The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

Abstract

Bronchoscopy is an important investigation in the diagnosis and management of childhood respiratory diseases widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). Aims and Objectives:Aim of this study was to describe the indications, findings and complications of paediatric bronchoscopy in a middle income country with a high prevalence of tuberculosis (TB) and HIV. Methodology:A retrospective analysis of a database which included all bronchoscopies on neonates and children over a 3.5 year period (January 2010 to June 2013) in a tertiary care children's hospital in South Africa. Results and Discussion:A total of 509 bronchoscopies, of which 502 (98%) were fibre-optic bronchoscopies, were performed on neonates (2.3%) and children (median age = 18 months; range 1 day-14.6 years)( (male=58%) of which 5.1% were HIV-infected. The main indications were: large airway compression 40% (n = 204) complicated pneumonia (25 %) and persistent stridor (15 %). Pathology was observed in 64% (n = 319) of bronchoscopes . The most common pathology seen was lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being removing foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications occurred during or following bronchoscopy. ConclusionThe diagnostic yield of paediatric bronchoscopy did not significantly differ from those reported from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.

Diagnostic utility of bronchoalveolar lavage in children with complicated intrathoracic tuberculosis

“…With increasing use of the more sensitive Ultra, diagnostic confirmation may be further improved. 8,19 Expansion of bronchoscopy services with adequate expertise and laboratory infrastructure should be supported, particularly in underresourced areas and in settings with high prevalence of DR-TB.…”

“…7 Bronchoscopy is not frequently performed for TB in resourcelimited settings. 8 However, it is a useful diagnostic and therapeutic procedure in children with TB disease complicated by airway obstruction, which may require surgical intervention, in cases where TB drug resistance is suspected, or to rule out an alternative diagnosis. However, for the sole purpose of diagnostic confirmation of TB or drug resistance in children, bronchoscopy with bronchoalveolar lavage (BAL) should only be performed when other, less invasive, samples cannot be collected or when they fail to provide useful diagnostic information.…”

The role of bronchoscopy in the diagnosis and management of pediatric pulmonary tuberculosis

“…Due to limited resources, bronchoscopy is not frequently performed for TB in resource-limited settings. 8 Bronchoscopy is useful as a diagnostic and therapeutic procedure in children with TB disease complicated by airway obstruction. Bronchoscopy is needed in children when surgical intervention may be required for airway compression, when drug resistance is suspected, and to rule out an alternative diagnosis for airway obstruction.…”

Foreign body aspiration in a tertiary Syrian centre: A 7-year retrospective study

“…Flexible bronchoscopy remains the gold standard for FBA. Indications for bronchoscopy include, airway compression, recurrent and complicated pneumonia, FBA, interstitial lung disease, endoscopic intubation, caustic ingestion, and bronchiectasis, with stridor and wheeze as the most common indications [4]. More recent reports have suggested using computed tomography (CT) to prevent unnecessary bronchoscopy, decrease operational risks and costs without increasing misdiagnosis [5,6].…”