[Reevaluation of pathogenesis of epituberculosis in infants and children with tuberculosis].
OBJECTIVE
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.


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.


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%).


CONCLUSIONS
The present study demonstrated 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.
Kondo
Shinya
S
Division of Respiratory Disease, Tokyo Metropolitan Kiyose Children's Hospital, Japan. shinya_kondo@tamahoku-hp.jp
Miyagawa
Tomoo
T
Ito
Masaki
M
D001980:Bronchi / Q000473:pathology; D001999:Bronchoscopy; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008482:Mediastinum; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy