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Chapter 15 : Upper Respiratory Tract Tuberculosis
Category: Clinical Microbiology; Bacterial Pathogenesis
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The upper respiratory tract is the portal of entry of all inhaled matter in the lungs. Tubercular involvement of the upper respiratory tract is not surprising, as inhalation is the most common and important route of mycobacterial infection. Symptoms and signs of upper respiratory tract tuberculosis (TB) depend upon the site of organ involvement. Patients with nasal TB are commonly present with nasal obstruction and purulent rhinorrhea. Lupus vulgaris, a slowly growing, indolent ulcerative lesion caused by Mycobacterium tuberculosis, may affect the nasal vestibule, the septum, and the alae. Infection of the oral cavity is associated with poor dental hygiene and other causes which result in mucosal injury. The larynx is the most vital part of the upper respiratory tract. It can be involved in different infective, neoplastic, granulomatous, and other conditions. There has been a shift in the age and sex distributions of laryngeal TB in the last three or four decades. Involvement of the posterior larynx was thought to result from pooling of infected saliva in the recumbent position, although not all reports have shown this predilection for posterior laryngeal involvement, and some experience has emphasized anterior vocal cord involvement; hypertrophic lesions are seen more commonly than ulcerative lesions. TB should be kept in the differential diagnosis of upper airway diseases and/or cervical lymphadenopathy whenever a patient presents with insidious onset of symptoms, ulcerative or granulomatous lesions, and failure of response to therapy for more common lesions.
Fiber-optic laryngoscopic image showing bilateral nodular masses above the level of vocal cords. Biopsy from these masses confirmed TB.
Roentgenogram soft tissue (A) and CT scan (B) of the neck showing well-defined tubercular abscess in the left aryepiglottic fold obliterating the left piriform fossa.
Common symptoms and signs of upper respiratory tract TB
Changes in clinical spectrum of laryngeal TB, pre- and postchemotherapeutic eras