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Update on protracted bacterial bronchitis in children
Xiao-Bo Zhang1, Xiao Wu1, Guang-Min Nong2
1Pediatric Department, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
Insights
Protracted bacterial bronchitis (PBB) in children often presents as chronic wet cough, particularly in young males, and may involve wheezing and airway issues. Treatment is effective for most, but prolonged antibiotics may be needed for those with comorbidities.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Infectious Diseases
Background:
- Chronic cough is a prevalent symptom in pediatric populations.
- Protracted bacterial bronchitis (PBB) is a significant, yet not fully understood, cause of chronic cough in children.
- This study aims to provide an updated understanding of PBB in children.
Purpose of the Study:
- To update current knowledge on protracted bacterial bronchitis (PBB) in children.
- To analyze clinical features and outcomes of PBB in pediatric patients.
- To compare PBB characteristics between China and Western countries.
Main Methods:
- Retrospective analysis of clinical data from 712 children diagnosed with PBB (2014-2018).
- Inclusion of 52 cases from the authors' center and 660 cases from 14 published studies.
- Systematic literature review of electronic databases (May 2019) for relevant clinical studies.
Main Results:
- PBB predominantly affects children under 6 years, presenting with chronic wet cough.
- Laryngomalacia was identified in 3 cases; microbiologically confirmed PBB involved Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa.
- Most patients experienced symptom resolution after treatment, though comorbidities necessitated prolonged antibiotic courses.
Conclusions:
- Protracted bacterial bronchitis (PBB) is common in male infants with chronic wet cough, often accompanied by wheezing and airway deformities.
- Clinical diagnosis of PBB is prevalent in China, while microbiologically confirmed cases are more common in Western countries.
- Streptococcus pneumoniae and Haemophilus influenza are key pathogens; extended antibiotic treatment may be required for patients with comorbidities.
Background:
Chronic cough is a common symptom in children and protracted bacterial bronchitis (PBB) is one of the causes of chronic cough. However, the understanding of this disease remains limited. The present study aims to update PBB in children.
Methods:
The clinical data of children with PBB from 2014 to 2018 were retrospectively analyzed, and PBB clinical features of published studies were summarized. Electronic databases were searched in May 2019. Clinical studies were included in the present study. Reviews were undertaken in duplicate.
Results:
Totally 712 cases were analyzed in this study, including 52 cases in our center and 660 cases from 14 studies. In the 52 cases, 88.5% of patients with PBB were less than 6 years old and all of them complained of wet cough. Three cases were confirmed with laryngomalacia, and microbiologically-based-PBB were identified in 13 cases (9 Streptococcus pneumonia, 3 Staphylococcus aureus, and 1 Pseudomonas aeruginosa). Twenty cases were completely remitted after treatment. In the 14 studies, the patients with PBB were typically younger than 3 years old, accompanying wheezing and airway malacia. Co-infection was common in most western cases, Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis were the top three pathogens. Symptoms were improved in most patients, whereas some cases with comorbidities required prolonged antibiotics treatment.
Conclusions:
PBB is common in male infants with chronic wet cough and accompanied by wheezing and airway deformities. Most cases are clinically diagnosed PBB in China and microbiologically-based-PBB is common in western countries. Co-infection could be found, Streptococcus pneumoniae and Haemophilus influenza were the most frequent etiology in China and western countries, respectively. Patients with comorbidities may need extended antibiotics treatment for more than 2 weeks.
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