Endobronchial tuberculosis

Abstract

Endobronchial tuberculosis (EBTB) is a highly infectious disease that remains a diagnostic challenge in the developed countries. It also presents as a troublesome therapeutic problem due to its sequelae of cicatrical stenosis. Due to the worldwide decrease of tuberculosis, diagnosis of EBTB is frequently delayed until the onset of serious bronchial stenosis with resultant atelectasis and bronchiectasis. The exact pathogenesis of EBTB is not yet completely understood and the course of EBTB differs according to the type. The prognosis of actively caseating type and edematous-hyperemic type EBTB is grave, resulting fibrostenosis in two thirds of patients. Fibrostenotic type EBTB shows no change or worsening of stenosis. The prognosis is good for granular and non-specific bronchitic type EBTB; however, the prognosis of tumorous type is poor, frequently resulting in bronchial stenosis despite adequate treatment. Antituberculous chemotherapy is effective in controlling the infection, but does not prevent residual bronchostenosis. Early treatment with steroid therapy is effective in certain groups of EBTB. Balloon dilatation and stent insertion is an effective treatment of bronchial stenosis if obstruction of the stent by granulation tissue overgrowth can be prevented. Future research should focus on the pathogenesis of bronchial inflammatory reaction and resulting fibrosis to prevent bronchial stenosis at the early stage.

<i>Mycobacterium kansasii</i> Endobronchial Ulcer in a Nonimmunocompromised Patient

“…A predisposing factor in our patient could have been severe endobronchial stenosis of the main bronchi and truncus intermedius, as well as the distortion of the carina, dating from endobronchial TB in his early youth [15]. More than 60% of cases of actively caseating endobronchial TB change into the fibrostenotic type and may necessitate bronchoscopic surgery or combined treatment with balloon dilation, laser resection and stent placement with varying results [16, 17, 18]. Our patient with M. kansasii also underwent multimodality treatment with partial improvement of his dyspnea and wheezing.…”

Tracheobronchial tuberculosis

“…Lee and colleagues (6) hypothesized that female patient population tend to expectorate less frequently due to social customs and norms causing endobronchial stasis of the secretions and subsequent infection. These women are usually found to be in their second and third decade of life (4,8,10,15,16). Presenting symptoms are variable, non-specific and insidious in onset.…”

“…While anti-tuberculous chemotherapy is efficient in controlling the infection, it does not appear to be a successful method in preventing residual TBTB (15,26,29) In a study done in South Korea Um et al retrospectively looked at the predictors of persistent airway stenosis in 67 patients with microbiologically or histologically confirmed endobronchial tuberculosis that had completed anti-tuberculosis therapy. Patients received at least two bronchoscopies and endobronchial lesions were characterized as one of the seven subtypes originally described by Chung et al (26).…”

Tracheobronchial tuberculosis: a clinical review

“…However, specific to EBTB, the routine use of corticosteroids remains controversial. Shim (15) proposed steroid therapy for the oedematous-hyperaemic, caseating and tumorous subtypes. The suggested dose was prednisolone 1 mg/kg for 4-6 weeks followed by slow taper over a further 4-6 weeks.…”