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Objective:To summarize the clinical characteristics of 102 children with protracted bacterial bronchitis in Qingdao area.Methods:One hundred and two children with protracted bacterial bronchitis treated at respiratory clinic of Women and Children′s Hospital affiliated to Qingdao University from January 2016 to March 2021 were included in this study.The clinical data, age and seasonal distribution, etiology, clinical manifestations, high-resolution CT of the lungs, characteristics of lung function, bronchoscopy and treatment prognosis were retrospectively analized.Results:The top three pathogens of protracted bacterial bronchitis in 102 children (55 boys, 47 girls, median age: 1.7 (0.8, 4.2)years were Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with frequency of 12.75%, 10.78%, and 6.86%, respectively.The onset season was mainly autumn and winter, with a total of 73 (71.57%) cases.The main clinical manifestations were wet cough and (or) wheezing, and the cough was not divided between day and night.CT of the lungs showed thickening of the bronchial wall in 16(15.69%) cases and uneven ventilation in 5(4.90%) cases.Twenty-three (22.55%) cases had abnormal lung function.Fifty-two (50.98%) cases underwent bronchoscopy, of which 33(32.35%) cases had multiple lung segmental purulent changes under the microscope.After standard anti-infection, bronchoscopy and alveolar lavage, expectorant and physical therapy, the prognosis was mostly good.Conclusion:The clinical manifestations of protracted bacterial bronchitis in children have no obvious specificity.Early diagnosis, identification of the cause and comprehensive management are critical to its prognosis.
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OBJECTIVE: To investigate the relationship between pathogenesis of PBB and the T cell subsets disorders and to evaluate the clinical significance of immunomodulatory therapy to the prognosis of PBB and the prevention of recurrent PBB. METHODS: A total of 127 cases of PBB children treated in the Fourth Hospital of Baotou City from May2015 to May 2018 were selected. Blood samples were collected before treatment,and the levels of CD4,CD8 cells and CD4/CD8 in peripheral blood T cell subsets were detected by flow cytometry. All children with PBB(PBB group)were given oral amoxicillin and clavulanate potassium for 2 to 4 weeks. The subjects were divided into Huaiqihuang group(n=66)and non-Huaiqihuang group(n=66). The Huaiqihuang group was given Huaiqihuang granules based on the anti-infective treatment. In addition,healthy children were enrolled as control group(n=39). T cell subsets of the two groups were reexamined 3 months after treatment. By analyzing the cough symptom scores of all children after 2 weeks,4 weeks and 12 weeks of treatment,the rate of cure and improvement and the recurrence rate after 1 year were evaluated.SPSS16.0 software was used for data processing,and the difference was significant if P0.05). In 2 weeks after treatment,the cough symptom scores of the PBB group began to decrease,and the non-Huaiqihuang group decreased more significantly,with statistically significant difference(P0.05). Follow-up showed that the recurrence rate of Huaiqihuang group was lower than that of non-Huaiqihuang group in 1 year after the end of treatment,and the difference between the two groups was statistically significant(P<0.01). CONCLUSION: Children with PBB have T cell subsets disorder,and the treatment of anti-infection combined with Huaiqihuang granules for at least 4 weeks has a positive effect on PBB prognosis and recurrence prevention.
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Objective To explore the characteristics of respiratory tract microbiota and its clinical significance in children with protracted bacterial bronchitis (PBB).Methods Twelve children aged from 5 months to 2 years old with PBB (PBB group) and 12 age-matched tracheomalacia(TM) children (TM group) were included in this study,who were admitted into the Respiratory Department of Shenzhen Children's Hospital.Their bronchoalveolar lavage fluid (BALF) samples were collected.Bacterial DNA was extracted from their BALF samples and the 16S rRNA V3-V4 region was sequenced by using Illumina MiSeq TMII system,and the findings were analyzed by bioinformatics methods.Results Principal component analysis revealed the difference in microbiota composition between 2 groups.Compared with TM group,PBB group exhibited lower microbial diversity:the Shannon indices were also 1.683 ± 0.703 and 2.324 ± 0.142 for PBB group and TM group respectively,and the differences were also significant(all P ＜ 0.05),and the Simpson indices were 0.416 ± 0.216 and 0.191 ± 0.025 for PBB group and TM group,respectively,and the differences were also significant (all P ＜ 0.05).The relative abundance of Actinobacteria was significantly lower in PBB group [(0.215 ± 0.228) ％] than that in TM group [(3.028 ± 0.592) ％] (P ＜ 0.01).The proportions of beneficial genera obviously decreased in PBB group,including Lactococcus [(13.464±7.319)％ in PBB group,and (44.784 ± 5.020)％ in TM group,P ＜0.01],Lactobacillus [(0.153 ±0.076)％ in PBB group,and (0.313 ±0.060)％ in TM group,P＜0.01],andArthrobacter [(0.024 ±0.018)％ in PBB group,and (2.970 ±0.584)％ in TM group,P＜0.01].On the other hand,the relative abundances of opportunistic pathogenic genera increased in PBB group significantly,including Haemophilus [(14.319 ± 29.532) ％ in PBB group,and (0.047 ± 0.127) ％ in TM group,P ＜ 0.Ol],Pseudomonas [(10.406 ± 25.439) ％ in PBB group,and (7.228 ± 0.948) ％ in TM group,P ＜ 0.01],and Escherichia [(0.432 ±0.441)％ in PBB group,and (0.055 ±0.035)％ in TM group,P ＜0.01].Conclusion These findings confirmed the existence of respiratory tract microbiotia dysbiosis in PBB,which probably was one of the pathogenetic mechanisms for PBB.
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Studies in Australia,England and New Zealand demonstrated protracted bacterial bronchitis (PBB)is the most common cause of chronic cough in children.While Chinese pediatrician don't have sufficient understanding of PBB,which may be associated with misdiagnosis and mismanagement.This article interpret foreign guidelines of PBB so as to supply a comprehensive understanding of it's pathogens,clinical manifestations,diagnosis,treatment recommendations and prognosis.
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Protracted bacterial bronchitis (PBB) is an important cause of chronic wet cough.Bacterial infection is the main pathogen of PBB,so antibacterial infection is the main treatment.As the main antibiotic of experiential treatment,Amoxicillin-clavulanate is recommended to be used for at least 2 weeks,usually 4 weeks,and 6 to 8 weeks in part.If the sputum culture or bronchoalveolar lavage fluid is positive,the selection of antibiotic therapy can be according to drug sensitivity test.
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Protracted bacterial bronchitis (PBB) and primary ciliary dyskinesia (PCD) have the same pathogenetic change of abnormal mucociliary clearance,but the initial factors are different.The former is the secondary changes caused by infections,and the latter is caused by ciliary structure and/or dysfunction.They all have chronic wet cough,so the differential diagnosis is important.Visceral transposition,recurrent otitis media,sinusitis and pseudomonas aeruginosa infection can help to identify PCD from PBB.But if the patients have recurrent PBB or no reaction to common antibiotic therapy,PCD is needed to be identified.Rational application of antibacterial drugs and whole course vaccine inoculation to prevent recurrent infections are important to both of the two diseases.
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Protracted bacterial bronchitis (PBB) in children is associated with protracted bacterial infection of the respiratory airways.The lesions of airway mucosa and/or airway lumen that is helpful for the diagnosis and differential diagnosis of PBB can be observed directly via the bronchoscope.
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Chronic cough is a very common symptom of children presenting to pediatric practitioners,moreover,chronic wet cough is especially troublesome for children's health.Since protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in children,it is of great importance to timely identify PBB from children with chronic cough.Now,the clinical features and diagnostic clues of PBB,as well as the diagnostic criteria of PBB based on microbiology are introduced;it is also proposed that comprehensive and reliable consultation,detailed physical examination and related laboratory tests are needed when identifying PBB out of children with chronic wet cough.For infants and young children,in particular those with persistent wet cough and without any specific changes of chest radiography and other specific cough pointers (eg,upper airway cough syndrom,cough type asthma,respiratory tract infection with specific pathogen,foreign body),the diagnosis of PBB should be taken into consideration and clinical observation and follow-up are needed to reevaluate.
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Protracted bacterial bronchitis (PBB) is a common cause of children with chronic wet cough.Original microbiologic-based case of PBB was defined as wet cough (＞ 4 weeks) without signs of another cause,bacterial pathogens growing and quantitative culture ≥ 107 cfu/L in bronchoalveolar lavage fluid and cough resolved following a 2-week course of an appropriate oral antibiotics (usually amoxicillin-clavulanate).In recent years,clinical-based case definition of PBB,refractory PBB and recurrent PBB have been proposed to increase its clinical applicability.At present,the pathogenesis of PBB including biofilm formation,impaired airway muco-ciliary clearance,neutrophil inflammation,immune dysfunction and inappropriate use of antibiotics.
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Protracted bacterial bronchitis (PBB) is one of the most common causes of chronic wet cough in children.Pediatricians have paid more attention to the PBB.Three most commonly identified bacteria are non-typeable Haemophilus influenzae,Streptococcus pneumoniae and Moraxella Mora bacteria.The occurrence of PBB is associated with bacterial biofilm formation in the airway,tracheobronchomalacia,systemic immune function disorder,and environmental pollution.The clinical presentations of PBB are wet cough and wheezing.Pulmonary signs are moist rale and(or) wheezeing.International guidelines recommend the treatment of Amoxicillin and C1 avulanate,the courses are at least two weeks.Domestic scholars have also used traditional Chinese medicine or western medicine therapy for the treatment of PBB.
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Protracted bacterial bronchitis(PBB)is one of the common causes of chronic cough in children.PBB is characterized by a chronic wet or productive cough( >4 weeks)without signs of an alterna-tive cause and responds to 2 weeks of appropriate antibiotics.If bronchoscopy and bronchoalveolar lavage are performed,evidence of bronchitis and purulent endobronchial secretions are seen. Bronchoalveolar lavage specimens typically reveal marked neutrophil infiltration and culture large numbers of respiratory bacterial pathogens,especially Haemophilus influenzae.The pathobiologic mechanisms of PBB remain uncertain.
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Protracted bacterial bronchitis ( PBB) is a common cause of children with chronic wet cough. It is defined by the presence of persistent wet cough for longer than 4 weeks,often accompanied by wheezing,but lacks of specific symptoms or signs suggestive of other alternative diagnosis of chronic cough. Airway malacia frequently coexists with PBB,and haemophilus influenzae and streptococcus pneumoniae are the most commonly identified pathogens. Neutrophilic inflammation is present in bronchoalveolar lavage fluid,and usually resolves with appropriate antibiotic treatment for two weeks(amoxicillin/clavulanate). By far,PBB hasn′t been fully recognized by most pediatricians in China. In this commentary, diagnosis and treatment were reviewed.
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Objective To study the diagnosis and treatment of protracted bacterial bronchitis (PBB) in children. Methods Children with PBB conifrmed by bronchoscopy were recruited from May 2013 to April 2015 . The clinical data were retrospectively analyzed. Results All 31 cases include 18 boys and 13 girls were recruited. 28/31 were younger than 6 years old. They all complained of wet cough, some of them were reported with wheeze ( 17/31 ) and with ruttle in the lungs ( 16/31 ). White blood cell were in normal range ( 18/31 ) or slightly elevated ( 13/31 ). The C-reactin protein was in normal range ( 28/31 ). Chest X-ray test of 16 cases were normal. Twenty-four cases taken chest computerized tomograph scan, 5 had a sign of tracheobronchial stenosis. The purulent bronchitis without tracheobronchial stenosis were conifrmed by bronchoscopy. Four cases had tracheomalacia. The medians of proportion of neutrophil were 80% in bronchoalveolar lavage lfuid (BALF). The pathogens were identiifed in BALF in 17 cases, 6 with Streptococcus pneumoniae, 6 with Haemophilus parainfluenzae, 3 with Moraxella catarrhalis, 2 with Staphylococcus aureus and 1 with Haemophilus influenzae. The symptoms were improved in all cases and co-amoxiclav was prescribed to most cases when discharged. The course of antibiotics therapy was 2-4 weeks in 23 cases, and more than 4 weeks in 8 cases. Twenty-three ( 23 ) cases were cured but 8 of them relapsed. Another 8 cases were improved but not completely remitted, 7/8 were cured by further treatment for concomitant diseases such as nasosinusitis and allergic rhinitis. Conclusions Children with PBB are typically younger than six years old, and presented with prolonged wet cough and parent-reported wheeze, normal or with ruttle in the lungs. A conifrmed diagnosis was reached by bronchoscopy. The antibiotics therapy were effective, the course should be more than 2-4 weeks, however, relapse were common. When antibiotics therapy does not lead to complete remission, concomitant diseases should be considered.