Prospective characterization of protracted bacterial bronchitis in children
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 de...
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| Published in: | Chest Vol. 145; no. 6; p. 1271 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
01.06.2014
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| ISSN: | 1931-3543, 1931-3543 |
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| Abstract | 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.
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.
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).
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. |
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| AbstractList | 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.
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.
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).
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. 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.BACKGROUNDPrior 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.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.METHODSChildren 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.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).RESULTSThe 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).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.CONCLUSIONSChildren 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. |
| Author | Wurzel, Danielle F Chang, Anne B Upham, John W Mackay, Ian M Masters, I Brent Marchant, Julie M Yerkovich, Stephanie T |
| Author_xml | – sequence: 1 givenname: Danielle F surname: Wurzel fullname: Wurzel, Danielle F email: Danielle.wurzel@uqconnect.edu.au organization: Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD. Electronic address: Danielle.wurzel@uqconnect.edu.au – sequence: 2 givenname: Julie M surname: Marchant fullname: Marchant, Julie M organization: Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD – sequence: 3 givenname: Stephanie T surname: Yerkovich fullname: Yerkovich, Stephanie T organization: School of Medicine, The University of Queensland, Brisbane, QLD; Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD – sequence: 4 givenname: John W surname: Upham fullname: Upham, John W organization: School of Medicine, The University of Queensland, Brisbane, QLD; Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD – sequence: 5 givenname: Ian M surname: Mackay fullname: Mackay, Ian M organization: Queensland Paediatric, Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert, Sakzewski Virus Research Centre, Children's Health Queensland Hospital and Health Service, The University of Queensland, Herston, QLD – sequence: 6 givenname: I Brent surname: Masters fullname: Masters, I Brent organization: Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD – sequence: 7 givenname: Anne B surname: Chang fullname: Chang, Anne B organization: Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24435356$$D View this record in MEDLINE/PubMed |
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| Snippet | Prior studies on protracted bacterial bronchitis (PBB) in children have been retrospective or based on small cohorts. As PBB shares common features with other... |
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| SubjectTerms | Adenoviridae - isolation & purification Adenoviridae Infections - diagnosis Adenoviridae Infections - epidemiology Bacterial Infections - diagnosis Bacterial Infections - epidemiology Bacterial Infections - pathology Bronchitis - diagnosis Bronchitis - microbiology Bronchitis - pathology Bronchoalveolar Lavage Fluid - virology Case-Control Studies Cell Count Child, Preschool Cohort Studies Comorbidity Cough - diagnosis Cough - epidemiology Female Humans Immune System - physiopathology Infant Killer Cells, Natural - pathology Lymphocyte Subsets - pathology Male Neutrophils - pathology Prospective Studies Sex Factors |
| Title | Prospective characterization of protracted bacterial bronchitis in children |
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