Abstract
Background/Aim: Children with chronic wet cough and without
cystic fibrosis (non-CF) may suffer from chronic suppurative lung
disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one
of the offending microbes in these children. The present study aimed to
describe the clinical course of children with the above two conditions
who were infected with Pa.
Methods : Data of 54 children with CSLD/bronchiectasis diagnosed
and attended in our department were retrospectively analysed through a
Cox proportional hazard model, with age, presence of bronchiectasis, use
of inhaled colistin, azithromycin, inhaled hypertonic saline as the
covariates. Disease remission was defined as the absence of daily wet
cough for six months along with four negative cultures taken during the
last four consecutive follow-up visits.
Results : Nebulised antibiotics and the presence of
bronchiectasis were statistically significant predictors of remission
(HR:3.99; 95%CI:1.12-14.14; p= 0.032, and HR:0.24; 95%CI:0.08-0.71; p=
0.010).
Conclusion : The rate of disease remission increases with the
use of inhaled colistin and decreases when there is established
bronchiectasis.
Chronic endobronchial infections in children not suffering from cystic
fibrosis (non-CF) are characterized as chronic suppurative lung disease
(CSLD) or bronchiectasis. These two conditions do not represent distinct
entities but are rather parts of the spectrum of the chronic infection
of conducting
airways1,2.
Their clinical characteristics are indistinguishable, with chronic wet
cough being the most prominent and essential feature of both conditions.
The distinction between these two otherwise similar entities is based on
the chest high-resolution CT scan (HRCT) which shows dilatation of the
bronchi in bronchiectasis whereas it is non-diagnostic in
CSLD1,3. Their pathogenesis is based on Cole’s vicious
cycle hypothesis where an initial bacterial endobronchial infection
leads to neutrophilic inflammation and impaired airway clearance that
results in airway damage, further growth and spread of the bacteria, and
eventually, the establishment of a chronic infection4.
Bronchiectasis represents the latter stage of this pathological process.
Pseudomonas aeruginosa (Pa) rarely infects the lung without an
underlying immunity defect or impairment of the mucociliary clearance.
It is a well-known and common pathogen in cystic fibrosis (CF)
especially in patients with advanced disease. It has been shown that Pa
is associated with an accelerated decline of lung function,
deterioration of the radiographic features, increase in the number of
exacerbations, and in general, it is considered a significant indicator
of the severity of bronchiectasis in both adult and pediatric
patients5-9.
The association of Pa with poor clinical outcomes renders its early
detection of great importance in patients with chronic endobronchial
infections. The present study aimed to describe the clinical course of
non-CF children with CSLD or established bronchiectasis who were
infected with Pa.