Journal Article

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

Kabesch, Michael, Brinkmann, Folke, Schwerk, Nicolaus, Soudah, Bisharah, Hansen, Gesine

2011

Overview

Neonates 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. Preschool 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. Chronic bacterial infections are relevant in a subgroup of preschool children with persistent wheezing and such children benefit significantly from antibiotic therapy.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Alveoli / Analysis / Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibiotics / Asthma / Bacteria / Bacterial diseases / Bacterial infections / Bacterial Infections - complications / Bacterial Infections - drug therapy / Biology / Bronchitis / Bronchoalveolar lavage / Bronchoalveolar Lavage Fluid - cytology / Bronchoalveolar Lavage Fluid - microbiology / Bronchoscopy / Bronchus / Cellular biology / Child, Preschool / Children / Children & youth / Chronic infection / Colonization / Colony Count, Microbial / Female / Granulocytes - drug effects / Health aspects / Humans / Infections / Inflammation / Leukocytes (neutrophilic) / Male / Medical research / Medical schools / Medicine / Microbiology / Neonates / Neutrophils / Pathology / Patients / Pediatrics / Pneumonia / Preschool children / Respiratory Sounds - drug effects / Respiratory Sounds - etiology / Respiratory tract / Respiratory Tract Infections - complications / Respiratory Tract Infections - drug therapy / Streptococcus / Streptococcus infections / Task forces / Therapy / Viral infections / Viruses / Wheezing