Tracheobronchial tuberculosis and its sequelae in children and adolescents

Abstract

The systematic review conducted by Igbokwe and colleagues1Igbokwe V Ruby LC Sultanli A Bélard S Post-tuberculosis sequelae in children and adolescents: a systematic review.Lancet Infect Dis. 2023; 23: e138-e150Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar indicated that a considerable proportion of children and adolescents (aged <18 years) have extensive sequelae after tuberculosis, such as radiological residua after pulmonary tuberculosis, deformities after musculoskeletal and cutaneous tuberculosis, and somatic and psychosocial impairment after tuberculous meningitis. However, this systematic review seems to not fully appreciate the sequelae of tracheobronchial tuberculosis and its long-term effects on children and adolescents. Tracheobronchial tuberculosis, defined as tuberculous infection of the mucous membranes of the trachea or bronchus, can be diagnosed by tracheoscopy. In adults (aged ≥18 years), 10–50% of patients with pulmonary tuberculosis were found to have concurrent tracheobronchial tuberculosis by diagnostic bronchoscopy.2Jung SS Park HS Kim JO Kim SY Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis.Respirology. 2015; 20: 488-495Crossref PubMed Scopus (0) Google Scholar, 3Kashyap S Solanki A Challenges in endobronchial tuberculosis: from diagnosis to management.Pulm Med. 2014; 2014594806Crossref Scopus (34) Google Scholar More than 68% of patients with tracheobronchial tuberculosis might develop some degree of tracheobronchial stenosis, even after adequate chemotherapy.2Jung SS Park HS Kim JO Kim SY Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis.Respirology. 2015; 20: 488-495Crossref PubMed Scopus (0) Google Scholar, 3Kashyap S Solanki A Challenges in endobronchial tuberculosis: from diagnosis to management.Pulm Med. 2014; 2014594806Crossref Scopus (34) Google Scholar Refractory tracheobronchial stenosis might eventually lead to persistent respiratory symptoms, respiratory failure, and death.2Jung SS Park HS Kim JO Kim SY Incidence and clinical predictors of endobronchial tuberculosis in patients with pulmonary tuberculosis.Respirology. 2015; 20: 488-495Crossref PubMed Scopus (0) Google Scholar, 3Kashyap S Solanki A Challenges in endobronchial tuberculosis: from diagnosis to management.Pulm Med. 2014; 2014594806Crossref Scopus (34) Google Scholar In children, an observational study revealed that 40–50% of children with pulmonary tuberculosis might also have concurrent tracheobronchial tuberculosis, as detected by tracheoscopy screening.4Goussard P Gie R The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis.Expert Rev Respir Med. 2014; 8: 101-109Crossref PubMed Scopus (25) Google Scholar Unlike adults, however, the most common type of tracheobronchial tuberculosis in children is lymph node fistula, which accounts for 96·4% of tracheobronchial tuberculosis cases in this age group.5Liu F Rao XC Ma YY et al.[Classification of tracheobronchial tuberculosis in 252 children].Zhonghua Jie He He Hu Xi Za Zhi. 2022; 45: 282-288PubMed Google Scholar Furthermore, some children might also develop cicatricial stenosis of the trachea or bronchus. As the most serious sequela of tracheobronchial tuberculosis, cicatricial stenosis of the trachea or bronchus might not only lead to obstructive pneumonia and respiratory failure, but even lead to death in severe cases.3Kashyap S Solanki A Challenges in endobronchial tuberculosis: from diagnosis to management.Pulm Med. 2014; 2014594806Crossref Scopus (34) Google Scholar, 4Goussard P Gie R The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis.Expert Rev Respir Med. 2014; 8: 101-109Crossref PubMed Scopus (25) Google Scholar, 5Liu F Rao XC Ma YY et al.[Classification of tracheobronchial tuberculosis in 252 children].Zhonghua Jie He He Hu Xi Za Zhi. 2022; 45: 282-288PubMed Google Scholar Currently, diagnosis of tracheobronchial tuberculosis and its sequelae mainly relies on tracheoscopy. Due to the poor compliance of children with this invasive test and potential infectivity of pulmonary tuberculosis, the current rate of use of tracheoscopy in screening for tracheobronchial tuberculosis is extremely low, which also leads to missed diagnoses and misdiagnoses. Moreover, current epidemiological data on the incidence of tracheobronchial tuberculosis and its sequelae in children are scarce. Therefore, future research should include investigations and other related clinical studies of tracheobronchial tuberculosis and its sequelae in children and adolescents. This research would lead to a more comprehensive understanding of the incidence and harm of tracheobronchial tuberculosis and its sequelae in children and adolescents and further increase the understanding and attention of paediatricians to the disease and its sequelae. Non-invasive diagnostic methods should urgently be developed to improve the compliance of paediatric patients and reduce the occupational exposure of medical personnel during the diagnostic process. We declare no competing interests. J-QH and S-LG contibuted equally.