Post-tuberculous bronchiectasis in children

Abstract

34 cases of bronchial occlusion complicating primary tuberculosis have been studied by means of bronchoscopy and bronchography over periods varying from six months to ten years. Bronchiectasis developed in 18 of these cases; in 4 cases the bronchi were distorted and crowded but not dilated; in 4 cases the airless lobe or segment failed to fill with lipiodol one to two years after the initial illness. Bronchial fibrostenosis was present in 4 of these 26 cases in addition, but in only 1 was it of severe degree. In only 8 cases did the bronchograms reveal completely normal appearances. Little information was obtained concerning the pathogenesis of post-tuberculous bronchiectasis. The duration of bronchial obstruction played no direct part. Secondary infection occurred in 6 of the 18 bronchiectatic patients but no evidence was obtained that this was an aetiological factor in the production of the bronchial dilatation, nor was tuberculous bronchitis a factor. The right lung was more often affected by bronchial occlusion than the left but the proportionate incidence of bronchiectasis was not greater in any one lobe or lung. It would appear that little can be done during the stage of active primary tuberculosis to prevent permanent sequelae. Bronchoscopy and treatment with streptomycin and PAS are of little value in the treatment of these cases. Secondary infection should be treated with antibiotics, postural drainage and bronchoscopic drainage but it is uncommon. When permanent sequelae have developed active treatment is only necessary in the minority of patients with symptoms. As a rule, conservative measures will suffice. The main indications for operation (lobectomy, etc.) are severe chronic secondary infection, bronchostenosis, the presence of pneumoliths or broncholiths, and episodes of acute infection which do not respond to adequate medical treatment; these indications are rarely encountered in paediatric practice.