Although rare in children, bronchiectasis should still be considered in the differential diagnosis of young patients with persistent wet or productive cough, a case report says.
In such cases, the presence or absence of the disease should rapidly be confirmed or ruled out by a high-resolution computerized tomography (HRCT) chest scan, researchers said.
The study, “Bronchiectasis with secondary pulmonary infection in a child,” was published in the journal Medicine.
Despite being regarded as a chronic pulmonary disease that occurs in adulthood, bronchiectasis may also affect children. Delays in its diagnosis are thought to occur more frequently in younger patients.
“It is likely that many [children] remain undiagnosed and untreated, risking premature and accelerated pulmonary decline,” the investigators from China and Canada wrote.
In the article, they described the case of a young girl with bronchiectasis who was diagnosed only after having an acute disease episode associated with a secondary lung infection.
The 8-year-old girl was admitted to the Shanghai Children‘s Hospital in China after seven days of experiencing shortness of breath, low-grade fever — 37.8 C or 100.04 F — and purulent fetid sputum (mucus expelled while coughing).
She started having these symptoms around age 4, and since then had been hospitalized multiple times due to repeated lower respiratory tract infections, her mother said. The girl had no history of any other medical conditions, and none of her family members experienced the same type of respiratory symptoms.
She was undernourished at first examination and had abnormal crackling sounds when breathing, which were detected during auscultation.
An HRCT chest scan revealed abnormally large bronchi (small lung airways), as well as signs of inflammation in both lungs.
She also underwent a bronchoscopy — a procedure in which a flexible, lighted tube is inserted through the mouth or nose to examine the bronchi — which showed a large amount of thick sticky mucus in the lung airways. In turn, lung function tests found airway obstruction.
Physicians then collected fluid samples from the girl’s most inflamed bronchi to determine which types of microbes could be causing her repeated lung infections. Tests revealed the presence of Pseudomonas aeruginosa, an opportunistic bacteria that frequently causes respiratory infections in people with cystic fibrosis (CF) and bronchiectasis.
Genetic tests performed afterwards ruled out CF and primary ciliary dyskinesia as the causes of her repeated respiratory infections.
The girl was then diagnosed with bronchiectasis associated with a secondary pulmonary infection and started treatment with cefoperazone-sulbactam, a broad-spectrum antibiotic often used to treat acute bacterial infections.
Her symptoms gradually eased over the next two weeks, and she was discharged with indications to remain on long-term prophylactic (preventive) antibiotic treatment with amoxicillin-clavulanic acid to prevent future lung infections.
Although bronchiectasis is typically deemed a disease of adulthood, “diagnosis should be considered in children with persistent symptomatology … [and] confirmed by a chest HRCT scan,” the investigators wrote.