Clinical Features of Plastic Bronchitis Related to Respiratory Tract Infection in 269 Children

Background. Plastic bronchitis (PB) is a pulmonary disease characterized by the formation of bronchial casts (BCs) that lead to airway blockage. The study aimed to investigate the clinical features of PB related to respiratory tract infection. Methods. A retrospective analysis was performed on data collected over a 5-year period (from January 2015 to December 2019) on children with PB (n=269). The clinical manifestations, laboratory data, imaging findings and management, were investigated. The single fiberoptic bronchoscopy (FOB, n=144) and multiple-treatment groups (n=125) were compared.Results. A total of 269 PB children were included with a mean age of 6.7 ± 2.8 years. The majority of cases (n=241, 89.6%) were diagnosed with Mycoplasma pneumonia (MP) infection. The mean duration of fever and hospitalization was 10.6 ± 3.7 and 9.3 ± 3.2 days, respectively. All patients presented with cough and fever, 62 (23.0%) suffered from hypoxemia, and 144 (53.5%) had extrapulmonary complications. Higher levels of ESR, CRP, PCT, IL-6, LA, LDH, FER and D-dimer were observed. CT findings, including pulmonary consolidation, segmental or lobar atelectasis, pleural effusion and pleural thickening, were observed in 97.4%, 46.5%, 47.9% and 63.2% of cases, respectively. Furthermore, multivariate logistic regression analysis showed that N% >75.5%, LDH >598.5U/L, and D-dimer>1.2mg/L were independent risk factors for multiple therapeutic FOB. Conclusions. MP is a major pathogen responsible for PB in children. Patients with PB are more likely to experience persistent fever and excessive inflammation and have severe radiological findings. FOB is an effective treatment for patients with PB, and children may require multiple FOBs for cast removal. N% >75.5%, LDH >598.5U/L and D-dimer > 1.2mg/L are independent predictors of multiple FOB treatment.