In young children, persistent wheezing is associated with bronchial bacterial infection: a retrospective analysis.
In young children, persistent wheezing is associated with bronchial bacterial infection: a retrospective analysis.
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DOI：
10.1186/1471-2431-12-83
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发表时间：
2012-06-22
期刊：
影响因子：
2.4
通讯作者：
Malfroot A
中科院分区：
文献类型：
--
作者：
De Schutter I;Dreesman A;Soetens O;De Waele M;Crokaert F;Verhaegen J;Piérard D;Malfroot A
持续喘息的幼儿对儿科医生的诊断和治疗提出了挑战。我们的目的是评估细菌性支气管感染作为常规哮喘治疗无效的一个可能原因，并确定和鉴定相关的主要病原体。我们回顾性分析了对吸入性皮质类固醇（ICS）治疗无反应的年轻喘息患者的微生物学和细胞学结果，这些患者接受了支气管镜检查和支气管肺泡灌洗（BAL）。采取程序措施限制污染风险，并使用BAL液的定量细菌培养（显著性临界值≥ 104菌落形成单位/ml）。现代微生物学方法用于检测广泛的病原体和细菌分离株的表征。对33名年龄在4至38个月之间，没有传导性气道结构异常的儿童进行了评价。在48.5%的患者中发现了显著的细菌BAL培养物。流感嗜血杆菌分离率为30.3%，肺炎链球菌分离率为12.1%，卡他莫拉菌分离率为12.1%。全是H。流感病毒分离株是无包囊的菌株，与非溶血性H.溶血性在21.9%的病例中检测到呼吸道病毒，在12.1%的病例中检测到细菌-病毒混合感染。细胞学检查显示有明显的嗜酸性炎症。支气管树的细菌感染在持续性学龄前喘息中很常见，并为ICS治疗无效提供了可能的解释。不可分型的H.流感病毒似乎是最主要的病原体，其次是S。pneumoniae和M.粘膜炎。
Young children with persistent wheezing pose a diagnostic and therapeutical challenge to the pediatrician. We aimed to evaluate bacterial bronchial infection as a possible reason for non response to conventional asthma therapy, and to identify and characterise the predominant pathogens involved. We retrospectively analysed microbiological and cytological findings in a selected population of young wheezers with symptoms unresponsive to inhaled corticosteroid (ICS) therapy, who underwent flexible bronchoscopy with bronchoalveolar lavage (BAL). Procedural measures were taken to limit contamination risk and quantitative bacterial culture of BAL fluid (significance cut-off ≥ 104 colony-forming units/ml) was used. Modern microbiological methods were used for detection of a wide panel of pathogens and for characterisation of the bacterial isolates. 33 children aged between 4 and 38 months, without structural anomalies of the conductive airways were evaluated. Significant bacterial BAL cultures were found in 48,5 % of patients. Haemophilus influenzae was isolated in 30,3 %, Streptococcus pneumoniae in 12,1 % and Moraxella catarrhalis in 12,1 %. All H. influenzae isolates were non-encapsulated strains and definitely distinguished from non-haemolytic H. haemolyticus. Respiratory viruses were detected in 21,9 % of cases with mixed bacterial-viral infection in 12,1 %. Cytology revealed a marked neutrophilic inflammation. Bacterial infection of the bronchial tree is common in persistent preschool wheezers and provides a possible explanation for non response to ICS therapy. Non-typeable H. influenzae seems to be the predominant pathogen involved, followed by S. pneumoniae and M. catarrhalis.
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