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Clinical features of post-infectious bronchiolitis obliterans in children undergoing long-term azithromycin treatment
Xueyan Wang1, Changshan Liu1, Mengjuan Wang1
1Department of Pediatrics, The Second Hospital of Tianjin Medical University, Heping, Tianjin 300211, P.R. China.
Insights
Post-infectious bronchiolitis obliterans (PIBO) in children often follows lung infections. Long-term azithromycin treatment showed improvement in some pediatric PIBO cases, highlighting its potential role alongside steroids.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Radiology
Background:
- Post-infectious bronchiolitis obliterans (PIBO) is a serious lung condition in children.
- Identifying predisposing factors and clinical/radiological features is crucial for early diagnosis and management.
Purpose of the Study:
- To outline predisposing factors and clinical/radiological features of PIBO in pediatric patients.
- To evaluate the effect of long-term azithromycin treatment on PIBO in children.
Main Methods:
- Retrospective review of 16 pediatric PIBO cases.
- Analysis of clinical presentations, chest X-rays, and high-resolution computed tomography (HRCT) findings.
- Assessment of treatment outcomes with low-dose azithromycin and prednisone.
Main Results:
- Adenovirus and Mycoplasma pneumoniae were common causes.
- Clinical features included persistent dyspnea, chronic cough, and wheezing.
- HRCT scans consistently showed patchy ground-glass opacity, bronchiectasis, and bronchial wall thickening.
- 10 out of 16 patients showed improvement with azithromycin and prednisone treatment over 7-31 months.
Conclusions:
- Typical clinical history and HRCT findings like patchy ground-glass opacity are key indicators for PIBO.
- While steroids are primary, long-term azithromycin may improve outcomes in pediatric PIBO.
- PIBO has high morbidity, requiring multidisciplinary care and extended follow-up.
Abstract:
The aim of the present study was to outline any predisposing factors and clinical and radiological features of post-infectious bronchiolitis obliterans (PIBO) in pediatric patients, and to determine the effect of long-term azithromycin treatment on these factors. In total, 16 cases of children with PIBO were retrospectively reviewed. Adenovirus and Mycoplasma pneumoniae were the most common etiological agents (12/16) in the children with PIBO. The patients presented with persistent dyspnea, a chronic cough, sputum production and wheezing following the initial lung infection. Chest X-rays indicated pulmonary overinflation and patchy ground-glass opacity. In addition, high-resolution computed tomography (HRCT) scans revealed patchy ground-glass opacity, bronchiectasis, bronchial wall thickening and mosaic perfusion in all 16 cases. A unilateral hyperlucent lung was observed in two cases. All the patients underwent treatment with low-dose azithromycin and prednisone. Follow-up examinations of the 16 cases, varying in duration between 7 and 31 months, showed that the disease condition had improved in 10 cases. However, no significant improvements were identified from the HRCT scans or were observed in the patient condition in the additional six cases. The diagnosis of BO is primarily based on a typical clinical presentation and HRCT observations. Therefore, a typical clinical history and patchy ground-glass opacity features on HRCT scans are screening indices that predict BO development. Steroids are the cornerstone of BO treatment; however, long-term azithromycin treatment can improve the condition of the patients. In summary, PIBO is a disease with a high morbidity rate and should be treated by a multidisciplinary team. Patients should receive follow-up examination for an extended period. Patchy ground-glass opacity features on HRCT scans indicate that clinical suspicion of BO is necessary in children with persistent and severe wheezing.
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