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.