Multiparametric assessment of children with recurrent and persistent lower respiratory tract infection

Abstract Background Lower respiratory tract infection (LRTI) refers to inflammation in the airways located below the larynx. LRTI encompasses several conditions, including bronchiolitis, wheeze-associated LRTI, bronchopneumonia, lobar pneumonia, and empyema. Persistent or recurrent pneumonia in children is considered notable challenge to pediatricians, thus assessment of those children needs multiple diagnostic tools including bronchoscopic evaluation using flexible bronchoscopy and subsequent multiparametric evaluation of bronchoalveolar lavage (BAL).The aim of this study was to assess the role of flexible bronchoscope in evaluation of those children, obtain BAL samples to find an etiology for LRTI. Method This prospective cross-sectional study included 60 pediatric patients, all subjected to flexible bronchoscopy and evaluation of BAL at gross, microscopic, microbiological, and chemical levels. Results Flexible bronchoscopy resulted in a precise diagnosis in 40% of the cases. The most common diseases diagnosed were congenital anomalies (15%), foreign body aspiration (8.3%) and mucus plugs (5%). BAL culture was positive in 36.7% of studied cases with commonest organism was Klebsiella (8.3%), about 54.5% of patients with positive cultures had biofilm formation, median total leucocytic count (TLC) of BAL was 200/HPF. The best cutoff value of TLC in BAL in diagnosis of bacterial infection is ≥ 375 with area under curve 0.875, sensitivity 90%, specificity 83.8%, positive predictive value, 75%, negative predictive value 93.9% an overall accuracy 86% ( p < 0.001). There was statistically significant relation between presence of bacterial LRTI (positive culture) and TLC in BAL ( p < 0.001), serum C reactive protein (CRP) ( p = 0.04). There was statistically non-significant relation between presence of bacterial LRTI and heparin binding protein (HBP). No significant complications were recorded following procedure. Conclusions Flexible bronchoscopy proved to be a safe effective tool in evaluation of children with persistent or recurrent LRTI.