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Published on: August 7, 2017
Bronchoscopy Identifies Bacterial Airway Colonization and Comorbidities in Preschool Children With Refractory
Helena Donath1, Julius Ruff1, Laura Heumüller1
1Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, Goethe University Frankfurt, Frankfurt am Main, Germany.
Insights
Bronchoscopy effectively diagnoses persistent respiratory issues in preschoolers. Bacterial airway colonization is common, linked to higher neutrophil counts in bronchoalveolar lavage (BAL) fluid.
Area of Science:
- Pediatric Pulmonology
- Microbiology
- Gastroenterology
Background:
- Preschoolers with persistent respiratory symptoms often require diagnostic bronchoscopy.
- Bronchoalveolar lavage (BAL) aids in detecting lower respiratory tract infections.
- This study investigates BAL findings, bacterial colonization, and associated comorbidities.
Purpose of the Study:
- To analyze BAL fluid findings in preschool children with refractory respiratory symptoms.
- To determine associations between bacterial colonization, allergic status, and comorbidities like GERD and EoE.
- To evaluate the diagnostic utility of bronchoscopy in this population.
Main Methods:
- Retrospective analysis of 355 children (aged 1-5 years) undergoing bronchoscopy (2010-2019).
- Evaluation of BAL differential cytology and bacterial cultures.
- Analysis of laboratory parameters, esophagogastroduodenoscopy (OGDS), and esophageal biopsy histology.
Main Results:
- Bacterial cultures were positive in 61.7% of children; Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were most common.
- Positive bacterial cultures correlated with significantly higher neutrophil percentages in BAL fluid.
- Gastroesophageal reflux disease (GERD) was present in 32% and eosinophilic esophagitis (EoE) in 2.8% of children.
Conclusions:
- Bronchoscopy is a valuable tool for diagnosing persistent respiratory symptoms in preschool children.
- Bacterial colonization is frequent in this group and associated with increased airway neutrophils.
- Comorbidities like GERD and EoE should be considered in the evaluation.
Background:
Preschool children with refractory respiratory symptoms often undergo diagnostic bronchoscopy to exclude anatomical and functional abnormalities and to detect suspected chronic lower respiratory tract infections by bronchoalveolar lavage (BAL). The objective of this retrospective analysis was to analyze BAL fluid findings with respect to bacterial colonization and cytology. Additionally, we aimed to determine associations with bacterial colonization of the airways and allergic sensitization status and symptoms as well as to identify comorbidities like gastroesophageal reflux disease (GERD) or eosinophilic esophagitis (EoE).
Methods:
In a retrospective analysis, the electronic medical records of 355 children aged 1-5 years who underwent bronchoscopy for refractory respiratory symptoms between 2010 and 2019 were evaluated. Differential cytology and bacterial cultures from BAL, laboratory parameters, oesophagogastroduodenoscopy (OGDS) and histology from esophageal biopsies were analyzed.
Results:
A positive bacterial culture from BAL fluid was found in 214 children (61.7%). Of these, 105 children (49%) subsequently received antibiotic treatment. The most frequently identified bacteria were Haemophilus influenzae (34%), Streptococcus pneumoniae (25%) and Moraxella catarrhalis (16%). The percentage of neutrophils in differential cell counts from BAL samples was significantly higher with positive bacterial cultures compared to negative cultures (29.2 + 28.1% vs. 21.2 + 25.4%, p = 0.02). Children with insufficient S. pneumoniae antibody titers had significantly more positive cultures for S. pneumoniae in BAL fluid (28.3% vs. 12.8%; p = 0.0024). GERD was identified in 115 children (32%) and EoE was diagnosed in nine children (2.8%).
Conclusion:
Bronchoscopy is a valuable diagnostic tool in the evaluation of persistent respiratory symptoms in preschool children. Bacterial colonization of the airways was common and associated with significantly elevated airway neutrophil counts.
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