REEVALUATION ON PATHOGENESIS OF EPITUBERCULOSIS IN INFANTS AND CHILDREN WITH TUBERCULOSIS

DOI Web Site 11 References
  • KONDO Shinya
    Division of Respiratory Disease, Tokyo Metropolitan Kiyose Children's Hospital Department of Pediatrics, Tokyo Metropolitan Health and Medical Treatment Corporation, TamaHokubu Medical Center
  • MIYAGAWA Tomoo
    Division of Respiratory Disease, Tokyo Metropolitan Kiyose Children's Hospital
  • ITO Masaki
    Division of Respiratory Disease, Tokyo Metropolitan Kiyose Children's Hospital

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Other Title
  • 乳幼児エピツベルクローシスの病因についての再評価
  • ニュウヨウジ エピツベルクローシス ノ ビョウイン ニ ツイテ ノ サイヒョウカ

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Abstract

[Object] We try to reevaluate the pathogenesis of epituberculosis in infants and children with tuberculosis, because most studies on epituberculosis were done more than 50 years ago.<BR>[Subje ct and methods] Nineteen children (less than 1 y /o: 12, 1 y/o: 2, 2 y/o: 3, and 4 y/o: 2) were studied by CT imaging and bronchofiberscopy in addition to gastric Mycobacterium tuberculosis examination and regular chest XP.<BR>[Results] In 13 of total 19 patients (68%), lobar or segmental epituberculosis occured after starting antituberculous chemotherapy, including a case in which epituberculosis of right upper lobe was recognized at the time of diagnosis of tuberculosis and after starting chemotherapy, epituberculosis of right middle lobe was observed. CT imaging revealed that all 19 patients had enlargement of mediastinal and/or hilar lymphonodes compressing neighboring bronchi, and 16 of total 19 patients (84%) demonstrated relevant parenchymal infiltration. Gastric Mycobacterium tuberculosis was positive in 15 out of 19 patients (79%). Bronchofiberscopy was done in 16 patients, and it demonstrated mass lesion of various size on the bronchial wall in 13 patients (81%).<BR>[Conclusion] The present study d emonstrated that epituberculosis predominantly occured in tuberculosis infants less than one year old, which was different from the previous reports. The CT imaging also makes clear that epituberculosis may be the atelectasis of lobe or segment which occurs mostly due to compression of bronchi by the enlargement of mediastinal and/or hilar lymphonodes and their early exacerbation after starting chemotherapy. Bronchofiberscopy also elucidated that bronchial wall mass lesion resulted from perforation of lynphonodes may partially contribute to the formation of epituberculosis.

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