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객담 배출이 어려운 소아청소년 결핵 의심 환자에서 굴곡성 기관지 내시경검사의 유용성

Usefulness of flexible bronchoscopy in children with suspected pulmonary tuberculosis who have difficulty in sputum expectoration

김현희|김진택|박유미|양은애|김환수|전윤홍|윤종서|이혜진
대한 소아알레르기 호흡기학회 (The Korean Academy Of Pediatric Allergy And Respiratory Disease)|2017.09|Allergy Asthma & Respiratory Disease (알레르기 천식 호흡기질환)|제5권 제5호|pp. 287-293|DOI https://doi.org/10.4168/aard.2017.5.5.287

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참고문헌

키워드

DiagnosisPulmonary tuberculosisDiagnostic imagingBronchoscopy
주제분류소아과학

초록

Purpose: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have difficulty in sputum expectoration. Methods: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and immunologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB-suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum specimen or in the bronchial washing fluid. Results: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the remaining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the sputum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tuberculosis. None of the patients had significant complications due to bronchoscopy. Conclusion: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspecting PTB in children who have difficulty expectorating sputum.

Abstract

Purpose: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have difficulty in sputum expectoration. Methods: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and immunologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB-suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum specimen or in the bronchial washing fluid. Results: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the remaining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the sputum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tuberculosis. None of the patients had significant complications due to bronchoscopy. Conclusion: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspecting PTB in children who have difficulty expectorating sputum.

참고문헌 (18)

  1. "Global tuberculosis report 2015" (2015)[URL]
  2. Steingart KR, "Xpert® MTB", RIF assay for pulmonary tuberculosis and rifampicin resistance in adults, 2013, pp.(1), CD009593~
  3. Dodd PJ, "Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study", Lancet Glob Health, 2, pp.e453~e459 (2014)
  4. Jenkins HE, "Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates", Lancet, 383, pp.1572~1579 (2014)
  5. Siddiqi K, "Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence", Lancet Infect Dis, 3, pp.288~296 (2003)
  6. Shin JA, "Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis", BMC Infect Dis, 12, pp.141~ (2012)
  7. 유리나, "국내 소아 결핵감염 진단에서의 결핵피부반응 검사와 Interferon-gamma Release Assay (IGRA)의 비교 연구", Pediatric Infection and Vaccine, 23(1), pp.18~24 (2016), 대한소아감염학회
  8. Jo YS, "Discordance between MTB", RIF and real-time tuberculosis-specific polymerase chain reaction assay in bronchial washing specimen and its clinical implications, 2016, pp.11, e0164923~
  9. Tamura A, "The value of fiberoptic bronchoscopy in culture-positive pulmonary tuberculosis patients whose pre-bronchoscopic sputum specimens were negative both for smear and PCR analyses", Intern Med, 49, pp.95~102 (2010)
  10. Lee SJ, "Diagnosis of suspected active pulmonary tuberculosis by flexible fiberoptic bronchoscopy", Tuberc Respir Dis, 36, pp.22~27 (1989)
  11. Le Palud P, "Retrospective observational study of diagnostic accuracy of the Xpert® MTB", RIF assay on fiberoptic bronchoscopy sampling for early diagnosis of smear-negative or sputum-scarce patients with suspected tuberculosis, 2014, pp.14, 137~
  12. Schoch OD, "Diagnostic yield of sputum, induced sputum, and bronchoscopy after radiologic tuberculosis screening", Am J Respir Crit Care Med, 175, pp.80~86 (2007)
  13. Dasgupta K, "Cost-effectiveness of tuberculosis control strategies among immigrants and refugees", Eur Respir J, 25, pp.1107~1116 (2005)
  14. 강석진, "청소년 폐결핵의 임상적 및 영상학적 특징: 재활동성 결핵과의 관련성", Allergy Asthma & Respiratory Diseases, 22(2), pp.163~170 (2012), 대한 소아알레르기 호흡기학회
  15. "Rapid diagnostic tests for tuberculosis: what is the appropriate use?", Am J Respir Crit Care Med, 155, pp.1804~1814 (1997), American Thoracic Society Workshop
  16. Iyer VN, "Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD(®) Gen-probe testing", Respir Med, 105, pp.1084~1090 (2011)
  17. Bai GH, "Trend of anti-tuberculosis drug resistance in Korea, 1994-2004", Int J Tuberc Lung Dis, 11, pp.571~576 (2007)
  18. Kahn MA, "Flexible fiberoptic bronchoscopy", Am J Med, 61, pp.151~155 (1976)

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