Bronchial tuberculosis is a special type of pulmonary tuberculosis, and the incidence has increased significantly in recent years. In addition to the symptoms of low-grade fever, fatigue, fatigue, and night sweats of tuberculosis in the afternoon, such patients also have typical local symptoms: mainly respiratory symptoms such as cough, sputum production, and hemoptysis.
Patients with bronchial tuberculosis have a mostly irritating dry cough with a sound similar to "dog barking", coughing up white sticky sputum or foamy sputum, the amount of sputum is not much, it is not easy to cough up when it is sticky, and the sputum may have blood streaks or even hemoptysis. Patients with severe disease may present with symptoms of airway obstruction, which can manifest as shortness of breath, wheezing, difficulty breathing, and even choking.
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Q: How is bronchial tuberculosis infected?
A: There are four main ways of infection with bronchial tuberculosis:
1. Mycobacterium tuberculosis in intrapulmonary lesions directly infects the bronchial mucosa with the expectoration process.
2. Lymph node tuberculosis involves and penetrates the trachea and bronchial wall to form a bronchial fistula, and the caseous necrotic material containing Mycobacterium tuberculosis directly invades the airway wall.
3. Mycobacterium tuberculosis spreads along the lymphatic vessels of the bronchial tree.
4. Mycobacterium tuberculosis in intrapulmonary lesions spreads to the trachea and bronchi through hematogenous transmission.
Q: What are the methods for diagnosing bronchial tuberculosis?
A: Bronchoscopy is an essential diagnostic tool. The necessity is as follows:
The first point is that it can improve the diagnosis rate of tuberculosis: the positive rate of conventional sputum bacteria is 15-30%, and if it is performed by sputum bacteria and molecular biology examination and NGS examination of tracheoscopic lavage fluid, the positive rate of sputum bacteria can be increased to about 50%.
The second point is to accurately formulate the treatment plan for tuberculosis: the chemotherapy regimen for pulmonary tuberculosis alone is usually 6 months, but if the diagnosis is complicated with tracheal tuberculosis, the treatment will take at least one year or more.
The third point is that patients with tracheal tuberculosis can accelerate the conversion rate of sputum bacteria to negative with tuberculosis drug nebulization therapy and tracheoscopic treatment.
Treatment of tracheal and bronchial tuberculosis: early systemic anti-tuberculosis drug chemotherapy. On the basis of systemic chemotherapy with anti-tuberculosis drugs, bronchial tuberculosis also needs to be combined with local nebulization therapy with anti-tuberculosis drugs and interventional and comprehensive interventional treatment of tracheobronchial tuberculosis. This also plays an important role in improving the prognosis of bronchial tuberculosis and shortening the total duration of systemic chemotherapy.
For patients with bronchial airway stenosis, the subsegment can be released by microwave coagulation, radiofrequency cutting, and forceps, and then lavage can be administered and lavage, and finally the purpose of airway dilation can be achieved. Rarely, if medications and local treatments are ineffective, doctors usually recommend surgery, such as bronchoplasty or lobectomy.
Of course, if patients with tracheal tuberculosis can cooperate with the whole course of treatment, they can generally achieve a good prognosis.
Artist: 佟勃杉
Source: Shenyang Tenth People's Hospital
Editor: Pei Li
Proofreader: Yang Wei
Preliminary review: Sun Ying
Review: Xu Jiang