The cause and differential diagnosis of protracted bacterial bronchitis in children / 中华实用儿科临床杂志

ABSTRACT

Protracted bacterial bronchitis (PBB) is a major cause of chronic wet cough in children.PBB is a chronic and persistent bacterial infection of the conductive airway,and is increasingly considered to be an important disease in the world.PBB may be associated with upper airway cough syndrome and tracheobronchomalacia.In some cases of PBB,allergic rhinitis and sinusitis were reported.A total of 74％ were reported with tracheobronchomalacia.Adenovirus infection may be associated with PBB,and adenovirus infection may damage the mucosa and cause chronic inflammation in the airway.Gastroesophageal reflux or inhalation may also damage the airway mucosa,or may be the cause of PBB.In the flexible bronchoscopy,increased bronchial secretions and bronchial wall edema were found in the patient with the PBB.The culture of bronchoalveolar lavage is mainly Haemophilus influenzae and Moraxella catarrhalis and Streptococcus pneumoniae.PBB diagnosis is not specific,parents often complain of wheezing,and may be misdiagnosed as bronchial asthma,and gastroesophageal reflux,the PBB should be distinguished from the persistent asthma.PBB may be a precursor of the chronic suppurative pulmonary disease and bronchiectasis.Recurrent PBB may develop to the bronchiectasis.Primary cilia dysfunction and cystic fibrosis is the causes of chronic wet cough in children.Prior to the bronchiectasis in the early stages,it's need to test the sweat chloride and the gene mutation to identify the cystic fibrosis or primary cilia dysfunction from PBB.Therefore,when the PBB recurrent or poor response to antibiotic,the differential diagnosis of the PBB from the chronic suppurative pulmonary disease,bronchiectasis,primary cilia dysfunction and cystic fibrosis should be taken,it is also needed to identify the immune deficiency disease from PBB.