Abstract
Introduction: Protracted bacterial bronchitis (PBB) is defined as the presence of more than 4 weeks of chronic wet cough that resolves with appropriate antibiotic therapy, in the absence of alternative diagnoses. Microbiological confirmation of PBB poses a significant challenge as affected children rarely expectorate sputum. The gold standard method of sampling the lower airways in young children is flexible bronchoscopy with bronchoalveloar lavage (FB-BAL) The objective of this study was to analyze the bronchoscopic findings of children suspected with PBB.
Methods: We retrospectively reviewed 31 children investigated for suspected PBB between January 2011 and December 2014 at Hacettepe University Pediatric Pulmonology Department.
Results: The median age at bronchoscopy was 7(2.5–14) years and the median duration of cough was 11(6–48) months. On physical examination 23 patients have no findings. Positive cultures were obtained from 12/31 (38.7%). Bronchoscopy revealed out purulent secretion in 16 patients, bronchomalasia in 2 patients and tracheomalasia in 1 patient. The commonest organisms isolated were Streptococcus pneumoniae (7 patients) and Haemophilus influenzae (5 patients).
Conclusion: In conclusion, a substantial number of children with chronic wet cough can be found to have a bacterial infection of the lower airway. Bacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed. Presence of purulent bronchitis during bronchoscopy is strongly associated with bacterial lower airway infection in this population of patients. The predominance of airway malacia in these patients suggests an etiologic role for those airway anomalies.
- Copyright ©ERS 2015