Clinical features of post‑infectious bronchiolitis obliterans in children undergoing long‑term azithromycin treatment

Wang,Xueyan; Liu,Changshan; Wang,Mengjuan; Zhang,Yi; Li,Hewen; Liu,Geli

doi:10.3892/etm.2015.2418

Clinical features of post‑infectious bronchiolitis obliterans in children undergoing long‑term azithromycin treatment

Authors:
- Xueyan Wang
- Changshan Liu
- Mengjuan Wang
- Yi Zhang
- Hewen Li
- Geli Liu
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Affiliations: Department of Pediatrics, The Second Hospital of Tianjin Medical University, Heping, Tianjin 300211, P.R. China, Department of Radiology, The Second Hospital of Tianjin Medical University, Heping, Tianjin 300211, P.R. China, Department of Pediatrics, The General Hospital of Tianjin Medical University, Heping, Tianjin 300052, P.R. China
Published online on: April 8, 2015 https://doi.org/10.3892/etm.2015.2418
Pages: 2379-2383

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Abstract

The aim of the present study was to outline any predisposing factors and clinical and radiological features of post‑infectious bronchiolitis obliterans (PIBO) in pediatric patients, and to determine the effect of long‑term azithromycin treatment on these factors. In total, 16 cases of children with PIBO were retrospectively reviewed. Adenovirus and Mycoplasma pneumoniae were the most common etiological agents (12/16) in the children with PIBO. The patients presented with persistent dyspnea, a chronic cough, sputum production and wheezing following the initial lung infection. Chest X‑rays indicated pulmonary overinflation and patchy ground‑glass opacity. In addition, high‑resolution computed tomography (HRCT) scans revealed patchy ground‑glass opacity, bronchiectasis, bronchial wall thickening and mosaic perfusion in all 16 cases. A unilateral hyperlucent lung was observed in two cases. All the patients underwent treatment with low‑dose azithromycin and prednisone. Follow‑up examinations of the 16 cases, varying in duration between 7 and 31 months, showed that the disease condition had improved in 10 cases. However, no significant improvements were identified from the HRCT scans or were observed in the patient condition in the additional six cases. The diagnosis of BO is primarily based on a typical clinical presentation and HRCT observations. Therefore, a typical clinical history and patchy ground‑glass opacity features on HRCT scans are screening indices that predict BO development. Steroids are the cornerstone of BO treatment; however, long‑term azithromycin treatment can improve the condition of the patients. In summary, PIBO is a disease with a high morbidity rate and should be treated by a multidisciplinary team. Patients should receive follow‑up examination for an extended period. Patchy ground‑glass opacity features on HRCT scans indicate that clinical suspicion of BO is necessary in children with persistent and severe wheezing.

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1	Lino CA, Batista AK, Soares MA, et al: Bronchiolitis obliterans: clinical and radiological profile of children followed-up in a reference outpatient clinic. Rev Paul Pediatr. 31:10162013.(In English and Portuguese). View Article : Google Scholar : PubMed/NCBI
2	Champs NS, Lasmar LM, Camargos PA, Marguet C, Fischer GB and Mocelin HT: Post-infectious bronchiolitis obliterans in children. J Pediatr (Rio J). 87:187–198. 2011.PubMed/NCBI
3	Friedlander AL and Albert RK: Chronic macrolide therapy in inflammatory airways diseases. Chest. 138:1202–1212. 2010. View Article : Google Scholar : PubMed/NCBI
4	Hickey AJ, Lu D, Ashley ED and Stout J: Inhaled azithromycin therapy. J Aerosol Med. 19:54–60. 2006. View Article : Google Scholar : PubMed/NCBI
5	Verleden GM, Vanaudenaerde BM, Dupont LJ and Van Raemdonck DE: Azithromycin reduces airway neutrophilia and interleukin-8 in patients with bronchiolitis obliterans syndrome. Am J Respir Crit Care Med. 174:566–570. 2006. View Article : Google Scholar : PubMed/NCBI
6	Teper A, Fischer GB and Jones MH: Respiratory sequelae of viral diseases: from diagnosis to treatment. J Pediatr (Rio J). 78 (Suppl 2):S187–S194. 2002.(In Portuguese). View Article : Google Scholar : PubMed/NCBI
7	Lynch JP III, Weigt SS, Der Hovanessian A, Fishbein MC, Gutierrez A and Belperio JA: Obliterative (constrictive) bronchiolitis. Semin Respir Crit Care Med. 33:509–532. 2012. View Article : Google Scholar : PubMed/NCBI
8	Mauad T and Dolhnikoff M: São Paulo Bronchiolitis Obliterans Study Group: Histology of childhood bronchiolitis obliterans. Pediatr Pulmonol. 33:466–474. 2002. View Article : Google Scholar : PubMed/NCBI
9	de Blic J, Deschildre A and Chinet T: Post-infectious bronchiolitis obliterans. Rev Mal Respir. 30:1521602013.(In French). View Article : Google Scholar : PubMed/NCBI
10	Weigt SS, DerHovanessian A, Wallace WD, Lynch JP III and Belperio JA: Bronchiolitis obliterans syndrome: the Achilles' heel of lung transplantation. Semin Respir Crit Care Med. 34:336–351. 2013. View Article : Google Scholar : PubMed/NCBI
11	Dogra S, Suri D, Saini AG, Rawat A and Sodhi KS: Fatal bronchiolitis obliterans complicating Stevens-Johnson syndrome following treatment with nimesulide: a case report. Ann Trop Paediatr. 31:259–261. 2011. View Article : Google Scholar : PubMed/NCBI
12	Mattiello R, Mallol J, Fischer GB, Mocelin HT, Rueda B and Sarria EE: Pulmonary function in children and adolescents with postinfectious bronchiolitis obliterans. J Bras Pneumol. 36:4534592010.(In English and Portuguese). View Article : Google Scholar : PubMed/NCBI
13	Hayes D Jr, Mansour HM, Kirkby S and Phillips AB: Rapid acute onset of bronchiolitis obliterans syndrome in a lung transplant recipient after respiratory syncytial virus infection. Transpl Infect Dis. 14:548–550. 2012. View Article : Google Scholar : PubMed/NCBI
14	Vu DL, Bridevaux PO, Aubert JD, Soccal PM and Kaiser L: Respiratory viruses in lung transplant recipients: a critical review and pooled analysis of clinical studies. Am J Transplant. 11:1071–1078. 2011. View Article : Google Scholar : PubMed/NCBI
15	Murtagh P, Giubergia V, Viale D, Bauer G and Pena HG: Lower respiratory infections by adenovirus in children. Clinical features and risk factors for bronchiolitis obliterans and mortality. Pediatr Pulmonol. 44:450–456. 2009. View Article : Google Scholar : PubMed/NCBI
16	Jones KD and Urisman A: Histopathologic approach to the surgical lung biopsy in interstitial lung disease. Clin Chest Med. 33:27–40. 2012. View Article : Google Scholar : PubMed/NCBI
17	Lee JW, Lee KS, Lee HY, et al: Cryptogenic organizing pneumonia: serial high-resolution CT findings in 22 patients. AJR Am J Roentgenol. 195:916–922. 2010. View Article : Google Scholar : PubMed/NCBI
18	Devakonda A, Raoof S, Sung A, Travis WD and Naidich D: Bronchiolar disorders: a clinical-radiological diagnostic algorithm. Chest. 137:938–951. 2010. View Article : Google Scholar : PubMed/NCBI
19	Hochhegger B, Irion KL, Marchiori E, Bello R, Moreira J and Camargo JJ: Computed tomography findings of postoperative complications in lung transplantation. J Bras Pneumol. 35:2662742009.(In English and Portuguese). View Article : Google Scholar : PubMed/NCBI
20	Leung AN, Fisher K, Valentine V, et al: Bronchiolitis obliterans after lung transplantation: detection using expiratory HRCT. Chest. 113:365–370. 1998. View Article : Google Scholar : PubMed/NCBI
21	Chen DH, Lin YN, Lan SL, et al: Clinical characteristics of bronchiolitis obliterans in pediatric patients. Zhonghua Er Ke Za Zhi. 50:981022012.(In Chinese). PubMed/NCBI
22	Colom AJ and Teper AM: Clinical prediction rule to diagnose post-infectious bronchiolitis obliterans in children. Pediatr Pulmonol. 44:1065–1069. 2009. View Article : Google Scholar : PubMed/NCBI
23	Lenney W, Boner AL, Bont L, et al: Medicines used in respiratory diseases only seen in children. Eur Respir J. 34:531–551. 2009. View Article : Google Scholar : PubMed/NCBI
24	Vega-Briceno LE and Zenteno AD: Clinical guide for diagnosis and care of children and adolescents with post-infectious bronchiolitis obliterans. Rev Chil Enf Resp. 25:141–163. 2009.
25	Yuksel H, Yilmaz O, Urk V, et al: Clinical significance of lung perfusion defects in children with post-infectious bronchiolitis obliterans. Tuberk Toraks. 57:376–382. 2009.PubMed/NCBI
26	Adde FV, Alvarez AE, Barbisan BN and Guimarães BR: Recommendations for long-term home oxygen therapy in children and adolescents. J Pediatr (Rio J). 89:6–17. 2013. View Article : Google Scholar : PubMed/NCBI
27	Yalcin E, Doğru D, Haliloğlu M, Ozcelik U, Kiper N and Gocmen A: Postinfectious bronchiolitis in children: Clinical and radiological profile and prognostic factors. Respiration. 70:371–375. 2003. View Article : Google Scholar : PubMed/NCBI
28	Kim TO, Oh IJ, Kang HW, et al: Temozolomide-associated bronchiolitis obliterans organizing pneumonia successfully treated with high-dose corticosteroid. J Korean Med Sci. 27:450–453. 2012. View Article : Google Scholar : PubMed/NCBI
29	Vos R, Vanaudenaerde BM, Verleden SE, et al: Anti-inflammatory and immunomodulatory properties of azithromycin involved in treatment and prevention of chronic lung allograft rejection. Transplantation. 94:101–109. 2012. View Article : Google Scholar : PubMed/NCBI
30	Aguerre V, Castanos C, Pena HG, Grenoville M and Murtagh P: Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings. Pediatr Pulmonol. 45:1180–1185. 2010. View Article : Google Scholar : PubMed/NCBI