Prospective Characterization of Protracted Bacterial Bronchitis in Children

Background Prior studies on protracted bacterial bronchitis (PBB) in children have been retrospective or based on small cohorts. As PBB shares common features with other pediatric conditions, further characterization is needed to improve diagnostic accuracy among clinicians. In this study, we aim to further delineate the clinical and laboratory features of PBB in a larger cohort, with a specific focus on concurrent viral detection. Methods Children with and without PBB (control subjects) undergoing flexible bronchoscopy were prospectively recruited. Basic immune function testing and lymphocyte subset analyses were performed. BAL specimens were processed for cellularity and microbiology. Viruses were identified using polymerase chain reaction (PCR) and bacteria were identified via culture. Results The median age of the 104 children (69% male) with PBB was 19 months (interquartile range [IQR], 12-30 mo). Compared with control subjects, children with PBB were more likely to have attended childcare (OR, 8.43; 95% CI, 2.34-30.46). High rates of wheeze were present in both groups, and tracheobronchomalacia was common. Children with PBB had significantly elevated percentages of neutrophils in the lower airways compared with control subjects, and adenovirus was more likely to be detected in BAL specimens in those with PBB (OR, 6.69; 95% CI, 1.50-29.80). Median CD56 and CD16 natural killer (NK) cell levels in blood were elevated for age in children with PBB (0.7 × 109/L; IQR, 0.5-0.9 cells/L). Conclusions Children with PBB are, typically, very young boys with prolonged wet cough and parent-reported wheeze who have attended childcare. Coupled with elevated NK-cell levels, the association between adenovirus and PBB suggests a likely role of viruses in PBB pathogenesis.

[1]  I. Masters,et al.  Wet cough in children: Infective and inflammatory characteristics in broncho‐alveolar lavage fluid , 2014, Pediatric pulmonology.

[2]  M. Guiver,et al.  Prevalence and quantitation of adenovirus DNA from human tonsil and adenoid tissues , 2013, Journal of medical virology.

[3]  P. Morris,et al.  A Cough Algorithm for Chronic Cough in Children: A Multicenter, Randomized Controlled Study , 2013, Pediatrics.

[4]  K. St. George,et al.  Human Rhinoviruses , 2013, Clinical Microbiology Reviews.

[5]  P. Morris,et al.  A multicenter study on chronic cough in children : burden and etiologies based on a standardized management pathway. , 2012, Chest.

[6]  I. Mackay,et al.  Co-circulation of Four Human Coronaviruses (HCoVs) in Queensland Children with Acute Respiratory Tract Illnesses in 2004 , 2012, Viruses.

[7]  M. Kazachkov,et al.  Bronchoscopic Findings in Children With Chronic Wet Cough , 2012, Pediatrics.

[8]  I. Masters,et al.  Wet cough in children: infective and inflammatory characteristics in broncho-alveolar lavage fluid , 2012 .

[9]  M. Weinberger,et al.  Protracted bacterial bronchitis in young children: association with airway malacia. , 2012, The Journal of pediatrics.

[10]  P. Yiallouros,et al.  Bronchoscopic and high-resolution CT scan findings in children with chronic wet cough. , 2011, Chest.

[11]  H. Zar,et al.  The Impact of Pneumonia on Development of Chronic Respiratory Illness in Childhood , 2010 .

[12]  K. Bønnelykke,et al.  Association of bacteria and viruses with wheezy episodes in young children: prospective birth cohort study , 2010, BMJ : British Medical Journal.

[13]  B. Chipps,et al.  Cough in the pediatric population. , 2010, The Journal of pediatrics.

[14]  Peter G Gibson,et al.  CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement , 2010, The Medical journal of Australia.

[15]  A. Chang,et al.  Cough in the pediatric population. , 2010, Otolaryngologic clinics of North America.

[16]  Gregory James,et al.  PCR for clinical microbiology: An Australian and international perspective , 2010 .

[17]  D. Whiley,et al.  Detection of human bocavirus in respiratory, fecal, and blood samples by real‐time PCR† , 2009, Journal of medical virology.

[18]  I. Masters,et al.  Prospective assessment of protracted bacterial bronchitis: Airway inflammation and innate immune activation , 2008, Pediatric pulmonology.

[19]  E. Juniper,et al.  What is the burden of chronic cough for families? , 2008, Chest.

[20]  G. Redding,et al.  Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis , 2008, Pediatric pulmonology.

[21]  P. Helms,et al.  Early rattles, purrs and whistles as predictors of later wheeze , 2008, Archives of Disease in Childhood.

[22]  S. Leconte,et al.  Prolonged cough in children: a summary of the Belgian primary care clinical guideline. , 2008, Primary care respiratory journal : journal of the General Practice Airways Group.

[23]  R. Barton.  Inoperable brain metastases from non-small cell lung cancer: what part does whole brain radiotherapy play in standard treatment? , 2007, Thorax.

[24]  I. Masters,et al.  Longitudinal quantification of growth and changes in primary tracheobronchomalacia sites in children , 2007, Pediatric pulmonology.

[25]  A Bush,et al.  Recommendations for the assessment and management of cough in children , 2007, Thorax.

[26]  A. Gould,et al.  Development and evaluation of real-time PCR assays for the detection of the newly identified KI and WU polyomaviruses , 2007, Journal of Clinical Virology.

[27]  P. Tomasec,et al.  Adenovirus vector delivery stimulates natural killer cell recognition , 2007, The Journal of general virology.

[28]  Deirdre Donnelly,et al.  Outcomes in children treated for persistent bacterial bronchitis , 2006, Thorax.

[29]  I. Masters,et al.  Utility of signs and symptoms of chronic cough in predicting specific cause in children , 2006, Thorax.

[30]  I. Masters,et al.  Evaluation and outcome of young children with chronic cough. , 2006, Chest.

[31]  A. Chang,et al.  Cough in children: definitions and clinical evaluation , 2006, The Medical journal of Australia.

[32]  M. Rosenthal,et al.  Investigation of young children with severe recurrent wheeze: any clinical benefit? , 2006, European Respiratory Journal.

[33]  R. Irwin,et al.  The New “Face” of CHEST Heralds a New Era , 2006 .

[34]  A. Chang,et al.  Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. , 2006, Chest.

[35]  L. Boulet,et al.  Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. , 2006, Chest.

[36]  D. Whiley,et al.  A sensitive, specific, and cost-effective multiplex reverse transcriptase-PCR assay for the detection of seven common respiratory viruses in respiratory samples. , 2004, The Journal of molecular diagnostics : JMD.

[37]  A. Fall,et al.  The need to redefine non-cystic fibrosis bronchiectasis in childhood , 2004, Thorax.

[38]  J. D. de Jongste,et al.  Cough • 2: Chronic cough in children , 2003, Thorax.

[39]  S. Mckenzie,et al.  Parents' interpretations of children's respiratory symptoms on video , 2001, Archives of disease in childhood.

[40]  R A Primhak,et al.  Survey of respiratory sounds in infants , 2001, Archives of disease in childhood.

[41]  S. Mckenzie,et al.  What do parents of wheezy children understand by “wheeze”? , 2000, Archives of disease in childhood.

[42]  A. Woolcock,et al.  Persistent cough: is it asthma? , 1998, Archives of disease in childhood.

[43]  P D Phelan,et al.  Subjective scoring of cough in children: parent-completed vs child-completed diary cards vs an objective method. , 1998, The European respiratory journal.

[44]  N. Fineberg,et al.  Reference ranges for lymphocyte subsets in pediatric patients. , 1993, American journal of clinical pathology.

[45]  N. S. Clark.  Bronchiectasis in Childhood , 1963, British medical journal.

[46]  Field Ce.  Bronchiectasis in childhood; prophylaxis, treatment and progress with a follow-up study of 202 cases of established bronchiectasis. , 1949 .

[47]  C. E. Field.  Bronchiectasis in childhood; prophylaxis, treatment and progress with a follow-up study of 202 cases of established bronchiectasis. , 1949, Pediatrics.