Bacterial Bronchitis Caused by Streptococcus pneumoniae and Nontypable Haemophilus influenzae in Children

Priftis, Kostas Ν.; Litt, David; Manglani, Sapna; Anthracopoulos, Michael B.; Thickett, Keith; Tzanakaki, Georgina; Fenton, Paul; Syrogiannopoulos, George A.; Vogiatzi, Aliki; Douros, Konstantinos; Slack, Mary P. E.; Everard, Mark L.

doi:10.1378/chest.12-0623

Cited by 39 publications

(47 citation statements)

References 42 publications

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“…As summarised previously [57], while children with PBB were typically young (median age ranging from 10 months to 4.8 years), PBB was also recognised in older (age >12 years) children [7,37,51]. Most children with PBB lacked systemic symptoms, without evidence of sinusitis or ear disease [4,43].…”

Section: Typical Profile Of a Child With Pbb (Kq1)mentioning

confidence: 96%

“…pneumoniae isolates from Greek children undergoing BAL for PBB were serotypes contained in the 13-valent pneumococcal conjugate vaccine, while only 28% of Strep. pneumoniae isolates in BAL cultures from fully vaccinated children with PBB in the UK were vaccine-type serotypes [51]. Finally, polymicrobial infections involving multiple respiratory bacterial pathogens were identified in the lower airways of 30-50% of affected children [16,42,[50][51][52].…”

Section: Pbb (Kq3)mentioning

confidence: 97%

“…As in children with chronic wet cough, H. influenzae was the most common pathogen (38-81%) cultured from children with PBB. Although most H. influenzae are likely to be nontypeable (NTHi) strains, only two studies have attempted capsular typing of H. influenzae isolates [51,61]. The other commonly detected bacteria are Strep.…”

Section: Pbb (Kq3)mentioning

confidence: 99%

“…When assessing the bacteriology of PBB it is important to note that not all BAL studies are directly comparable with one another, as only some utilised quantitative bacterial culture to describe BAL findings [50,51]. The distribution of bacteria within the lungs is not uniform.…”

Section: Pbb (Kq3)mentioning

confidence: 99%

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ERS statement on protracted bacterial bronchitis in children

et al. 2017

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This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care.This article has supplementary material available from

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Section: Typical Profile Of a Child With Pbb (Kq1)mentioning

confidence: 96%

Section: Pbb (Kq3)mentioning

confidence: 97%

Section: Pbb (Kq3)mentioning

confidence: 99%

Section: Pbb (Kq3)mentioning

confidence: 99%

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ERS statement on protracted bacterial bronchitis in children

et al. 2017

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“…The 3 bacterial species most commonly identified in the BAL of children with PBB include: Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis [2]. Research into S. pneumoniae serotypes isolated from the airways of children with PBB has shown that both vaccine and non-vaccine serotypes are present, suggesting that serotype replacement is unlikely to be the sole explanation for the specific strains identified [82]. The majority of H. influenzae isolates from the nasopharynx and lower airways of children with non-CF bronchiectasis are NTHi [83].…”

Section: Bacterial Infectionmentioning

confidence: 99%

Chronic wet cough in children and further exploration of protracted bacterial bronchitis

Wurzel¹

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Chronic wet cough (i.e. lasting > 4 weeks) is common in children and is associated with significant burden on children, families and the healthcare system. Although some clinicians view chronic cough in children as trivial, for parents, chronic cough is associated with significant quality of life impairment, which improves when the cough resolves.Further, chronic cough in children may signify the presence of underlying lung disease, such as bronchiectasis.Prior to this thesis, my supervisors were the first to define the clinical entity of protracted bacterial bronchitis (PBB) in children. PBB is characterised by chronic wet cough, response to antibiotics (suggestive of bacterial infection of the airways) and absence of pointers indicating an alternative cause for cough. This early research demonstrated the existence of a recognisable pattern of lower airway inflammation and bacterial infection in children with chronic wet cough. However, many questions relating to chronic wet cough and PBB remained.This thesis explored the clinical, demographic, immunological and microbiological characteristics of children with chronic wet cough and PBB, with specific focus on viruses and viral-bacterial interactions. A longitudinal 2-year cohort study was also undertaken to describe the natural history of PBB. The medium-term risk of bronchiectasis (BE), in children with PBB, was evaluated; with the over-arching aim of identifying a link between these two conditions and identifying specific risk factors for a diagnosis of bronchiectasis.The objectives of the thesis were, to:1. Examine and contrast the lower airway findings of children with different types of cough (wet and dry) compared to no cough, with respect to infection and inflammation.2. Evaluate the sensitivity, specificity and predictive values of nasopharyngeal aspirate (NPA) for detecting viruses in bronchoalveolar lavage (BAL); and determine the relationship between infection and lower airway neutrophilic inflammation in children with non-acute respiratory illness. III 3. Evaluate the major human adenovirus genotypes/species, and relationships to bacterial co-infection, in children with PBB and BE.4. Delineate the clinical and laboratory characteristics of children with PBB with a specific focus on viruses.5. Determine the 2-year outcomes and risk factors for BE and recurrent PBB, in children with PBB.6. Undertake a systematic review on the efficacy of short-course antibiotic therapy for bronchiectasis in children and review specific treatment options for cough in children in general practice.Five of these objectives have been published (as 6 papers) and presented as chapters.The remaining chapter (objective 5) has been submitted to a peer-reviewed journal. An overview of the major findings, with respect to each chapter is detailed below:Objective-1 is a study on 232 children undergoing bronchoscopy for evaluation of respiratory symptoms. Children were grouped using a cough nature symptom-based approach into "wet cough," "dry cough" and "no cough". Children ...

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Protracted bacterial bronchitis: The last decade and the road ahead

et al. 2015

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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. Most children with PBB are unable to expectorate sputum. 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. Although regarded as having a good prognosis, recurrences are common and if these are frequent or do not respond to antibiotic treatments of up to 4-weeks duration, the child should be investigated for other causes of chronic wet cough, such as bronchiectasis. The contribution of airway malacia and pathobiologic mechanisms of PBB remain uncertain and, other than reduced alveolar phagocytosis, evidence of systemic, or local immune deficiency is lacking. Instead, pulmonary defenses show activated innate immunity and increased gene expression of the interleukin-1β signalling pathway. Whether these changes in local inflammatory responses are cause or effect remains to be determined. It is likely that PBB and bronchiectasis are at the opposite ends of the same disease spectrum, so children with chronic wet cough require close monitoring.

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Bacterial Bronchitis Caused by Streptococcus pneumoniae and Nontypable Haemophilus influenzae in Children

Cited by 39 publications

References 42 publications

ERS statement on protracted bacterial bronchitis in children

ERS statement on protracted bacterial bronchitis in children

Chronic wet cough in children and further exploration of protracted bacterial bronchitis

Protracted bacterial bronchitis: The last decade and the road ahead

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