ABSTRACT
Protracted bacterial bronchitis is Chronic lower respiratory infection,defined as chronic moist cough for more than 4 weeks and resolution of symptoms in the majority when antibiotic therapy is given for at least 2 to 3 weeks.After airway epithelial cells impaired by various factors,bacteria such as haemophilus influenzae and streptococcus pneumoniae colonizes on bronchial mucous membranes and leads to neutrophil infiltration.The diagnosis of protracted bacterial bronchitis is mainly based on chronic moist cough persisting for more than 4 weeks,sometimes accompanied by wheezing,with normal chest x-ray and bronchial wall thickened on high-resolution computed tomography,revealed redness and edema of the bronchial mucous membranes sometimes accompanied by tracheobronchomalacia as the main characteristic of bronchoscopy.The definite diagnosis can be made if the culture of bronchoalveolar lavage fluid is positive.If the majority of symptoms cannot be removed after 4-week therapy,the underline pathogenesis should be searched.Curing of of acute bacterial infection can prevent protracted bacterial bronchitis.New vaccines offering all serotype protection are needed to prevent protracted bacterial bronchitis caused by haemophilus infiuenzae and streptococcus pneumoniae.
ABSTRACT
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.