Bronchial tuberculosis
Introduction
Introduction to bronchial tube Bronchial tuberculosis, also known as endobronchial tuberculosis (EBTB), refers to tuberculosis that occurs in the trachea, bronchial mucosa, and submucosa. The most common route of infection for adult EBTB is the direct implantation of Mycobacterium tuberculosis into the bronchial mucosa in the lung lesions. Secondly, the intrapulmonary lesions can also invade the bronchial mucosa through the peribronchial tissues. Mycobacterium tuberculosis can also be first invaded by hematogenous dissemination and lymphatic drainage. The bronchial submucosa then involves the mucosal layer. Children with EBTB often cause tuberculous bronchitis due to erosion of the bronchus adjacent to the mediastinal lymphadenopathy. Primary bronchial tuberculosis is rare. The most common route of infection for adult EBTB is the direct implantation of Mycobacterium tuberculosis into the bronchial mucosa in the lung lesions. Secondly, the intrapulmonary lesions can also invade the bronchial mucosa through the peribronchial tissues. Mycobacterium tuberculosis can also be first invaded by hematogenous dissemination and lymphatic drainage. The bronchial submucosa then involves the mucosal layer. Children with EBTB often cause tuberculous bronchitis due to erosion of the bronchus adjacent to the mediastinal lymphadenopathy. basic knowledge The proportion of illness: 0.015% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: bronchiectasis, atelectasis, bronchial asthma
Cause
Bronchial tuberculosis
Mycobacterium tuberculosis infection (90%)
The most common route of infection for adult EBTB is the direct implantation of Mycobacterium tuberculosis into the bronchial mucosa in the lung lesions. Secondly, the intrapulmonary lesions can also invade the bronchial mucosa through the peribronchial tissues. Mycobacterium tuberculosis can also be first invaded by hematogenous dissemination and lymphatic drainage. The bronchial submucosa then involves the mucosal layer. Children with EBTB often cause tuberculous bronchitis due to erosion of the bronchus adjacent to the mediastinal lymphadenopathy.
Pathogenesis
1. Pipeline dissemination: It is the most common, when the tuberculosis bacteria in the local lesion or cavity, directly invade the bronchial mucosa through the bronchial drainage, or invade the bronchial wall through the mucosal gland orifice.
2, adjacent lesion spread: tuberculosis in the lung lesions directly spread near the bronchial tube, the cause of bronchial tuberculosis is the cheese lesions of the parabronchial lymph nodes, corrosion, penetration, penetrate the adjacent bronchial wall, spread to the bronchi.
3, blood line spread: in the acute and chronic blood line spread, the cause of bronchial tuberculosis may have bronchial submucosal tuberculosis spread, but very rare.
Prevention
Bronchial tuberculosis prevention
1. Develop good health habits that don't spit. The TB patients are burned or disinfected.
2, regular physical examination, early detection, early isolation, early treatment. In addition, BCG should be given to infants and young children on time to make the body immune and reduce the incidence of tuberculosis.
3, found that there are low fever, night sweats, dry cough, sputum with blood, fatigue, diet and other symptoms should be promptly to the hospital for examination. After the diagnosis of tuberculosis, treatment should be carried out immediately, and at the same time, attention should be paid to increasing nutrition to enhance physical fitness.
Complication
Bronchial tuberculosis complications Complications bronchiectasis atrophic bronchial asthma
Bronchiectasis
It is a common complication of tuberculosis. Tuberculosis is one of the most common causes of bronchiectasis. Whether it is primary pulmonary tuberculosis in children, or chronic fibrotic tuberculosis, endobronchial tuberculosis, atelectasis, and pleurisy in late adulthood, it can cause different degrees of bronchiectasis.
Atelectasis
Atelectasis is not an independent disease, but a complication of certain chest diseases, especially tuberculosis. Atelectasis is part or no gas in the lungs, so it cannot expand and the lung volume shrinks. Can occur in one side of the lung, a lobe or a segment of the lung. Most of the early stages are reversible, and the lungs can be taken in time for treatment. If the duration is long, a large number of microscopic hyperplasia, extensive fibrosis, the lung volume shrinks, and the formation of lung collapse is irreversible. Tuberculosis bronchial lymphadenopathy or endobronchial tuberculosis is one of the common causes of atelectasis. In the clinical department of tuberculosis, differential diagnosis of atelectasis caused by other causes, especially malignant tumor caused by atelectasis, is needed to prevent misdiagnosis and mistreatment.
Bronchial asthma (referred to as asthma)
It is a chronic inflammation of the airway involving various inflammatory cells such as eosinophils and mast cell nuclear T lymphocytes. Its main clinical features are high reactivity of the airways and airway obstruction. Tuberculosis is often associated with asthma for a variety of reasons, and its incidence is five times higher than that of healthy people.
Symptom
Bronchial tuberculosis symptoms Common symptoms Wheezing fever with cough, slightly... Wheezing dyspnea, night sweats
EBTB has a slow onset, multiple symptoms and lack of specificity: cough 71% to 100%, sputum 41% to 95%, fever 24% to 50%, night sweats 50%, dyspnea 19.7% to 35%, weight loss 2.6% ~ 30%, hemoptysis 19.7% to 25%, chest pain 15%, wheezing 10% to 15%, hoarseness 10%, localized wheezing 3%, no clinical symptoms 2.6% to 24%.
Examine
Examination of bronchial tuberculosis
Bacteriological examination
The positive rate of conventional anti-acid staining microscopy was 4.3% to 68.8%, and most reported below 30%. The positive rate of Mycobacterium tuberculosis culture was 10.7%100%, and the positive rate of Mycobacterium tuberculosis culture in children was higher. The reason for the low positive rate of bacteriological examination may be multi-faceted. For example, the drainage bronchus is not smooth, the necrosis containing Mycobacterium tuberculosis is not easy to be excreted or the brush is not easy to brush to the tuberculous secretion, the amount of bacteria is small, and the lesion is Submucosal infiltration, proliferative lesions are relatively static, case selection and detection methods are different. In recent years, it has been proposed to use a 2 mm diameter silica gel tube to infiltrate the subarachnoid bronchus in the subarachnoid tube to make a thick smear examination under the direct view of the fiberoptic bronchoscope. The positive rate can reach 20.8%. Using brush smear, bronchial smear smear culture, postoperative sputum smear is a good supplement for sputum bacteriological examination. Different sampling samples and different detection methods can improve the positive detection rate of EBTB.
2. Tissue and cytology
Tissue and cytology of broncho-bronchial sampling for EBTB is the most important means of diagnosing EBTB, and the diagnostic value of EBTB with negative bacteriological examination is greater. The common microscopic findings of EBTB are mucosal hypertrophy (43%), congestion and edema (20.6%), erosive ulcer (18.2%), scar stenosis (18.2%), and different degrees of stenosis can reach more than 90%. However, the naked eye can not make a correct diagnosis. Histopathological changes were mainly cheese-like, non-case-like granuloma, epithelial cells, and lymphocyte infiltration. The typical change is only 36%, and AIDS (AIDS) combined with EBTB lacks characteristic changes in tuberculous granuloma. The EBTB cytology is characterized by complete necrosis, less necrotic water, more fat, and easy to dry and granular. There are no free ciliated columnar cells around the tuberculous nodules. The ciliated columnar cells are still arranged in a polar, free edge, columnar structure, and the nucleus is arranged in a mulberry-like arrangement. The above characteristics are different from tumor coagulative necrosis and foreign body type multinucleated giant cells. Some authors reported that 746 patients underwent morphological examination of bronchial washings, and 23 patients were diagnosed with EBTB. Only one of them was positive for acid-fast staining. It is believed that the positive rate of cytology is not lower than that of bacteriological examination, which can be compensated to some extent. Insufficient bacteriological detection rate.
3. Polymerase chain reaction
(PCR) and immunological techniques: there are not many reports. Wu Xueqiong et al reported the results of PCR, smear and culture of 83 tuberculous bronchoalveolar lavage fluid (BALF). The positive rates of the three methods were 56.6%, 20.5% and 25.3%, respectively. 26 non-tuberculous BALF pCR tests were negative. I think PCR has a good diagnostic value. Chen Zhang et al detected the positive rate of tuberculosis antibody, postoperative smear, brushing and biopsy in BALF of 62 cases of EBTB, which were 85.7%, 46.6%, 45.8% and 30.9%, respectively. The amount of lotion recovered is large, close to the lesion, and the antibody content is relatively high. Detection of Mycobacterium tuberculosis DNA in tissue samples is an advanced technical method, and its application prospects are promising. Hu Min et al. used polymerase chain in situ amplification to detect Mycobacterium tuberculosis DNA in lung paraffin sections. The positive area was rod, rod or point-like dark blue body, and 24 of 30 specimens were positive, while conventional acid-fast staining Only 5 cases were positive. Using nested polymerase chain reaction (NPCR) to detect Mycobacterium tuberculosis DNA in living tissue, the method uses the inner primer and the second amplification to reduce the number of cycles, and as a result, the background band decreases the specificity. The final product was amplified on the basis of primer specificity, overcoming contamination. The positive rate in the 110 specimens was 76%, which was significantly higher than 13% of histopathology, 19% of brush smears, 22% of postoperative sputum examinations, and 15% of cultures. Of the 43 patients diagnosed with lung cancer, none of the NPCRs were positive. For EBBS with normal chest radiographs, negative sputum, and histology without typical TB changes, it is of diagnostic value.
4. Imaging examination
X-ray chest X-rays of EBTB have different manifestations and are closely related to bronchial, pulmonary, pleural and mediastinal lesions. Pleural infiltrates accounted for 29% to 41%, atelectasis 28% to 49%, lung consolidation 36%, lung inactive lesions 13% to 33%, cavities 26%, hilar enlargement 8 % ~ 15.8%, pleural fluid 5.3%, 5.2% of damaged lungs, 3% to 40% of chest radiographs. Qi Erhu et al proposed that the CT features of EBTB are (1) the upper lobe, middle and lingual leaves of the two lungs are the sites of tuberculosis; (2) the affected bronchial lesions are extensive, 74% are involved; (3) there are bronchoconstriction, wall thickening, obstruction (4) 78% had tuberculosis and had hilar lymphadenopathy; (5) Most bronchial drainage of the lung lobe, segmental proximal hilar layer without swelling and local exudation. The enhanced scan showed no pulmonary hilar mass in the lung tissue with ring-enhanced lymph nodes or consolidation, which further supports the diagnosis of this disease. Moon et al believe that CT performance depends on the disease stage, when the active lesions, the airway wall irregular thickening, while in chronic fibrotic lesions, the airway is smooth stenosis and mild wall thickening, no significant changes in dynamic observation .
Diagnosis
Diagnosis of bronchial tuberculosis
Diagnostic points
Based on the literature in recent years, it is suggested that the following situations should consider the possibility of EBTB:
(1) Unexplained irritating cough, repeated blood stasis, difficulty breathing, wheezing and chest discomfort.
(2) The following imaging changes are available:
1 There is a rapid change of atelectasis and localized emphysema.
2 bronchial disseminated lesions appeared repeatedly on one or both sides of the lung.
At 3 o'clock, there is a small tension hole or a cavity with a gas-liquid level.
4 There was no obvious lesion in the lung, but the acid-fast staining was positive.
More than 5 sites of bronchial damage, stenosis, distortion, deformation. There is no obvious soft tissue block around.
(3) Fiberoptic bronchoscopy has a decisive role in the diagnosis of EBTB.
Differential diagnosis
EBTB needs to be differentiated from bronchial lung cancer, pulmonary fungal disease, pulmonary bacterial infection, sarcoidosis and Kaposi's sarcoma.
