The Role of Flexible Bronchoscopy in Pediatric Pulmonary Tuberculosis

Tuberculosis (TB) disease in children is complicated by the unique challenges that it poses to the clinician. Despite the availability of effective preventive measures and chemotherapy, the prevalence of TB is increasing in the developing world and in much of the industrialized world as well, the incidence of TB in developed countries has declined over the last several decades. However, in recent years, there has been an increase in reported cases, especially in urban areas. In developing countries, the risk for TB infection and disease is relatively uniform in the population; annual rates of infection often exceed 2%. In pediatric patients, pulmonary tuberculosis (PTB) is a major TB infection, but the diagnosis of PTB presents a challenge. The symptoms of PTB infection are often absent or less specific in the affected pediatric population. Because children aged <8 years old lack sputum production, it is difficult to diagnose by sputum specimen. Children with PTB typically have closed caseous lesions with a relatively small number of mycobacteria. The large cavitary population of tubercle bacilli seen in adults is usually absent in children. This is compounded by the difficulty in collecting sputum in children as they swallow the expectorate coming from the lungs. Furthermore, at present, diagnostic tests are costly, slow and lacking in sensitivity. Flexible bronchoscopy (FB) is a newly available tool in the investigation of pediatric pulmonary disease. FB has been used mainly to evaluate unresolved chronic respirator symptoms, and in certain circumstances, to obtain cultures from the immune system of compromised hosts. Therefore, the aim of this retrospective survey is to evaluate the role of FB in the diagnosis of pediatric PTB.