PMID- 34674343
OWN - NLM
STAT- MEDLINE
DCOM- 20230105
LR  - 20230111
IS  - 1442-200X (Electronic)
IS  - 1328-8067 (Linking)
VI  - 64
IP  - 1
DP  - 2022 Jan
TI  - Is secondary tracheomalacia associated with airway inflammation and infection?
PG  - e15034
LID - 10.1111/ped.15034 [doi]
AB  - BACKGROUND: Recurrent lower respiratory tract infections are among the most 
      prevalent symptoms in secondary tracheomalacia due to mediastinal vascular 
      anomalies (MVAs). It is not known whether this condition could result in 
      persistent lower respiratory tract inflammation and subclinical infection. 
      METHODS: A retrospective study was performed on records of children with 
      tracheomalacia due to MVAs and recurrent respiratory infections who underwent 
      computed tomography scan, bronchoscopy, and bronchoalveolar lavage (BAL) as part 
      of their clinical evaluation. RESULTS: Thirty-one children were included in the 
      study: 21 with aberrant innominate artery, four with right aortic arch, one with 
      double aortic arch, and five with aberrant innominate artery associated with 
      right aortic arch. Cytological evaluation of bronchoalveolar lavage fluid showed 
      increased neutrophil percentages and normal lymphocyte and eosinophil 
      proportions. Microorganism growth was detected in 13 BAL samples, with a 
      bacterial load >/=10(4) colony-forming units/mL in eight (25.8%) of them. Most 
      isolates were positive for Haemophilus influenzae. Bronchiectasis was detected in 
      four children, all with BAL culture positive for H. influenzae. Four patients 
      underwent MVA surgical correction and 27 conservative management, i.e., 
      respiratory physiotherapy in all and high-dose amoxicillin/clavulanic acid 
      (40 mg/kg/day) for 2-4 weeks in those with significant bacterial growth. There 
      was an excellent outcome in most of them. CONCLUSIONS: Neutrophilic alveolitis is 
      detectable in secondary tracheomalacia but is associated with a clinically 
      significant bacterial load only in a quarter of the patients. Caution should be 
      used regarding inappropriate antibiotic prescriptions to avoid the emergence of 
      resistance, whilst airway clearance maneuvers and infection preventive measures 
      should be promoted.
CI  - (c) 2021 Japan Pediatric Society.
FAU - Capizzi, Antonino
AU  - Capizzi A
AD  - Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute 
      and University Hospital, Genoa, Italy.
FAU - Salvati, Pietro
AU  - Salvati P
AD  - Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute 
      and University Hospital, Genoa, Italy.
FAU - Gallizia, Annalisa
AU  - Gallizia A
AD  - Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute 
      and University Hospital, Genoa, Italy.
FAU - Rossi, Giovanni A
AU  - Rossi GA
AD  - Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute 
      and University Hospital, Genoa, Italy.
FAU - Sacco, Oliviero
AU  - Sacco O
AUID- ORCID: 0000-0002-9350-9134
AD  - Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute 
      and University Hospital, Genoa, Italy.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Pediatr Int
JT  - Pediatrics international : official journal of the Japan Pediatric Society
JID - 100886002
SB  - IM
MH  - Child
MH  - Humans
MH  - Infant
MH  - *Tracheomalacia/complications/diagnosis
MH  - Retrospective Studies
MH  - Bronchoalveolar Lavage
MH  - Bronchoalveolar Lavage Fluid
MH  - Inflammation
MH  - Bronchoscopy
MH  - Respiratory System
OTO - NOTNLM
OT  - airway anomaly
OT  - bronchiectasis
OT  - bronchoalveolar lavage
OT  - computed tomography
OT  - persistent bacterial bronchitis
EDAT- 2021/10/22 06:00
MHDA- 2023/01/06 06:00
CRDT- 2021/10/21 21:39
PHST- 2021/09/14 00:00 [revised]
PHST- 2021/04/29 00:00 [received]
PHST- 2021/10/01 00:00 [accepted]
PHST- 2021/10/22 06:00 [pubmed]
PHST- 2023/01/06 06:00 [medline]
PHST- 2021/10/21 21:39 [entrez]
AID - 10.1111/ped.15034 [doi]
PST - ppublish
SO  - Pediatr Int. 2022 Jan;64(1):e15034. doi: 10.1111/ped.15034.