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Vol. 13. Issue 4.
Pages 495-509 (July - August 2007)
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Vol. 13. Issue 4.
Pages 495-509 (July - August 2007)
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Pos-infectious bronchiolitis obliterans in children
Bronquiolite obliterante pós-infecciosa na criança
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Ana Luísa Lobo1,6,*, Micaela Guardiano2,6, Teresa Nunes3,6, Inês Azevedo4,6, Luísa Guedes Vaz5,6, Álvaro Aguiar7
1 Assistente Eventual de Pediatria – Serviço de Pediatria, Hospital Padre Américo / Future Paediatrics Consultant – Paediatric Unit, Hospital Padre Américo
2 Assistente Eventual de Pediatria – Departamento de Pediatria, Hospital de S. João / Future Paediatrics Consultant – Paediatric Unit, Hospital de S. João
3 Assistente Hospitalar Graduada – Departamento de Pediatria, Hospital de S. João / Specialist Consultant – Paediatric Unit, Hospital de S. João
4 Professora Auxiliar de Pediatria – Faculdade de Medicina do Porto / Assistant Professor, Paediatrics – Faculdade de Medicina do Porto
5 Chefe de Serviço – Departamento de Pediatria, Hospital de S. João / Head, Paediatric Unit, Hospital de S. João
6 Departamento de Pediatria – Hospital de São João / Paediatric Unit – Hospital de São João,
7 Director de Departamento, Alameda Professor Hernâni Monteiro 4200 – Porto Portugal
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Article information
Abstract

Bronchiolitis obliterans (BO) is a rare disease in immunocompetent children that usually occurs after infection of the lower airways. While a diagnosis of BO was usually confirmed by lung biopsy, identification of prior lung lesion plus a typical clinical course and a suggestive chest X-ray and CT scan have replaced the need for more invasive procedures.

The authors reviewed the clinical records of 10 BO patients, followed in the Outpatients Paediatric Pulmonology Unit from January 1997 to De cember 2002, to identify the most common aetiology, clinical and radiological profiles, treatment and course.

All patients maintained cough and/or wheezing after the initial acute episode. 80% had failure to thrive at the time of the diagnosis, mean age 16 months. Viral pneumonia was the main initial event (5 adenovirus, 3 respiratory syncytial virus, 1 parainfluenza virus, 1 unknown). Lung biopsies were not performed as clinical and radiological presentations were typical of BO. The follow-up (mean 36 months) revealed clinical resolution in 3 children and persistent symptoms in 6. One patient had progressive respiratory failure and died.

Prompt recognition of the diagnosis with supportive treatment that included oxygen therapy and an aggressive nutrition plan helped to improve the clinical state of the children.

Key-words:
Bronchiolitis obliterans
adenovirus
aetiology
diagnosis
evolution
children
Resumo

Na criança imunocompetente, a bronquiolite obliterante (BO) é uma doença rara que geralmente ocorre após uma infecção vírica das vias aéreas inferiores. O diagnóstico de BO era, tradicionalmente, confirmado por biópsia pulmonar. Contudo, a identificação de lesão pulmonar prévia, aliada à evolução clínica típica, radiografia e tomografia computorizada sugestivas, substituíram a necessidade de procedimentos mais invasivos. Os autores fizeram uma revisão dos processos clínicos das crianças, com o diagnóstico de BO (n=10) em seguimento numa consulta externa de pneumo-logia pediátrica, entre Janeiro de 1997 e Dezembro de 2002, com o objectivo de determinar etiologia, apresentação clínica, alterações imagiológicas, tratamento e evolução mais frequentes.

Todas as crianças com o diagnóstico de BO apresentavam tosse e/ou pieira persistentes após o episódio agudo inicial. Na altura, 80% das crianças tinham má evolução ponderal. A idade média de diagnóstico foi de 16 meses. O evento inicial foi uma pneumonia e, em 9 casos, identificou-se o agente causal (cinco adenovírus, três vírus sincicial respiratório, um parainfluenzae e um desconhecido). Na nossa casuística, nenhuma das crianças efectuou biópsia pulmonar, por a apresentação clínica e radiológica ser típica de BO. O seguimento, de 36 meses em média, revelou resolução clínica em 3 crianças e sintomas persistentes em 6. Uma criança morreu por falência respiratória progressiva. O reconhecimento rápido do diagnóstico e o tratamento de suporte, que inclui oxigenioterapia e plano nutricional agressivo, contribuíram para melhorar o estado clínico destas crianças.

Palavras-chave:
Bronquiolite obliterante
adenovírus
etiologia
diagnóstico
evolução
criança
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