Management of children with tuberculous broncho‐esophageal fistulae

Introduction Broncho‐esophageal fistula (BOF) is a rare complication of Mycobacterium tuberculosis (MTB). TB‐associated BOF presents either as acute respiratory failure, aspiration pneumonia or as a complication of surgical decompression of thoracic lymph nodes. Methods All children with TB‐ associa...

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Bibliographic Details
Published in:Pediatric pulmonology 2020-07, Vol.55 (7), p.1681-1689
Main Authors: Goussard, Pierre, Andronikou, Savvas, Morrison, Julie, Wyk, Lizelle, Mfingwana, Lunga, Janson, Jacques T.
Format: Article
Language:English
Subjects:
aspiration pneumonia
bronchoscopy
broncho‐alveolar lavage
broncho‐oespophageal fistula
Childrens health
Esophagus
Fistula
Tuberculosis
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Summary:Introduction Broncho‐esophageal fistula (BOF) is a rare complication of Mycobacterium tuberculosis (MTB). TB‐associated BOF presents either as acute respiratory failure, aspiration pneumonia or as a complication of surgical decompression of thoracic lymph nodes. Methods All children with TB‐ associated BOF were included. TB was diagnosed if MTB was cultured from respiratory secretions, Ziehl‐Neelsen (ZN) smear was positive, GeneXpert MTB/RIF was positive or a chest radiograph revealed radiographic features typical of TB. BOF was diagnosed by a contrast swallow study and/or flexible bronchoscopy. Chest computed tomography (CT) scan was performed, if required. Results Total of 20 children were diagnosed with TB‐associated BOF between 1999 and 2019, with a 75% survival. A total of 85% BOF involved the left main bronchus. A total of 80% of patients were MTB culture or ZN smear‐positive. Chest X‐ray abnormalities included: extensive parenchymal disease (80%) and lymph gland enlargement (45%). CT features included visualization of the BOF (60%), esophageal air (73%) and pneumomediastinum (40%). BOF closure was achieved by surgical closure (46%), spontaneous closure (26%), fibrin glue (13%), and esophageal stent (13%). Multivariant regression analysis showed that C‐ reactive protein (CRP), albumin and CRP/albumin ratio were associated with mortality. Conclusion Most TB‐associated BOF are left‐sided. It presents either acutely, with respiratory failure, or with chronic respiratory symptoms of aspiration. Children requiring invasive ventilation have high mortality. Most TB‐associated BOF requires surgical intervention, although the use of fibrin glue offers an attractive alternative option.
ISSN:8755-6863
1099-0496
DOI:10.1002/ppul.24775