YI5 / 140 C – INCIDENCE OF BACTERIAL BRONCHITIS IN CHILDREN WITH CHRONIC WET
COUGH: THE ANALYSIS OF 203 BRONCHOSCOPIES.
D Zgherea, S Shelov, M Mendiratta, M Marcus, M Kazachkov.
Maimonides Infants and Children's Hospital – Brooklyn NY, USA
Introduction: Chronic wet cough is commonly present in children. Persistent bacterial bronchitis
(PBB) is defined as the presence of isolated chronic wet cough of > 3 weeks duration in the absence
of pointers suggesting alternative diagnoses, which resolves with appropriate antibiotic therapy (1).
However, the diagnosis of PBB is not readily accepted by pediatricians and the data on the real
incidence of bacterial bronchitis in children are lacking.
Objective: to define the incidence of bacterial bronchitis in children with chronic wet cough.
Materials and Methods: The charts of 260 children with predominant complaint of chronic wet cough
ranging in duration from 4 weeks to 5 years and with poor response to therapy at the time of referral
were retrospectively reviewed. None of the children had obvious evidence of asthma or any other
major pulmonary disorder at the time of the referral. Fifty children with major airway anomalies or
obvious aspiration syndrome and seven children subsequently diagnosed with CF, PCD or
immunodeficiency were excluded from the analysis
Results: Two hundred and three charts with bronchoscopy reports were analyzed. The bronchoscopic
inspection showed purulent bronchitis in 106 (52%) cases and non-purulent bronchitis in 96 (47%).
The BAL bacterial cultures were positive in total of 93 (46%) children. The following pathogens were
identified: H. influenza (47), S. pneumonia(18), M.catarrhalis (14), S. aureus (13) and Klebsiella
pneumoniae (1). Chi square analysis showed that positive bacterial cultures occurred significantly (P <
0.001) more frequently in children with purulent bronchitis (74, 69.8%) than in children with nonpurulent bronchitis (19, 19.8%). The cytology of BAL showed increased BAL fluid neutrophil counts in
158 children and airway eosinophilia in 11 children. Other frequent endoscopic findings included:
adenoid hypertrophy (32), laryngomalacia (21), posterior laryngitis (65), and tracheomalacia (14).
Conclusions: Incidence of bacterial bronchitis is higher than commonly appreciated in children with
chronic wet cough. It confirms the role of PBB as a leading cause of chronic moist cough in children.
Flexible bronchoscopy and BAL studies play an important role in the differential diagnosis of chronic
wet cough in children.
Refference:
(1) Chang AB, landau LI, van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM.
Cough in children: definitions and clinical evaluation. Med J Aust 2006; 184: 398-403.