Bronchoscopic techniques in the management of patients with tuberculosis

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).

Haemoptysis and fever in a young refugee from Somalia

“…Bronchoscopy is crucial to collect biological samples in the case of sputum negative/scarce patients, in the case of suspected EBTB, to exclude severe complications (i.e., atelectasis, obstructive pneumonia, etc. ), and in sampling mediastinal lymph nodes (Mondoni et al, 2017). As demonstrated for other diseases, the association of endoscopic sampling techniques increases the diagnostic yield of bronchoscopy (Mondoni et al, 2015a).…”

“…Active TB is an uncommon cause of haemoptysis in Italy, but represents an important bleeding aetiology in high TB incidence countries (Mondoni et al, 2018). Patients with haemoptysis from these areas should be screened promptly for the disease and a bronchoscopy should be considered to exclude endobronchial tuberculosis (EBTB) (Mondoni et al, 2017). EBTB is a rare disease form involving the tracheobronchial tree; TB lymphadenitis is the most frequent extrapulmonary disease form.…”

“…EBTB is a rare disease form involving the tracheobronchial tree; TB lymphadenitis is the most frequent extrapulmonary disease form. Both conditions may occur without any clinically significant parenchymal involvement (Mondoni et al, 2017). Furthermore, extrapulmonary TB (particularly lymphatic) is more incident in African patients (Sotgiu et al, 2017b).…”

New perspectives on difficult-to-treat tuberculosis based on old therapeutic approaches

“…New collapse therapies may be key for life-threatening hemoptysis, as old collapse techniques have been shown to be useful in the case of severe respiratory bleeding (Veronesi, 1932;Ferrari, 1933;Lalla et al, 2017). Flexible bronchoscopy and imaging techniques (i.e., computed tomography, angiography) may now accurately detect the site of the disease and localize the source of the bleeding (Mondoni et al, 2015;Lalla et al, 2017;Sferrazza Papa et al, 2017;Mondoni et al, 2017;Mondoni et al, 2019).…”

Benign Central Airway Obstruction

“…The success of balloon dilation as the initial treatment for stenosis ranges from 6.3 to 73%. 122 A study of 75 patients with stenotic EBTB who underwent silicone stent placement noted significant relief of dyspnea in 88% of cases. Stents were removed in 65% of patients after a median of 14 months.…”