Analysis of clinical and bronchoscopic features of multidrug- resistant tracheobronchial tuberculosis

Analysis of clinical and bronchoscopic features of multidrug- resistant tracheobronchial tuberculosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of clinical and bronchoscopic features of multidrug- resistant tracheobronchial tuberculosis Jian Li, Xue Li, Lulu Qiu, Guoyi Huang, Jiamin Huang, Zhichao Liu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5598354/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 9 You are reading this latest preprint version Abstract Objective: Investigate patients' clinical characteristics and bronchoscopic features with multidrug-resistant tracheobronchial tuberculosis. Methods: A total of 118 patients with confirmed diagnosis of multidrug-resistant tracheobronchial tuberculosis were selected retrospectively, and the demographic data, clinical characteristics, and bronchoscopic manifestations were analyzed. Results: Among patients with multidrug-resistant tracheobronchial tuberculosis, the main clinical features were cough (92.3%,109/118) and sputum (83.0%,98/118). The primary infection sites of multidrug-resistant tuberculosis were the right upper bronchus (39.8%,47/118) and the left upper bronchus (37.3%,44/118). The main types of multidrug-resistant tracheobronchial tuberculosis lesions were inflammatory infiltration type (46.6%,55/118) and necrosis type (32.2%,38/118). Conclusion: The clinical manifestations of multidrug-resistant tracheobronchial tuberculosis are non-specific. The main clinical features are cough and fever. It often invades the right upper bronchus. The main bronchoscopic manifestation is inflammatory infiltration. multidrug resistance tracheobronchial tuberculosis bronchoscopy clinical features characteristics Figures Figure 1 1. Introduction The World Health Organization (WHO) released the "2023 Global Tuberculosis Report"[1], pointing out that in 2022, there will be approximately 410,000 people suffering from multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) worldwide. China estimates that there are 30,000 patients with multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB), accounting for 7.32%. China ranks second among the countries with a high burden of multidrug-resistant tuberculosis in the world[2]. With bronchoscopy's application and popularization, the tracheobronchial tuberculosis (TBTB) detection rate has gradually increased. The incidence of TBTB may be as high as 54.3% or more[3], which also includes multidrug-resistant tracheobronchial tuberculosis. The global treatment success rate of drug-resistant tuberculosis is 63%, while the treatment success rate of multidrug-resistant tuberculosis in China is only 54%. For patients with multidrug-resistant tracheobronchial tuberculosis, treatment is more complex and delayed diagnosis and treatment may cause airway stenosis and atelectasis, which requires attention. However, the clinical characteristics and bronchoscopic features of patients with multidrug-resistant tracheobronchial tuberculosis are rarely reported in the literature. Therefore, this article aims to retrospectively analyze the clinical characteristics and bronchoscopic features of patients with multidrug-resistant tracheobronchial tuberculosis to provide a better clinical reference. 2. Information and methods 2.1 General Information A retrospective analysis was conducted on 118 patients diagnosed with multidrug-resistant tracheobronchial tuberculosis from January 2021 to December 2023. Inclusion criteria: positive culture of Mycobacterium tuberculosis (MTB), drug sensitivity test indicating MDR-TB, and meeting the MDR-TB diagnostic criteria of the "Chinese Expert Consensus on the Treatment of Multidrug-Resistant and Rifampicin-Resistant Tuberculosis (2019)"[4]. The TBTB diagnostic criteria and bronchoscopic classification criteria were based on the "Guidelines for the Diagnosis and Treatment of Tracheobronchial Tuberculosis (Trial)"[5] published in 2012.The present study was approved by the Ethics Committee of The Third People’s Hospital of Shenzhen and conductedin accordance with the Declaration of Helsinki. All patients in this study signed informed consent forms for tuberculosis chemotherapy, and consent forms for bronchoscopy. 2.2 Method The inclusion criteria of this study were based on the Guidelines for the Diagnosis and Treatment of Tracheal and Bronchial Tuberculosis (Trial) [5], and combined with the international classification standard [6], the clinical characteristics and bronchoscopic characteristics of 118 cases of multidrug resistant tuberculosis were observed and analyzed. According to the bronchoscopic pathological changes observed under bronchoscopy, they were divided into inflammatory infiltration (type I), ulceration and necrosis (type II), granulation proliferation (type III), scar stenosis (type IV), wall softening (type V) and lymph node fistula (type VI). 2.3 Electronic bronchoscopy observation The evidence for chest CT showing lesions in the trachea and bronchi is limited, and the quality of sputum specimens collected from patients is not high (3 sputum tuberculosis smears and 1 sputum tuberculosis culture were completed before the examination). In order to more accurately and clearly diagnose MDR-TBTB, all 118 patients in this study underwent bronchoscopy examination.All subjects in this study had indications for bronchoscopy, no contraindications, and signed informed consent. A flexible Olympus electronic bronchoscope was used to enter the tracheobronchial tubes through the nasal cavity or oral cavity, and the lesions were classified according to their characteristics.During bronchoscopy, medical staff wear N95 masks, goggles, gloves, and surgical gowns and operate in negative pressure isolation rooms. After surgery, the electronic bronchoscope undergoes strict cleaning, disinfection, and sterilization. This strategy is consistent with the safety guidelines for MDR-TB diagnosis and treatment recommended by WHO [7]. 2.4 Drug sensitivity testing This study used a liquid culture system (BACTEC MGIT 960) to culture Mycobacterium tuberculosis in bronchoalveolar lavage fluid. After positive culture of Mycobacterium tuberculosis, drug susceptibility testing was performed using the Minimum Inhibition Concentration (MIC) method. For first-line/second-line drug sensitivity testing, if the results show that Mycobacterium tuberculosis is at least resistant to isoniazid and rifampicin, it is confirmed as multidrug resistant tuberculosis. 2.5 Statistical analysis Chi square test and SPSS 22.0 statistical software were used for analysis.Descriptive statistical analysis was performed on the basic information of the subjects and the test results. Count data were described by case number or percentage (%), and measurement data were expressed as mean ± standard deviation. 3. Results 3.1 Clinical symptoms A total of 118 patients with multidrug-resistant tracheobronchial tuberculosis were enrolled, including 49 males and 69 females. The male-to-female ratio was 0.71:1. The age ranged from 18 to 71 years, with an average age of (38.4±13.8) years. The average age of males was (37.8±13.5) years, and the average age of females was (38.9±14.2) years. The main symptoms of patients with multidrug-resistant tracheobronchial tuberculosis were cough (92.3%), sputum (83.0%), fever (50.0%), shortness of breath (25.3%), and night sweats (23.7%), as shown in Table 1. Table 1 Clinical manifestations of tracheobronchial tuberculosis (cases, %) 3.2 Chest CT examination results All subjects underwent chest CT examinations. The most common imaging lesions shown by CT were lung cavitation in 52 cases, followed by lung destruction in 32 cases, and tracheobronchial stenosis in 28 cases. CT showed that the lung lesions mainly were bilateral multi-lobar segments, followed by unilateral multi-lobar segments. See Table 2. Table 2 Imaging changes 3.3 Results of electronic bronchoscopy The most common types of sites of invasion under electronic bronchoscopy in this study were inflammatory infiltration (46.6%), ulcer necrosis (32.2%), and scar stenosis (10.1%), as shown in Table 3. The microscopic manifestations of each type are shown in Figure 1. A. Inflammatory infiltration type (type I); B. necrosis type(type II); C. granulation proliferative type (type III); D. Scar stenosis type (type IV); E. Tube wall softening type (type V); F. Lymphatic fistula type (type VI) Table 3 Microscopic classification of patients with tracheobronchial tuberculosis The most common sites of invasion in this study under electronic bronchoscopy were the right upper lobe bronchus (39.8%), left upper lobe bronchus (37.3%), and right mainstem bronchus (15.3%).as summarized in Table 4. Table 4 Distribution of lesion locations of tracheobronchial tuberculosis (cases, %) 3.4 Bronchoscopy intervention therapy Among the 38 necrotic patients, 36 (94.7%) underwent bronchoscopy cryotherapy. One month after surgery, bronchoscopy showed significant improvement in bronchial mucosa. Among the 12 patients with scar stenosis, 5 (66.7%) underwent bronchoscopy balloon dilation surgery, and one month after surgery, bronchoscopy showed an average increase of 40% in lumen diameter; Among the 3 patients with wall softening, 2 (66.7%) received bronchoscopy covered stent placement. One month after surgery, the bronchial tube lumen was unobstructed in 1 case, and another intervention was needed due to granulation hyperplasia. 3.5 Complications Two cases of mild nasal mucosal bleeding were recorded during the operation, and local compression was used to stop the bleeding. One patient experienced transient hypoxemia (SpO ₂<90%) after surgery, which was relieved after oxygen therapy. No serious complications such as bleeding or pneumothorax occurred. 4. Discussion This study showed that the most common clinical manifestations of multidrug-resistant tracheobronchial tuberculosis are cough, sputum, fever, and shortness of breath [5], which are similar to the clinical manifestations of diseases such as pneumonia, asthma, and lung cancer. They have no obvious specificity and are, therefore, often missed in clinical diagnosis. High-resolution CT scans can only indicate the presence of airway lesions in 23.7% of patients. Therefore, chest imaging cannot rule out tracheobronchial tuberculosis [8]. With the popularization of electronic bronchoscopy technology, the incidence of TBTB has gradually increased and is on an upward trend. Bronchoscopy has been proven to be the most reliable method for diagnosing tracheobronchial tuberculosis [9,10]. For chest imaging changes that indicate the presence of airway stenosis or atelectasis, routine bronchoscopy is recommended [11]. Chest imaging examinations show that cavitation is more likely to cause bronchial stenosis or obstruction [12]. Early bronchoscopy can detect tracheobronchial tuberculosis as early as possible and collect alveolar lavage fluid for pathogenic and molecular biological testing to determine whether it is sensitive or resistant to tuberculosis drugs as early as possible [13,14]. Under direct vision of the electronic bronchoscope, the location and range of airway lesions can be effectively understood, and bronchoscopic interventional treatment of local lesions can be performed, such as interventional treatment methods such as freezing, to accelerate the repair of tracheobronchial tuberculosis [15]. Some scholars have pointed out that on the basis of systemic anti-tuberculosis treatment, bronchoscopic interventional treatment [16] can be used to accelerate recovery. Bronchoscopy cryosurgery is because it will cause local damage to the treated tracheal mucosa and will not cause granulation proliferation[17,18].Patients with scar stenosis showed significant improvement in lung function (FEV1) after bronchoscopy balloon dilation (average increase of 18%, p<0.01), but caution should be taken against the risk of restenosis caused by granulation hyperplasia [19]. Research has shown that female patients with multidrug-resistant tracheobronchial tuberculosis are more common than male patients (OR=2.1, 95% CI 1.2-3.8, p=0.01)[10,20], and gender is an independent risk factor for the combination of TBTB and tracheobronchial stenosis, which is consistent with this study[21]. This may be related to the fact that women's immune response and hormone levels[22], as well as the smaller diameter of the bronchial lumen, are more minor than men's, and sputum retention makes it easier for Mycobacterium tuberculosis to invade the bronchial mucosa[12]. It is worth noting that scar stenosis is more common in males (P=0.047), indicating that gender may affect the progression pattern of the disease, and further research is needed to investigate the role of hormone levels or immune response differences. The results of this study indicate that the presence of atelectasis or severe cough is associated with an increased likelihood of coexisting with TBTB [23]. This study found that the bronchoscopic manifestations of multidrug-resistant TBTB were mainly inflammatory infiltration type (46.6%), significantly higher than non drug-resistant tuberculosis (27%) [24], suggesting that drug-resistant strains may be more likely to cause persistent mucosal inflammation rather than rapid progression to necrosis or granulation tissue proliferation. Studies have shown that the incidence of TBTB is related to age, especially in elderly TBTB patients who have received anti-tuberculosis drug treatment in the past; the proportion of drug-resistant TB is significantly higher[25]. However, the results of this study showed that the average age was relatively low, which may be related to the fact that most of the patients enrolled in this study were young people and the small number of people enrolled. Common sites of tracheobronchial tuberculosis are the right upper lobe, right middle lobe, and left upper lobe, which is related to Mycobacterium tuberculosis being an aerobic bacterium[10]. The most common type of bronchoscopic manifestation was inflammatory infiltration (46.6%), consistent with previous studies[25,26]. Some scholars have pointed out that it is necessary to pay attention to the correct classification and standardized treatment of tracheobronchial tuberculosis[27]. Early diagnosis and timely anti-tuberculosis treatment can significantly reduce the occurrence of tracheobronchial stenosis and improve prognosis[28,29]. In-depth genotypic and phenotypic drug sensitivity testing is needed to establish personalized, well-tolerated treatment plans to improve treatment outcomes[30].The MDR-TBTB patients in this study were treated according to the WHO guidelines for the treatment of drug-resistant tuberculosis (6-9 months), and the sputum culture negative conversion rate, changes in tracheal and bronchial lesions, and chest CT changes were subsequently tracked. In addition to the high cost of drugs, patients with multidrug-resistant tracheobronchial tuberculosis also need to undergo bronchoscopy or interventional treatment. Therefore, the treatment time is extended, the economic burden is heavy, and the patient is under great mental stress, and psychological assessment or intervention is required[31]. WHO pointed out that in low-income and middle-income countries, psychological counseling or educational intervention is considered to be the most effective intervention measure[32]. In addition, it is necessary to implement socioeconomic and nutritional support, DOTS and DOTS-Plus programs, and optimized management of comorbidities[33,34,35]. At the same time, the problem of multidrug-resistant tuberculosis (LTBI) needs to be addressed to curb and eliminate the tuberculosis epidemic[36,37]. In summary, the clinical manifestations of MDR-TBTB are nonspecific, and patients with multidrug-resistant pulmonary tuberculosis who have airway involvement on chest imaging should be alert to the occurrence of TBTB. In the diagnosis and treatment of MDR-TB, it is recognized that the incidence of MDR-TB combined with TBTB is high, and more attention should be paid to bronchoscopy and treatment of MDR-TB patients. This study has some limitations: First, this is a retrospective study, which may have some subjective bias, and some meaningful variables may not be included in the analysis. Second, this is a single-center study with a small sample size, and the results need to be further verified by more prospective, large-sample, and multicenter studies.In the future, further research is needed to investigate the pathogenesis of multidrug resistant Tracheobronchial Tuberculosis. 5. Conclusion In conclusion,The clinical manifestations of multidrug-resistant tracheobronchial tuberculosis are non-specific. The main clinical features are cough and fever. It often invades the right upper bronchus. The main bronchoscopic manifestation is inflammatory infiltration.For chest imaging changes that indicate the presence of airway stenosis or atelectasis, routine bronchoscopy is recommended.Early diagnosis and timely anti-tuberculosis treatment can significantly reduce the occurrence of tracheobronchial stenosis and improve prognosis. Abbreviations MDR/RR-TBmultidrug-resistant or rifampicin-resistant tuberculosis TBTB the tracheobronchial tuberculosis CT computed Tomography Declarations Acknowledgements Not applicable. Authors’ contributions JL conceived and designed the article and analyzed and interpreted the data. Administrative support was provided by WYG and GBL. JL,XL,LLQ,GYH,JMH, and ZCL provided study materials or patients. JL, XK, and XFW collected and assembled the data. All authors contributed to writing and fnal approval of the manuscript. Funding Shenzhen Clinical Research Center for Tuberculosis (Project No: 20210617141509001). Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The present study was approved by the Ethics Committee of The Third People’s Hospital of Shenzhen and conducted in accordance with the Declaration of Helsinki. All patients in this study signed informed consent forms for tuberculosis chemotherapy, and consent forms for bronchoscopy. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Clinical trial Not applicable. This manuscript does not report on or involve any clinical trials. References WORLD HEALTH ORGANIZATION. Global tuberculosis report 2023[EB/OL]. [2023-11-07]. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/globaltuberculosis-report-2023 World Health Organization. Global tuberculosis report 2021. Geneva. World Health Organization. Tingting H, Li Y, Wang X, Chen Y, Nie X, Zhuang R, Li Y. Shuliang Guo; Early and Regular Bronchoscopy Examination on Effect of Diagnosis and Prognosis for Patients With Tracheobronchial Tuberculosis. Front Med. 2022;9:825736. Chinese expert consensus on multidrug-resistant tuberculosis and Rifampicin-resistant tuberculosis treatment]. Zhonghua Jie He He Hu Xi Za Zhi. 2019;42(10):733–49. Chinese Medical Association. Diagnosis and treatment guideline fortracheobronchial tuberculosis. Chin J Tuberc Respir Dis. 2012;35:581–7. Nurul Yaqeen Mohd Esa, Othman SK. Mohd Arif Mohd Zim, Tengku Saifudin Tengku Ismail, Ahmad Izuanuddin Ismail; Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience. J Clin Med 2022;11(3). WHO. Infection prevention and control of tuberculosis in health-care facilities, congregate settings and households. Geneva: World Health Organization; 2021. Vikas Pathak, Ray W, Shepherd S. Shojaee; Tracheobronchial tuberculosis J Thorac disease. 2016;8(12):3818–25. Hanh DA. Case Report of an Endobronchial Tuberculosis-Challenges in Diagnosis and the Role of High-resolution CT Scans and Bronchoscopic Biopsy CURR RESPIR MED REV. 2024; 20. Siawosh K, Eskandari, Onno W. Akkerman; Endobronchial tuberculosis.The Lancet. Infect Dis. 2024;24(5):e343. Nurul Yaqeen Mohd Esa, Othman SK. Mohd Arif Mohd Zim, Tengku Saifudin Tengku Ismail, Ahmad Izuanuddin Ismail; Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience. J Clin Med 2022;11(3). Fu J, Li J, Liu Z, et al. Sex-Specific Differences in the Clinical Profile Among Patients with Tracheobronchial Tuberculosis: A Hospital-Based Cross-Sectional Study in Shenzhen, China. Int J Gen Med. 2022;15:5741–50. Yang S, Guo JQ, Li TX, et al. [Annual progress of interventional diagnosis and treatment of tuberculosis in 2023]. Zhonghua Jie He He Hu Xi Za Zhi. 2024;47(4):363–70. Lee P, Chee CBE. Xpert MTB/RIF for rapid detection of TB and rifampicin resistance in the evaluation of tracheobronchial lesions: What's to stop its use? RESPIROLOGY. 2018; 23 (10): 889–90. Mu D, Nan D, Li W et al. Efficacy and safety of bronchoscopiccryotherapy for granular endobronchial tuberculosis. Respiration2011;82:268–72. Ding WM, Tang SJ. [Attention should be paid to the early and correct classification and staging of diagnosis of tracheobronchial tuberculosis].Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese. J tuberculosis respiratory Dis. 2021;44(3):167–9. Krimsky WS, Broussard JN, Sarkar SA, et al. Bronchoscopic spray cryotherapy: assessment of safety and depth of airway injury. J Thorac Cardiovasc Surg. 2010;139:781–2. Jiang Liu S, Xie L, Yu. Xiaoling Su; Multidrug resistant lymph node fistula tracheobronchial tuberculosis: A. case Rep Med. 2019;98(49):e18288. Lee JH, et al. Long-term outcomes of bronchoscopic intervention for tracheobronchial stenosis. Respiration. 2018;95(4):244–51. Xinmei Guo C, Wang X, Wang J, Ma L, Xv T, Luan. Changwei Kou; Characteristics and risk factor analysis of 410 cases of tracheobronchial tuberculosis. Experimental therapeutic Med. 2014;8(3):781–4. Su Z, Cheng Y, Wu Z, Zhang P, Chen W, Zhou Z, Zhong M, Luo W, Guo W, Li S. Incidence and predictors of tracheobronchial tuberculosis in pulmonary tuberculosis: A multicentre, large– scale and prospective study in southern China. Respiration. 2019;97:153–9. Peng A-Z, Yang A, Li S-J, Qiu Q, Yang S. Yong Chen; Incidence, laboratory diagnosis and predictors of tracheobronchial tuberculosis in patients with pulmonary tuberculosis in Chongqing, China.Experimental and therapeutic medicine 2020;20(6):174. Moon SM, Lee WY, Shin B. Clinical characteristics and drug resistance profile of patients with endobronchial tuberculosis in South Korea: single-center experience. ANN PALLIAT MED. 2023;12(3):487–95. Fu J, et al. Sex-specific differences in tracheobronchial tuberculosis. Int J Med Sci. 2022;19(3):567–73. Moon SM, Lee W-Y. Clinical characteristics and drug resistance profile of patients with endobronchial tuberculosis in South Korea: single-center experience. Annals Palliat Med. 2023;12(3):487–95. Mohd Esa NY, Othman SK, Mohd Zim MA, et al. Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience. J Clin Med. 2022;11:676. Ding WM, Tang SJ, Fu Y. [Attention should be paid to the early and correct classification and staging of diagnosis of tracheobronchial tuberculosis]. Zhonghua Jie He He Hu Xi Za Zhi. 2021;44(3):167–9. Tingting H, Li Y, Wang X, Chen Y, Nie X, Zhuang R, Li Y. Shuliang Guo; Early and Regular Bronchoscopy Examination on Effect of Diagnosis and Prognosis for Patients With Tracheobronchial Tuberculosis. Front Med. 2022;9:825736. Nathavitharana RR, Lederer P, Tierney DB, Nardell E. Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis. Int J tuberculosis lung disease: official J Int Union against Tuberculosis Lung Disease 2019 04 01;23(4):396–404. Lange C, Aarnoutse RE, Alffenaar JWC, Bothamley G, Brinkmann F, Costa J, Chesov D, van Crevel R, Dedicoat M, Dominguez J, Duarte R, Grobbel HP, Günther G, Guglielmetti L, Heyckendorf J, Kay AW, Kirakosyan O, Kirk O, Koczulla RA, Kudriashov GG, Kuksa L, van Leth F, Magis-Escurra C, Mandalakas AM, Molina-Moya B, Peloquin CA, Reimann M, Rumetshofer R, Schaaf HS, Schön T, Tiberi S, Valda J, Yablonskii PK. K Dheda; Management of patients with multidrug-resistant tuberculosis.The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 2019 06 01;23(6):645–662. Octaviani P, Ikawati Z, Yasin NM, Kristina SA. Kusuma; Interventions to Improve Adherence to Medication on Multidrug-Resistant Tuberculosis Patients: A Scoping Review. Med J Malay. 2024;79(2):212–21. World Health Organization. Global Tuberculosis Report 2022. World Health Organization, 21, 2022. [cited November 2022] Accessed from: https://apps.who.int/iris/handle/10665/363752 Charles M, Bark W, Henry Boom, Jennifer J. Furin; More Tailored Approaches to Tuberculosis Treatment and Prevention. Annu Rev Med. 2024;75:177–88. Thomas BE, Kumar JV, Periyasamy M, Khandewale AS, Mercy JH, Raj EM, et al. Acceptability of the medication event reminder monitor for promoting adherence to multidrugresistant tuberculosis therapy in two indian cities: Qualitative study of patients and health care providers. J Med Internet Res. 2021;23(6):e23294. Chien JY, Lai CC, Tan CK, Chien ST, Yu CJ, Hsueh PR. Decline in rates of acquired multidrug-resistant tuberculosis after implementation of the directly observed therapy, short course (DOTS) and DOTS-Plus programmes in Taiwan. J Antimicrob Chemother. 2013;68(8):1910–16. World Health Organization. Latent tuberculosis infection: Updated and consolidated guidelines for programmatic management Background document on the 2019 revision. Geneva, WHO Global TB Programme. Deng G, Zhang P. Hongzhou Lu; Challenges in the screening and treatment of latent multidrug-resistant tuberculosis infection. Drug discoveries Ther. 2022;16(2):52–4. Tables Table 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table14.docx Cite Share Download PDF Status: Published Journal Publication published 07 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 09 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviews received at journal 06 Apr, 2025 Reviews received at journal 31 Mar, 2025 Reviewers agreed at journal 31 Mar, 2025 Reviewers agreed at journal 31 Mar, 2025 Reviewers invited by journal 31 Mar, 2025 Submission checks completed at journal 30 Mar, 2025 First submitted to journal 25 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5598354","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436456322,"identity":"0faa3be6-4373-4934-9c59-de24062b3d2a","order_by":0,"name":"Jian Li","email":"","orcid":"","institution":"National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Southern University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Li","suffix":""},{"id":436456323,"identity":"bf30e5f6-5147-4e50-9146-b2ed10831220","order_by":1,"name":"Xue Li","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Li","suffix":""},{"id":436456324,"identity":"b365016a-eb94-4454-b7b6-2de92a6b8ad0","order_by":2,"name":"Lulu Qiu","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lulu","middleName":"","lastName":"Qiu","suffix":""},{"id":436456325,"identity":"dc14f241-0142-43a8-9513-9ce13a1e775f","order_by":3,"name":"Guoyi Huang","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guoyi","middleName":"","lastName":"Huang","suffix":""},{"id":436456326,"identity":"2a94a3a4-1d83-49b3-8746-9b282de7b045","order_by":4,"name":"Jiamin Huang","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiamin","middleName":"","lastName":"Huang","suffix":""},{"id":436456327,"identity":"e1fd7618-7590-4db1-b6c2-69de72632932","order_by":5,"name":"Zhichao Liu","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhichao","middleName":"","lastName":"Liu","suffix":""},{"id":436456328,"identity":"d719dbbb-bfd2-42e4-8b7e-786376a26193","order_by":6,"name":"Xue Ke","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Ke","suffix":""},{"id":436456329,"identity":"aa5fcfd3-99b1-4354-b494-cc652bb1dbdf","order_by":7,"name":"Xiufen Wang","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiufen","middleName":"","lastName":"Wang","suffix":""},{"id":436456330,"identity":"c3fd5b97-eb6d-44ce-aadc-dcf058ad521a","order_by":8,"name":"Wenying Gao","email":"","orcid":"","institution":"Shenzhen Third People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenying","middleName":"","lastName":"Gao","suffix":""},{"id":436456331,"identity":"9be3389b-2cbd-4466-9144-98e62fc7d217","order_by":9,"name":"Guobao Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAjklEQVRIiWNgGAWjYBACA/4GNoYPpGmROMDGOIM0LQwJbMw8JGo5fu2xTZk1A397dwKRWph7yo1zzqUzSJw5u4FYW86kSee2HQZ6KpdoLTlp0pYkakk/Js1ImhaJM+yGPefSeYj3i31/+7MHP8qs5fjbe4nUwsDAY8DAQGLUsD8AaSFFxygYBaNgFIw0AACJcii+1th2oQAAAABJRU5ErkJggg==","orcid":"","institution":"Shenzhen Clinical Research Center for Tuberculosis, Shenzhen, People's Republic of China","correspondingAuthor":true,"prefix":"","firstName":"Guobao","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-12-07 10:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5598354/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5598354/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-11689-6","type":"published","date":"2025-10-07T15:56:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79803553,"identity":"bd958015-2c62-42e4-8600-0717e6cc7c6b","added_by":"auto","created_at":"2025-04-03 04:48:26","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":845139,"visible":true,"origin":"","legend":"\u003cp\u003eMicroscopic changes of various types of tracheobronchial tuberculosis\u003c/p\u003e\n\u003cp\u003eA. Inflammatory infiltration type (type I); B. necrosis type(type II); C. granulation proliferative type (type III); D. Scar stenosis type (type IV); E. Tube wall softening type (type V); F. Lymphatic fistula type (type VI)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5598354/v1/e08255a6992b3e7a5b46f89a.jpeg"},{"id":93419454,"identity":"a4fa8b86-3d1c-4b41-a2bb-7b39d60c9924","added_by":"auto","created_at":"2025-10-13 16:00:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1246139,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5598354/v1/70c481fa-e272-4be8-a282-14150690e5fc.pdf"},{"id":79803548,"identity":"b368a80e-e82c-4291-a1b4-657c66e11772","added_by":"auto","created_at":"2025-04-03 04:48:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16717,"visible":true,"origin":"","legend":"","description":"","filename":"Table14.docx","url":"https://assets-eu.researchsquare.com/files/rs-5598354/v1/0d5cb2b570d8da090d5e1eb5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of clinical and bronchoscopic features of multidrug- resistant tracheobronchial tuberculosis","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe World Health Organization (WHO) released the \u0026quot;2023 Global Tuberculosis Report\u0026quot;[1], pointing out that in 2022, there will be approximately 410,000 people suffering from multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB) worldwide. China estimates that there are 30,000 patients with multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB), accounting for 7.32%. China ranks second among the countries with a high burden of multidrug-resistant tuberculosis in the world[2]. With bronchoscopy\u0026apos;s application and popularization, the tracheobronchial tuberculosis (TBTB) detection rate has gradually increased. The incidence of TBTB may be as high as 54.3% or more[3], which also includes multidrug-resistant tracheobronchial tuberculosis. The global treatment success rate of drug-resistant tuberculosis is 63%, while the treatment success rate of multidrug-resistant tuberculosis in China is only 54%. For patients with multidrug-resistant tracheobronchial tuberculosis, treatment is more complex and delayed diagnosis and treatment may cause airway stenosis and atelectasis, which requires attention. However, the clinical characteristics and bronchoscopic features of patients with multidrug-resistant tracheobronchial tuberculosis are rarely reported in the literature. Therefore, this article aims to retrospectively analyze the clinical characteristics and bronchoscopic features of patients with multidrug-resistant tracheobronchial tuberculosis to provide a better clinical reference.\u003c/p\u003e"},{"header":"2. Information and methods","content":"\u003cp\u003e2.1 General Information\u003c/p\u003e\n\u003cp\u003eA retrospective analysis was conducted on 118 patients diagnosed with multidrug-resistant tracheobronchial tuberculosis from January 2021 to December 2023. Inclusion criteria: positive culture of Mycobacterium tuberculosis (MTB), drug sensitivity test indicating MDR-TB, and meeting the MDR-TB diagnostic criteria of the \u0026quot;Chinese Expert Consensus on the Treatment of Multidrug-Resistant and Rifampicin-Resistant Tuberculosis (2019)\u0026quot;[4]. The TBTB diagnostic criteria and bronchoscopic classification criteria were based on the \u0026quot;Guidelines for the Diagnosis and Treatment of Tracheobronchial Tuberculosis (Trial)\u0026quot;[5] published in 2012.The present study was approved by the Ethics Committee of The Third People\u0026rsquo;s Hospital of Shenzhen and conductedin accordance with the Declaration of Helsinki. All patients in this study signed informed consent forms for tuberculosis chemotherapy, and consent forms for bronchoscopy.\u003c/p\u003e\n\u003cp\u003e2.2 Method\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria of this study were based on the Guidelines for the Diagnosis and Treatment of Tracheal and Bronchial Tuberculosis (Trial) [5], and combined with the international classification standard [6], the clinical characteristics and bronchoscopic characteristics of 118 cases of multidrug resistant tuberculosis were observed and analyzed. According to the bronchoscopic pathological changes observed under bronchoscopy, they were divided into inflammatory infiltration (type I), ulceration and necrosis (type II), granulation proliferation (type III), scar stenosis (type IV), wall softening (type V) and lymph node fistula (type VI).\u003c/p\u003e\n\u003cp\u003e2.3 Electronic bronchoscopy observation\u003c/p\u003e\n\u003cp\u003eThe evidence for chest CT showing lesions in the trachea and bronchi is limited, and the quality of sputum specimens collected from patients is not high (3 sputum tuberculosis smears and 1 sputum tuberculosis culture were completed before the examination). In order to more accurately and clearly diagnose MDR-TBTB, all 118 patients in this study underwent bronchoscopy examination.All subjects in this study had indications for bronchoscopy, no contraindications, and signed informed consent. A flexible Olympus electronic bronchoscope was used to enter the tracheobronchial tubes through the nasal cavity or oral cavity, and the lesions were classified according to their characteristics.During bronchoscopy, medical staff wear N95 masks, goggles, gloves, and surgical gowns and operate in negative pressure isolation rooms. After surgery, the electronic bronchoscope undergoes strict cleaning, disinfection, and sterilization. This strategy is consistent with the safety guidelines for MDR-TB diagnosis and treatment recommended by WHO [7].\u003c/p\u003e\n\u003cp\u003e2.4 Drug sensitivity testing\u003c/p\u003e\n\u003cp\u003eThis study used a liquid culture system (BACTEC MGIT 960) to culture Mycobacterium tuberculosis in bronchoalveolar lavage fluid. After positive culture of Mycobacterium tuberculosis, drug susceptibility testing was performed using the Minimum Inhibition Concentration (MIC) method. For first-line/second-line drug sensitivity testing, if the results show that Mycobacterium tuberculosis is at least resistant to isoniazid and rifampicin, it is confirmed as multidrug resistant tuberculosis.\u003c/p\u003e\n\u003cp\u003e2.5 Statistical analysis\u003c/p\u003e\n\u003cp\u003eChi square test and SPSS 22.0 statistical software were used for analysis.Descriptive statistical analysis was performed on the basic information of the subjects and the test results. Count data were described by case number or percentage (%), and measurement data were expressed as mean \u0026plusmn; standard deviation.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1 Clinical symptoms\u003c/p\u003e\n\u003cp\u003eA total of 118 patients with multidrug-resistant tracheobronchial tuberculosis were enrolled, including 49 males and 69 females. The male-to-female ratio was 0.71:1. The age ranged from 18 to 71 years, with an average age of (38.4\u0026plusmn;13.8) years. The average age of males was (37.8\u0026plusmn;13.5) years, and the average age of females was (38.9\u0026plusmn;14.2) years. The main symptoms of patients with multidrug-resistant tracheobronchial tuberculosis were cough (92.3%), sputum (83.0%), fever (50.0%), shortness of breath (25.3%), and night sweats (23.7%), as shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 Clinical manifestations of tracheobronchial tuberculosis (cases, %)\u003c/p\u003e\n\u003cp\u003e3.2 Chest CT examination results\u003c/p\u003e\n\u003cp\u003eAll subjects underwent chest CT examinations. The most common imaging lesions shown by CT were lung cavitation in 52 cases, followed by lung destruction in 32 cases, and tracheobronchial stenosis in 28 cases. CT showed that the lung lesions mainly were bilateral multi-lobar segments, followed by unilateral multi-lobar segments. See Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 Imaging changes\u003c/p\u003e\n\u003cp\u003e3.3 Results of electronic bronchoscopy\u003c/p\u003e\n\u003cp\u003eThe most common types of sites of invasion under electronic bronchoscopy in this study were inflammatory infiltration (46.6%), ulcer necrosis (32.2%), and scar stenosis (10.1%), as shown in Table 3. The microscopic manifestations of each type are shown in Figure 1.\u003c/p\u003e\n\u003cp\u003eA. Inflammatory infiltration type (type I); B. necrosis type(type II); C. granulation proliferative type (type III); D. Scar stenosis type (type IV); E. Tube wall softening type (type V); F. Lymphatic fistula type (type VI)\u003c/p\u003e\n\u003cp\u003eTable 3 Microscopic classification of patients with tracheobronchial tuberculosis\u003c/p\u003e\n\u003cp\u003eThe most common sites of invasion in this study under electronic bronchoscopy were the right upper lobe bronchus (39.8%), left upper lobe bronchus (37.3%), and right mainstem bronchus (15.3%).as summarized in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4 Distribution of lesion locations of tracheobronchial tuberculosis (cases, %)\u003c/p\u003e\n\u003cp\u003e3.4 Bronchoscopy intervention therapy\u003c/p\u003e\n\u003cp\u003eAmong the 38 necrotic patients, 36 (94.7%) underwent bronchoscopy cryotherapy. One month after surgery, bronchoscopy showed significant improvement in bronchial mucosa. Among the 12 patients with scar stenosis, 5 (66.7%) underwent bronchoscopy balloon dilation surgery, and one month after surgery, bronchoscopy showed an average increase of 40% in lumen diameter;\u003c/p\u003e\n\u003cp\u003eAmong the 3 patients with wall softening, 2 (66.7%) received bronchoscopy covered stent placement. One month after surgery, the bronchial tube lumen was unobstructed in 1 case, and another intervention was needed due to granulation hyperplasia.\u003c/p\u003e\n\u003cp\u003e3.5 Complications\u003c/p\u003e\n\u003cp\u003eTwo cases of mild nasal mucosal bleeding were recorded during the operation, and local compression was used to stop the bleeding. One patient experienced transient hypoxemia (SpO ₂\u0026lt;90%) after surgery, which was relieved after oxygen therapy. No serious complications such as bleeding or pneumothorax occurred.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study showed that the most common clinical manifestations of multidrug-resistant tracheobronchial tuberculosis are cough, sputum, fever, and shortness of breath [5], which are similar to the clinical manifestations of diseases such as pneumonia, asthma, and lung cancer. They have no obvious specificity and are, therefore, often missed in clinical diagnosis.\u003c/p\u003e\n\u003cp\u003eHigh-resolution CT scans can only indicate the presence of airway lesions in 23.7% of patients. Therefore, chest imaging cannot rule out tracheobronchial tuberculosis [8]. With the popularization of electronic bronchoscopy technology, the incidence of TBTB has gradually increased and is on an upward trend. Bronchoscopy has been proven to be the most reliable method for diagnosing tracheobronchial tuberculosis [9,10]. For chest imaging changes that indicate the presence of airway stenosis or atelectasis, routine bronchoscopy is recommended [11]. Chest imaging examinations show that cavitation is more likely to cause bronchial stenosis or obstruction [12]. Early bronchoscopy can detect tracheobronchial tuberculosis as early as possible and collect alveolar lavage fluid for pathogenic and molecular biological testing to determine whether it is sensitive or resistant to tuberculosis drugs as early as possible [13,14]. Under direct vision of the electronic bronchoscope, the location and range of airway lesions can be effectively understood, and bronchoscopic interventional treatment of local lesions can be performed, such as interventional treatment methods such as freezing, to accelerate the repair of tracheobronchial tuberculosis [15]. Some scholars have pointed out that on the basis of systemic anti-tuberculosis treatment, bronchoscopic interventional treatment [16] can be used to accelerate recovery. Bronchoscopy cryosurgery is because it will cause local damage to the treated tracheal mucosa and will not cause granulation proliferation[17,18].Patients with scar stenosis showed significant improvement in lung function (FEV1) after bronchoscopy balloon dilation (average increase of 18%, p\u0026lt;0.01), but caution should be taken against the risk of restenosis caused by granulation hyperplasia [19].\u003c/p\u003e\n\u003cp\u003eResearch has shown that female patients with multidrug-resistant tracheobronchial tuberculosis are more common than male patients (OR=2.1, 95% CI 1.2-3.8, p=0.01)[10,20], and gender is an independent risk factor for the combination of TBTB and tracheobronchial stenosis, which is consistent with this study[21]. This may be related to the fact that women\u0026apos;s immune response and hormone levels[22], as well as the smaller diameter of the bronchial lumen, are more minor than men\u0026apos;s, and sputum retention makes it easier for Mycobacterium tuberculosis to invade the bronchial mucosa[12]. It is worth noting that scar stenosis is more common in males (P=0.047), indicating that gender may affect the progression pattern of the disease, and further research is needed to investigate the role of hormone levels or immune response differences. The results of this study indicate that the presence of atelectasis or severe cough is associated with an increased likelihood of coexisting with TBTB [23]. This study found that the bronchoscopic manifestations of multidrug-resistant TBTB were mainly inflammatory infiltration type (46.6%), significantly higher than non drug-resistant tuberculosis (27%) [24], suggesting that drug-resistant strains may be more likely to cause persistent mucosal inflammation rather than rapid progression to necrosis or granulation tissue proliferation.\u003c/p\u003e\n\u003cp\u003eStudies have shown that the incidence of TBTB is related to age, especially in elderly TBTB patients who have received anti-tuberculosis drug treatment in the past; the proportion of drug-resistant TB is significantly higher[25]. However, the results of this study showed that the average age was relatively low, which may be related to the fact that most of the patients enrolled in this study were young people and the small number of people enrolled.\u003c/p\u003e\n\u003cp\u003eCommon sites of tracheobronchial tuberculosis are the right upper lobe, right middle lobe, and left upper lobe, which is related to Mycobacterium tuberculosis being an aerobic bacterium[10]. The most common type of bronchoscopic manifestation was inflammatory infiltration (46.6%), consistent with previous studies[25,26].\u003c/p\u003e\n\u003cp\u003eSome scholars have pointed out that it is necessary to pay attention to the correct classification and standardized treatment of tracheobronchial tuberculosis[27]. Early diagnosis and timely anti-tuberculosis treatment can significantly reduce the occurrence of tracheobronchial stenosis and improve prognosis[28,29]. In-depth genotypic and phenotypic drug sensitivity testing is needed to establish personalized, well-tolerated treatment plans to improve treatment outcomes[30].The MDR-TBTB patients in this study were treated according to the WHO guidelines for the treatment of drug-resistant tuberculosis (6-9 months), and the sputum culture negative conversion rate, changes in tracheal and bronchial lesions, and chest CT changes were subsequently tracked.\u003c/p\u003e\n\u003cp\u003eIn addition to the high cost of drugs, patients with multidrug-resistant tracheobronchial tuberculosis also need to undergo bronchoscopy or interventional treatment. Therefore, the treatment time is extended, the economic burden is heavy, and the patient is under great mental stress, and psychological assessment or intervention is required[31]. WHO pointed out that in low-income and middle-income countries, psychological counseling or educational intervention is considered to be the most effective intervention measure[32]. In addition, it is necessary to implement socioeconomic and nutritional support, DOTS and DOTS-Plus programs, and optimized management of comorbidities[33,34,35]. At the same time, the problem of multidrug-resistant tuberculosis (LTBI) needs to be addressed to curb and eliminate the tuberculosis epidemic[36,37].\u003c/p\u003e\n\u003cp\u003eIn summary, the clinical manifestations of MDR-TBTB are nonspecific, and patients with multidrug-resistant pulmonary tuberculosis who have airway involvement on chest imaging should be alert to the occurrence of TBTB. In the diagnosis and treatment of MDR-TB, it is recognized that the incidence of MDR-TB combined with TBTB is high, and more attention should be paid to bronchoscopy and treatment of MDR-TB patients.\u003c/p\u003e\n\u003cp\u003eThis study has some limitations: First, this is a retrospective study, which may have some subjective bias, and some meaningful variables may not be included in the analysis. Second, this is a single-center study with a small sample size, and the results need to be further verified by more prospective, large-sample, and multicenter studies.In the future, further research is needed to investigate the pathogenesis of multidrug resistant Tracheobronchial Tuberculosis.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion,The clinical manifestations of multidrug-resistant tracheobronchial tuberculosis are non-specific. The main clinical features are cough and fever. It often invades the right upper bronchus. The main bronchoscopic manifestation is inflammatory infiltration.For chest imaging changes that indicate the presence of airway stenosis or atelectasis, routine bronchoscopy is recommended.Early diagnosis and timely anti-tuberculosis treatment can significantly reduce the occurrence of tracheobronchial stenosis and improve prognosis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMDR/RR-TBmultidrug-resistant or rifampicin-resistant tuberculosis\u003c/p\u003e\n\u003cp\u003eTBTB the tracheobronchial tuberculosis\u003c/p\u003e\n\u003cp\u003eCT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; computed Tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJL conceived and designed the article and analyzed and interpreted the data. Administrative support was provided by WYG and GBL. JL,XL,LLQ,GYH,JMH, and ZCL provided study materials or patients. JL, XK, and XFW collected and assembled the data. All authors contributed to writing and fnal approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShenzhen Clinical Research Center for Tuberculosis (Project No: 20210617141509001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Ethics Committee of The Third People\u0026rsquo;s Hospital of Shenzhen and conducted in accordance with the Declaration of Helsinki. All patients in this study signed informed consent forms for tuberculosis chemotherapy, and consent forms for bronchoscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not report on or involve any clinical trials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWORLD HEALTH ORGANIZATION. Global tuberculosis report 2023[EB/OL]. [2023-11-07].\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/global-tuberculosis-programme/tb-reports/globaltuberculosis-report-2023\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/global-tuberculosis-programme/tb-reports/globaltuberculosis-report-2023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Global tuberculosis report 2021. Geneva. World Health Organization.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTingting H, Li Y, Wang X, Chen Y, Nie X, Zhuang R, Li Y. Shuliang Guo; Early and Regular Bronchoscopy Examination on Effect of Diagnosis and Prognosis for Patients With Tracheobronchial Tuberculosis. Front Med. 2022;9:825736.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChinese expert consensus on multidrug-resistant tuberculosis and Rifampicin-resistant tuberculosis treatment]. Zhonghua Jie He He Hu Xi Za Zhi. 2019;42(10):733\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChinese Medical Association. Diagnosis and treatment guideline fortracheobronchial tuberculosis. Chin J Tuberc Respir Dis. 2012;35:581\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNurul Yaqeen Mohd Esa, Othman SK. Mohd Arif Mohd Zim, Tengku Saifudin Tengku Ismail, Ahmad Izuanuddin Ismail; Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience. J Clin Med 2022;11(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Infection prevention and control of tuberculosis in health-care facilities, congregate settings and households. Geneva: World Health Organization; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVikas Pathak, Ray W, Shepherd S. Shojaee; Tracheobronchial tuberculosis J Thorac disease. 2016;8(12):3818\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanh DA. Case Report of an Endobronchial Tuberculosis-Challenges in Diagnosis and the Role of High-resolution CT Scans and Bronchoscopic Biopsy CURR RESPIR MED REV. 2024; 20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiawosh K, Eskandari, Onno W. Akkerman; Endobronchial tuberculosis.The Lancet. Infect Dis. 2024;24(5):e343.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNurul Yaqeen Mohd Esa, Othman SK. Mohd Arif Mohd Zim, Tengku Saifudin Tengku Ismail, Ahmad Izuanuddin Ismail; Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience. J Clin Med 2022;11(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu J, Li J, Liu Z, et al. Sex-Specific Differences in the Clinical Profile Among Patients with Tracheobronchial Tuberculosis: A Hospital-Based Cross-Sectional Study in Shenzhen, China. Int J Gen Med. 2022;15:5741\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang S, Guo JQ, Li TX, et al. [Annual progress of interventional diagnosis and treatment of tuberculosis in 2023]. Zhonghua Jie He He Hu Xi Za Zhi. 2024;47(4):363\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee P, Chee CBE. Xpert MTB/RIF for rapid detection of TB and rifampicin resistance in the evaluation of tracheobronchial lesions: What's to stop its use? RESPIROLOGY. 2018; 23 (10): 889\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMu D, Nan D, Li W et al. Efficacy and safety of bronchoscopiccryotherapy for granular endobronchial tuberculosis. Respiration2011;82:268\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing WM, Tang SJ. [Attention should be paid to the early and correct classification and staging of diagnosis of tracheobronchial tuberculosis].Zhonghua jie he he hu xi za zhi\u0026thinsp;=\u0026thinsp;Zhonghua jiehe he huxi zazhi\u0026thinsp;=\u0026thinsp;Chinese. J tuberculosis respiratory Dis. 2021;44(3):167\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrimsky WS, Broussard JN, Sarkar SA, et al. Bronchoscopic spray cryotherapy: assessment of safety and depth of airway injury. J Thorac Cardiovasc Surg. 2010;139:781\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang Liu S, Xie L, Yu. Xiaoling Su; Multidrug resistant lymph node fistula tracheobronchial tuberculosis: A. case Rep Med. 2019;98(49):e18288.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JH, et al. Long-term outcomes of bronchoscopic intervention for tracheobronchial stenosis. Respiration. 2018;95(4):244\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXinmei Guo C, Wang X, Wang J, Ma L, Xv T, Luan. Changwei Kou; Characteristics and risk factor analysis of 410 cases of tracheobronchial tuberculosis. Experimental therapeutic Med. 2014;8(3):781\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu Z, Cheng Y, Wu Z, Zhang P, Chen W, Zhou Z, Zhong M, Luo W, Guo W, Li S. Incidence and predictors of tracheobronchial tuberculosis in pulmonary tuberculosis: A multicentre, large\u0026ndash; scale and prospective study in southern China. Respiration. 2019;97:153\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng A-Z, Yang A, Li S-J, Qiu Q, Yang S. Yong Chen; Incidence, laboratory diagnosis and predictors of tracheobronchial tuberculosis in patients with pulmonary tuberculosis in Chongqing, China.Experimental and therapeutic medicine 2020;20(6):174.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoon SM, Lee WY, Shin B. Clinical characteristics and drug resistance profile of patients with endobronchial tuberculosis in South Korea: single-center experience. ANN PALLIAT MED. 2023;12(3):487\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu J, et al. Sex-specific differences in tracheobronchial tuberculosis. Int J Med Sci. 2022;19(3):567\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoon SM, Lee W-Y. Clinical characteristics and drug resistance profile of patients with endobronchial tuberculosis in South Korea: single-center experience. Annals Palliat Med. 2023;12(3):487\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohd Esa NY, Othman SK, Mohd Zim MA, et al. Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience. J Clin Med. 2022;11:676.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing WM, Tang SJ, Fu Y. [Attention should be paid to the early and correct classification and staging of diagnosis of tracheobronchial tuberculosis]. Zhonghua Jie He He Hu Xi Za Zhi. 2021;44(3):167\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTingting H, Li Y, Wang X, Chen Y, Nie X, Zhuang R, Li Y. Shuliang Guo; Early and Regular Bronchoscopy Examination on Effect of Diagnosis and Prognosis for Patients With Tracheobronchial Tuberculosis. Front Med. 2022;9:825736.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNathavitharana RR, Lederer P, Tierney DB, Nardell E. Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis. Int J tuberculosis lung disease: official J Int Union against Tuberculosis Lung Disease 2019 04 01;23(4):396\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLange C, Aarnoutse RE, Alffenaar JWC, Bothamley G, Brinkmann F, Costa J, Chesov D, van Crevel R, Dedicoat M, Dominguez J, Duarte R, Grobbel HP, G\u0026uuml;nther G, Guglielmetti L, Heyckendorf J, Kay AW, Kirakosyan O, Kirk O, Koczulla RA, Kudriashov GG, Kuksa L, van Leth F, Magis-Escurra C, Mandalakas AM, Molina-Moya B, Peloquin CA, Reimann M, Rumetshofer R, Schaaf HS, Sch\u0026ouml;n T, Tiberi S, Valda J, Yablonskii PK. K Dheda; Management of patients with multidrug-resistant tuberculosis.The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 2019 06 01;23(6):645\u0026ndash;662.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOctaviani P, Ikawati Z, Yasin NM, Kristina SA. Kusuma; Interventions to Improve Adherence to Medication on Multidrug-Resistant Tuberculosis Patients: A Scoping Review. Med J Malay. 2024;79(2):212\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Global Tuberculosis Report 2022. World Health Organization, 21, 2022. [cited November 2022] Accessed from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apps.who.int/iris/handle/10665/363752\u003c/span\u003e\u003cspan address=\"https://apps.who.int/iris/handle/10665/363752\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharles M, Bark W, Henry Boom, Jennifer J. Furin; More Tailored Approaches to Tuberculosis Treatment and Prevention. Annu Rev Med. 2024;75:177\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas BE, Kumar JV, Periyasamy M, Khandewale AS, Mercy JH, Raj EM, et al. Acceptability of the medication event reminder monitor for promoting adherence to multidrugresistant tuberculosis therapy in two indian cities: Qualitative study of patients and health care providers. J Med Internet Res. 2021;23(6):e23294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChien JY, Lai CC, Tan CK, Chien ST, Yu CJ, Hsueh PR. Decline in rates of acquired multidrug-resistant tuberculosis after implementation of the directly observed therapy, short course (DOTS) and DOTS-Plus programmes in Taiwan. J Antimicrob Chemother. 2013;68(8):1910\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Latent tuberculosis infection: Updated and consolidated guidelines for programmatic management Background document on the 2019 revision. Geneva, WHO Global TB Programme.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng G, Zhang P. Hongzhou Lu; Challenges in the screening and treatment of latent multidrug-resistant tuberculosis infection. Drug discoveries Ther. 2022;16(2):52\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"multidrug resistance, tracheobronchial tuberculosis, bronchoscopy, clinical features, characteristics","lastPublishedDoi":"10.21203/rs.3.rs-5598354/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5598354/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: Investigate patients' clinical characteristics and bronchoscopic features with multidrug-resistant tracheobronchial tuberculosis.\u003c/p\u003e\n\u003cp\u003eMethods: A total of 118 patients with confirmed diagnosis of multidrug-resistant tracheobronchial tuberculosis were selected retrospectively, and the demographic data, clinical characteristics, and bronchoscopic manifestations were analyzed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Among patients with multidrug-resistant tracheobronchial tuberculosis, the main clinical features were cough (92.3%,109/118) and sputum (83.0%,98/118). The primary infection sites of multidrug-resistant tuberculosis were the right upper bronchus (39.8%,47/118) and the left upper bronchus (37.3%,44/118). The main types of multidrug-resistant tracheobronchial tuberculosis lesions were inflammatory infiltration type (46.6%,55/118) and necrosis type (32.2%,38/118).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: The clinical manifestations of multidrug-resistant tracheobronchial tuberculosis are non-specific. The main clinical features are cough and fever. It often invades the right upper bronchus. The main bronchoscopic manifestation is inflammatory infiltration.\u003c/p\u003e","manuscriptTitle":"Analysis of clinical and bronchoscopic features of multidrug- resistant tracheobronchial tuberculosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-03 04:48:19","doi":"10.21203/rs.3.rs-5598354/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-09T12:54:49+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"228700022928859159601814331374873914224","date":"2025-04-07T17:33:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-06T05:59:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-01T01:59:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223547777704639189123430330483035482869","date":"2025-03-31T16:21:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214816407087459150649591969347180280489","date":"2025-03-31T10:29:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-31T10:16:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-31T03:50:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-03-25T14:21:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6cf77c4f-f2ef-4e9b-bfbc-a7a957c43ada","owner":[],"postedDate":"April 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T15:58:47+00:00","versionOfRecord":{"articleIdentity":"rs-5598354","link":"https://doi.org/10.1186/s12879-025-11689-6","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-10-07 15:56:53","publishedOnDateReadable":"October 7th, 2025"},"versionCreatedAt":"2025-04-03 04:48:19","video":"","vorDoi":"10.1186/s12879-025-11689-6","vorDoiUrl":"https://doi.org/10.1186/s12879-025-11689-6","workflowStages":[]},"version":"v1","identity":"rs-5598354","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5598354","identity":"rs-5598354","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}