Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience.

Nurul Yaqeen Mohd Esa,Siti Kamariah Othman,Mohd Arif Mohd Zim,Tengku Saifudin Tengku Ismail,Ahmad Izuanuddin Ismail

doi:10.3390/jcm11030676

Abstract

The diagnosis of endobronchial tuberculosis (EBTB) is difficult as it is not well visualized radiologically, and bronchoscopy is not routinely performed for tuberculosis (TB) patients. Bronchoscopic characterization via endoscopic macroscopic features can speed up the diagnosis of EBTB and prompt immediate treatment. In this study, we identified the clinical and bronchoscopic morphology of 17 patients who were diagnosed with EBTB from 2018 to 2020. Demographics, radiological, microbiological and histopathological data were recorded. Endobronchial lesions were classified according to Chung classification. The diagnosis was made based on a histopathological examination (HPE) of endobronchial biopsy, and/or positive ‘Acid-fast bacilli’ (AFB) microscopy/Mycobacterium tuberculosis (MTB) culture on microbiological examination of bronchial alveolar lavage (BAL) and/or positive MTB culture on endobronchial biopsy specimens. Furthermore, EBTB was predominant in young women, age 20 to 49 years old, with a male to female ratio of 1 to 2. Underlying comorbidities were found in 53% of the patients. Cough, fever and weight loss were the main symptoms (23.5%). The indications for bronchoscopy are smear-negative TB and persistent consolidation on chest radiographs. Consolidation was the main radiological finding (53%). An active caseating lesion was the main EBTB endobronchial subtype (53%). The leading HPE finding was caseating granulomatous inflammation (47%). All patients showed good clinical response to TB treatment. Repeated bronchoscopy in six patients post TB treatment showed a complete resolution of the endobronchial lesion. EBTB bronchoscopic characterization is paramount to ensure correct diagnosis, immediate treatment and to prevent complication.

Highlights

Endobronchial tuberculosis (EBTB) refers to a tuberculous infection of the tracheobronchial tree with microbial and histopathological features, with or without the involvement of the lung parenchyma [1]
Seventeen of 217 Acid-fast bacilli’ (AFB) smear negative patients were found to have endobronchial lesion via bronchoscopic examination, and were included in the study. These 17 patients were diagnosed as having EBTB based on the histopathological examination (HPE) of endobronchial biopsy which showed granulomatous inflammation with caseation necrosis, and/or positive AFB-culture on the microbiological examination of bronchoalveolar lavage (BAL) and endobronchial biopsy
The bronchial alveolar lavage (BAL) samples obtained were sent for AFB microscopic examination and Mycobacterium tuberculosis (MTB) culture

Summary

Introduction

Endobronchial tuberculosis (EBTB) refers to a tuberculous infection of the tracheobronchial tree with microbial and histopathological features, with or without the involvement of the lung parenchyma [1]. It is a rare entity and often underdiagnosed as the symptoms are mainly attributed to pulmonary tuberculosis [2]. Corticosteroids may halt the progression of active disease to fibro-stenotic stage albeit its role is still controversial. If complications such as post-obstructive pneumonia, atelectasis and dyspnea occurred due to tracheobronchial stenosis, airway patency must be reestablished mechanically by surgery or bronchoscopic methods [1]

Methods

Discussion

Conclusion