Incidence and Predictors of Tracheobronchial Tuberculosis in Pulmonary Tuberculosis: A Multicentre, Large-Scale and Prospective Study in Southern China

Abstract

Background: Patients with pulmonary tuberculosis (PTB) have a high risk of concomitant tracheobronchial tuberculosis (TBTB), which commonly causes severe complications such as tracheobronchial stenosis. The prevalence and predictors of TBTB in China remain unclear due to the lack of prospective and large-scale studies. Objectives: To investigate the incidence of TBTB in PTB patients in southern China, and elucidate the predictors of TBTB and related tracheobronchial stenosis. Methods: We prospectively performed bronchoscopy in PTB patients to diagnose TBTB at four medical centres in southern China from September 2015 to August 2016. Clinical and epidemiological data were recorded and analysed to determine predictors of TBTB and related tracheobronchial stenosis. Results: A total of 345 (23.9%) of the 1,442 PTB patients undergoing bronchoscopy were diagnosed with TBTB. Female sex (OR 2.53), age < 50 years (OR 1.88), living in urban (OR 2.19), diabetes (OR 1.84), coughing (OR 2.61), and symptoms ≥4 weeks (OR 1.66) were predictors of PTB concomitant with TBTB. About 59.7% TBTB patients developed tracheobronchial stenosis, of which 23.3% cases presented severe airway narrowing. Female sex (OR 2.27), age < 50 years (OR 2.11), shortness of breath (OR 1.97), and symptoms ≥4 weeks (OR 1.71) were predictors of TBTB-related tracheobronchial stenosis. Conclusions: About 23.9% of PTB patients undergoing bronchoscopy present with TBTB in Guangdong province, southern China. Young and middle-aged females with symptoms persisting for ≥4 weeks (the main predictors of TBTB and related tracheobronchial stenosis) should receive bronchoscopy immediately when diagnosed with PTB.

Incidence, laboratory diagnosis and predictors of tracheobronchial tuberculosis in patients with pulmonary tuberculosis in Chongqing, China

“…Furthermore, undergoing the bronchoscopic examination is uncomfortable and costly for older individuals and, therefore, certain older patients refused to undergo bronchoscopic examination in the current study. The present results indicated that female patients with TB were more prone to having TBTB than male patients and that sex was an independent risk factor for concomitant TBTB and tracheobronchial stenosis, which is consistent with previous studies (12,13,20). Several possible reasons may explain why female patients were more likely to present with TBTB including the bronchial structure, as well as sociocultural and aesthetic factors (21).…”

“…It is interesting to note that no history of smoking was an independent risk factor for concomitant TBTB, which is consistent with the results of Su et al (13); a possible explanation is that smoking may produce changes in the airway epithelium, thereby preventing MTB from growing in the airways (13). Certain studies have indicated that a longer clinical symptom duration may correlate with longer exposure to Myobacterium tuberculosis and contribute to the development of TBTB (12,13). In the present study, the parameter of longer clinical symptom duration was associated with concomitant TBTB, as determined by univariate analysis.…”

“…To the best of our knowledge, only a limited number of studies have been performed on the application of epidemiological diagnostic yields and predictors of TBTB (11)(12)(13). Therefore, the present retrospective observational study performed in Chongqing, China aimed to explore the incidence and laboratory yields of TBTB among patients with pulmonary tuberculosis (PTB) and to report the predictors of TBTB and associated tracheobronchial stenosis.…”

Clinical significance of serum transforming growth factor‑β1 and procollagen type I N‑propeptide in post‑tuberculosis tracheobronchial stenosis

“…Tuberculosis (TB) is a major global health problem associated with significant morbidity and potential mortality (1,2). Diagnostic bronchoscopy studies have suggested that 10-50% of patients with pulmonary TB have tracheobronchial TB (TBTB) (3,4). Airway stenosis is the most common complication of TBTB.…”

Diagnostic Value of Virtual Bronchoscopic Navigation in the Bronchial Tuberculosis Induced Central Airway Stenosis

“…China has a high prevalence of tuberculosis with about 900,000 new cases of tuberculosis every year; about 10-40% of active tuberculosis patients have concomitant TBT [8], and about 23.3% of patients develop severe airway stenosis [9]. Regular bronchoscopy is invasive and may cause pain.…”