Clinical features of post-infectious bronchiolitis obliterans in children undergoing long-term azithromycin treatment

Wang, Xueyan; Liu, Changshan; Wang, Mengjuan; Zhang, Y I; Li, Hewen; Liu, Geli

doi:10.3892/etm.2015.2418

Cited by 33 publications

(35 citation statements)

References 29 publications

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“…It is known that 14% to 60% of children with documented adenovirus LRTIs have some degree of pulmonary sequelae 9 . Wang et al 8 found that adenovirus and M. pneumoniae were the most common etiologic agents of PIBO. Similarly, we found that adenovirus was the most common infectious agent giving rise to PIBO; there was one patient with adenovirus infection in group 1 and five patients in group 2.…”

Section: Discussionmentioning

confidence: 99%

Postinfectious bronchiolitis obliterans masked by misdiagnosis as asthma

Onay

Gürsoy

Aslan

et al. 2020

Pediatric Pulmonology

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Objectives Asthma and postinfectious bronchiolitis obliterans (PIBO) have similar clinical findings, and PIBO may be misdiagnosed with asthma. This study aimed to determine the clinical features of PIBO in children and the causes of delay in its diagnosis. Methods We retrospectively evaluated all patients diagnosed with PIBO in four pediatric pulmonology centers between 2007 and 2018. In total, 64 PIBO patients were retrospectively reviewed. We compared the clinical and laboratory differences between PIBO patients who had initially been misdiagnosed with asthma and correctly diagnosed with PIBO. Results Of the 64 patients, 22 (34.4%) had initially been misdiagnosed with asthma. Adenovirus was the most common infectious agent in children. The age upon diagnosis was older, and the symptom duration was significantly longer in patients misdiagnosed with asthma (P < .05). There were no statistical differences in terms of sex, history of prematurity, duration of hospitalization, treatment, history of oxygen or mechanical ventilation support, pulmonary function test (PFT) results and asthma‐predisposing findings between the two groups (P > .05). Conclusions Patients with PIBO who had initially been misdiagnosed with asthma were correctly diagnosed at older ages and had longer symptom duration. Asthma may mask PIBO diagnosis by the similarity of symptoms and the clinical response to inhaled β2‐agonist or steroid treatment. PFTs may not help clinicians because of the age of children. The delay in the diagnosis of PIBO is probably attributable to the fact that some clinicians fail to include PIBO in the differential diagnosis when there is no clinical response to asthma medication.

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Section: Discussionmentioning

confidence: 99%

Postinfectious bronchiolitis obliterans masked by misdiagnosis as asthma

Onay

Gürsoy

Aslan

et al. 2020

Pediatric Pulmonology

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“…The children with PIBO are frequently hospitalized with acute exacerbation due to respiratory infection and so were the patients enrolled in this study. However, clinical differentiation of PIBO exacerbation from acute bronchiolitis in young children is often challenging, which might cause treatment delay [7]. The search for non-invasive biomarkers for early diagnosis is needed to prevent chronic lung function impairment associated with PIBO.…”

Section: Discussionmentioning

confidence: 99%

“…They also need frequent hospitalization because of acute exacerbation due to respiratory infection during the first disease years. Clinical differentiation of PIBO exacerbation from acute bronchiolitis in young children is often challenging, which may result in treatment delay and chronic lung function impairment [7].…”

Section: Introductionmentioning

confidence: 99%

Serum YKL-40 levels may help distinguish exacerbation of post-infectious bronchiolitis obliterans from acute bronchiolitis in young children

2017

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Our results suggest that measuring serum YKL-40 levels might help distinguish exacerbation of PIBO from acute bronchiolitis in young children. What is Known: • The children with post-infectious BO (PIBO) usually have recurrent wheezing and need frequent hospitalization due to acute exacerbation during the first disease years. • Clinical differentiation of PIBO exacerbation from acute bronchiolitis in young children is often challenging, which may result in treatment delay and chronic lung function impairment. What is New: • Measuring serum YKL-40 levels might help distinguish exacerbation of PIBO from acute bronchiolitis in young children.

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“…Bronşiyolitis obliterans, terminal ve respiratuvar bronşiyollerin kronik inflamasyonu, lümen içi granülasyon dokusu oluşumu, peribronşiyal fibrozisi ve tüm bunların sonucun-da meydana gelen distal hava yollarının kısmî ya da tam obstrüksiyonu ile karakterize, morbidite ve mortalitesi yüksek, kronik bir akciğer hastalığıdır 5,6,9 . İnhale edilen toksik gazlar, immünolojik hastalıklar, aspirasyon sendromları, organ nakilleri (akciğer ve kemik iliği), kollajen doku hastalıkları, Steven-Johnson sendromu ve solunum yolu enfeksiyonları (postenfeksiyöz) hastalıktan sorumlu sebepler arasında gösterilmektedir 6 .…”

Section: Discussionunclassified

“…İnhale edilen toksik gazlar, immünolojik hastalıklar, aspirasyon sendromları, organ nakilleri (akciğer ve kemik iliği), kollajen doku hastalıkları, Steven-Johnson sendromu ve solunum yolu enfeksiyonları (postenfeksiyöz) hastalıktan sorumlu sebepler arasında gösterilmektedir 6 . Çocuk yaş grubunda sıklığı tam olarak bilinmeyen bu hastalık, çoğunlukla virusların sebep olduğu solunum yolu enfeksiyonlarına ikincil olarak ortaya çıkmaktadır 5,6,9 . En sık tespit edilen viral etken adenovirus olup, bunu RSV, parainfluenza, influenza, su çiçeği ve kızamık izlemektedir.…”

Section: Discussionunclassified

İnsan Metapnömovirus Bronşiyolitine İkincil Gelişen Bronşiyolitis Obliterans Olgusu

Yeşilbaş¹,

Şevketoğlu²,

Kıhtır³

et al. 2016

Mikrobiyol Bul

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Human metapneumovirus (hMPV), formerly classified in Paramyxoviridae family is now moved into Pneumoviridae, which was described as a novel family. It causes upper and lower respiratory tract infections (LRTIs) usually in children younger than five years old. The recent epidemiological studies indicated that hMPV is the second most frequently detected virus in LRTIs of young children, following the respiratory syncytial virus (RSV). Bronchiolitis obliterans (BO) is a chronic obstructive lung disease characterized by fibrosis of the distal respiratory airways. It is usually a result of an inflammatory process triggered by a LRTI related to adenovirus, RSV, Mycoplasma pneumoniae, measles virus, Legionella pneumophila, influenza virus or Bordetella pertussis as a causative agent. In this report, a case of hMPV bronchiolitis complicated with BO has been reported to point out the complications and severity of the clinical progress belongs to this virus. A three-month-old female patient has admitted to our pediatric intensive care unit with the diagnosis of acute bronchiolitis and respiratory failure. She was born at term, weighing 2950 gram and had been hospitalized in newborn intensive care unit for 11 days with the diagnosis of transient tachypnea of the newborn and neonatal sepsis. On auscultation, there were bilateral crepitant rales, wheezing and prolonged expirium. Her oxygen saturation was 97-98% while respiratory support was given with a non-rebreathing reservoir mask. Complete blood count, procalcitonin and C-reactive protein levels were in normal ranges. The chest radiography yielded right middle lobe atalectasia, left paracardiac infiltration and bilateral air trapping. A nasopharyngeal swab sample was analyzed by a commercial multiplex real-time reverse transcriptase-polymerase chain reaction (Thermo Fisher Scientific®, USA) developed for the detection of 15 respiratory viruses. Her sample yielded positive result for only hMPV. On the 4th day of hospitalization, the patient was intubated because of respiratory failure and carbon dioxide retention. She was extubated on the 19th day but could not tolerate. In the thorax computed tomography (CT), bilateral hyperinflation, patchy infiltration, mosaic perfusion and atelectasis especially bilateral posterior areas were detected. Bronchoscopy was normal except mild bronchomalacia in right middle lobe bronchus. The patient was diagnosed as BO secondary to hMPV bronchiolitis, according to the clinical, virological, bronchoscopic and thorax CT results. On the 76th day of admission, she was discharged with respiratory support with home ventilation via a tracheostomy cannula and medical treatments of oral metilprednisolone, nebulized salbutamol and budesonide. In conclusion, hMPV should not be undervalued especially in infants with severe LRTI that can be complicated with BO.

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Clinical features of post-infectious bronchiolitis obliterans in children undergoing long-term azithromycin treatment

Cited by 33 publications

References 29 publications

Postinfectious bronchiolitis obliterans masked by misdiagnosis as asthma

Postinfectious bronchiolitis obliterans masked by misdiagnosis as asthma

Serum YKL-40 levels may help distinguish exacerbation of post-infectious bronchiolitis obliterans from acute bronchiolitis in young children

İnsan Metapnömovirus Bronşiyolitine İkincil Gelişen Bronşiyolitis Obliterans Olgusu

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