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Upper Respiratory Tract Tuberculosis

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  • Authors: Surinder K. Jindal1, Aditya Jindal3, Ritesh Agarwal4
  • Editor: David Schlossberg5
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India; 2: Jindal Clinics, Chandigarh 160020, India; 3: Jindal Clinics, Chandigarh 160020, India; 4: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India; 5: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
  • Received 25 September 2016 Accepted 10 October 2016 Published 11 November 2016
  • Surinder K. Jindal, dr.skjindal@gmail.com
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  • Abstract:

    Upper respiratory tract involvement in cases of tuberculosis (TB) of the head and neck continues to be described in the most recent reports from several different regions, including some from developed countries. Laryngeal TB is the most common of all forms of upper respiratory tract TB (URT-TB). Pulmonary lesions in URT-TB are present in about 20% of adults and about 50 to 60% of children. Systemic manifestations are uncommon. URT-TB is especially seen in patients with a variety of risk factors, such as the presence of human immunodeficiency virus (HIV) infection, diabetes, smoking, alcoholism, drug abuse, malignancies, and use of immunosuppressive drugs. Nodules or ulcerative lesions are seen on morphological examination. Endoscopic examination is required for mucosal lesions. Diagnosis of TB is suspected on an epidemiological basis in high-prevalence countries or from the failure of a patient to respond to routine treatment. Smear and/or histopathological examinations help in establishing the final etiological diagnosis. Treatment includes standard anti-TB chemotherapy for at least 6 months with four primary drugs during the initial intensive phase of 2 months and two or three primary drugs during the remaining maintenance phase of 4 months. Treatment is modified on the basis of culture and sensitivity reports in cases of suspected drug resistance. Surgical intervention may be required for some patients with abscess formation and progressive disease unresponsive to medical therapy. Airway obstruction, although rare, even in fulminant cases may require tracheostomy for relief.

  • Citation: Jindal S, Jindal A, Agarwal R. 2016. Upper Respiratory Tract Tuberculosis. Microbiol Spectrum 4(6):TNMI7-0009-2016. doi:10.1128/microbiolspec.TNMI7-0009-2016.

Key Concept Ranking

Systemic Lupus Erythematosus
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Magnetic Resonance Imaging
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Positron Emission Tomography
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Allergic Bronchopulmonary Aspergillosis
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0.5028569

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2016-11-11
2017-09-22

Abstract:

Upper respiratory tract involvement in cases of tuberculosis (TB) of the head and neck continues to be described in the most recent reports from several different regions, including some from developed countries. Laryngeal TB is the most common of all forms of upper respiratory tract TB (URT-TB). Pulmonary lesions in URT-TB are present in about 20% of adults and about 50 to 60% of children. Systemic manifestations are uncommon. URT-TB is especially seen in patients with a variety of risk factors, such as the presence of human immunodeficiency virus (HIV) infection, diabetes, smoking, alcoholism, drug abuse, malignancies, and use of immunosuppressive drugs. Nodules or ulcerative lesions are seen on morphological examination. Endoscopic examination is required for mucosal lesions. Diagnosis of TB is suspected on an epidemiological basis in high-prevalence countries or from the failure of a patient to respond to routine treatment. Smear and/or histopathological examinations help in establishing the final etiological diagnosis. Treatment includes standard anti-TB chemotherapy for at least 6 months with four primary drugs during the initial intensive phase of 2 months and two or three primary drugs during the remaining maintenance phase of 4 months. Treatment is modified on the basis of culture and sensitivity reports in cases of suspected drug resistance. Surgical intervention may be required for some patients with abscess formation and progressive disease unresponsive to medical therapy. Airway obstruction, although rare, even in fulminant cases may require tracheostomy for relief.

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Figures

Image of FIGURE 1
FIGURE 1

Cervical lymph node enlargement, superficial erythema, and sinus formation in an HIV-positive patient with extensive laryngeal TB. (Courtesy of A. K. Janmeja, Government Medical College, Chandigarh, India.)

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
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Image of FIGURE 2
FIGURE 2

Pale nodule in the oropharynx noticed incidentally during fiber optic bronchoscopy for mediastinal lymphadenopathy. Needle aspiration from the nodule revealed necrotizing granulomatous inflammation and multiple, pink-stained AFB.

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
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Image of FIGURE 3
FIGURE 3

Extensive congestion and edema of arytenoid cartilages and interarytenoid lesion which showed tubercular granulomas on biopsy. (Courtesy of Ashok Gupta, Department of Otorhinolaryngology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.)

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
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Tables

Generic image for table
TABLE 1

Various sites of URT-TB described in different reports

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
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TABLE 2

Important risk factors described in cases of URT-TB

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
Generic image for table
TABLE 3

Common symptoms and signs of URT-TB

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
Generic image for table
TABLE 4

Differential diagnosis of lesions of nasopharyngeal TB

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016
Generic image for table
TABLE 5

Endoscopic appearances of lesions of laryngeal TB

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0009-2016

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