title: Wheeze in preschool age is associated with pulmonary bacterial infection and resolves after antibiotic therapy.
abstract: BACKGROUND
  Neonates with airways colonized by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis are at increased risk for recurrent wheeze which may resemble asthma early in life. It is not clear whether chronic colonization by these pathogens is causative for severe persistent wheeze in some preschool children and whether these children might benefit from antibiotic treatment. We assessed the relevance of bacterial colonization and chronic airway infection in preschool children with severe persistent wheezing and evaluated the outcome of long-time antibiotic treatment on the clinical course in such children.
  
  
  RESULTS
  Preschool children (n = 42) with severe persistent wheeze but no symptoms of acute pulmonary infection were investigated by bronchoscopy and bronchoalveolar lavage (BAL). Differential cell counts and microbiological and virological analyses were performed on BAL samples. Patients diagnosed with bacterial infection were treated with antibiotics for 2-16 weeks (n = 29). A modified ISAAC questionnaire was used for follow-up assessment of children at least 6 months after bronchoscopy. Of the 42 children with severe wheezing, 34 (81%) showed a neutrophilic inflammation and 20 (59%) of this subgroup had elevated bacterial counts (≥ 10⁴ colony forming units per milliliter) suggesting infection. Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were the most frequently isolated species. After treatment with appropriate antibiotics 92% of patients showed a marked improvement of symptoms upon follow-up examination.
  
  
  CONCLUSIONS
  Chronic bacterial infections are relevant in a subgroup of preschool children with persistent wheezing and such children benefit significantly from antibiotic therapy.
authors.affiliation: Department of Pneumology, Allergy and Neonatology, University Children's Hospital, Hanover Medical School, Hanover, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Schwerk
authors.forename: Folke
authors.initials: F
authors.lastname: Brinkmann
authors.forename: Bisharah
authors.initials: B
authors.lastname: Soudah
authors.forename: Michael
authors.initials: M
authors.lastname: Kabesch
authors.forename: Gesine
authors.initials: G
authors.lastname: Hansen
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000382:microbiology; D002675:Child, Preschool; D015169:Colony Count, Microbial; D005260:Female; D006098:Granulocytes / Q000187:drug effects; D006801:Humans; D008297:Male; D012135:Respiratory Sounds / Q000187:drug effects* / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000150:complications* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents