Post Infectious Bronchiolitis Obliterans in Children

doi:10.1016/j.prrv.2010.07.005

Paediatric Respiratory Reviews

Volume 11, Issue 4, December 2010, Pages 233-239

https://doi.org/10.1016/j.prrv.2010.07.005 Get rights and content

Summary

Bronchiolitis Obliterans (BO) is an infrequent chronic and obstructive lung disease secondary to an insult to the terminal airway and its surroundings. In children, the most common presentation is the post-infectious variant, closely related to a severe viral infection in the first three years of life. However, the increase in the number of lung and bone-marrow transplants has also been followed by an increase in post-transplant BO. Post-transplant BO is progressive while post-infectious BO does not seem to be, but both forms share some common pathways that result in a characteristic histopathology of bronchiolar obliteration. This review covers up-to-date evidence on epidemiology, diagnosis, treatment and prognosis of post-infectious bronchiolitis obliterans, including areas of controversy that need to be addressed in future studies.

Introduction

Bronchiolitis Obliterans is a rare form of chronic obstructive lung disease secondary to a severe insult to the lower respiratory tract that leads to a variable degree of inflammation and scarring. The ultimate result of this process is the narrowing and/or complete obliteration of the small airways.¹ In children, the most common form is post-infectious bronchiolitis obliterans (PBO), except in locations with a considerable number of paediatric lung or bone marrow transplant recipients.

As a disease, PBO has been reported in North and South America, Western and South-Eastern Europe, India, South-Korea, Taiwan, Malaysia, New Zealand, and Australia. In the last two decades of the 20^th century, South American countries accumulated an unexpected number of cases: more than seven hundred, according to the Bronchiolitis Obliterans in Latin America (BOLAT) initiative. This review covers important information on the epidemiology, risk factors, diagnosis, imaging, lung function, treatment and prognosis of PBO.

Section snippets

Epidemiology

There are reports of PBO secondary to influenza, parainfluenza, measles, respiratory syncytial virus, varicella, and Mycoplasma pneumoniae. However, adenovirus (Ad) is by far the most common agent linked to the development of PBO.2, 3, 4 Thus, although the prevalence of PBO is not known, its epidemiology is directly related to the epidemiology of severe viral respiratory tract infections in young children, particularly of adenoviral aetiology. The serotypes mostly involved are Ad3, Ad7 and

Conclusion

Post-infectious bronchiolitis obliterans is an infrequent chronic obstructive pulmonary disease that develops in children as sequelae of a severe viral LRTI that injured irreversibly the bronchiolar micro-environment. The diagnosis is reached only through the integration of clinical, radiological and laboratory data suggestive of the disease. The treatment requires a multidisciplinary strategy and a multi-centred approach to address the challenges in terms of defining the molecular pathology,

Practice points

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Post-infectious bronchiolitis obliterans is a chronic obstructive lung disease occurring in children following a severe viral lower respiratory tract infection during their first two years of life.
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Mechanical ventilation and adenoviral infection are two strong risk factors for the development of the disease.
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The diagnostic approach should be based on the summation of clinical, microbiological, epidemiological and imaging information.
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Lung function is characterized by a moderately severe to severe

Educational aims

The reader will become familiar with:

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The risk factors and epidemiology of post-infectious bronchiolitis obliterans (PBO)
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The diagnostic criteria of PBO
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The importance of imaging and pulmonary function testing in the diagnosis and follow-up of PBO
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The multidisciplinary strategy for treating PBO
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What is known about outcomes and prognosis of PBO

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References (48)

C.K. Kim et al.
Bronchiolitis obliterans in the 1990s in Korea and the United States
Chest.
(2001)
G.B. Fischer et al.
Acute viral bronchiolitis and its sequelae in developing countries
Paediatr Respir Rev.
(2002)
A.L. Lobo et al.
Pos-infectious bronchiolitis obliterans in children
Rev Port Pneumol.
(2007)
K.A. Hardy et al.
Obliterative bronchiolitis in children
Chest.
(1988)
T. Mauad et al.
Histology of childhood bronchiolitis obliterans
Pediatr Pulmonol.
(2002)
L. Zhang et al.
Clinical course of postinfectious bronchiolitis obliterans
Ped Pulmonol.
(2000)
A.J. Colom et al.
Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis
Thorax.
(2006)
A.E. Kajon et al.
Molecular epidemiology of adenovirus acute lower respiratory infections of children in the south cone of South America (1991–1994)
J Med Virol.
(1996)
C. Larranaga et al.
Adenovirus surveillance on children hospitalized for acute lower respiratory infections in Chile (1988-1996)
J Med Virol.
(2000)
P. Murtagh et al.
Lower respiratory infections by adenovirus in children. Clinical features and risk factors for bronchiolitis obliterans and mortality
Pediatr Pulmonol.
(2009)

J.A. Castro-Rodriguez et al.

Adenovirus pneumonia in infants and factors for developing bronchiolitis obliterans: a 5-year follow-up

Pediatr Pulmonol.

(2006)

A.M. Teper et al.

Association between HLA and the incidence of Bronchiolitis Obliterans in Argentina

Am J Respir Crit Care Med.

(2004)

V.L. Bosa et al.

Assessment of nutritional status in children and adolescents with post-infectious bronchiolitis obliterans

J Pediatr (Rio J).

(2008)

J. Lee et al.

Comprehensive serotyping and epidemiology of human adenovirus isolated from the respiratory tract of Korean children over 17 consecutive years (1991–2007)

J Med Virol.

(2010)

Callaway Z, Kim SH, Kim JY, Kim DW, Kim C-K. Adenovirus infection with serious pulmonary sequelae in Korean children....

P.W. Chan et al.

Bronchiolitis obliterans in children: clinical profile and diagnosis

Respirology.

(2000)

M.H. Jones et al.