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Endobronchial Tuberculosis in Anthracotic Bronchitis

Fariba Rezaeetalab, Donya Farrokh

Abstract: 

Background: Endobronchial tuberculosis (EBTB) is a serious form of pulmonary tuberculosis. In EBTB, mycobacterium tuberculosis involves trachea, large airways and bronchial trees. Combustion of biomass fuels causes anthracotic bronchitis that is characterized by black pigmentation in bronchial tissue. The majority of anthracotic bronchitis are in aged patients, particularly rural women, that use biomass fuel for cooking or traditional bakery .The aim of this study was to evaluate the endobronchial tuberculosis in anthracotic bronchitis.
Material and Methods: In total, 483 EBTB patients who underwent flexible bronchoscopy (FB), for various indications, were included. Tuberculosis was confirmed by microbiological analysis of bronchoalveolar ( smear and culture for Koch’s bacillus) and histopathological methods. EBTB patients were divided in two groups: subjects with anthracotic bronchitis (group 1) and without anthracosis (group 2). Demographic data and important clinical , radiological and bronchoscopic findings were recorded. Chi-squre test and Spss 11.5 software were used for statistical analysis.
Results: 483 out of 1824 patients who underwent FB had EBTB. 73.7% patients had EBTB and anthracotic bronchitis (versus 27.3% EBTB without anthracosis).
The mean age was significantly higher in EBTB and anthracotic bronchitis (68.45±16.31 versus 49.08±14.7). Female/male ratio was 1.4:4 in EBTB and anthracotic group versus 1:1 in non anthracotic patients. Dyspnea, cough, hemoptysis and wheezing were higher in group 1. History of biomass fuel was more significant in EBTB and anthracotic bronchitis. Mass, diffuse infiltration in lower lobes were revealed higher in radiography of group 1. Bronchoscopy showed the higher frequency of bronchial stenosis in EBTB with anthracosis (P value <0.05).
Conclusion: This study suggested significant association between EBTB and anthracotic bronchitis. Unusual findings in radiological and bronchoscopic features were seen in EBTB with anthracosis.
 

Keywords: 
endobronchial tuberculosis, anthracotic bronchitis, biomass

Mycobacterium tuberculosis in trachea and bronchial tree causes a serious type of highly contagious infection named endobronchial tuberculosis (EBTB)(1). Irreversible bronchostenosis is an important delayed complication of EBTB(2,3). Anthracotic bronchitis is a bronchopathy characterized by anthracotic pigmentation in mucosa and submucosa of the bronchial tree(4). It is caused by inhalation of smoke made by incomplete biomass combustion or exposure to wood fire(5). Therefore, it is frequent in rural areas where women, in particular, make bread or food in traditional ovens(6). Anthracotic depositions induce inflammation, narrowing, stenosis and cicatricle reactions in the bronchial lumen or anthracofibrosis(7,8,9). Bronchostenosis is a predisposing factor for pulmonary infection, atelectasis and bronchiectasis, which can contribute to intractable and resistant tuberculosis infection(10-13).According to high frequency
of tuberculosis worldwide, coincidence of the endobronchial tuberculosis and anthracotic bronchitis and greater endobronchial complications are possible(14). The aim of present study is to evaluate the endobronchial tuberculosis in anthracotic bronchitis.

References: 
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  2. Lee JH, Park SS, Lee DH, Shin DH, Yang SC, Yoo BM. Endobronchial tuberculosis. Clinical and bronchoscopic features in 121 cases. Chest 1992 Oct;102(4):990-4.
  3. Rezaeetalab F, Farrokh D, Zandiee B. Multiplanar CT Bronchoscopy of endobronchial TB. Iran J Radiol 2012;9(4):234-6.
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  5. Gupta A, Shah. Bronchial anthracofibrosis:an emerging pulmonary disease due to biomass fuel exposure. Int J Tuberc Lung Dis 2011;15:602-12.
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