Department of Pulmonology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Radiology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Pediatr Pulmonol. 2024 Nov;59(11):2754-2760. doi: 10.1002/ppul.27113. Epub 2024 Jun 13.
Plastic bronchitis (PB) is a clinical-pathological syndrome characterized by the abnormal accumulation of endogenous substances in the bronchial airways, causing partial or complete obstruction and resulting in impaired lung ventilation.
In this retrospective analysis, we aim to summarize the clinical manifestations, imaging characteristics, diagnostic methods, and treatment approaches to enhance clinicians' ability to detect children who are infected with human bocavirus 1 (hBoV 1) and develop PB.
In the period from January 2021 to January 2024, a total of six hBoV 1 infection children were diagnosed with PB through bronchoscopy. The onset of the condition was mainly concentrated between June and December. The detection methods used included metagenomic next-generation sequencing for pathogen identification (three cases) and respiratory pathogen nucleic acid 13-plex detection (oropharyngeal swab) (three cases), both of which confirmed the presence of hBoV 1. Out of the six children with PB, two were girls and four were boys. Their ages ranged from 10 months to 4 years old. Common symptoms reported by all patients included fever, cough, and wheezing. Chest high-resolution computed tomography scans revealed atelectasis in six cases, in addition to pneumonia. After the removal of the plastic bronchi via bronchoscopy, the airway obstruction symptoms in the children were relieved, and no recurrence was observed during the follow-up period. Pathological findings indicated cellulose exudation and inflammatory cell infiltration, consistent with nonlymphatic PB.
When children infected with hBoV 1 exhibit persistent or worsening symptoms such as cough, fever, and wheezing despite treatment, clinicians should remain highly vigilant for the potential occurrence of PB. Bronchoscopy plays a crucial role not only in diagnosing the presence of a plastic bronchus but also in effectively treating PB.
塑型性支气管炎（PB）是一种临床-病理综合征，其特征为支气管内异常积聚内源性物质，导致部分或完全气道阻塞，引起肺通气受损。
本回顾性分析旨在总结人类博卡病毒 1（hBoV 1）感染患儿发生 PB 的临床表现、影像学特征、诊断方法及治疗方法，以提高临床医生对该疾病的认识。
2021 年 1 月至 2024 年 1 月，经支气管镜诊断为 PB 的 hBoV 1 感染患儿共 6 例。发病主要集中在 6 月至 12 月。病原体检测方法包括宏基因组二代测序（3 例）和呼吸道病原体核酸 13 重荧光检测（咽拭子）（3 例），均明确 hBoV 1 感染。6 例 PB 患儿中，女 2 例，男 4 例；年龄 10 个月至 4 岁。所有患儿均有发热、咳嗽、喘息症状。胸部高分辨率 CT 扫描显示 6 例患儿均有肺不张，合并肺炎。经支气管镜取出塑型性支气管后，患儿气道阻塞症状缓解，随访期间无复发。病理检查提示纤维素渗出和炎症细胞浸润，符合非淋巴性 PB。
当 hBoV 1 感染患儿在治疗后持续或加重咳嗽、发热、喘息等症状时，临床医生应高度警惕 PB 的发生。支气管镜不仅对诊断塑型性支气管具有重要价值，而且对治疗 PB 也具有积极作用。
