Ann. Pak. Inst. Med. Sci. 2013; 9(3): 105-109
Abstract
Endobronchial tuberculosis (EBTB) is a special type of pulmonary tuberculosis and its incidence has increased in recent years. The EBTB often injures the tracheobronchial wall and leads to tracheobronchial stenosis resulting in intractable tuberculosis and make patients become chronic infection sources of tuberculosis, or may even cause pulmonary complications and resulting in death. The etiological confirmation of Mycobacterium tuberculosis is most substantial for diagnosis. However, because the positive rate of acid-fast bacillus staining for sputum smears is low and the clinical and radiological findings are usually non-distinctive, the diagnosis of EBTB is often mistaken and delayed. For early diagnosis, a high index of suspicion is required and the bronchoscopy should be performed as soon as possible in suspected patients. The eradication of Mycobacterium tuberculosis and the prevention of tracheobronchial stenosis are two most substantial treatment goals. For this, the diagnosis must be established early and aggressive treatments must be performed before the disease progresses too far.
Keywords: Endobronchial tuberculosis; Mycobacterium tuberculosis.
Introduction
Pulmonary tuberculosis is one of the major health problems worldwide.1 In spite of much progress in diagnosis and therapy, this problem still remains.2 Moreover, there has been a resurgence of pulmonary tuberculosis recently, which is related to the HIV epidemic3, multidrug-resistant strains, poverty, immigration, and shortness in the prevention and treatment system.4 About 10% to 40% of patients with active pulmonary tuberculosis had EBTB as reported in previous studies.5,6 It has been defined as tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence7 or a complication of progressive primary tuberculosis.8 Endobronchial tuberculosis (EBTB) is a special form of pulmonary tuberculosis9 not easily recognizable, often dangerous for its consequences and potentially a source of spread of infection in the community. The diagnosis of typical pulmonary tuberculosis is easily confirmed by bacteriological studies and radiological findings. However, the diagnosis of EBTB is more difficult because of varied clinical manifestations. The long term sequelae of endobronchial tuberculosis is bronchostenosis, which is mainly determined by the extent of disease progression and closely related to the formation of granulation tissue.10,11 Once fibrostenosis develops or extensive granulation tissue appears, marked bronchostenosis is inevitable despite efficacious anti-tuberculosis chemotherapy.11,12 The incidence rate of bronchostenosis may reach up to 68% in initial 4 to 6 months of the disease and rises further with the course of disease elongating.13,14 Severe bronchostenosis may cause pulmonary complications such as pulmonary infection, atelectasis, bronchiectasis, and even death by inducing respiratory failure and asphyxia. Additionally, the bronchostenosis may cause intractable tuberculosis and make patients to become chronic infection sources of tuberculosis. The eradication of tubercle bacilli and the prevention of bronchostenosis are the two most important goals of EBTB treatment. To fulfill these treatment goals, the diagnosis of this disease must be established early and aggressive treatment should be started before the disease progresses further. This review article is aimed at detection of early diagnosis and initiation of effective therapy.
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