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Protracted bacterial bronchitis

Danielle F Wurzel, Julie M Marchant, Stephanie T Yerkovich, John W Upham, Helen L Petsky, Heidi Smith-Vaughan, Brent Masters, Helen Buntain, Anne B Chang
BACKGROUND: Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproven, that PBB precedes a diagnosis of bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to: (a) determine the medium-term risk of bronchiectasis and (b) identify risk factors for bronchiectasis and recurrent episodes of PBB. METHODS: 161 children with PBB and 25 controls were prospectively recruited to this cohort study...
August 24, 2016: Chest
Sandra Hodge, John W Upham, Susan Pizzutto, Helen L Petsky, Stephanie Yerkovich, Katherine J Baines, Peter Gibson, Jodie L Simpson, Helen Buntain, Alice C H Chen, Greg Hodge, Anne B Chang
BACKGROUND: Children with recurrent protracted bacterial bronchitis (PBB) and bronchiectasis share common features, and PBB is likely a forerunner to bronchiectasis. Both diseases are associated with neutrophilic inflammation and frequent isolation of potentially pathogenic microorganisms, including nontypeable Haemophilus influenzae (NTHi), from the lower airway. Defective alveolar macrophage phagocytosis of apoptotic bronchial epithelial cells (efferocytosis), as found in other chronic lung diseases, may also contribute to tissue damage and neutrophil persistence...
February 2016: Chest
Anne B Chang, John W Upham, I Brent Masters, Gregory R Redding, Peter G Gibson, Julie M Marchant, Keith Grimwood
Cough is the single most common reason for primary care physician visits and, when chronic, a frequent indication for specialist referrals. In children, a chronic cough (>4 weeks) is associated with increased morbidity and reduced quality of life. One common cause of childhood chronic cough is protracted bacterial bronchitis (PBB), especially in children aged <6 years. PBB is characterized by a chronic wet or productive cough without signs of an alternative cause and responds to 2 weeks of appropriate antibiotics, such as amoxicillin-clavulanate...
March 2016: Pediatric Pulmonology
Ahmad Kantar
Despite the high prevalence of cough in children, the topic has been poorly researched. Although pediatricians recognize that chronic cough in children is different from that in adults, this difference seems less recognizable to other health professionals. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. Additionally, immunological responses undergo developmental and memorial processes that make infection and congenital abnormalities the overwhelming cause of cough in children...
February 2016: Lung
Ahmet Hakan Gedik, Erkan Cakir, Emel Torun, Aysegul Dogan Demir, Mehmet Kucukkoc, Ufuk Erenberk, Selcuk Uzuner, Mustafa Nursoy, Emin Ozkaya, Fadlullah Aksoy, Selim Gokce, Kayhan Bahali
BACKGROUND: This study aims to evaluate the children with chronic cough and to analyze their etiological factors according to the age groups. METHOD: Five hundred sixty-three children with chronic cough were included. The last diagnosis were established and were also emphasized according to the age groups. RESULTS: The mean age was 5.4 ± 3.8 years (2-months-17-years) and 52 % of them were male. The most common final diagnosis from all the participants were: asthma (24...
2015: Italian Journal of Pediatrics
Yuqing Wang, Chuangli Hao, FanFan Chi, Xingmei Yu, Huiquan Sun, Li Huang, Meijuan Wang, Wei Ji, Yongdong Yan, Hong Zhu, Xuejun Shao
Protracted bacterial bronchitis (PBB) is the common cause of chronic cough in children worldwide, but its etiology has not been fully recognized in China. We retrospectively investigated a total of 66 hospitalized infants under the age of three years with chronic wet cough enrolled in the Affiliated Children's Hospital of Soochow University from October 2010 to March 2014. All patients underwent bronchoscopy and broncho-alveolar lavage (BAL) samples were processed for microbiological and cytological analysis...
2015: Scientific Reports
Aneela Bidiwala, Leonard R Krilov, Melodi Pirzada, Sameer J Patel
Pro: Children with chronic cough present a diagnostic challenge. Protracted bacterial bronchitis (PBB) is a chronic, persistent bacterial infection of conducting airways defined by the presence of cough for longer than 4 weeks that resolves with antimicrobial therapy and without an alternative diagnosis. The diagnosis is made by the findings of increased bronchial secretions and edema of the lower airways on flexible bronchoscopy and positive cultures on bronchoalveolar lavage. It is speculated that an initial respiratory insult such as viral infection disrupts normal surface morphology and ciliary function, which leads to chronic self-perpetuating inflammation with the formation of bacterial biofilms, leading to PBB...
August 2015: Pediatric Annals
Ann-Katrin Rother, Nicolaus Schwerk, Folke Brinkmann, Frank Klawonn, Werner Lechner, Lorenz Grigull
BACKGROUND: Clinical symptoms in children with pulmonary diseases are frequently non-specific. Rare diseases such as primary ciliary dyskinesia (PCD), cystic fibrosis (CF) or protracted bacterial bronchitis (PBB) can be easily missed at the general practitioner (GP). OBJECTIVE: To develop and test a questionnaire-based and data mining-supported tool providing diagnostic support for selected pulmonary diseases. METHODS: First, interviews with parents of affected children were conducted and analysed...
2015: PloS One
Stephen Oo, Peter Le Souëf
BACKGROUND: Wheezing is a common presentation in young children. Diagnosis and treatment of these children can be challenging, as arriving at a final diagnosis often requires a process of elimination. OBJECTIVE: This article aims to provide an algorithm for managing a young child with wheeze in the primary care setting. We will aim to address key questions of some controversy that relate to this algorithm: 1. Does the child actually have wheeze – how accurate is the parents' description? 2...
June 2015: Australian Family Physician
Matthew J Martin, Tim W Harrison
A chronic 'productive' or 'wet' cough is a common presenting complaint for patients attending the adult respiratory clinic. Most reviews and guidelines suggest that the causes of a productive cough are the same as those of a non-productive cough and as such the same diagnostic pathway should be followed. We suggest a different diagnostic approach for patients with a productive cough, focussing on the conditions that are the most likely causes of this problem. This review is intended to briefly summarise the epidemiology, clinical features, pathophysiology and treatment of a number of conditions which are often associated with chronic productive cough to aid decision making when encountering a patient with this often distressing symptom...
September 2015: Respiratory Medicine
Siba P Paul, Swathi Sanapala, Jayesh M Bhatt
Chronic moist cough in children can be associated with serious pathologies. Protracted bacterial bronchitis remains a clinical diagnosis causing persistent moist cough, disturbed sleep, exercise intolerance and significant levels of morbidity. Management involves minimal investigations and prolonged courses of antibiotics.
July 2015: British Journal of Hospital Medicine
Lilly M Verhagen, Ronald de Groot
Community-acquired pneumonia is a potentially life-threatening disease affecting children worldwide. Recurrent pneumonia episodes can lead to the development of chronic respiratory morbidity. Chronic wet cough, a common pediatric complaint, is defined as a wet cough indicating excessive airway mucus that lasts for a minimum of 4 weeks. Most children with a chronic wet cough do not suffer from underlying debilitating pulmonary disorders. Rather, chronic wet cough is generally associated with neutrophilic airway inflammation and bacterial infections of the conducting airways...
June 2015: Journal of Infection
G Benoist, E Bidat
A persistent cough lasting more than 4-8weeks should lead to a diagnostic workup. A detailed history and a full clinical examination, with a chest X-ray, are essential for initial assessment. Most reported causes of chronic cough in children are post-nasal drip syndrome, cough variant asthma (a spirometry with test of bronchodilator responsiveness should be attempted in children old enough to perform the manoeuvres). GERD is often suspected but a causal relationship is difficult to establish. Protracted bacterial bronchitis, post-infectious cough (B...
April 2015: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Ravi Narang, Kelly Bakewell, Jane Peach, Sadie Clayton, Martin Samuels, John Alexander, Warren Lenney, Francis J Gilchrist
OBJECTIVES: Flexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly used for the microbiological confirmation of protracted bacterial bronchitis (PBB) in children with a chronic wet cough. At our centre, when performing FB-BAL for microbiological diagnosis we sample 6 lobes (including lingula) as this is known to increase the rate of culture positive procedures in children with cystic fibrosis. We investigated if this is also the case in children with PBB. METHODS: We undertook a retrospective case note review of 50 children investigated for suspected PBB between May 2011 and November 2013...
2014: PloS One
Iulia Ioan, Mathias Poussel, Laurianne Coutier, Jana Plevkova, Ivan Poliacek, Donald C Bolser, Paul W Davenport, Jocelyne Derelle, Jan Hanacek, Milos Tatar, François Marchal, Cyril Schweitzer, Giovanni Fontana, Silvia Varechova
The cough reflex is modulated throughout growth and development. Cough-but not expiration reflex-appears to be absent at birth, but increases with maturation. Thus, acute cough is the most frequent respiratory symptom during the first few years of life. Later on, the pubertal development seems to play a significant role in changing of the cough threshold during childhood and adolescence resulting in sex-related differences in cough reflex sensitivity in adulthood. Asthma is the major cause of chronic cough in children...
2014: Frontiers in Physiology
Katherine J Baines, John W Upham, Stephanie T Yerkovich, Anne B Chang, Julie M Marchant, Melanie Carroll, Jodie L Simpson, Peter G Gibson
BACKGROUND: Protracted bacterial bronchitis (PBB) is a common and treatable cause of chronic wet cough in children in which the mechanisms are not understood. This study investigates the IL-1 pathway and a neutrophil gene expression signature in PBB. METHODS: BAL was collected from children in an experimental cohort (n = 21, PBB; n = 33, control subjects), and a second validation cohort (n = 36, PBB; n = 11, control subjects). IL-1β, IL-1 receptor antagonist (IL-1RA), and α-defensins 1-3 were assayed by enzyme-linked immunosorbent assay, western blot, and quantitative real-time polymerase chain reaction, together with selected IL-1 pathway members and neutrophil-related molecules...
October 2014: Chest
Danielle F Wurzel, Ian M Mackay, Julie M Marchant, Claire Y T Wang, Stephanie T Yerkovich, John W Upham, Heidi C Smith-Vaughan, Helen L Petsky, Anne B Chang
BACKGROUND: The role of human adenoviruses (HAdVs) in chronic respiratory disease pathogenesis is recognized. However, no studies have performed molecular sequencing of HAdVs from the lower airways of children with chronic endobronchial suppuration. We thus examined the major HAdV genotypes/species, and relationships to bacterial coinfection, in children with protracted bacterial bronchitis (PBB) and mild bronchiectasis (BE). METHODS: Bronchoalveolar lavage (BAL) samples of 245 children with PBB or mild (cylindrical) BE were included in this prospective cohort study...
July 1, 2014: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Miles Weinberger, Anthony Fischer
A cough is considered chronic when it lasts >4 weeks. Chronic cough can be from a variety of causes. This article provides a structured approach to evaluating the child with chronic cough. Beginning with the disturbing cough that is absent once asleep, consistent with the habit cough syndrome, the diagnostic criteria for 10 causes of chronic cough are discussed. Using a structured approach to the differential diagnosis, common and uncommon causes can be identified. Well-established causes of chronic cough, such as asthma, are likely to be well known to the reader, whereas more recently identified etiologies, such as protracted bacterial bronchitis, are presented in more detail...
March 2014: Allergy and Asthma Proceedings:
Christopher J van der Gast, Leah Cuthbertson, Geraint B Rogers, Christopher Pope, Robyn L Marsh, Gregory J Redding, Kenneth D Bruce, Anne B Chang, Lucas R Hoffman
RATIONALE: DNA-based microbiological studies are moving beyond studying healthy human microbiota to investigate diverse infectious diseases, including chronic respiratory infections, such as those in the airways of people with cystic fibrosis (CF) and non-CF bronchiectasis. The species identified in the respiratory secretion microbiota from such patients can be classified into those that are common and abundant among similar subjects (core) versus those that are infrequent and rare (satellite)...
September 2014: Annals of the American Thoracic Society
Danielle F Wurzel, Julie M Marchant, Stephanie T Yerkovich, John W Upham, Ian M Mackay, I Brent Masters, Anne B Chang
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...
June 2014: Chest
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