Childhood Pulmonary Tuberculosis by Xpert MTB/RIF Assay Using Bronchoalveolar Lavage Fluid

Yin

Jiao

Han

et al. 2014

BioMed Research International

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In order to evaluate the diagnostic accuracy of the Xpert MTB/RIF assay on childhood pulmonary tuberculosis (PTB) using bronchoalveolar lavage fluid (BALF), we evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of Xpert MTB/RIF assay using BALF in comparison with acid-fast bacilli (AFB) microscopy and Mycobacterium tuberculosis (MTB) culture for diagnosing childhood PTB using Chinese “composite clinical reference standard” (CCRS) as reference standard. Two hundred fifty-five children with suspected PTB were enrolled at Beijing Children's Hospital from September 2010 to July 2013. Compared with Chinese CCRS, the sensitivity of AFB microscopy, MTB culture, and Xpert MTB/RIF assay was 8.4%, 28.9%, and 53.0%, respectively. The specificity of three assays was all 100%. Xpert MTB/RIF assay could detect 33.9% of cases with negative MTB culture, and 48.7% of cases with negative AFB microscopy. Younger age (<3 years), absence of BCG scar, and contact with TB patient were found significantly associated with a positive result of Xpert MTB/RIF assay. In conclusion, Xpert MTB/RIF assay using BALF can assist in diagnosing childhood PTB much faster when fiberoptic bronchoscopy is necessary according to the chest radiograph.

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“…In this group of patients, both infection and malnutrition may have had an influence. A previous study on TB associated airway obstruction reported that 50% of children had a weight below the third percentile for age 27 …”

Section: Discussionmentioning

confidence: 98%

Management of children with tuberculous broncho‐esophageal fistulae

Goussard

Andronikou

Morrison

et al. 2020

Pediatric Pulmonology

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Introduction Broncho‐esophageal fistula (BOF) is a rare complication of Mycobacterium tuberculosis (MTB). TB‐associated BOF presents either as acute respiratory failure, aspiration pneumonia or as a complication of surgical decompression of thoracic lymph nodes. Methods All children with TB‐ associated BOF were included. TB was diagnosed if MTB was cultured from respiratory secretions, Ziehl‐Neelsen (ZN) smear was positive, GeneXpert MTB/RIF was positive or a chest radiograph revealed radiographic features typical of TB. BOF was diagnosed by a contrast swallow study and/or flexible bronchoscopy. Chest computed tomography (CT) scan was performed, if required. Results Total of 20 children were diagnosed with TB‐associated BOF between 1999 and 2019, with a 75% survival. A total of 85% BOF involved the left main bronchus. A total of 80% of patients were MTB culture or ZN smear‐positive. Chest X‐ray abnormalities included: extensive parenchymal disease (80%) and lymph gland enlargement (45%). CT features included visualization of the BOF (60%), esophageal air (73%) and pneumomediastinum (40%). BOF closure was achieved by surgical closure (46%), spontaneous closure (26%), fibrin glue (13%), and esophageal stent (13%). Multivariant regression analysis showed that C‐ reactive protein (CRP), albumin and CRP/albumin ratio were associated with mortality. Conclusion Most TB‐associated BOF are left‐sided. It presents either acutely, with respiratory failure, or with chronic respiratory symptoms of aspiration. Children requiring invasive ventilation have high mortality. Most TB‐associated BOF requires surgical intervention, although the use of fibrin glue offers an attractive alternative option.

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Bronchoscopic assessment of airway involvement in children presenting with clinically significant airway obstruction due to tuberculosis

Cited by 32 publications

References 9 publications

GeneXpert MTB/RIF on bronchoalveolar lavage samples in children with suspected complicated intrathoracic tuberculosis: A pilot study

GeneXpert MTB/RIF on bronchoalveolar lavage samples in children with suspected complicated intrathoracic tuberculosis: A pilot study

Rapid Diagnosis of Childhood Pulmonary Tuberculosis by Xpert MTB/RIF Assay Using Bronchoalveolar Lavage Fluid

Management of children with tuberculous broncho‐esophageal fistulae

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