Wheeze in Preschool Age Is Associated with Pulmonary Bacterial Infection and Resolves after Antibiotic Therapy

Abstract

BackgroundNeonates with airways colonized by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis are at increased risk for recurrent wheeze which may resemble asthma early in life. It is not clear whether chronic colonization by these pathogens is causative for severe persistent wheeze in some preschool children and whether these children might benefit from antibiotic treatment. We assessed the relevance of bacterial colonization and chronic airway infection in preschool children with severe persistent wheezing and evaluated the outcome of long-time antibiotic treatment on the clinical course in such children.Methodology/Principal FindingsPreschool children (n = 42) with severe persistent wheeze but no symptoms of acute pulmonary infection were investigated by bronchoscopy and bronchoalveolar lavage (BAL). Differential cell counts and microbiological and virological analyses were performed on BAL samples. Patients diagnosed with bacterial infection were treated with antibiotics for 2–16 weeks (n = 29). A modified ISAAC questionnaire was used for follow-up assessment of children at least 6 months after bronchoscopy. Of the 42 children with severe wheezing, 34 (81%) showed a neutrophilic inflammation and 20 (59%) of this subgroup had elevated bacterial counts (≥104 colony forming units per milliliter) suggesting infection. Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were the most frequently isolated species. After treatment with appropriate antibiotics 92% of patients showed a marked improvement of symptoms upon follow-up examination.Conclusions/SignificanceChronic bacterial infections are relevant in a subgroup of preschool children with persistent wheezing and such children benefit significantly from antibiotic therapy.

Association between Household Income and Asthma Symptoms among Elementary School Children in Seoul

“…The study sample was quite large, and the subjects were from relatively homogenous regional backgrounds. Additionally, we excluded preschool children because wheezing in preschool age children might be more frequently associated with respiratory infections rather than with asthma [39]. …”

Respiratory sequelae and quality of life in children one‐year after being admitted with a lower respiratory tract infection: A prospective cohort study from a developing country

“…Studies are emerging showing a positive link between “colonization” of bacteria in the upper respiratory tract and risk of respiratory symptoms or disease in infants . Does the use of antibiotics, when reducing bacterial load alleviate respiratory symptoms?…”

“…PBBs and its link with chronic cough also support the need for antibiotics in children who do not have an acute lung infection but a bacterial airway infection. In a study of persistent wheezy young children, use of antibiotics reduced the symptoms in 92% of children …”

Interactions micro-organismes et voies aériennes distales : spécificités pédiatriques

“…L'analyse moléculaire ARN16S a montré qu'il y avait plus de séquences chez les asthmatiques que chez les enfants contrôles (1135 vs 670), que les protéobactéries (Hemophilus, Neisseiria en particulier) et les staphylocoques étaient plus fréquents chez l'enfant asthmatique, et qu'en revanche les Bacteroides étaient plus fréquents chez les contrôles. Un certain nombre de données existent sur la fréquence des infections/colonisations des voies aériennes inférieures au cours de l'asthme préscolaire [52][53][54][55][56][57]. Le Tableau 2 résume les principales études publiées à partir des données du lavage broncho-alvéolaire.…”

“…Sur un plan clinique, une seule étude a montré une amélioration du contrôle de l'asthme après traitement antibiotique [57]. Dans ce travail 42 enfants préscolaires explorés pour un asthme sévère ont eu une analyse bactériologique et virologique du liquide de lavage alvéolaire.…”