Clinical analysis of 28 cases of bronchiolitis obliterans

WU Xiao-Ying; LUO Zheng-Xiu; FU Zhou; LIU En-Mei; LUO Jian; HE Ling

doi:10.7499/j.issn.1008-8830.2013.10.009

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Chinese Journal of Contemporary Pediatrics ›› 2013, Vol. 15 ›› Issue (10) : 845-849. DOI: 10.7499/j.issn.1008-8830.2013.10.009

CLINICAL RESEARCH

Clinical analysis of 28 cases of bronchiolitis obliterans

WU Xiao-Ying, LUO Zheng-Xiu, FU Zhou, LIU En-Mei, LUO Jian, HE Ling

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Abstract

OBJECTIVE: To study the clinical features of bronchiolitis obliterans (BO) in children. METHODS: The clinical data of 28 children with BO between July 2007 and April 2012 was retrospectively reviewed. RESULTS: All patients presented with persistent or repeated cough and wheezing. Twenty-three cases were post-infectious bronchiolitis obliterans (PIBO), among whom the etiology were adenovirus (12 cases), measles (2 cases), influenza virus A (2 cases), mycoplasma pneumoniae (1 case), mycoplasma pneumoniae coinfection with adenovirus (1 case), respiratory syncytial virus coinfection with Parainfluenza type 3 virus (1 case) and pulmonary tuberculosis (1 case). The etiology of 3 cases was not associated with infection. The etiology was unknown in 2 cases. Pulmonary HRCT revealed that decreased density in 25 cases, mosaic perfusion in 21 cases, bronchial wall thickening in 15 cases, bronchiectasis in 12 cases and air retention in 6 cases. Lung function test was performed on 21 cases and demonstrated that obstructive ventilation disorder in all 21 cases. Bronchodilation test was performed on 18 cases and 17 cases showed a negative result. All 28 cases received corticosteroid treatment, and 24 cases were orally administered with low doses of azithromycin. One case died during hospitalization. Eighteen cases were followed up for 4 months to 4 years and seven months. Clinical manifestations were improved in 12 cases and one case died. CONCLUSIONS: Low respiratory infection is the most common cause of pediatric BO and adenovirus is a major pathogen. Persistent wheezing and cough were main clinical manifestations. Pulmonary HRCT imaging is important for diagnosis and follow-up of BO. Lung function test can typically show obstructive ventilation disorder. Corticosteroid and methotrexate may be effective for treatment of BO. Prognosis of this disease is unsatisfactory. Early diagnosis and treatment, and avoidance of repeated respiratory tract infection may be helpful to improve the prognosis.

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Bronchiolitois, Obliterans / Prognosis / Child

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WU Xiao-Ying, LUO Zheng-Xiu, FU Zhou, LIU En-Mei, LUO Jian, HE Ling. Clinical analysis of 28 cases of bronchiolitis obliterans[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(10): 845-849 https://doi.org/10.7499/j.issn.1008-8830.2013.10.009

References

[1] 中华医学会儿科学分会呼吸学组《中华儿科杂志》编辑委员会.儿童闭塞性细支气管炎的诊断与治疗建议[J].中华儿科杂志, 2012, 50(10): 743-745.

[2] Kim CK, Kim SW, Kim JS, Koh YY, Cohen AH, Deterding RR, et al. Bronchiolitis obliterans in the 1990s in Korea and the United States[J]. Chest, 2001, 120(4): 1101-1106.

[3] Champs NS, Lasmar LM, Camargos PA, Marguet C, Fischer GB, Mocelin HT. Post-infectious bronchiolitis obliterans in children[J]. J Pediatr (Rio J), 2011, 87(3): 187-198.

[4] Colom AJ, Teper AM, Vollmer WM, Diette GB. Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis[J]. Thorax, 2006, 61(6): 503-506.

[5] Moonnumakal SP, Fan LL. Bronchiolitis obliterans in children[J]. Curr Opin Pediatr, 2008, 20(3): 272-278.

[6] 王维, 申昆玲, 曾津津. 儿童闭塞性细支气管炎42例临床分析[J]. 中华儿科杂志, 2008, 46(10): 732-738.

[7] 朱晓华, 刘建梅, 陈强, 李岚, 章高平, 杜云, 等. 儿童闭塞性细支气管炎临床诊治分析[J]. 中国当代儿科杂志, 2010, 12(12): 998-1000.

[8] Yuksel H, Yilmaz O, Akcali S, Sogut A, Yilmaz Ciftdogan D, Urk V, et al. Common viral etiologies of community acquired lower respiratory tract infections in young children and their relationship with long term complications[J]. Mikrobiyol Bul, 2008, 42(3): 429-435.

[9] Murtagh P, Giubergia V, Viale D, Bauer G, Pena HG. Lower respiratory infections by adenovirus in children. Clinical features and risk factors for bronchiolitis obliterans and mortality[J]. Pediatr Pulmonol, 2009, 44(5): 450-456.

[10] 陈德晖, 林育能, 蓝淑玲, 潘小安, 曾庆思, 何振涛, 等. 儿童闭塞性细支气管炎26例临床研究[J]. 中华儿科杂志, 2012, 50(2): 98-102.

[11] Gothi D, Shah DV, Joshi JM. Clinical profile of diseases causing chronic airflow limitation in a tertiary care centre in India[J]. J Assoc Physicians India, 2007, 55: 551-555.

[12] 王全, 赵德育. 闭塞性细支气管炎5例临床分析[J]. 临床儿科杂志, 2012, 30(2): 124-127.

[13] Dogra S, Suri D, Saini AG, Rawat A, Sodhi KS. Fatal bronchiolitis obliterans complicating Stevens-Johnson syndrome following treatment with nimesulide: a case report[J]. Ann Trop Paediatr, 2011, 31(3): 259-261.

[14] Siegel MJ, Bhalla S, Gutierrez FR, Hildebolt C, Sweet S. Post-lung transplantation bronchiolitis obliterans syndrome: usefulness of expiratory thin-section CT for diagnosis[J]. Radiology, 2001, 220(2): 455-462.

[15] 刘秀云, 江载芳, 彭云. 闭塞性细支气管炎23例临床分析[J]. 中国实用儿科杂志, 2008, 23(4): 263-265.

[16] Yalcin E, Dogru D, Haliloglu M, Ozcelik U, Kiper N, Gocmen A. Postinfectious bronchiolitis obliterans in children: clinical and radiological profile and prognostic factors[J]. Respiration, 2003, 70(4): 371-375.

[17] Federica M, Nadia S, Monica M, Alessandro C, Tiberio O, Francesco B, et al. Clinical and immunological evaluation of 12-month azithromycin therapy in chronic lung allograft rejection[J]. Clin Transplant, 2011, 25(4): E381-E389.

[18] De Baets F. Bronchiolitis obliterans in children: a ghostly journey to the origin[J]. Allergol Immunopathol (Madr), 2011, 39(5): 251-252.