Journal Information
Vol. 13. Issue 4.
Pages 495-509 (July - August 2007)
Share
Share
Download PDF
More article options
Vol. 13. Issue 4.
Pages 495-509 (July - August 2007)
Artigo Original / Original Article
Open Access
Bronquiolite obliterante pós-infecciosa na criança
Pos-infectious bronchiolitis obliterans in children
Visits
7365
Ana Luísa Lobo1,*, Micaela Guardiano2, Teresa Nunes3, Inês Azevedo4, Luísa Guedes Vaz5
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
This item has received

Under a Creative Commons license
Article information
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, radio-grafia e tomografia computorizada sugestivas, substi-tuíram 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 apresen-tavam 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 parain-fluenzae e um desconhecido). Na nossa casuística, ne-nhuma 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.

Rev Port Pneumol 2007; XIII (4): 495-509

Palavras-chave:
Bronquiolite obliterante
adenovírus
etiologia
diagnóstico
evolução
criança
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 December 2002, to identify the most common aetio-logy, 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.

Rev Port Pneumol 2007; XIII (4): 495-509

Key-words:
Bronchiolitis obliterans
adenovirus
aetiology
diagnosis
evolution
children
Full text is only aviable in PDF
Bibliografia / Bibliography
[1.]
J.L. Wright, P. Cagle, A. Chung, et al.
Diseases of small airways.
Am Rev Respir Dis, 146 (1992), pp. 240-262
[2.]
K.A. Hardy, D.V. Schidlow, N. Zaeri.
Obliterative bron-chiolitis in children.
Chest, 93 (1998), pp. 460-466
[3.]
J.L. Myers, T.V. Colby.
Pathologic manifestations of bronchiolitis, constrictive bronchiolitis, cryptogenic organising pneumonia and diffuse panbronchiolitis.
Clin Chest Med, 1 (1993), pp. 611-622
[4.]
H. Popper.
Bronchiolitis, an update.
Virchows Arch, 437 (2000), pp. 471-481
[5.]
T. Mauad, M. Dolhnikoff.
Sao Paulo Bronchiolitis Obliterans Study Group. Histology of childhood bronchiolitis obliterans.
Pediatr Pulmonol, 33 (2002), pp. 466-474
[6.]
M.D. Calabria.
Bronchiolitis obliterans in the child.
Allergol Immunopathol, 23 (1995), pp. 267-270
[7.]
P.W.K. Chan, R. Muridan, J.A. DeBruyne.
Bronchiolitis obliterans in children: clinical profile and diagnosis.
Respirology, 5 (2000), pp. 369-375
[8.]
A. Teper, G.B. Fischer, M.H. Jones.
Respiratory sequela of viral disease: from diagnosis to treatment.
J Pediatr (Rio J), 78 (2002), pp. S187-S194
[9.]
L. Zhang, F. Abreu e Silva.
Bronquiolite obliterante em crianças.
J Pediatr (Rio J), 76 (2000), pp. 185-192
[10.]
T. Higuchi, A. Jaramillo, Z. Kaleem, G.A. Patterson, T. Mohanakumar.
Different Kinetics of obliterative airway disease development in heterotopic murine tracheal allografts induced by CD4+ and CD8+ Tcells.
Transplantation, 74 (2002), pp. 998-1005
[11.]
G.I. Snell, C. Ward, J.W. Wilson, B. Orsida, T.J. Williams, E.H. Walters.
Immunopathological changes in the airways of stable lung transplant recipients.
Thorax, 52 (1997), pp. 1762-1766
[12.]
T.T. Mauad, A. Van Schadewijk, J. Schrumpf, C.E. Hack, S. Fernezlian, A.L. Garippo, B. Ejzenberg, P.S. Hiemstra, K.F. Rabe, M. Dolhnikoff.
Sao Paulo BO Study Group. Lymphocytic inflammation in childhood bronchiolitis obliterans.
Pediatr Plumonol, 38 (2004), pp. 233-239
[13.]
C.D. Eber, P. Stark, P. Bertozzi.
Bronchiolitis obliterans on high-resolution CT. A pattern of mosaic oligemia.
J Comput Assist Tomogr, 17 (1993), pp. 853-856
[14.]
D.M. Lau, M.J. Siegel, C.F. Hildebolt, et al.
Bronchiolitis obliterans syndrome: Thin-section CT diagnosis of obstructive changes in infants and young children after lung transplantation.
Radiology, 208 (1998), pp. 783-788
[15.]
C.K. Kim, S.W. Kim, J.S. Kim, et al.
Bronchiolitis obliterans in the 1990 in Korea and the United States.
Chest, 120 (2001), pp. 1101-1106
[16.]
A.B. Chang, J.P. Masel, B. Masters.
Pos-infectious bronchiolitis obliterans: clinical, radiological and pulmonary functional sequelae.
Pediatr Radiol, 28 (1998), pp. 23-29
[17.]
T.W. Ferkol, P.B. Davis.
Bronchiectasis and Bronchiolitis Obliterans.
Pediatric Respiratory Medicine, pp. 784-792
[18.]
M.R. Kramer, C. Stoher, J.L. Whang, et al.
The diagnosis of obliterative bronchiolitis after heart-lung transplantation: Low yield of transbronchial lung biopsy.
J Heart Lung Transplant, 12 (1993), pp. 675-681
[19.]
A.D. Milner, M. Murray.
Acute bronchiolitis in infancy: treatment and prognosis.
Thorax, 44 (1989), pp. 1-5
[20.]
K.A. Hardy.
Obliterative Bronchiolitis.
Pediatric Respiratory Disease: diagnosis and treatment, pp. 218-221
[21.]
T. Costa, V. Alves, T. Nunes, et al.
Infecção pulmonar por adenovírus.
Experiência da Unidade de Pneumologia Pediátrica. Acta Pediátrica Portuguesa, 30 (1999), pp. 185-190
[22.]
G.R. Epler, T.V. Colby, T.C. Macloud, C.B. Carrington, E.A. Gaensler.
Bronchiolitis obliterans organizing pneumonia.
N Engl J Med, 312 (1985), pp. 152-158
[23.]
L. Zhang, K. Irion, H. Kozakewich, et al.
Clinical course of postinfectious bronchiolitis obliterans.
Pediatr Pulmonol, 29 (2000), pp. 341-350
Copyright © 2007. Sociedade Portuguesa de Pneumologia/SPP
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?