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Persistent adenoviral infection and chronic obstructive bronchitis in children: is there a link?
M Pichler1, G Herrmann, H Schmidt
1Department of Pediatrics, University of Bonn, Bonn, Germany.
Insights
Adenoviral infection may initiate chronic obstructive bronchitis in children. However, persistent infection is not the cause of the chronic airway obstruction, suggesting other mechanisms are involved.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Respiratory Medicine
Background:
- Chronic obstructive bronchitis is a rare pediatric disorder.
- Inadequate response to standard therapies suggests underlying complex causes.
- Persistent adenoviral infection is a suspected, though unproven, cause.
Purpose of the Study:
- To investigate the role of persistent adenoviral infection in pediatric chronic obstructive bronchitis.
- To identify potential pathogenetic mechanisms for unremitting airway obstruction in children.
Main Methods:
- Studied 11 children with chronic bronchial obstruction.
- Utilized high-resolution computed tomography (HR-CT) for imaging.
- Performed lung biopsies and bronchoalveolar lavage (BAL) for viral analysis.
Main Results:
- HR-CT revealed hyperinflation and ground-glass opacities.
- Adenoviral antigen detection and culture in BAL and biopsy were negative for persistent infection.
- Some patients had a history of initial adenoviral infection.
Conclusions:
- Adenoviral infection may trigger chronic obstructive bronchitis in children.
- Persistent adenoviral infection is unlikely to be the sole cause of chronicity.
- Other pathogenetic mechanisms are likely responsible for the long-term airway obstruction.
Abstract:
Chronic obstructive bronchitis with inadequate response to inhaled steroid and bronchodilator therapy is a rather rare disorder in children. Persistence of an adenoviral infection has been described as a possible cause of unremitting airway obstruction. We studied a group of 11 children with the clinical feature of chronic bronchial obstruction. A high-resolution computed tomography (HR-CT) scan was performed and typically showed hyperinflation and ground-glass-like opacities. All children underwent either bronchoscopic transbronchial or open lung biopsy. Biopsy specimens were stained with monoclonal antibodies detecting adenoviral antigen and analyzed by light-microscopy. Bronchoalveolar lavage (BAL) fluid was cultured for adenovirus, and antigen detection tests were performed. While some children had a history of proven adenoviral infection at the onset of their disease, in none of the cases could a persistence of adenovirus be shown. We conclude that adenoviral infection might act as a starter of chronic obstructive bronchitis in children, but that pathogenetic mechanisms other than persistent infection must be responsible for the chronicity of the disease.