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Clinical Spectrum of Endobronchial Tuberculosis in Elderly Patients

Clinical Spectrum of Endobronchial Tuberculosis in Elderly Patients Abstract • We describe 11 elderly patients with bacteriologically proved endobronchial tuberculosis, representing 15% of our 73 geriatric patients with pulmonary tuberculosis in the period 1980 to 1987. In seven (64%) of the 11 patients, an incorrect diagnosis was initially made. Cough, mostly nonproductive, was invariably present, and general symptoms (fever, anorexia, weight loss) predominated over specific pulmonary symptoms. The radiographic features were rather "unusual": in only two (18%) of the 11 cases, apicoposterior consolidations with or without cavitation were found. Fiberoptic bronchoscopy showed a range of endobronchial abnormalities that included ulcerations, mass lesions, and fibrostenoses. Antituberculous treatment generally led to satisfactory results. Still, residual bronchostenosis was observed in four (57%) of seven patients in whom a control bronchoscopy was done. In one of these four patients, a pneumonectomy had to be performed for uncontrollable retro-obstructive infections, and in another, repeated endoscopic dilatations were effective. In elderly patients, endobronchial tuberculosis should be considered in the differential diagnosis, especially in the presence of chronic cough. In these patients, the chest roentgenogram may be clear or suggestive of bronchial carcinoma or pneumonitis. (Arch Intern Med. 1990;150:2105-2108) References 1. Uydebrouck M, Gyselen A. Tuberculose in Vlaanderen anno 1983-1988 . Tijdschr Geneesk . 1989;45:1455-1460. 2. Stead W, Lofgren J. Does the risk of tuberculosis increase in old age? J Infect Dis . 1983;147:951-955.Crossref 3. Auerbach O. Tuberculosis of the trachea and major bronchi . Am Rev Tuberc . 1949;60:604-620. 4. Weber A, Bird K, Janower M. Primary tuberculosis in childhood with particular emphasis on changes affecting the tracheobronchial tree . AJR Am J Roentgenol . 1968;103:123-132.Crossref 5. Smith L, Schillaci R, Sarlin R. Endobronchial tuberculosis: serial fiberoptic bronchoscopy and natural history . Chest . 1987;91:644-647.Crossref 6. Davidson P. Tuberculosis: new views of an old disease . N Engl J Med . 1985;312:1514-1515.Crossref 7. Yee A, Hardwick J, Wasef E, Sharma O. Pigmented polypoid obstructive endobronchial tuberculosis . Chest . 1985;87:702-703.Crossref 8. Seiden H, Thomas P. Endobronchial tuberculosis in its sequelae . Can Med Assoc J. 1981;124:165-169. 9. Albert R, Petty T. Endobronchial tuberculosis progressing to bronchial stenosis . Chest . 1976;70:537-539.Crossref 10. Lynch J, Ravikrishnan K. Endobronchial mass caused by tuberculosis . Arch Intern Med . 1980;140:1090-1091.Crossref 11. Jokinen K, Palva T, Nuutinen J. Bronchial findings in pulmonary tuberculosis . Clin Otolaryngol . 1977;2:139-148.Crossref 12. Matthews J, Matarese S, Carpenter J. Endobronchial tuberculosis simulating lung cancer . Chest . 1984;86:642-644.Crossref 13. Khan A, Kovnat D, Bachus B, Whitcomb M, Brody J, Snider G. Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult . Am J Med . 1977;62:31-38.Crossref 14. Pierson D, Lakshminarayan S, Petty T. Endobronchial tuberculosis . Chest . 1973;64:537-539.Crossref 15. Stead W, Lofgren J, Warren E, Thomas C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes . N Engl J Med . 1985;312:1483-1487.Crossref 16. Ip M, So S, Lam W, Mok C. Endobronchial tuberculosis revisited . Chest . 1986;89:727-730.Crossref 17. So S, Lam W, Sham M. Bronchorrhea: a presenting feature of active endobronchial tuberculosis . Chest . 1983;84:635-636.Crossref 18. Williams D, York E, Nobert E, Sproule B. Endobronchial tuberculosis presenting as asthma . Chest . 1988;93:836-838.Crossref 19. Natkunam R, Tse C, Ong B, Sriragavan P. Carinal resection for stenotic tuberculous tracheitis . Thorax . 1988;43:492-493.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clinical Spectrum of Endobronchial Tuberculosis in Elderly Patients

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390210081018
Publisher site
See Article on Publisher Site

Abstract

Abstract • We describe 11 elderly patients with bacteriologically proved endobronchial tuberculosis, representing 15% of our 73 geriatric patients with pulmonary tuberculosis in the period 1980 to 1987. In seven (64%) of the 11 patients, an incorrect diagnosis was initially made. Cough, mostly nonproductive, was invariably present, and general symptoms (fever, anorexia, weight loss) predominated over specific pulmonary symptoms. The radiographic features were rather "unusual": in only two (18%) of the 11 cases, apicoposterior consolidations with or without cavitation were found. Fiberoptic bronchoscopy showed a range of endobronchial abnormalities that included ulcerations, mass lesions, and fibrostenoses. Antituberculous treatment generally led to satisfactory results. Still, residual bronchostenosis was observed in four (57%) of seven patients in whom a control bronchoscopy was done. In one of these four patients, a pneumonectomy had to be performed for uncontrollable retro-obstructive infections, and in another, repeated endoscopic dilatations were effective. In elderly patients, endobronchial tuberculosis should be considered in the differential diagnosis, especially in the presence of chronic cough. In these patients, the chest roentgenogram may be clear or suggestive of bronchial carcinoma or pneumonitis. (Arch Intern Med. 1990;150:2105-2108) References 1. Uydebrouck M, Gyselen A. Tuberculose in Vlaanderen anno 1983-1988 . Tijdschr Geneesk . 1989;45:1455-1460. 2. Stead W, Lofgren J. Does the risk of tuberculosis increase in old age? J Infect Dis . 1983;147:951-955.Crossref 3. Auerbach O. Tuberculosis of the trachea and major bronchi . Am Rev Tuberc . 1949;60:604-620. 4. Weber A, Bird K, Janower M. Primary tuberculosis in childhood with particular emphasis on changes affecting the tracheobronchial tree . AJR Am J Roentgenol . 1968;103:123-132.Crossref 5. Smith L, Schillaci R, Sarlin R. Endobronchial tuberculosis: serial fiberoptic bronchoscopy and natural history . Chest . 1987;91:644-647.Crossref 6. Davidson P. Tuberculosis: new views of an old disease . N Engl J Med . 1985;312:1514-1515.Crossref 7. Yee A, Hardwick J, Wasef E, Sharma O. Pigmented polypoid obstructive endobronchial tuberculosis . Chest . 1985;87:702-703.Crossref 8. Seiden H, Thomas P. Endobronchial tuberculosis in its sequelae . Can Med Assoc J. 1981;124:165-169. 9. Albert R, Petty T. Endobronchial tuberculosis progressing to bronchial stenosis . Chest . 1976;70:537-539.Crossref 10. Lynch J, Ravikrishnan K. Endobronchial mass caused by tuberculosis . Arch Intern Med . 1980;140:1090-1091.Crossref 11. Jokinen K, Palva T, Nuutinen J. Bronchial findings in pulmonary tuberculosis . Clin Otolaryngol . 1977;2:139-148.Crossref 12. Matthews J, Matarese S, Carpenter J. Endobronchial tuberculosis simulating lung cancer . Chest . 1984;86:642-644.Crossref 13. Khan A, Kovnat D, Bachus B, Whitcomb M, Brody J, Snider G. Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult . Am J Med . 1977;62:31-38.Crossref 14. Pierson D, Lakshminarayan S, Petty T. Endobronchial tuberculosis . Chest . 1973;64:537-539.Crossref 15. Stead W, Lofgren J, Warren E, Thomas C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes . N Engl J Med . 1985;312:1483-1487.Crossref 16. Ip M, So S, Lam W, Mok C. Endobronchial tuberculosis revisited . Chest . 1986;89:727-730.Crossref 17. So S, Lam W, Sham M. Bronchorrhea: a presenting feature of active endobronchial tuberculosis . Chest . 1983;84:635-636.Crossref 18. Williams D, York E, Nobert E, Sproule B. Endobronchial tuberculosis presenting as asthma . Chest . 1988;93:836-838.Crossref 19. Natkunam R, Tse C, Ong B, Sriragavan P. Carinal resection for stenotic tuberculous tracheitis . Thorax . 1988;43:492-493.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1990

References