Not every cough in bronchiolitis season is bronchiolitis

Abstract

A 2-month-old male infant presented to hospital for the third time in late autumn with a 4 week history of cough and respiratory distress. He had presented to hospital on two occasions during the previous two weeks, and had twice been discharged with a diagnosis of bronchiolitis, based on clinical findings and the season. That the nasopharyngeal aspirate (NPA) was negative for respiratory viruses did not alter the diagnosis as this was felt to be a common false negative finding. However his cough worsened and on his third presentation he had respiratory distress with bilateral crackles and wheeze. The C reactive protein was 121 mg/l but the NPA was again negative for viruses. He was investigated for atypical causes of lower respiratory tract infection and the NPA was positive for Chlamydia trachomatis by polymerase chain reaction. He was treated with a 5 day course of azithromycin and made a full recovery.

Pljučnica pri dojenčku, povzročena z bakterijo Chlamydiae trachomatis

“…Vendar je znano tudi, da dojenčki z bronhiolitisom v tej starostni skupini pogosteje kot starejši otroci nimajo vročine. 15 Pri okužbi z bakterijo C. trachomatis je bris nosno-žrelnega prostora na respi-ratorne viruse z metodo PCR negativen, vendar je lahko v začetku sezone virusnih okužb dihal ta preiskava negativna tudi pri akutnem bronhiolitisu.…”

“…V Angliji je bila pri 17 % dojenčkov s klinično sliko bronhiolitisa, ki so imeli negativen bris nosno-žrelnega prostora na respiratorne viruse, dokazana okužba z bakterijo C. trachomatis. 15 Smernice in priporočila glede ugotavljanja okužb novorojenčkov z bakterijo C. trachomatis se niso spremenile.20 Še vedno se priporoča uporaba standardne metode osamitve bakterije iz nosnožrel-nega prostora. Ker pa ima metoda nizko občutljivost za dokaz klamidij v teh kužninah, jo v večini mikrobioloških laboratorijih vse bolj nadomeščajo visoko specifične in visoko občutljive molekularne metode, čeprav so validirane le za testiranje urogenitalnih kužnin.…”