Clinical and bronchoscopic features of 280 patients with endobronchial tuberculosis (1990-2001)

Park, Eun Joo; Kim, Mi Ok; Yang, Seok Chul; Sohn, Jang Won; Yoon, Ho Joo; Shin, Dong Ho; Park, Sung Soo

Abstract

BACKGROUND: Endobronchial tuberculosis is a serious complication of pulmonary tuberculosis and may result from rupture of an infected lymph node through the bronchial wall or from lymphatic spread to the mucosal surface of the bronchial tree. It is a major cause of morbidity, as it frequently heals with concentric scarring, resulting in bronchial stenosis, atelectasis, and secondary pneumonia. The clinical and bronchoscopic features of endobronchial tuberculosis in 280 patients were retrospectively investigated and compared to clinical and bronchoscopic features of 121 patients with endobronchial tuberculosis from 1982 to 1990.
METHODS
A total of 280 patients with endobronchial tuberculosis out of 1,639 subjects, who had a flexible fiberoptic bronchoscopic examination at the Department of Respiratory Medicine of Hanyang University Hospital during the period between the beginning of January 1990 and the end of June 2001 were included in this study. The diagnostic criteria used for endobronchial tuberculosis included those patients with certain endobronchial lesions present on bronchoscpy, patients with tuberculosis proven by culture of sputum or bronchial brush and washing and patients with positive AFB or bronchoscopic biopsy specimens. Clinical information was retrospectively gathered from all available medical records.
RESULTS
The peak incidence of endobronchial tuberculosis occurred in the third decades, with 2.3 times higher incidence noted in female than in male subjects. A barking cough (73.9%) with sputum (55.7%) was the most common chief complaint. The barking cough was not responsive to antitussive medication over a 3~4 week period but it did respond well to steroids in combination with antituberculosis combination therapy. Pulmonary function tests showed a normal pattern in 47.4% of patients, a restrictive pattern in 27.9% and an obstructive pattern in 16.2%. Parenchymal infiltration and/or consolidation was the most common roentgenographic finding of the chest (61.7%). Caseating necrosis was the most common bronchoscopic finding (31.4%). By bronchoscopic examination, the right upper bronchi and left upper bronchi were the most frequently involved in 42.2%. The positive rate of AFB smear and culture from bronchoscopic washing and/or brushing samples 46.4% and 30.5%, respectively. The positive rate of tuberculosis PCR was 51.3%(40/78).
CONCLUSION
The incidence of endobronchial tuberculosis did not decrease compared to the clinical features of 1982~1990. Thus, young female patients presenting with a barking cough not responsive to antitussives over a 3~4 week period, endobronchial tuberculosis should be considered as an etiology.