D105-16 Pediatric Persistent Fungal Bronchitis, It Really a Disease Tinct Entity? Clinical Observations of 14 Cases in Children

Abstract Background Chronic wet cough is a common syndrome in children. Our clinical practice has identified a group of chronic wet cough cases associated with bronchitis and persistent fungal infections. Now, let's summarize their clinical characteristics for reference.Methods. Clinical data from 14 children diagnosed with persistent fungal bronchitis and admitted to our hospital since 2021 were collected and analyzed retrospectively.Results. 1. Case Report A 4-year-old male patient was admitted for recurrent cough with sputum for 21 days. Initial treatment with ceftriaxone, ampicillin/sulbactam, and clarithromycin for 10 days failed to resolve the sputum. Chest CT showed bronchial wall thickening, and metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) detected Aspergillus fumigatus.After one day of treatment with itraconazole, sputum significantly decreased, and by the fourth day, the wet cough and lung rales had completely resolved.2.Clinical characteristics of the children: 7 males and 7 females, with a median age of 58.5 months (range: 32-134 months). The cases included one with neuroblastoma, three involving hematopoietic stem cell transplantation, one with asthma, and eight with other allergic diseases.Clinical manifestations include a wet cough lasting 1 to 48 months. Chest CT scans reveal thickening of the bronchial walls. Bronchoscopy: repeated aspiration of transparent or white translucent, fibrous viscous secretions.Pathogen detection: BALF cultures isolated Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, Trichoderma, and dark fungi, each in one case. Sputum cultures identified filamentous fungi in one case. BALF mNGS detected Aspergillus fumigatus in five cases, Penicillium citrinum in one case, and elevated IgM antibodies against Aspergillus fumigatus in six cases. All children received antibiotic therapy for 14-54 days but still exhibited persistent wet cough. After detecting fungal infection evidence, antifungal treatment was administered for 1-14 days, leading to symptom improvement. The therapeutic efficacy difference between the two groups was statistically significant (P≤0.001).Conclusions. 1. The incidence of persistent fungal bronchitis is low, rarely reported in children, there is no unified diagnostic criteria, and whether it is an independent disease is still controversial;2. This group of cases started with chronic wet cough, and after bronchoscopy and BALF examination found evidence of fungal infection, antifungal treatment was given and the wet cough disappeared, which supported that this disease was a rare cause of chronic wet cough in children;3. Unlike ABPA, the majority of cases in this group can be treated solely with antifungal medications, Only one case required combined hormone therapy in addition to antifungal drug therapy. This abstract is funded by: None