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Bronchoscopic findings in children with chronic wet cough
Daniela Zgherea1, Sobhan Pagala, Monita Mendiratta
1Department of Pediatrics, Maimonides Infants and Children’s Hospital of Brooklyn, Brooklyn, NY, USA.
Insights
Protracted bacterial bronchitis, a chronic wet cough in children, was frequently diagnosed via bronchoscopy. Purulent bronchitis and positive bacterial cultures indicate lower airway infection in these cases.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Respiratory Medicine
Background:
- Protracted bacterial bronchitis (PBB) is defined as a chronic wet cough lasting over 4 weeks, resolving with antibiotics.
- Diagnosis of PBB is challenging in pediatrics, with limited data on its incidence.
- This study aimed to investigate the frequency of bacterial bronchitis in children with chronic wet cough.
Purpose of the Study:
- Determine the frequency of bacterial bronchitis in children presenting with chronic wet cough.
- Analyze bronchoscopic findings in children with chronic wet cough.
- Correlate bronchoscopic findings with bacterial culture results.
Main Methods:
- Retrospective chart review of children with chronic wet cough unresponsive to initial therapy.
- Analysis of 197 patient charts and bronchoscopy reports.
- Bronchoalveolar lavage (BAL) bacterial cultures performed during bronchoscopy.
Main Results:
- Bronchoscopy revealed purulent bronchitis in 56% and nonpurulent bronchitis in 44% of cases.
- Positive bacterial cultures were found in 46% of children, with common pathogens including H. influenzae, S. pneumoniae, and M. catarrhalis.
- Positive bacterial cultures were significantly more frequent in children with purulent bronchitis (69.8%) compared to nonpurulent bronchitis (19.8%).
Conclusions:
- Children with chronic wet cough often exhibit purulent bronchitis upon bronchoscopy.
- Purulent bronchitis in this cohort frequently signifies a bacterial lower airway infection.
- These findings support bronchoscopy for diagnosing bacterial bronchitis in persistent pediatric cough.
Objectives:
Protracted bacterial bronchitis 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. The diagnosis of protracted bacterial bronchitis is not readily accepted within the pediatric community, however, and data on the incidence of bacterial bronchitis in children are deficient. The objective of this study was to determine the frequency of bacterial bronchitis in children with chronic wet cough and to analyze their bronchoscopic findings.
Methods:
We performed a retrospective review of charts of children who presented with chronic wet cough, unresponsive to therapy, before referral to the pediatric pulmonary clinic.
Results:
A total of 197 charts and bronchoscopy reports were analyzed. Of 109 children who were 0 to 3 years of age, 33 (30.3%) had laryngomalacia and/or tracheomalacia. The bronchoscopy showed purulent bronchitis in 56% (110) cases and nonpurulent bronchitis in 44% (87). The bronchoalveolar lavage bacterial cultures were positive in 46% (91) of the children and showed nontypable Haemophilus influenzae (49%), Streptococcus pneumoniae (20%), Moraxella catarrhalis (17%), Staphylococcus aureus (12%), and Klebsiella pneumoniae in 1 patient. The χ(2) analysis demonstrated that positive bacterial cultures occurred more frequently in children with purulent bronchitis (74, 69.8%) than in children with nonpurulent bronchitis (19, 19.8%) (P < .001).
Conclusions:
Children who present with chronic wet cough are often found to have evidence of purulent bronchitis on bronchoscopy. This finding is often indicative of a bacterial lower airway infection in these children.
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