Endoscopic classification of healing process in tracheobronchial tuberculosis

Abstract

Out of 404 patients with pulmonary and/or tracheobronchial tuberculosis treated during the last 10 years at Kurume University Hospital and St. Mary Hospital, in 41 patients, who had been histopathologically or bacteriologically diagnosed as having active tracheobronchial tuberculosis, tracheobronchial lesions were examined by use of bronchofiberscope. Most patients were treated by a combination of three antituberculous agents (INH, RFP and SM or EB). In 31 patients out of the 41 patients, broncho-fiberscopic examinations were performed twice or more. We observed the ulcerous lesions of bronchial tuberculosis at various stages of healing, and could classify the ulcerous lesions into the following three stages. Active Stage: stage A; ulcer formation without regenerating epithelium, Healing Stage: stage H; ulcer formation with regenerating epithelium, Scarring Stage: stage S; and no ulcer formation. Only the lesions of stage A were observed before treatment. In many patients during the first and second month of treatment, the lesions were stage A or H. It was found that healing of the lesions of tracheobronchial tuberculosis progressed through the stages A, H, and S, in this order. The smear positive rates in sputum were 88.5% in stage A, 12.9% in stage H and 5.0% in stage S. The culture positive rates in sputum were 88.5% in stage A, 20.0% in stage H, and 0% in stage S. We conclude that at least 3 months were generally required for the healing of tracheobronchial tuberculosis with ulcerous lesion. However, it seems that the period of time for healing of ulcerous lesions is shorter in patients who are treated by aerosol therapy with SM.(ABSTRACT TRUNCATED AT 250 WORDS)