| Presenting Features: |
| |
Repeated episodes (5x) of fever for 2-3 days in past
3 months, with apparent response to
short courses of treatment. |
| |
Associated productive cough in recent 2 episodes. |
| |
|
| Background: |
| |
Mother been treated for TB 3 years ago. |
| |
Infant had been given BCG at birth. |
| |
|
| When seen in Sept 1999: |
| |
 |
| Fig.1A |
Fig. 1B |
|
Click to Enlarge
|
Complete collapse of left lung with shifted mediastinum,
but infant only minimally dyspneic (Fig. 1A) |
| |
|
| Relvant Investigations & Procedures: |
| |
Bronchoscopy revealed yellowish granulation tissue
obliterating left main bronchus,
anticipatory
foreign body not found. (Fig.
2)
|
Fig. 2
Click to Enlarge
|
Suctioning resulted in re-opening of left lung (Fig.
1B)
|
BAL yielded AFB and culture positive for TB
|
|
| |
|
| Diagnosis: |
| |
Endobronchial Tuberculosis |
| |
|
| Distinctive Features: |
| |
- Young infant with non-primary pulmonary TB (endobronchial)
- Sputum-positive / open TB, therefore could be "infectious"
to others
- Similar sputum-positive cases have been seen in a number of Chinese
infants and small children
|
| Author's Hypotheses: |
| |
- This is a post- primary pulmonary tuberculosis - with endobronchial
disease.
- B.C.G. at birth togather with repeated early exposures to T.B. organisms
through over-crowding living conditions, traditional feeding habits
which tend to enhance droplet-spread diseases, or over-powering number
of invading organisms may have contributed to the pathology.
- Sub-nutritrion may play a role.
|
| |
|
