Bronchiectasis: a bacteriological profile

Bronchiectasis: a bacteriological profile

 

Régis Gothard Bopaka^1,&, Wiam El Khattabi¹, Hind Janah¹, Hasna Jabri¹, Hicham Afif¹

 

¹Department of Respiratory Diseases, Hospital on August 20, UHC Ibn Rochd, Casablanca, Morocco

 

 

^&Corresponding author
Régis Gothard Bopaka, Department of Respiratory Diseases, Hospital on August 20, UHC Ibn Rochd, Casablanca, Morocco

 

 

 

 

Bronchiectasisis a common illness that is often underestimated. Its treatment is complicated by the fact that it presents clinical and bacteriological heterogeneity. It is a permanent and irreversible increase in the diameter of bronchial tubes from the third to the eight degree. It can be the consequence of many different factors including infection [1]. Bronchiectasis can develop complications which fall into four categories: chronic respiratory failure, hemoptysis, infection and amyloidosis. Infectious complications are the most prevalent, and can come with various bacteriological profiles. Secretions accumulate in the bronchi and cause infections and secondary infections. The goal of this study is to determine the bacteriological profile of this illness as identified in bronchiectasis patients.

 

 

This study retrospective was conducted between January 2010 and July 2013 with a selection of 100 patients hospitalized with bronchiectasis (patients have a pre-existing diagnosis before hospital admission and during hospitalization). Data was collected according to a premade that gathered personal data, medical history, and symptoms, as well as the results of a chest examination, X-ray, Computerized Tomography scan, and bacteriological examinations. The Computerized Tomography scan diagnosis criteria was a bronchus diameter greater than the associated artery diameter, bronchial tubes visualized at the level of external third of the lung parenchyma and the absence of progressive reduction of bronchial tubes, as they gradually than take away of the hilum [2]. The criteria qualities of the sputum sample were neutrophil higher than 25 elements, and lower than 10 epithelial cells/field, bacteria count upper than 107/ml. The criteria quality of the bronchoaspiration liquid is positive bacteriology (by germs count upper than 10⁵/ml). Data concerning treatment and the evolution of the illness were gathered as well. All data was analyzed using Epi Info Version 6.04. The difference is significant when p <0.05.

 

 

Patient backgrounds

 

All patients were of Moroccan origin. 58% of cases were female patients, and 42% were male patients. The average age was 48 years with extremes of 15 and 80 years.

 

Relevant medical history

 

Repeated respiratory infection in childhood was reported in 58% of cases. 35% of patients reported a history of tuberculosis. 2% of patients had Kartagener syndrome.

 

Symptoms

 

Bronchorrhea and purulent sputum was the most prevalent symptom, present in 90% of cases. Dyspnea was present in 76% of cases, and hemoptysis was present in 45% of cases.

 

Examination of the chest

 

Pleuropulmonary auscultation was normal in 25% of cases. Crackles were identified in 60% of cases and wheezing in the remaining 15% of cases.

 

Chest radiograph and computerized tomography scan: (Figure 1 and Figure 2) All cases of Bronchiectasis were confirmed by Computerized tomography scan. The scans identified diffuse lesions in 66% cases and localized lesions in 34% of cases.

 

Bacteriological examination

 

The sampling was performed before antibiotic therapy in 40% of cases and 60% of cases after having received antibiotic therapy before coming to the hospital. The bacteriological examination in all cases was able to isolate the infecting bacteria in 35% of cases (Table 1) and unable to isolate in 65% of cases. The method of successful isolation was examination of sputum cytology in 27 cases, examination of liquid bronchial aspiration in 5 cases, and targeted test for Mycobacterium tuberculosis in sputum in 3 cases.

 

Pulmonary function test

 

Obstructive lung disease was found in 37% of cases. Restrictive lung disease was found in 55% of cases. Pulmonary function test results were normal in the remaining 8% of cases.

 

Treatment

 

In 15% of cases, patients were started on empiric antibiotic therapy which was adapted according to the results of the susceptibility test and the patient's progression (Table 2). Tuberculosis treatment was administered in 3% of cases. Surgery (lobectomy) was performed in 16% of located and complicated bronchiectasis cases. All patients operated had a simple evolution. Bronchial drainage was employed in all cases.

 

Evolution

 

Chronic respiratory failure developed in 15% of cases. Infection presented in 13 % of cases. Only 5% of patients experienced more than 2 flare-ups within the year following the treatment. Favourable evolution was noted in 67% of cases.

 

 

The bacteriological profile of diffuse bronchiectasis according to geographical location, the stage of the disease, and the status of the patient immune system. Infections are responsible for oedema of the bronchial mucosa and are the principle elements in Cole's "vicious cycle" [1, 3]. This illness is more likely to affect females, as noted by multiple authors [4, 5]. In our study females represented a higher percentage than males, although the difference was not significant. The average age at which the infection showed in our patients was 48 years, which was lower than that of other studies. Martinez-Garcia MA et al found an average age 69.9 [5], and Darrien found that the infection presented in patients older than 50 years in 75% of cases [6]. The cause of bronchiectasis is difficult to determine, even after an exhaustive examination. The cause of bronchiectasis stays unknown in 50% cases [6]. In our study, the microbe was isolated in only 35% of the cases. The rate of positive bacteriology is relatively low for the hospitalized bronchiectasis cohort. This observation is probably linked to the selection bias inherent in the sampling for 60% of patients received antibiotic therapy before coming to the hospital. The occurrence of bronchiectasis often implicates the conjunction of multiple environmental factors, especially factors that are bacterial in nature. Previous respiratory infections were noted in more than half of patients in the existing literature, but this decreased with the arrival of antibiotics and vaccinations [2, 7]. We found previous childhood respiratory infections in less than 50% of our cases. Tuberculosis can also be responsible for bronchiectasis, as was found in certain cases of our study. Symptomology is not specific for bronchiectasis, as bronchorrhea or dyspnea can be seen in the course of chronic bronchitis [6]. Likewise hemoptysis is not specific to bronchiectasis. An inflammation or infection in the lungs causes this type of hemoptysis [6], however it is one of the greatest causes of bronchiectasis [8]. Normal pleuropulmonary auscultation does not exclude a diagnosis according to this study. The presence of crackles is often evidence of parenchymatous infection and secondary infection. Thecomputed tomography (CT) scan of the chest sets the diagnosis of bronchiectasis. At the same time it allows the doctor to assess extent of the lesions and can indicate an etiological diagnosis. The scan has transformed the diagnostic approach to bronchiectasis particularly as it can detect smaller lesions that pass unseen on a chest x-ray [9-11]. A bacteriological examination must be systematically given to any patient presenting bronchiectasis. This test sometimes makes it possible to isolate the infecting microbe, as 35% of the cases in our study. Some authors have found similar numbers [12], while others have found lower or higher percentages [12, 13] (Table 3). Cytobacteriogical testing of sputum has an important place in this process. In our study this test allowed us to isolate the bacterium in 27% of cases. Examination of liquid bronchial aspiration can also accurately isolate bacterium [14], as was achieved in 5 % of cases in our study. Among the bacteria identified, Streptococcus pneumoniae and Pseudomonas aeruginosa were the first and second-most frequently found in our study, respectively 11% and 10% of cases. However, the literature generally presents the most frequently found bacteria as Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pneumoniae, in order of decreasing frequency [2]. This difference, especially with regards to Haemophilus influenza, could be due to the relatively younger age of our patients, as Haemophilus influenza is most often found in children and the elderly. Bacteria such as Pseudomonas aeruginosa can grow into a colony within their hosts. The presence of a Pseudomonas aeruginosa colony is correlated with decreased quality of life [15, 16]. It is an independent factor associated with an accelerated decline in respiratory function [5]. It presents in later stages of bronchiectasis and marks a downward turning point in the progression of the disease [5, 16-18]. The testing of sputum for Koch's bacillus must be performed. Mycobacterium tuberculosis was found in 3 patients (3%) in our study, while other authors found as many as 9 cases in a study of 91 patients with bronchiectasis [19]. The progression and prognosis for bronchiectasis are a function of how widespread the lesions are and the medical history of the patient [6]. Chronic respiratory failure is the most reliable evidence of bronchiectasis that has been developing over the course of several years.

 

 

Through this work, the authors emphasize that the bacteriological profile of bronchiectasis is variable. Streptococcus pneumoniae and Pseudomonas aeruginosa were the most commonly isolated bacteria in their patients. The presence of Pseudomonas aeruginosa has a poor prognosis. Regular and repeated bacterial checkups are necessary over the course of bronchiectasis.

 

 

The authors declare no competing interest.

 

 

All authors have read and agreed to the final version of this manuscript and have equally contributed to its content and to the management of the case.

 

 

Table 1: bacteriological profil

Table 2: bacterial infections and/or bacterial super infections

Table 3: comparing data between the study publications and our study

Figure 1: chest radiograph of a patient with bronchiectasis diffus

Figure 2: computerized Tomography scan of patient with bronchiectasis diffus

 

 

1. Cole PJ. Inflammation: a two-edged sword-the model of bronchiectasis. Eur J Respir Dis Suppl. 1986; 147: 6-15. PubMed | Google Scholar


2. Journeau S, Kerjouan M, Desrues B, Delaval P. Dilatation des bronches. In: Lemarié E. La pneumologie fondée sur les preuves, Paris, Margaux Orange, 2013; pp. 195-214. Google Scholar


3. Barker AF, Bardana EJ Jr. Bronchiectasis: update of an orphan disease. Am Rev Respir Dis. 1988 Apr;137(4):969-78. PubMed | Google Scholar


4. Minov J, Karadzinska-Bislimovska J, Vasilevska K, Stoleski S, Mijakoski D. Assessment of the Non-Cystic Fibrosis Bronchiectasis Severity : The FACED Score vs the Bronchiectasis Severity Index. Open Respir Med J. 2015 Mar 31; 9: 46-51. PubMed | Google Scholar


5. Martinez-Garcia MA, Soler-Cataluna JJ, Perpina-Tordera M, Roman-Sanchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007 Nov; 132(5): 1565-72. PubMed | Google Scholar


6. Pasteur MC, Helliwell SM, Houghton SJ, Webb SC, Foweraker JE, Coulden RA et al. An invetigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med. 2000 Oct; 162(4 Pt 1): 1277-84. PubMed | Google Scholar


7. Pasteur MC, Bilton D, Hill AT. British Thoracic Society Guideline for non-CF bronchiectasis. Thorax. 2010 Jul;65 Suppl 1: i1-58. PubMed | Google Scholar


8. Orriols R, Núñez V, Hemando R, Drobnic E, Moreiras M. Life-threatning hemoptysis: study of 154 patients. Med Clin (Barc). 2012 Sep 8; 139(6): 255-60. PubMed | Google Scholar


9. Remy J, Marache P. Les bronchectasies. In Bismuth V BM, Remy J: Traité de radiodiagnostic. 2 Masson: 1979; 349-67. Google Scholar


10. Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthris: Clinicat, functional, and HRCT findings. Am J Respir Crit Care Med. 1998 May; 157(5 Pt 1): 1658-65. PubMed | Google Scholar


11. Hill AT, Pasteur M, Cornford C, Welham S, Bilton D. Primary care summary of the British Thorac Society Guideline on the management of non-cystic fibrosis bronchiectasis. Prim Care Respir J. 2011 Jun; 20(2): 135-40. PubMed | Google Scholar


12. Wilson CB, Jones PW, O'Leary CJ, Hansell DM, Cole PJ, Wilson R. Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. Eur Respir J. 1997 Aug; 10(8): 1754-60. PubMed | Google Scholar


13. Hare KM, Brinks MJ, Grimwood K, Chang AB, Leach AJ, Smith-Vaughan H. Culture and PCR detection of Haemophilus influenzae and Haemophilus haemolyticus in Australien indigenous children with bronchiectasis. J Clin Microbiol. 2012; 50:2444-5. PubMed | Google Scholar


14. Charlson ES, Bittinger K, Haas AR, Fitzgerald AS, Frank I, Yadav A et al. Topographical continuity of bacterial populations in the healthy human respiratory tract. Am J Respir Crit Care Med. 2011; 184(8): 957-63. PubMed | Google Scholar


15. Wilson CB, Jones PW, O'leary CJ, Hansell DM, Cole PJ, Wilson R. Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. Eur Respir J. 1997 Aug; 10(8): 1754-60. PubMed | Google Scholar


16. Davies G, Wells AU, Doffman S, Watanabe S, Wilson R. The effect of Pseudomonas aeruginosa on pulmonary fonction in patients with bronchiectasis. Eur Respir J. 2006 Nov; 28(5): 974-9. PubMed | Google Scholar


17. Miszkiel KA, Wells AU, Rubens MB, Cole PJ, Hansell DM. Effects of airway infection by Pseudomonas aeruginosa: a computed tomographic study. Thorax. 1997 Mar; 52(3): 260-4. PubMed | Google Scholar


18. Evans SA, Tuner SM, Bosch BJ, Hardy CC, Woodhead MA. Lung function in bronchiactasis: The influence of pseudomonas aeruginosa. Eur Respir J. 1996 Aug; 9(8): 1601-4. PubMed | Google Scholar


19. Chan CH, Ho AK, Chan RC, Cheung H, Cheng AF. Mycobacteria as a cause of infective exacerbation in bronchectasis. Postgrad Med J. 1992 Nov; 68(805): 896-9. PubMed | Google Scholar