|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 1 | Page : 40
Pulmonary tuberculosis mimicking reactive airway disease
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
|Date of Web Publication||20-Mar-2014|
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Aliyu I. Pulmonary tuberculosis mimicking reactive airway disease. Sahel Med J 2014;17:40
I read with great interest the case report by Singhal titled "Endobronchial tuberculosis simulating exacerbation of bronchial asthma" published in Sahel Med J Vol. 2 no. 1 (April-June 2013 edition) and wish to share my experience of a similar case scenario in a 3-year-old Nigerian boy who presented with cough and wheezing for 4-months. He did not receive bacille Calmette-Guérin immunization. He had been treated with bronchodilator and oral steroid for 2-week with worsening of symptoms. His anthropometry was normal for age. The chest X-ray was normal [Figure 1], while Mantoux test read 13 mm. The full blood count and erythrocyte sedimentation rate were not remarkable. He was started on anti-tuberculosis drugs (HRZE for 2 months followed by HR for 4 months), he made remarkable improvement by the 3 rd week of treatment and was free of symptoms by the 4 th week of treatment. He completed a 6-month course of anti-tuberculous treatment.
Tuberculosis still remains a huge burden in developing countries despite global effort to curtail it. Probably because of adverse effects of combination of poverty and human immunodeficiency viral infection among others.  The association between tuberculosis and wheezing in children has been largely attributed to atopy;  enlarged lymph compressing the airway,  endobronchial tuberculosis  and allergenic antigens of the mycobacterium causing bronchoconstriction due to a hypersensitivity reaction. 
A diagnosis of tuberculosis may be difficult in children because they often do not expectorate sputum and the yield of gastric lavage may be poor. Furthermore, there is frequent inability to routinely culture the organism. Though Mantoux test was significant in this case, it may be non-reactive in severely malnourished children and in those with overwhelming infection. Therefore a low threshold for the diagnosis of tuberculosis is often observed in most developing countries with the high disease burden.
Tuberculosis has myriads of clinical presentation and a normal chest X-ray does not exclude its diagnosis. A high index of suspicion is the key to its successful diagnosis and treatment especially in countries with a high disease burden.
| References|| |
|1.||World Health Organization. Tuberculosis/human deficiency virus. Available from: http://www.who.int/tb/challenges/hiv/en. [Last accessed on 2013 Jul 23]. |
|2.||Lee TH, Sin Fai Lam KN. Endobronchial tuberculosis simulating bronchial asthma. Singapore Med J 2004;45:390-2. |
|3.||Kitai IC, Sanders DM, Manungo J. Tuberculosis presenting as corticosteroid responsive wheezing in infancy. Trop Geogr Med 1989;41:274-6. |
|4.||Singhal S. Endobronchial tuberculosis simulating exacerbation of bronchial asthma. Sahel Med J 2013;16:35-6. |
|5.||Park CS, Kim KU, Lee SM, Jeong SW, Uh S, Kim HT, et al. Bronchial hyperreactivity in patients with endobronchial tuberculosis. Respir Med 1995;89:419-22. |