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[Clinical and bronchoscopy features of tracheobronchial tuberculosis in children]
Shuai Peng1, Guang-Li Zhang1, Jing-Xian Hong1
1Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
Insights
Delayed diagnosis of tracheobronchial tuberculosis (TBTB) in children increases the risk of residual airway obstruction or stenosis. Early suspicion and intervention are crucial for better outcomes in pediatric TBTB cases.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Tuberculosis Research
Context:
- Tracheobronchial tuberculosis (TBTB) presents nonspecific symptoms in children, often mimicking other respiratory conditions.
- Infants under one year exhibit a higher incidence of severe symptoms like dyspnea and wheezing.
Purpose:
- To investigate the clinical and bronchoscopic features of TBTB in pediatric patients.
- To identify factors contributing to residual airway obstruction or stenosis following TBTB.
Summary:
- A retrospective study of 92 children with TBTB revealed cough and fever as primary symptoms, with mediastinal lymph node enlargement and airway stenosis common on CT scans.
- Lymphatic fistula was the predominant bronchoscopic type (77%). Delayed diagnosis and treatment initiation were significantly associated with residual airway obstruction or stenosis (P<0.05).
- ROC curve analysis indicated that a diagnostic time of 92 days could predict residual airway obstruction with 70.7% AUC, 58.8% sensitivity, and 75.9% specificity.
Impact:
- Highlights the nonspecific nature of TBTB symptoms and emphasizes the need for high clinical suspicion in children with tuberculosis and airway involvement on imaging.
- Underscores the critical role of timely diagnosis and intervention in preventing long-term respiratory complications like airway stenosis in pediatric TBTB.
Objectives:
To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis.
Methods:
The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (n=34) and a group without residual airway obstruction or stenosis (n=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB.
Results:
A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (P<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (P<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (P<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%.
Conclusions:
The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis.
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