{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:01:29Z","timestamp":1789387289801,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,4,10]],"date-time":"2020-04-10T00:00:00Z","timestamp":1586476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Broncho\u2010esophageal fistula (BOF) is a rare complication of <jats:italic>Mycobacterium tuberculosis<\/jats:italic> (MTB). TB\u2010associated BOF presents either as acute respiratory failure, aspiration pneumonia or as a complication of surgical decompression of thoracic lymph nodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All children with TB\u2010 associated BOF were included. TB was diagnosed if MTB was cultured from respiratory secretions, Ziehl\u2010Neelsen (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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total of 20 children were diagnosed with TB\u2010associated 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\u2010positive. Chest X\u2010ray 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\u2010 reactive protein (CRP), albumin and CRP\/albumin ratio were associated with mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Most TB\u2010associated BOF are left\u2010sided. It presents either acutely, with respiratory failure, or with chronic respiratory symptoms of aspiration. Children requiring invasive ventilation have high mortality. Most TB\u2010associated BOF requires surgical intervention, although the use of fibrin glue offers an attractive alternative option.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.24775","type":"journal-article","created":{"date-parts":[[2020,4,10]],"date-time":"2020-04-10T18:04:58Z","timestamp":1586541898000},"page":"1681-1689","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Management of children with tuberculous broncho\u2010esophageal fistulae"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1146-1307","authenticated-orcid":false,"given":"Pierre","family":"Goussard","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health, Tygerberg Hospital Stellenbosch University  Tygerberg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savvas","family":"Andronikou","sequence":"additional","affiliation":[{"name":"Department of Pediatric Radiology, The Children's Hospital of Philadelphia University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Morrison","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Tygerberg Hospital Stellenbosch University  Tygerberg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9245-3282","authenticated-orcid":false,"given":"Lizelle","family":"van Wyk","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Tygerberg Hospital Stellenbosch University  Tygerberg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lunga","family":"Mfingwana","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Tygerberg Hospital Stellenbosch University  Tygerberg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques T.","family":"Janson","sequence":"additional","affiliation":[{"name":"Department of Cardio\u2010Thoracic Surgery, Tygerberg Hospital Stellenbosch University  Tygerberg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,10]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"2","volume-title":"Global Tuberculosis Report 2012","author":"WHO","year":"2012"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1966.03100150063016"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11938\u2010004\u20100023\u20103"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02011325"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109610(57)90785\u20107"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099\u20100496(199804)25:4<285::AID\u2010PPUL9>3.0.CO;2\u2010J"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.22728"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0025\u20107125(16)36207\u20101"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.10.4.351"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.135.3.525"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.20532"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247\u2010009\u20101537\u20106"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00012271"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.7196\/SAMJ.5552"},{"key":"e_1_2_8_16_1","first-page":"1205","article-title":"Guidance for national tuberculosis programmes on the management of tuberculosis in children. 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