Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.
Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.
Pediatr Pulmonol. 2018 Apr;53(4):467-474. doi: 10.1002/ppul.23952. Epub 2018 Feb 6.
Endobronchial suppuration is present in children with protracted bacterial bronchitis (PBB), bronchiectasis, and cystic fibrosis (CF). However, no studies have directly compared bronchoscopy and bronchoalveolar lavage (BAL) findings across these conditions within a single center using the same techniques and with shared community pathogens.
To determine; (i) the bronchoscopic findings and BAL microbiology and cellularity among children with these conditions and; (ii) the relationship between bacterial pathogens, airway cellularity and aberrant macroscopic bronchoscopic findings.
We retrospectively reviewed all bronchoscopy data (undertaken over 6.5-years) from our center in children (<6 years; n = 316) meeting definitions of PBB (n = 125), bronchiectasis (n = 138), and CF (n = 53).
The children's median age was 26-months (Interquartile range (IQR) = 16-43). Children with PBB and bronchiectasis had higher rates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae infection, whereas children with CF had frequent Pseudomonas aeruginosa and Staphylococcus aureus infections. Novel findings include detection of cytomegalovirus and Epstein-Barr virus (EBV) (by polymerase chain reaction) in children with PBB (26%, 17%, respectively) and bronchiectasis (27%, 29%). Median airway neutrophil percentage was significantly higher in CF (68%; IQR = 42-83) compared to PBB (36%; IQR = 18-68) and bronchiectasis (22%; IQR = 8-64) (P < 0.0001), despite lower rates of infection. Presence of malacia did not significantly impact on infection or inflammation.
In this first study to directly compare bronchoscopic data among young children with PBB, bronchiectasis, and CF, microbiological patterns of airway infections and neutrophilia varied. Our findings of cytomegalovirus and EBV detection in children with PBB and bronchiectasis require confirmation and further evaluation.
持续性细菌性支气管炎（PBB）、支气管扩张症和囊性纤维化（CF）患儿存在支气管内化脓。然而，尚无研究在同一中心使用相同技术和相同社区病原体直接比较这些疾病的支气管镜检查和支气管肺泡灌洗（BAL）结果。
确定：（i）这些疾病患儿的支气管镜检查结果和 BAL 微生物学和细胞计数；（ii）细菌病原体、气道细胞数量与异常大体支气管镜检查结果之间的关系。
我们回顾性分析了过去 6.5 年来我院（<6 岁；n=316）满足 PBB（n=125）、支气管扩张症（n=138）和 CF（n=53）定义的所有支气管镜检查数据。
患儿中位年龄为 26 个月（IQR=16-43）。PBB 和支气管扩张症患儿的流感嗜血杆菌、卡他莫拉菌和肺炎链球菌感染率较高，而 CF 患儿则经常感染铜绿假单胞菌和金黄色葡萄球菌。新发现包括在 PBB（分别为 26%、17%）和支气管扩张症（分别为 27%、29%）患儿中检测到巨细胞病毒和 EBV（通过聚合酶链反应）。CF（68%；IQR=42-83）气道中性粒细胞百分比显著高于 PBB（36%；IQR=18-68）和支气管扩张症（22%；IQR=8-64）（P<0.0001），尽管感染率较低。黏膜软化症的存在对感染或炎症没有显著影响。
在这项直接比较 PBB、支气管扩张症和 CF 患儿支气管镜数据的第一项研究中，气道感染的微生物学模式和中性粒细胞增多存在差异。我们在 PBB 和支气管扩张症患儿中发现的巨细胞病毒和 EBV 检测结果需要进一步证实和评估。
