Turkiye Klinikleri Pediatri, vol.26, no.2, pp.39-43, 2017 (Scopus)
Objective: Protracted bacterial bronchitis (PBB) is defined as the presence of more than 4 weeks of chronic wet cough that resolves with appropriate antibiotic therapy, in the absence of alternative diagnoses. Microbiological confirmation of PBB poses a significant challenge as affected children rarely expectorate sputum. The gold standard method of sampling the lower airways in young children is flexible bronchoscopy with bronchoalveloar lavage (FB-BAL). The objective of this study was to analyze the clinical and flexible bronchoscopic findings of children suspected with PBB. Material and Methods:We retrospectively reviewed clinical and bronchoscopy findings of 31 children investigated for suspected PBB between January 2011-December 2014 at Hacettepe University Department of Pediatric Pulmonology. Patients who underwent flexible bronchoscopy with complaint of prolonged wet cough over four weeks due to protracted bacterial bronchitis were included in the study. Patients who were diagnosed with cystic fibrosis, primary ciliary dyskinesia, immune deficiency, genetic diseases, neurological diseases, history of aspiration and asthma were excluded. Results: The median age of flexible bronchoscopy was 7 (2.5-14) years and the median duration of cough was 11 (6-48) months. All the patients had wet cough at presentation. On physical examination 74% (23) patients had no findings; and the other patients had fine rales. Chest X-ray was found normal in 61.3% (n=19) of the patients. Positive cultures were obtained from 12/31 (38.7%) of the patients. Bronchoscopy revealed out purulent secretion in 16 (51.6%) patients, bronchomalacia in bronchomalasia 2 patients 6.5%, tracheomalasia 1 patient 3.2%. The most common microorganisms isolated were Streptococcus pneumoniae (7 patients) and Haemophilus influenzae (5 patients). Conclusion: Bacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed. Presence of purulent bronchitis during bronchoscopy is strongly associated with bacterial lower airway infection in this population of patients. Early diagnosis and appropriate treatment may prevent progression to bronchiectasis in PBB.