From the Guidelines
A bronchopleural fistula (BPF) associated with tuberculosis (TB) typically involves Mycobacterium tuberculosis as the primary causative organism, but secondary infections can complicate the condition, including Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter species, and anaerobic bacteria such as Bacteroides and Peptostreptococcus, as well as fungal pathogens like Aspergillus species and Candida, particularly in immunocompromised patients 1.
Possible Organisms
The possible organisms involved in a bronchopleural fistula from TB include:
- Mycobacterium tuberculosis
- Staphylococcus aureus
- Pseudomonas aeruginosa
- Klebsiella pneumoniae
- Acinetobacter species
- Anaerobic bacteria such as Bacteroides and Peptostreptococcus
- Fungal pathogens like Aspergillus species and Candida
Management
Management of BPF in TB requires a multidrug TB regimen (isoniazid, rifampin, ethambutol, and pyrazinamide) for at least 6-9 months, along with targeted antibiotics for secondary infections based on culture results 1.
Treatment Duration
The treatment duration may be extended to at least 20 months for patients with drug-resistant organisms, with a minimum of five effective anti-TB drugs 1.
Surgical Intervention
Surgical intervention may be necessary if the fistula doesn't heal with medical therapy alone 1.
Development of BPF
The development of BPF in TB occurs when the infection erodes through the bronchial wall and pleura, creating an abnormal communication that allows air and infected material to move between the bronchial tree and pleural space, perpetuating infection and complicating treatment 1.
From the Research
Possible Organisms in a Bronchopleural Fistula from TB
- The organisms that can be found in a bronchopleural fistula from TB are not explicitly stated in the provided studies, but it can be inferred that the fistula can be complicated by superinfections with other bacteria, such as Streptococcus pneumoniae 2.
- Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, and its management requires an individualized approach based on the patient's condition and response to treatment 3.
- The presence of mixed infections, including tuberculosis and other concurrent pulmonary infections, can be found in patients with BPF 4.
- Multidrug-resistant tuberculosis can also be a complication in patients with BPF 5.
- Past pleural inflammation with resultant fibrothorax appeared to be the source of the late BPF formation in some patients, while rupture of a cavity during active disease was likely in others 6.
Complications and Management
- BPF can be complicated by superinfections, severe malnutrition, and coexisting infections, making its management challenging 2.
- The management of tuberculous BPF requires anti-tuberculosis therapy, intercostal drainage, and suction, as well as more invasive surgeries, such as decortication, thoracoplasty, or pleuropneumonectomy, in some cases 3, 4, 6.
- Conservative measures, including single-lung ventilation and supportive care, can be employed in patients with high surgical risk 2.
- Open-window thoracostomy and long-term tube drainage can be useful alternatives when surgery is not feasible 6.