Complications of Pneumonia: Postinfective Bronchiolitis Obliterans

Chapter 65


image


Complications of Pneumonia: Postinfective Bronchiolitis Obliterans


Paul C. Stillwell, MD, FAAP, and Deborah R. Liptzin, MD, MS, FAAP


Introduction/Etiology/Epidemiology


Obliterative bronchiolitis, or bronchiolitis obliterans, is obliteration of the small brochiolar airways with fibrinoproliferative material.


It occurs in a variety of settings (Box 65-1).


In North America, it occurs infrequently after viral infection and more commonly after lung transplantation or hematopoietic stem cell transplantation.


In indigenous populations, it is commonly seen after viral infections (postinfectious bronchiolitis obliterans).



Box 65-1. Underlying Systemic Disease or Trigger for Development of Obliterative Bronchiolitis










































Autoimmune disease Posttransplant causes
Rheumatoid arthritis Hematopoietic stem cell transplant
Sjogren syndrome
Systemic lupus erythematosus Lung transplant
Inhalational agents Aspiration
Sulfur mustard
Nitrogen oxides Stevens-Johnson syndrome
Mold
Avian antigens
Others
Infections
Adenovirus
Measles
Mycoplasma
Others

Clinical Features


Signs of obliterative bronchiolitis are inspiratory crackles, barrel chest, hypoxemia, and tachypnea.


Symptoms of obliterative bronchiolitis are cough, dyspnea, and wheezing.


Signs and symptoms may be subtle. Dyspnea is often very prominent, even with minimal exertion.


Diagnostic Considerations


The standard of reference for diagnosis is lung biopsy; however, disease can be patchy and missed at biopsy (particularly transbronchial biopsy).


The pathologic process causes the airways to be narrowed or completely obliterated; airway fibrosis will be present.


At pulmonary function testing, obstruction and air trapping will be found, typically with minimal postbronchodilator improvement (Figure 65-1).


Chest radiographs show variable, nonspecific findings that range from patchy to diffuse air space opacity (Figure 65-2). Computed tomographic (CT) findings are more specific and include air trapping, mosaic perfusion, and vascular attenuation, with or without bronchiectasis (Figure 65-3).


Mosaic perfusion appears as areas of decreased attenuation that are darker on CT images, due to decreased perfusion.


Vascular attenuation appears as loss of blood vessel visibility in areas of decreased lung perfusion.


Lung transplant recipients with a clinically significant change in pulmonary function test results (obstruction) without a lung biopsy have bronchiolitis obliterans syndrome.


Treatment


Treatment is based on expert opinion and on adult trials for bronchiolitis obliterans syndrome.


Monitor the patient for hypoxemia with exercise and at night, and treat as needed.


Monitor the patient for pulmonary hypertension, and treat as needed.


Consult with a pediatric pulmonologist with expertise in children’s interstitial and diffuse lung disease.


Common medication regimens are listed in Table 65-1.


Adult studies also suggest fluticasone, azithromycin, and montelukast.


If the patient also has bronchiectasis, airway clearance and early antibiotics should be initiated for a cough.


image


Figure 65-1. Pulmonary function testing demonstrates severe obstruction in obliterative bronchiolitis. ex = expiratory, FEF25%-75% = forced expiratory flow between 25% and 75% of vital capacity, FEV 1 = forced expiratory volume in 1 second, F/V = flow-volume, FVC = forced vital capacity, in = inspiratory, PEF = peak expiratory flow, Ref = reference, VBe = volume backextrapolation, Vol = volume.


image


Figure 65-2. Obliterative bronchiolitis in a 10-year-old boy with leukemia. Frontal chest radiograph demonstrates nonspecific bilateral, diffuse air space opacity. Note the central line overlying the left brachiocephalic vein.


image


Figure 65-3. Obliterative bronchiolitis in a patient after having Stevens-Johnson syndrome. Axial chest computed tomographic image demonstrates regions of mosaic perfusion (typical of obliterative bronchiolitis) scattered between areas of normal lung. The mosaic perfusion areas can be recognized by the well-defined margins and low attenuation due to decreased visualization of the normal vascular structures.


























Table 65-1. Treatment for Obliterative Bronchiolitis
Treatment Dose Interval
Methylprednisolone IV 10–30 mg/kg for 3 d Every month
IV immunoglobulin IV 2 g/kg for 1 d Every month
Azithromycin 10 mg/kg by mouth (maximum, 500 mg)
Alternate dosing:
18.0–35.9 kg: 250 mg
>36.0 kg: 500 mg
3 d a week

IV, intravenous.


Prognosis


Few outcome data exist in children.


Some patients, especially those with postinfectious bronchiolitis obliterans, may have stable lung function for years.


Other patients may have progressive disease despite therapy.


Once fibrosis has set in, reversal of the disease may be challenging.


There may be a role for antifibrotic therapy in this population.


When to Refer


Establishing the correct diagnosis


Treatment induction and maintenance therapy


Disease follow-up and management of exacerbations


Resource for Families


What Is Interstitial Lung Disease in Children? (American Thoracic Society) www.thoracic.org/patients/patient-resources/resources/interstitial-lung-disease-in-children.pdf


Clinical Pearls


Consider a diagnosis of obliterative bronchiolitis in patients who have new shortness of breath, exercise intolerance, and/or crackles after a hematopoietic stem cell transplant or lung transplant.


A diagnosis of obliterative bronchiolitis should also be considered in patients with a history of severe pneumonia, particularly with adenovirus, Stevens-Johnson syndrome, or measles, and poorly reversible airway obstruction (“atypical asthma”).



Part IV Bibliography


CHAPTER 45: UPPER RESPIRATORY INFECTIONS


Asher IM, Grant CC. Infections of the Upper Respiratory Tract. In: Pediatric Respiratory Medicine. 2nd ed. Mosby; 452–480


Wald ER, Applegate KE, Bordley C, et al; American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262–e280


Morris PS. Upper respiratory tract infections (including otitis media). Pediatr Clin North Am. 2009;56(1):101–117, x


Bush A. Recurrent respiratory infections. Pediatr Clin North Am. 2009;56(1):67–100, x


Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD; TARGET Programme Team. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347:f7027


Dziechiolowska-Baran E, Gawlikowska-Sroka A, Mularczyk M. Disease of the upper respiratory tract in preschool and school age children in ambulatory ear nose throat practice. Adv Exp Med Biol. 2015;16:35–41


CHAPTER 46: LARYNGITIS


Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349:g5827


Tulunay OE. Laryngitis—diagnosis and management. Otolaryngol Clin North Am. 2008;41(2):437–451, ix


Klassen TP. Recent advances in the treatment of bronchiolitis and laryngitis. Pediatr Clin North Am. 1997;44(1):249–261


CHAPTER 47: EPIGLOTTITIS


Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED. Epiglottitis: it hasn’t gone away. Anesthesiology. 2016;124(6):1404–1407


Balfour-Lynn IM, Davies JC. Acute infections that produce upper airway obstruction. In: Chernick V, Boat TF, Wilmott RW, Bush A, eds. Kendig’s Disorders of the Respiratory Tract in Children. 8th ed. Philadelphia, PA: Elsevier Saunders; 2012:429–431


Adams WG, Deaver KA, Cochi SL, et al. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era. JAMA. 1993;269(2):221–226


Briere EC, Rubin L, Moro PL, Cohn A, Clark T, Messonnier N; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC. Prevention and control of Haemophilus influenzae type b disease: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2014;63(RR-01):1–14


CHAPTER 48: CROUP


Balfour-Lynn IM, Davies JC. Acute infections that produce upper airway obstruction. In: Chernick V, Boat TF, Wilmott RW, Bush A, eds. Kendig’s Disorders of the Respiratory Tract in Children. 8th ed. Philadelphia, PA: Elsevier Saunders; 2012:429–431


Petrocheilou A, Tanou K, Kalampouka E, Malakasioti G, Giannios C, Kaditis AG. Viral croup: diagnosis and a treatment algorithm. Pediatr Pulmonol. 2014;49(5):421–429


CHAPTER 49: PAPILLOMATOSIS


Armstrong LR, Derkay CS, Reeves WC. Initial results from the national registry for juvenile-onset recurrent respiratory papillomatosis. RRP Task Force. Arch Otolaryngol Head Neck Surg. 1999;125(7):743–748


Shah KV, Stern WF, Shah FK, Bishai D, Kashima HK. Risk factors for juvenile onset recurrent respiratory papillomatosis. Pediatr Infect Dis J. 1998;17(5):372–376


Derkay CS, Volsky PG, Rosen CA, et al. Current use of intralesional cidofovir for recurrent respiratory papillomatosis. Laryngoscope. 2013;123(3):705–712


Bishai D, Kashima H, Shah K. The cost of juvenile-onset recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg . 2000;126(8):935–939


Freed GL, Derkay CS. Prevention of recurrent respiratory papillomatosis: role of HPV vaccination. Int J Pediatr Otorhinolaryngol. 2006;70(10):1799–1803


Kosko JR, Derkay CS. Role of cesarean section in prevention of recurrent respiratory papillomatosis—is there one? Int J Pediatr Otorhinolaryngol . 1996;35(1):31–38


CHAPTER 50: PERTUSSIS


American Academy of Pediatrics. Pertussis (whooping cough). In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:608–621


CDC. Pertussis. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf.Accessed October 23, 2017


CDC. Manual for the Surveillance of Vaccine-Preventable Diseases. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt10-pertussis.html. Accessed October 23, 2017


Pertussis and Other Bordetella Infections. In: Cherry JD, Heininger U, eds. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Saunders Elsevier; 2014: 1616–1639


CHAPTER 51: BACTERIAL TRACHEITIS


Balfour-Lynn IM, Davies JC. Acute infections that produce upper airway obstruction. In: Chernick V, Boat TF, Wilmott RW, Bush A, eds. Kendig’s Disorders of the Respiratory Tract in Children. 8th ed. Philadelphia, PA: Elsevier Saunders; 2012:429–431


Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011;27(10):950–953


Gomez-Rubio AM, Mosquera RA, Yadav A, et al. Incidence, characteristics, and outcomes of bacterial tracheitis in children with an artificial airway. In: B26. Updates in Pediatric Lung Infections. Am J Resp Crit Care Med. 2016;193:A3049


Graf J, Stein F. Tracheitis in pediatric patients. Semin Pediatr Infect Dis. 2006;17:11–13


CHAPTER 52: BRONCHITIS


Carolan PL. Pediatric Bronchitis. Updated Dec 19, 2016. http://emedicine.medscape.com/article/1001332-overview. Accessed October 23, 2017


CDC. Acute Cough Illness. https://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/adult-acute-cough-illness.pdf. Accessed October 23, 2017


Bradley JS, et al. Pediatric Community Pneumonia Guidelines. Clin Infect Dis. 2011


Kunder R, Kunder C, Sun HY, et al. Pediatric plastic bronchitis: case report and retrospective comparative analysis of epidemiology and pathology. Case Rep Pulmonology. 2013; article ID 649365 y Wurzel DF, Marchant JM, Yerkovich ST, et al. Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis. Chest. 2016;150(5): 1101–1108


Kompare M, Weinberger M. Protracted bacterial bronchitis in young children: association with airway malacia. J Pediatr. 2012;160(1):88–92


CHAPTER 53: BRONCHIOLITIS


Ralston SL, Lieberthal AS, Meissner HC, et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474–e1502


Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1):62–72


Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2010;(12):CD001266


Ali S, Plint AC, Klassen TP. Bronchiolitis. In: Chernick V, Boat TF, Wilmott RW, Bush A, eds. Kendig’s Disorders of the Respiratory Tract in Children. 8th ed. Philadelphia, PA: Elsevier Saunders; 2012:443–452


Holman RC, Shay DK, Curns AT, Lingappa JR, Anderson LJ. Risk factors for bronchiolitis-associated deaths among infants in the United States. Pediatr Infect Dis J. 2003;22(6):483–490


Wang EE, Law BJ, Stephens D. Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr . 1995;126(2):212–219


CHAPTER 54: BACTERIAL PNEUMONIA


Bradley JS, Byington CL, Shah SS, et al; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Executive summary: the management Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):617–630 of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the


Jain S, Williams DJ, Arnold SR, et al; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015; 372(9):835–845


Wilson S, Grundy R, Vyas H. Investigation and management of a child who is immunocompromised and neutropoenic with pulmonary infiltrates. Arch Dis Child Educ Pract Ed. 2009;94(5):129–137


CHAPTER 55: VIRAL PNEUMONIA


Bradley JS, Byington CL, Shah SS, et al; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):617–630


Jain S, Williams DJ, Arnold SR, et al; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015; 372(9):835–845


Jartti T, Söderlund-Venermo M, Hedman K, Ruuskanen O, Mäkelä MJ. New molecular virus detection methods and their clinical value in lower respiratory tract infections in children. Paediatr Respir Rev. 2013;14(1):38–45


Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011; 377(9773):1264–1275


CHAPTER 56: MYCOPLASMA PNEUMONIA


Seltz LB, Colvin M, Barton LL. Atypical pneumonias in children. In: Wilmott RW, Boat TF, Bush A, Chernick V, Deterding RR, Ratjen F, eds. Kendig and Chernick’s Disorders of the Respiratory Tract in Children. Philadelphia, PA: Elsevier; 2012:493–505


Jain S, Williams DJ, Arnold SR, et al; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015; 372(9):835–845


Biondi E, McCulloh R, Alverson B, Klein A, Dixon A, Ralston S. Treatment of mycoplasma pneumonia: a systematic review. Pediatrics. 2014;133(6):1081–1090


American Academy of Pediatrics Committee on Infectious Diseases. Mycoplasma pneumoniae and other Mycoplasma species infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:568–571


CHAPTER 57: CHLAMYDIAL PNEUMONIA


Seltz LB, Colvin M, Barton LL. Atypical pneumonias in children. In: Wilmott RW, Boat TF, Bush A, Chernick V, Deterding RR, Ratjen F, eds. Kendig and Chernick’s Disorders of the Respiratory Tract in Children. Philadelphia, PA: Elsevier; 2012:493–505


Jain S, Williams DJ, Arnold SR, et al; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015; 372(9):835–845


American Academy of Pediatrics Committee on Infectious Diseases. Chlamydial infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:284–294


CHAPTER 58: TUBERCULOSIS


American Academy of Pediatrics. Tuberculosis. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:805–831


Schmit KM, Wansaula Z, Pratt R, Price SF, Langer AJ. Tuberculosis—United States, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(11):289–294


Steingart KR, Schiller I, Horne DJ, Pai M, Boehme CC, Dendukuri N. Xpert MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2014;(1):CD009593


World Health Organization. Global Tuberculosis Report 2014. http://www.who.int/tb/publications/global_report/en/. Accessed October 2, 2017


Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/ Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017;64(2):e1–e33


CHAPTER 59: NONTUBERCULOUS MYCOBACTERIAL PULMONARY DISEASE


Martiniano SL, Nick JA. Nontuberculous mycobacterial infections in cystic fibrosis. Clin Chest Med. 2015;36(1):101–115


Griffith DE, Aksamit T, Brown-Elliott BA, et al; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175(4):367–416 y American Academy of Pediatrics Committee on Infectious Diseases. Diseases caused by nontuberculous mycobacteria. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:831–839


Floto RA, Olivier KN, Saiman L, et al; US Cystic Fibrosis Foundation and European Cystic Fibrosis Society. US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis. Thorax. 2016;71(Suppl 1):i1–i22


CHAPTER 60: FUNGAL PNEUMONIA


Lease ED, Alexander BD. Fungal diagnostics in pneumonia. Semin Respir Crit Care Med. 2011;32(6):663–672


Thompson GR III, Cadena J, Patterson TF. Overview of antifungal agents. Clin Chest Med. 2009;30:203–215


Nania JJ, Wright PF. The mycoses. In: Wilmott RW, Boat TF, Bush A, Chernick V, Deterding RR, Ratjen F, eds. Kendig and Chernick’s Disorders of the Respiratory Tract in Children. Philadelphia, PA: Elsevier; 2012:531–544


Wilson S, Grundy R, Vyas H. Investigation and management of a child who is immunocompromised and neutropoenic with pulmonary infiltrates. Arch Dis Child Educ Pract Ed. 2009;94(5):129–137


Ostrosky-Zeichner L. Invasive mycoses: diagnostic challenges. Am J Med. 2012; 125(1 Suppl):S14–S24


Patterson TF, Thompson GB III, Denning DW, et al. Practice guidelines for the diagnosis and management of Aspergillus: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63:e1–e60


CHAPTER 61: HISTOPLASMOSIS AND OTHER ENDEMIC FUNGAL PNEUMONIAS


Nania JJ, Wright PF. The mycoses. In: Wilmott RW, Boat TF, Bush A, Chernick V, Deterding RR, Ratjen F, eds. Kendig and Chernick’s Disorders of the Respiratory Tract in Children, Philadelphia: Elsevier; 2012:531–544


Hage CA, Azar MM, Bahr N, Loyd J, Wheat LJ. Histoplasmosis: up-to-date evidence-based approach to diagnosis and management. Semin Respir Crit Care Med. 2015;36(5):729–745


Lease ED, Alexander BD. Fungal diagnostics in pneumonia. Semin Respir Crit Care Med. 2011;32(6):663–672


Thompson GR III, Cadena J, Patterson TF. Overview of antifungal agents. Clin Chest Med. 2009;30:203–215


Galgiani JN, Ampel NM, Blair JE, et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016;63(6):e112–e146


CHAPTER 62: COMPLICATIONS OF PNEUMONIA: PLEURAL EFFUSIONS


Hendaus MA, Janahi IA. Parapneumonic effusion in children: an up-to-date review. Clin Pediatr (Phila). 2016;55(1):10–18


Corcoran JP, Wrightson JM, Belcher E, DeCamp MM, Feller-Kopman D, Rahman NM. Pleural infection: past, present, and future directions. Lancet Respir Med. 2015;3(7):563–577


Dorman RM, Vali K, Rothstein DH. Trends in treatment of infectious parapneumonic effusions in U.S. children’s hospitals, 2004-2014. J Pediatr Surg . 2016;51(6):885–890 y Mong A, Epelman M, Darge K. Ultrasound of the pediatric chest. Pediatr Radiol. 2012;42(11):1287–1297


Kontouli K, Hatziagorou E, Kyrvasilis F, Roilides E, Emporiadou M, Tsanakas J. Long-term outcome of parapneumonic effusions in children: Lung function and exercise tolerance. Pediatr Pulmonol. 2015;50(6):615–620


CHAPTER 63: COMPLICATIONS OF PNEUMONIA: EMPYEMA


Corcoran JP, Wrightson JM, Belcher E, DeCamp MM, Feller-Kopman D, Rahman NM. Pleural infection: past, present, and future directions. Lancet Respir Med. 2015;3(7):563–577


Hendaus MA, Janahi IA. Parapneumonic effusion in children: an up-to-date review. Clin Pediatr (Phila). 2016;55(1):10–18


Walker W, Wheeler R, Legg J. Update on the causes, investigation and management of empyema in childhood. Arch Dis Child. 2011;96(5):482–488


Li S-TT, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics. 2010;125(1):26–33


Marhuenda C, Barceló C, Fuentes I, et al. Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial. Pediatrics. 2014;134(5): e1301–e1307


Kontouli K, Hatziagorou E, Kyrvasilis F, Roilides E, Emporiadou M, Tsanakas J. Long-term outcome of parapneumonic effusions in children: Lung function and exercise tolerance. Pediatr Pulmonol. 2015;50(6):615–620


Stockmann C, Ampofo K, Pavia AT, et al. Comparative effectiveness of oral versus outpatient parenteral antibiotic therapy for empyema. Hosp Pediatr. 2015;5(12): 605–612


Shah SS, Srivastava R, Wu S, et al; Pediatric Research in Inpatient Settings Network. Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia. Pediatrics. 2016;138(6):e20161692


CHAPTER 64: COMPLICATIONS OF PNEUMONIA: PULMONARY ABSCESS


Desai H, Agrawal A. Pulmonary emergencies: pneumonia, acute respiratory distress syndrome, lung abscess, and empyema. Med Clin North Am. 2012;96(6):1127–1148


Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin North Am. 2013; 27(1):149–155


Brook I. Anaerobic pulmonary infections in children. Pediatr Emerg Care. 2004;20(9): 636–640


CHAPTER 65: COMPLICATIONS OF PNEUMONIA: POSTINFECTIVE BRONCHIOLITIS OBLITERANS


Barker AF, Bergeron A, Rom WN, Hertz MI. Obliterative bronchiolitis. N Engl J Med. 2014;370(19):1820–1828


Welsh CH, Wang TS, Lyu DM, et al; The American Thoracic Society Implementation Task Force. An international ISHLT/ATS/ERS clinical practice guideline: summary for clinicians. Bronchiolitis obliterans syndrome complicating lung transplantation. Ann Am Thorac Soc. 2015;12(1):118–119


Williams KM, Cheng GS, Pusic I, et al. Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2016;22(4):710–716


Moonnumakal SP, Fan LL. Bronchiolitis obliterans in children. Curr Opin Pediatr. 2008;20(3):272–278

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Aug 22, 2019 | Posted by in PEDIATRICS | Comments Off on Complications of Pneumonia: Postinfective Bronchiolitis Obliterans

Full access? Get Clinical Tree

Get Clinical Tree app for offline access