Bronchiectasis in children in a high HIV and tuberculosis prevalence setting

Main Article Content

P Juggernath
K Mopeli
R Masekela
Z Dangor
A Goga
D M Gray
C Verwey

Abstract





Background. Bronchiectasis, a chronic suppurative lung condition, is a largely neglected disease, especially in low- to middle-income countries (LMICs), from which there is a paucity of data. Post-infectious causes are more common in LMICs, while in high-income countries, inborn errors of immunity (IEIs), recurrent aspiration, primary ciliary dyskinesia (PCD) and cystic fibrosis are more common. Children living with HIV (CLWH), especially those who are untreated, are at increased risk of bronchiectasis. Data on risk factors, diagnosis and follow-up of children with bronchiectasis are required to inform clinical practice and policy.


Objectives. To describe the demographics, medical history, aetiology, clinical characteristics and results of special investigations in children with bronchiectasis.


Methods. We undertook a retrospective descriptive study of children aged <16 years with chest computed tomography (CT) scan-confirmed bronchiectasis in Johannesburg, South Africa, over a 10-year period. Demographics, medical history, aetiology, clinical characteristics and results of special investigations were described and compared according to HIV status.


Results. A total of 91 participants (51% male, 98% black African) with a median (interquartile range) age of 7 (3 - 12) years were included in the study. Compared with HIV-uninfected children, CLWH were older at presentation (median 10 (6 - 13) years v. 4 (3 - 9) years; p<0.01), and more likely to be stunted (p<0.01), to have clubbing (p<0.01) and hepatosplenomegaly (p=0.03), and to have multilobar involvement on the chest CT scan (p<0.01). All children had a cause identified, and the majority (86%) of these were presumed to be post-infectious, based on a previous history of a severe lower respiratory tract infection. This group included all 38 CLWH. Only a small proportion of the participants had IEIs, secondary immune deficiencies or PCD.


Conclusion. A post-infectious cause for bronchiectasis was the most common aetiology described in children from an LMIC in Africa, especially CLWH. With improved access to diagnostic techniques, the aetiology of bronchiectasis in LMICs is likely to change.





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1.
Juggernath P, Mopeli K, Masekela R, Dangor Z, Goga A, Gray DM, et al. Bronchiectasis in children in a high HIV and tuberculosis prevalence setting. Afr J Thoracic Crit Care Med [Internet]. 2024 Dec. 11 [cited 2025 Feb. 19];30(4):e1899. Available from: https://samajournals.co.za/index.php/ajtccm/article/view/1899
Section
Original Research: Articles

How to Cite

1.
Juggernath P, Mopeli K, Masekela R, Dangor Z, Goga A, Gray DM, et al. Bronchiectasis in children in a high HIV and tuberculosis prevalence setting. Afr J Thoracic Crit Care Med [Internet]. 2024 Dec. 11 [cited 2025 Feb. 19];30(4):e1899. Available from: https://samajournals.co.za/index.php/ajtccm/article/view/1899

References

1. Chang AB, Byrnes CA, Everard ML. Diagnosing and preventing chronic suppurative lung disease (CSLD) and bronchiectasis. Paediatr Respir Rev 2011;12(2):97-103. https://doi. org/10.7196/10.1016/j.prrv.2010.10.008

2. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016;51(5):450-469. https://doi. org/10.7196/10.1002/ppul.23380

3. Kapur N, Karadag B. Differences and similarities in non-cystic fibrosis bronchiectasis between developing and affluent countries. Paediatr Respir Rev 2011;12(2):91-96. https:// doi.org/10.7196/10.1016/j.prrv.2010.10.010

4. Chang AB, Fortescue R, Grimwood K, et al. European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J 2021;58(2):2002990. https://doi.org/10.7196/10.1183/13993003.02990-2020

5. QuintJK,MillettERC,JoshiM,etal.Changesintheincidence,prevalenceandmortalityof bronchiectasis in the UK from 2004 to 2013: A population-based cohort study. Eur Respir J 2016;47(1):186-193. https://doi.org/10.7196/10.1183/13993003.01033-2015

6. Quint JK, Smith MP. Paediatric and adult bronchiectasis: Diagnosis, disease burden and prognosis. Respirology 2019;24(5):413-422. https://doi.org/10.7196/10.1111/resp.13495

7. Singleton RJ, Valery PC, Morris P, et al. Indigenous children from three countries with

non-cystic fibrosis chronic suppurative lung disease/bronchiectasis. Pediatr Pulmonol

2014;49(2):189-200. https://doi.org/10.7196/10.1002/ppul.22763

8. Kumar A, Lodha R, Kumar P, Kabra SK. Non-cystic fibrosis bronchiectasis in children:

Clinical profile, etiology and outcome. Indian Pediatr 2015;52(1):35-37. https://doi.

org/10.7196/10.1007/s13312-015-0563-8

9. Eralp EE, Gokdemir Y, Atag E, et al. Changing clinical characteristics of non-cystic fibrosis bronchiectasis in children. BMC Pulm Med 2020;20(1):172. https://doi. org/10.7196/10.1186/s12890-020-01214-7

10. Grimwood K. Airway microbiology and host defences in paediatric non-CF bronchiectasis. Paediatric Respir Rev 2011;12(2):111-118. https://doi.org/10.7196/10.1016/j. prrv.2010.10.009

11. McCallum GB, Binks MJ. The epidemiology of chronic suppurative lung disease and bronchiectasis in children and adolescents. Front Pediatr 2017;5:27. https://doi. org/10.7196/10.3389/fped.2017.00027

12. Gray DM, Zar HJ. Community-acquired pneumonia in HIV-infected children: A global perspective. Curr Opin Pulm Med 2010;16(3):208-216. https://doi.org/10.7196/10.1097/ MCP.0b013e3283387984

13. Attia EF, Miller RF, Ferrand RA. Bronchiectasis and other chronic lung diseases in adolescents living with HIV. Curr Opin Infect Dis 2017;30(1):21-30. https://doi. org/10.7196/10.1097/QCO.0000000000000325

14. Ferrand RA, Desai SR, Hopkins C, et al. Chronic lung disease in adolescents with delayed diagnosis of vertically acquired HIV infection. Clin Infect Dis 2012;55(1):145-152. https:// doi.org/10.7196/10.1093/cid/cis271

15. Masekela R, Anderson R, Moodley T, et al. HIV-related bronchiectasis in children: An emerging spectre in high tuberculosis burden areas. Int J Tuberc Lung Dis 2012;16(1):114- 119. https://doi.org/10.7196/10.5588/ijtld.11.0244

16. Mwalukomo T, Rylance SJ, Webb EL, et al. Clinical characteristics and lung function in older children vertically infected with human immunodeficiency virus in Malawi. J Pediatr Infect Dis Soc 2016;5(2):161-169. https://doi.org/10.7196/10.1093/jpids/piv045

17. Verwey C, Gray DM, Dangor Z, et al. Bronchiectasis in African children: Challenges and barriers to care. Front Pediatr 2022;10:954608. https://doi.org/10.7196/10.3389/ fped.2022.954608

18. Chang AB, Masel JP, Boyce NC, Wheaton G, Torzillo PJ. Non-CF bronchiectasis: Clinical and HRCT evaluation. Pediatr Pulmonol 2003;35(6):477-483. https://doi. org/10.7196/10.1002/ppul.10289

19. Chang AB, Redding GJ, Everard ML. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 2008;43(6):519-531. https:// doi.org/10.7196/10.1002/ppul.20821

20. Chandrasekaran R, Mac Aogáin M, Chalmers JD, Elborn SJ, Chotirmall SH. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med 2018;18(1):83. https://doi.org/10.7196/10.1186/s12890-018-0638-0

21. Allwood BW, Byrne A, Meghji J, Rachow A, van der Zalm MM, Schoch OD. Post- tuberculosis lung disease: Clinical review of an under-recognised global challenge. Respiration 2021;100(8):751-763. https://doi.org/10.7196/10.1159/000512531

22. World Health Organization. Global Tuberculosis Report 2020. Geneva: WHO, 2020. https://www.who.int/publications/i/item/9789240013131 (accessed 22 August 2023).

23. Joint United Nations Progamme on HIV/AIDS. UNAIDS Data 2021. Geneva: UNAIDS,

2021. https://www.unaids.org/sites/default/files/media_asset/JC3032_AIDS_Data_

book_2021_En.pdf (accessed 22 August 2023).

24. De Campos KR, Granga DD, Olorunju S, Masekela R. The impact of highly active

antiretroviral therapy on the burden of bacterial lower respiratory tract infections in children. S Afr Med J 2015;105(7):554-557. https://doi.org/10.7196/10.7196/ SAMJnew.7820

25. Madhi SA, Nunes MC. The potential impact of pneumococcal conjugate vaccine in Africa: Considerations and early lessons learned from the South African experience. Hum Vaccin Immunother 2016;12(2):314-325. https://doi.org/10.7196/10.1080/21645515.2015.1084450

26. Von Gottberg A, de Gouveia L, Tempia S, et al. Effects of vaccination on invasive pneumococcal disease in South Africa. N Engl J Med 2014;371(20):1889-1899. https:// doi.org/10.7196/10.1056/NEJMoa1401914

27. Bakaki P, Kayita J, Moura Machado JE, et al. Epidemiologic and clinical features of HIV-infected and HIV-uninfected Ugandan children younger than 18 months. J Acquir Immune Defic Syndr 2001;28(1):35-42. https://doi.org/10.7196/10.1097/00042560- 200109010-00006

28. Ferrand RA, Luethy R, Bwakura F, Mujuru H, Miller RF, Corbett EL. HIV infection presenting in older children and adolescents: A case series from Harare, Zimbabwe. Clin Infect Dis 2007;44(6):874-878. https://doi.org/10.7196/10.1086/511873

29. Callahan CW, Redding GJ. Bronchiectasis in children: Orphan disease or persistent problem? Pediatr Pulmonol 2002;33(6):492-496. https://doi.org/10.7196/10.1002/ ppul.10104

30. Chang AB, Bush A, Grimwood K. Bronchiectasis in children: Diagnosis and treatment. Lancet 2018;392(10150):866-879. https://doi.org/10.7196/10.1016/S0140- 6736(18)31554-X

31. Desai SR, Nair A, Rylance J, et al. Human immunodeficiency virus-associated chronic lung disease in children and adolescents in Zimbabwe: Chest radiographic and high- resolution computed tomographic findings. Clin Infect Dis 2018;66(2):274-281. https:// doi.org/10.7196/10.1093/cid/cix778

32. Verwey C, Velaphi S, Khan R. Bacteria isolated from the airways of paediatric patients with bronchiectasis according to HIV status. S Afr Med J 2017;107(5):435-439. https://doi. org/10.7196/10.7196/SAMJ.2017.v107i5.10692

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