Analysis Of Clinical Characteristics Of 39 Cases Of Plastic Bronchitis In Children

Objectives:The objective of this study was to retrospectively analyze the clinical characteristics,treatment and prognosis of 39 children with plastic bronchitis,to improve the understanding of this disease and improve the early diagnosis and appropriate therapy.Methods:Retrospective analysis was performed on children diagnosed with plastic bronchitis during hospitalization in the Second Department of Pediatric Respiratory,The First Hospital of Jilin University from January 2012 to December 2021,to collect the medical records of children and to perform analysis of the clinical characteristics and treatment of plastic bronchitis.Related clinical data including general information,symptoms,laboratory examination and imaging,bronchoscopic findings,treatment,and prognosis,were collected.Results:1.A total of 39 cases were enrolled,ranged from 17 months to 12 years,with a median of 4 years.Male to female ratio was 1.05:1.Patients mainly occurred in autumn and spring.The length of stay was 13.5±5.32 days averagely.Eight children had allergic history.One child was diagnosed as bronchial asthma after admission.2.Before admission,the course of illness ranged from 2 days to 2 months.All included patients had different degrees of cough.Other symptoms and signs included fever（92.3%）,wheezing（12.8%）,cyanosis（7.7%）,retraction sign of three fossae（17.9%）,moist rales（56.4%）,dry rales（15.4%）and weakened breath sounds（69.2%）.All symptoms were not specific.3.In terms of etiology,25 cases（64.1%）were single pathogen infection,13cases（33.3%）were mixed pathogen infection,and 1 case（2.6%）had no evidence of infection.Among the single pathogens,mycoplasma pneumoniae（68%）accounted for the largest proportion,and other pathogens included parainfluenza virus 3（4%）and streptococcus pneumoniae（4%）.In the mixed effect,except mycoplasma pneumoniae,other pathogens included chlamydia pneumoniae（23.1%）,Epstein-Barr virus（23.1%）,influenza virus（23.1%）,adenovirus（7.7%）and so on.4.On lung imaging,38 cases（97.4%）had inflammatory changes,and atelectasis（28.2%）,lung consolidation（10.3%）,pleural effusion（48.7%）were also suggested.There were 4 cases（10.3%）suspected to be with bronchial foreign bodies or bronchial changes.5.All 39 cases of plastic bronchitis were treated with fiberoptic bronchoscopy,to remove sputum plug.One case was assisted with alteplase under bronchoscopy.Among the plastic bronchitis cases with mycoplasma pneumoniae infection,the plastic distribution was mainly located in the right lower bronchus.Pathological examination was performed in 17 cases,and pathological classification was considered as Seear type I.6.After systematic treatment,37 cases improved and discharged from hospital,and 2 cases transferred to ICU and finally died.The idiopathic plastic bronchitis patient’s atelectasis relapsed after 2 months and 7 months later,and bronchoscopy suggested plastic recurrence.There was no recurrence in other post-infection plastic bronchitis cases.Conclusion:1.In this study,the pathological classification of pediatric plastic bronchitis was Seear type I,and the etiology was mainly secondary to respiratory tract infection,among which mycoplasma pneumoniae infection was most common.2.Flexible bronchoscopy is an important method in the diagnosis and treatment of plastic bronchitis.