Clinical Study Of Protracted Bacterial Bronchitis In Children

Objective:To investigate the clinical features,bronchoscopy characteristics and pathogenic features of protracted Bacterial Bronchitis(PBB)in children.And compared with the clinical features of persistent pneumonia,so that pediatric clinicians have a deeper understanding of protracted bacterial bronchitis.methods:We enrolled the children diagnosed with PBB hospitalized in the Department of respiration of Children's Hospital Affiliated to Soochow University from April 2014 to December 2017.We also selected Children who were diagnosed with persistent pneumonia at the same time as the control group.After admission,we carry out blood routine examination,PCT,humoral immunity and cellular immunity,imaging examination,bronchoscopy examination,detection of a variety of respiratory pathogens.Respiratory viruses were detected by direct immunofluorescence assay:respiratory syncytial virus RSV,adenovirus(ADV),influenza virus typeAand B(influenza virus typeAand B,),parainfluenza virustype 1?3,Pinf1?3.HBoV was detected by polymerase chain reaction(PCR).Bronchoalveolar lavage fluid(BALF)was taken for bacterial culture and cell classification.Clinical data of children diagnosed with PBB in the respiratory department from April 2014 to December 2017 and those in the control group with chronic pneumonia were collected.we analyze the clinical symptoms,signs,chest imaging changes,bronchoscopic features,and bacterial culture etiology and bacterial count characteristics of bronchoscopic alveolar lavage fluid in children with PBB retrospectively,and compare with the clinical characteristics of chronic pneumonia.results:1.68 children with PBB were enrolled and 35 patients with persistent pneumonia were enrolled.Among the 68 children with PBB,the age ranged from 3 to 106 months,including 40 cases(58.8%)? 12 months,14 cases(20.6%)>12 months to 36 months,14 cases(20.6%)>36 months.There were 54 male patients(79.4%)and 14 female patients(20.6%).The male to female ratio was 3.86:1.Of the 35 children with persistent pneumonia,22(62.9%)were?12 months old,6 cases(17.1%)were>12 months to 36 months,7 cases(20%)were>36 months old,and 26 cases were male.(74.3%),9 cases(25.7%)were female,and the ratio of male to female was 2.89:1.2.Clinical manifestations:There are 68 cases(100%)of wet cough,39 cases(57.4%)of wheezing,15 cases(22.1%)of laryngeal rumbling,45 cases(66.2%)of lung smelling and sputum rumbling,39 cases(57.4%)of lung smelling and sputum rumbling,and 29 cases(42.6%)of lung smelling and sputum rumbling+wheezing.There was no significant difference in age,gender,clinical symptoms and signs between PBB children without airway softening and PBB children with airway softening(P>0.05).3.Under bronchoscopy,there were 68 cases(100%)with mucosal congestion and edema,47 cases(69.1%)with thin secretions,4 cases(5.9%)with some sputum plugs,21 patients(30.9%)with airway softening.Among the children with airway softening,there were 7 cases(10.3%)with combined laryngeal softening,6 cases(8.8%)with combined tracheal softening,and 8 cases(11.8%)with combined bronchial softening.4.In the bacterial culture of Bronchoalveolar Lavage Fluid BALF,6 cases(8.8%)of Haemophilus influenzae(HI)were detected,and 3 cases were Streptococcus pneumoniae(SP).(4.4%)and Moraxelle catarrhalis(MC)in 1 case(1.5%).BALF cytological examination showed that neutrophils were 36.5%(12.25-74),lymphocytes 3.0%(2.0-6.0),reticulocytes 55.5%(18.0-83.0),and eosinophils 0%(0-0.75).The percentage of neutrophils increased in 68 cases(100%),40 cases(58.8%)of which neutrophils>30%.5.Among them,45 patients underwent X chest X-ray examination in my hospital.Chest imaging showed that 45 cases of lung texture were thickened(66.2%);19 cases underwent chest CT examination,and chest CT showed increased lung texture and disorder in 13 cases(19.1%).6 cases(8.8%)of spots and flocculation.4 cases(5.9%)underwent X chest X-ray examination in other hospital,and Chest imaging showed normal.6.All the 68 children with PBB received antibiotic treatment(14.3±6.4d),with the shortest course of 2 weeks and the longest course of 5 weeks,and the cough symptoms were relieved(100%).7.Compared with children with persistent pneumonia,children with PBB had 32 cases of wet cough(91.4%),10 cases of shortness of breath(28.6%),19 cases of fever(54.3%),and radiographic findings.There were 29 cases(82.9%)and 2 cases(5.7%)with lung consolidation.Compared with PBB,the two groups were compared,and the shortness of breath,fever and patchy shadow were statistically significant(P<0.05).Conclusions:1.PBB is more common in male children<3 years old,and its clinical manifestations are wet cough,most of which are combined with wheezing,and the lung smells phlegm and/or wheezing sounds are more common,and the chest imaging mainly shows thickening and disorder of lung texture.2.PBB children are often associated with airway softening.3.Haemophilus influenzae,streptococcus pneumoniae and moramorella catarrhalis were the main pathogens detected in PBB children.4.Under the microscope,the main manifestations of PBB children were bronchial mucosal congestion and edema.Partial thin or sticky secretions are seen.Airway inflammation is neutrophilic.5.The clinical symptoms and imaging manifestations of PBB were different from that of chronic pneumonia.