Tuberculosis of the upper respiratory tract, trachea and bronchi

Tuberculosis of the respiratory tract is considered a complication of tuberculosis of the lungs or intrathoracic lymph nodes. Only in very rare cases, tuberculosis of the respiratory tract is an isolated lesion without clinically established tuberculosis of the respiratory system.

Epidemiology of tuberculosis of the upper respiratory tract, trachea and bronchi

Among all localizations of the tuberculosis of the respiratory tract, bronchial tuberculosis is mainly observed. In patients with various forms of intrathoracic tuberculosis, it is diagnosed in 5-10% of cases. Less commonly observed tuberculosis of the larynx. Tubercular lesions of the oropharynx (tongue, tonsils) and trachea are rare.

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Pathogenesis and pathological anatomy of tuberculosis of the upper respiratory tract, trachea and bronchi

As a rule, tuberculosis of the respiratory tract complicates untimely diagnosed and untreated pulmonary tuberculosis or a process caused by drug-resistant mycobacteria.

Tuberculosis of the bronchus appears more often as a complication of primary, infiltrative and fibrous-cavernous tuberculosis. In patients with primary tuberculosis, granulations from the adjacent caseous-necrotic lymph nodes germinate in the bronchus. Mycobacteria can enter the bronchus wall and lymphogenically. With infiltrative and fibrous-cavernous tuberculosis, the infection spreads from the cavern to the submucous layer of the bronchus. Less important is hematogenous infection of the bronchial wall.

Tuberculosis of the bronchus is infiltrative and ulcerative. The process is characterized mainly by productive and, more rarely, exudative reactions. In the wall of the bronchus under the epithelium, typical tubercle tubercles form which merge with each other. There is an unsharply outlined infiltrate of limited length with hyperemic mucosa. With caseous necrosis and the decay of the infiltrate on the mucous membrane covering it, an ulcer is formed, ulcerative tuberculosis of the bronchus develops. Sometimes it is combined with nodulobronchal fistula, which starts from the side of the caseo-necrotic lymph node in the root of the lung. Penetration of infected masses through the fistula in the bronchi may be the cause of the formation of foci of bronchogenic colonization in the lungs.

Tuberculosis of the larynx is also infiltrative or ulcerative with a predominantly productive or exudative response. The defeat of the inner ring of the larynx (false and true vocal folds, lining and intercapital space, blinking ventricles) occurs as a result of infection with phlegm, and the defeat of the outer ring (epiglottis, arytenoid cartilages) - by hematogenous or lymphogenous drift of mycobacteria.

Symptoms of tuberculosis of the upper respiratory tract, trachea and bronchi

Tuberculosis of the bronchus occurs gradually and proceeds asymptomatically or with complaints of dry persistent cough, cough with the release of crumbly masses, pain behind the sternum, shortness of breath. Infiltration in the bronchial wall can completely close its lumen, which is why there may be shortness of breath and other symptoms of bronchial obstruction.

Symptoms of tuberculosis of the larynx are hoarseness up to aphonia, dryness and choking in the throat. Pain on swallowing is a sign of defeat of the epiglottis and the posterior half-circle of the entrance to the larynx. The disease develops against the background of the progression of the main tuberculosis process in the lungs. Symptoms of laryngeal involvement may be the first clinical manifestation of tuberculosis, most often asymptomatic disseminated pulmonary tuberculosis. In such cases, the detection of pulmonary tuberculosis provides the basis for establishing a diagnosis of tuberculosis of the larynx.

Diagnosis of tuberculosis of the upper respiratory tract, trachea and bronchi

In the diagnosis of respiratory tuberculosis, it is important to take into account its association with the progression of pulmonary tuberculosis and intrathoracic lymph nodes. There is also a limited mucosal involvement.

With X-ray examination and especially CT, deformation and narrowing of the bronchi are revealed. A characteristic x-ray picture occurs when the bronchial tuberculosis is complicated by hypoventilation or atelectasis.

In cases of ulcerative forms of pulmonary tuberculosis in patients with sputum, mycobacteria of tuberculosis can be detected.

The main method for diagnosing tuberculosis of the respiratory tract is considered to be research using a laryngeal mirror, a laryngoscope and a fibroblochoscope, which allows you to examine the mucous membrane up to the mouth of the subsegmental bronchi. In the absence of destructive pulmonary tuberculosis, endoscopic examination helps to determine the source of bacterial excretion, which is usually an ulcerated bronchus or (extremely rarely) a trachea.

Tubercular infiltrates in the larynx and bronchial tubes can be from grayish pink to red, with a smooth or slightly tuberous surface, a dense or softer consistency. Ulcers are irregular in shape, with pitted edges, usually shallow, covered with granulations. In cases of breakthrough in the bronchus of caseous-necrotic lymph nodes, nodulo-bronchial fistulas are formed, granulation grows.

For the morphological and bacteriological confirmation of the diagnosis of tuberculosis, various methods of sampling and biopsy are used. Examine for the presence of mycobacteria separable ulcers. Separated from the fistula aperture, granulation tissue.

The involution of bronchial tuberculosis is completed by the formation of a fibrous tissue - from a small scar to a scar's stenosis of the bronchus.

Treatment of tuberculosis

• Chemotherapy for tuberculosis
• Anti-TB drugs
• Surgical methods of treatment of tuberculosis
• Treatment of extrapulmonary tuberculosis
• Pathogenetic therapy of tuberculosis
• Immunotherapy in the treatment of tuberculosis
• Physical methods of treatment of tuberculosis
• Methods of extracorporal hemocorrection in tuberculosis
• Prevention of tuberculosis (BCG vaccination)
• Chemoprophylaxis of tuberculosis

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