Bronchial anthracofibrosis and tuberculosis in immigrants to Canada from the Indian subcontinent

• Published in: The international journal of tuberculosis and lung disease Vol. 14; no. 2; pp. 231 - 237
• Main Authors: HWANG, J, PUTTAGUNTA, L, GREEN, F, SHIMANOVSKY, A, BARRIE, J, LONG, R
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01.02.2010; International Union against Tuberculosis and Lung Disease
• Subjects: Aged; Anthracosis - epidemiology; Anthracosis - etiology; Anthracosis - pathology; Asia - ethnology; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Biomass Fuels; Bronchi - pathology; Bronchial Anthracofibrosis; Bronchoscopy; Canada - epidemiology; Dust; Female; Human bacterial diseases; Humans; India - ethnology; Infectious diseases; Male; Medical sciences; Middle Aged; Mycobacterium; Occupational Exposure - adverse effects; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Smoke - adverse effects; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - pathology; Canada; North America; America; Asia; India; Immigrant; Respiratory disease; Bronchial tuberculosis; bronchial anthracofibrosis; tuberculosis; Bronchus; Bronchus disease; Indian; biomass fuels; Pneumology
• ISSN: 1027-3719; 1815-7920

BACKGROUND: Bronchial anthracofibrosis is a condition of proximal airway narrowing or obliteration and hyperpigmentation in persons with or without a history of occupational dust exposure. It is a bronchoscopic finding that is not uncommonly associated with pulmonary tuberculosis (PTB) in residents of South Korea, Iran and India. It is largely unrecognized in the Western world.METHODS: We report the frequency of anthracofibrosis in foreign-born PTB patients who underwent bronchoscopy in two cities of Canada. We describe the composition of the pigment in the lungs of patients and speculate on the pathogenesis of anthracofibrosis-associated PTB.RESULTS: Anthracofibrosis was present in 10/60 (16.7%) foreign-born patients who underwent bronchoscopy and had PTB between 2002 and 2006. Compared to patients from other Asian countries, patients from the Indian subcontinent were more likely to have anthracofibrosis (9/18, 50.0% vs. 1/26, 3.7%, P < 0.001). Carbonaceous particles, silica and silicates predominated in tissue specimens. Proximal airway narrowing appeared to be secondary to mixed dust- and smoke-related anthracofibrosis, PTB, or both.CONCLUSIONS: Anthracofibrosis is not uncommon in immigrants to Canada from the Indian subcontinent with PTB. PTB may be a responsible or complicating condition in patients with anthracofibrosis.