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In young children, persistent wheezing is associated with bronchial bacterial infection: a retrospective analysis Full Text
BMC Pediatrics, 06/26/2012
De Schutter I et al. – Bacterial infection of the bronchial tree is common in persistent preschool wheezers and provides a possible explanation for non response to inhaled corticosteroid (ICS) therapy. Non–typeable H. influenzae seems to be the predominant pathogen involved, followed by S. pneumoniae and M. catarrhalis.
Methods- The authors retrospectively analysed microbiological and cytological findings in a selected population of young wheezers with symptoms unresponsive to inhaled corticosteroid (ICS) therapy, who underwent flexible bronchoscopy with bronchoalveolar lavage (BAL).
- Procedural measures were taken to limit contamination risk and quantitative bacterial culture of BAL fluid (significance cut-off [greater than or equal to] 104 colony-forming units/ml) was used.
- Modern microbiological methods were used for detection of a wide panel of pathogens and for characterisation of the bacterial isolates.
- 33 children aged between 4 and 38 months, without structural anomalies of the conductive airways were evaluated.
- Significant bacterial BAL cultures were found in 48,5 % of patients.
- Haemophilus influenzae was isolated in 30,3 %, Streptococcus pneumoniae in 12,1 % and Moraxella catarrhalis in 12,1 %.
- Respiratory viruses were detected in 21,9 % of cases with mixed bacterial-viral infection in 12,1 %. Cytology revealed a marked neutrophilic inflammation.