Some Respiratory Symptoms Should Spark Suspicion of Bronchiectasis in Children

Some Respiratory Symptoms Should Spark Suspicion of Bronchiectasis in Children

A case report of a young girl calls attention to the need to evaluate children with recurrent respiratory symptoms for bronchiectasis.

The report, “Pediatric bronchiectasis: An orphan disease ending in pneumonectomy: A case report,” was published in the International Journal of Surgery Case Reports.

Bronchiectasis in children often appears differently than in adults and can vary with age and severity, clinicians note.

A chronic wet cough is the most common symptom in children at the disorder’s onset. The disease is a major cause of respiratory impairment in children in developing nations, who often remain undiagnosed.

A 10-year-old girl sought treatment at St. Paul’s Hospital Millennium Medical College, in Ethiopia, with an intermittent wet cough that had lasted for five weeks. The cough appeared alongside low-grade fever, shortness of breath, susceptibility to fatigue, and loss of appetite.

She reported having had similar complaints over the previous four years, which were treated as pneumonia, with antibiotics. The patient also experienced six to eight episodes of acute flare-ups per year. No personal or family history of relevant conditions was reported.

Upon examination, the clinicians found a diminished volume of air flowing through her lower left lung. A chest CT scan revealed a collapsed left lung with fluid in her bronchi, the airways from the trachea to the lungs.

The content of the girl’s chest cavity had shifted noticeably to the left and her right lung had hyperinflated to compensate for the collapse of the left.

An assessment of her airways showed further destruction of the bronchial wall and extensive pus secretion. The thickness of the pus secretions made suctioning difficult.

Lab tests of the fluid suctioned from the child’s airway revealed an infection by the antibiotic-resistant Staphyloccocus aureus bacteria.

The girl’s medical team diagnosed bronchiectasis with recurrent infection, leading to left lung collapse. They started her on intravenous (IV, or into-the-vein) antibiotics and provided her with oxygen through nasal tubing.

During surgery, the clinicians confirmed a hyperinflated right lung and a completely collapsed left lung with bronchiectasis.

After the procedure, the child was transferred to a pediatric intensive care unit, where she remained on oxygen, IV antibiotics, and painkillers. The lung tissue that was removed during surgery showed extensive signs of inflammation, fibrosis (scarring), and damaged blood vessels.

The patient’s recovery went smoothly, with doctors removing her chest tube on the fourth day after surgery. She was discharged in stable condition.

According to the investigators, delayed diagnosis in children often associates with lower socioeconomic status, as was the case with this girl’s family. Relatives had attributed her bronchiectasis to having been repeatedly treated for pneumonia.

“Although surgery is the last option of management for bronchiectasis especially for pediatric patients,” they wrote, “it is very difficult to salvage the lung once destroyed irreversibly.”

The medical team continues to monitor the girl, administering a chest X-ray every three months. A chest CT will be done annually for the coming two years.

The child’s respiratory and other symptoms had disappeared by the time the study was finished and she showed no further sign of infection.

“Neglected pediatric bronchiectasis is associated with significant morbidity and mortality,” the investigators wrote. “So, it should be considered as differential diagnosis in children with recurrent respiratory symptoms, as timely and prompt diagnosis is crucial for early intervention.”

The team also called for better education about concerning respiratory symptoms for pediatricians and other health care providers, especially in lower socioeconomic areas.

“It is also crucial to equip health care professionals with adequate knowledge about the disease as most pediatric patients like our case may not have productive cough like adults leading to misdiagnosis or significant delay in diagnosis,” they wrote.