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Original Research: Signs and Symptoms of Chest Disease |

Prospective Characterization of Protracted Bacterial Bronchitis in ChildrenProtracted Bacterial Bronchitis in Children

Danielle F. Wurzel, MBBS; Julie M. Marchant, PhD; Stephanie T. Yerkovich, PhD; John W. Upham, PhD; Ian M. Mackay, PhD; I. Brent Masters, PhD; Anne B. Chang, PhD
Author and Funding Information

From the Queensland Children’s Medical Research Institute (Drs Wurzel, Marchant, Masters, and Chang), The University of Queensland, and Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD; School of Medicine (Drs Yerkovich and Upham), The University of Queensland, Brisbane, QLD; Queensland Lung Transplant Service (Dr Yerkovich), The Prince Charles Hospital, Brisbane, QLD; Department of Respiratory Medicine (Dr Upham), Princess Alexandra Hospital, Brisbane, QLD; Queensland Paediatric, Infectious Diseases Laboratory (Dr Mackay), Queensland Children’s Medical Research Institute, Sir Albert, Sakzewski Virus Research Centre, Children’s Health Queensland Hospital and Health Service, The University of Queensland, Herston, QLD; and Child Health Division (Dr Chang), Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.

Correspondence to: Danielle F. Wurzel, MBBS, Queensland Children’s Medical Research Institute, The University of Queensland, Royal Children’s Hospital, Herston, QLD 4006, Australia; e-mail: Danielle.wurzel@uqconnect.edu.au


Part of this article has been presented in abstract form (Wurzel DF, Marchant JM, Mackay IM, et al. Further description of protracted bacterial bronchitis [PBB] in children. Am J Respir Crit Care Med. 2013;187:A5904).

Funding/Support: This study received funding from the National Health and Medical Research Council [project grants 1042601 and 1040830], Financial Markets Foundation for Children [project grant 2010-005], Thoracic Society of Australia and New Zealand/Allen and Hanbury’s, and the Queensland Children’s Medical Research Institute.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1271-1278. doi:10.1378/chest.13-2442
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Background:  Prior studies on protracted bacterial bronchitis (PBB) in children have been retrospective or based on small cohorts. As PBB shares common features with other pediatric conditions, further characterization is needed to improve diagnostic accuracy among clinicians. In this study, we aim to further delineate the clinical and laboratory features of PBB in a larger cohort, with a specific focus on concurrent viral detection.

Methods:  Children with and without PBB (control subjects) undergoing flexible bronchoscopy were prospectively recruited. Basic immune function testing and lymphocyte subset analyses were performed. BAL specimens were processed for cellularity and microbiology. Viruses were identified using polymerase chain reaction (PCR) and bacteria were identified via culture.

Results:  The median age of the 104 children (69% male) with PBB was 19 months (interquartile range [IQR], 12-30 mo). Compared with control subjects, children with PBB were more likely to have attended childcare (OR, 8.43; 95% CI, 2.34-30.46). High rates of wheeze were present in both groups, and tracheobronchomalacia was common. Children with PBB had significantly elevated percentages of neutrophils in the lower airways compared with control subjects, and adenovirus was more likely to be detected in BAL specimens in those with PBB (OR, 6.69; 95% CI, 1.50-29.80). Median CD56 and CD16 natural killer (NK) cell levels in blood were elevated for age in children with PBB (0.7 × 109/L; IQR, 0.5-0.9 cells/L).

Conclusions:  Children with PBB are, typically, very young boys with prolonged wet cough and parent-reported wheeze who have attended childcare. Coupled with elevated NK-cell levels, the association between adenovirus and PBB suggests a likely role of viruses in PBB pathogenesis.

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