When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children

Abstract

Chronic cough is defined as a daily cough that persists longer than 4 weeks. Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in preschool children with no symptoms or signs of other specific causes, and resolution usually follows a 2-week course of an appropriate oral antibiotic. The diagnosis is mainly clinical; generally, no instrumental examinations are necessary. The most common bacteria found in the bronchoalveolar lavage (BAL) of subjects with PBB include Haemophilus influenzae, Streptococcus pneumoniae , and Moraxella catarrhalis . Nowadays, there is no certain evidence of the role of viruses in PBB pathogenesis even though different types of viruses have been detected in BAL from children with PBB. Airway malacia is commonly found in children with PBB; conversely, there is no correlation with any type of immunodeficiency. Amoxicillin-clavulanate acid is the most commonly used antibiotic, as first-line, prolonged therapy (longer than 2 weeks) is sometimes required to cough resolution. When the wet cough does not improve despite prolonged antibiotic treatment, an underlying disease should be considered. Moreover, there are several hypotheses of a link between PBB and bronchiectasis, as recent evidences show that recurrent PBB (>3 episodes/years) and the presence of H. influenzae infection in the lower airways seem to be significant risk factors to develop bronchiectasis. This underlines the importance of a close follow-up among children with PBB and the need to consider chest computerized tomography (CT) in patients with risk factors for bronchiectasis. In this brief review, we summarize the main clinical and pathogenetic findings of PBB, a disease that may be related to a relevant morbidity and decreased quality of life during the pediatric age.

Associated risk factors and diagnostic value of fiberoptic bronchoscopy for protracted bacterial bronchitis in children

“…Similar to other studies, the clinical symptoms in most of the children were significantly ameliorated after BAL. 37 Our study also showed that children with patchy opacities observed via CT had good absorption of inflammatory lesions after elective follow-up BAL.…”

Non-Cystic Fibrosis Bronchiectasis in Pediatric Age: A Case Series in a Metropolitan Area of Northern Italy

“…A failure to improve a wet cough after a 4-weeks antibiotic therapy requires more investigations (such as CT scan, bronchoscopy, immunity tests) to rule out the presence of another underlying disease [ 23 ]. In our case, the early diagnosis of NCFB allowed a mild and well-controlled course of the disease since the bronchiectasis detected by HRCT were at a very early radiological stage.…”

Pathogen detection and characterization from throat swabs using unbiased metatranscriptomic analyses

“…The significantly higher microbial load (figure 1) observed in all of the throat swabs from PID-0001 compared to all other participants corroborates this probable diagnosis (Sibila et al, 2019). In addition, all samples from PID-0001 show the presence of Haemophilus influenzae , whose presence is associated with persistent bacterial bronchitis (Gallucci et al, 2020). These results indicate that the participant may be suffering from bronchiectasis characterized by a general overgrowth of microorganisms in the throat leading to airway and epithelial damage which is the root cause of their cough, as opposed to being caused by a transient pathogenic infection (Martin and Harrison, 2015).…”