Endobronchial tuberculosis

Abstract

Endobronchial tuberculosis (EBTB) is a highly infectious disease that remains a diagnostic challenge in the developed countries. It also presents as a troublesome therapeutic problem due to its sequelae of cicatrical stenosis. Due to the worldwide decrease of tuberculosis, diagnosis of EBTB is frequently delayed until the onset of serious bronchial stenosis with resultant atelectasis and bronchiectasis. The exact pathogenesis of EBTB is not yet completely understood and the course of EBTB differs according to the type. The prognosis of actively caseating type and edematous-hyperemic type EBTB is grave, resulting fibrostenosis in two thirds of patients. Fibrostenotic type EBTB shows no change or worsening of stenosis. The prognosis is good for granular and non-specific bronchitic type EBTB; however, the prognosis of tumorous type is poor, frequently resulting in bronchial stenosis despite adequate treatment. Antituberculous chemotherapy is effective in controlling the infection, but does not prevent residual bronchostenosis. Early treatment with steroid therapy is effective in certain groups of EBTB. Balloon dilatation and stent insertion is an effective treatment of bronchial stenosis id obstruction of the stent by granulation tissue overgrowth can be prevented. Future research should focus on the pathogenesis of bronchial inflammatory reaction and resulting fibrosis to prevent bronchial stenosis at the early stage.