Abstract/References

Plastic bronchitis (PB) is a severe acute respiratory disease that develops as a result of the formation of branching mucus plugs in the bronchial tree. PB is known as a complication of influenza A virus infection, but some cases have been associated with influenza B virus infections. This patient was a 3-year-old boy with no history of allergic disease who developed PB requiring ventilator management after influenza B virus infection. He was hospitalized and managed with ventilator support because of acute respiratory failure. Influenza B virus infection was diagnosed via rapid antigen test and real-time reverse-transcription polymerase chain reaction (RT-PCR). A bronchoscopy performed after a chest X-ray and computed tomography confirmed the presence of extensive atelectasis in the right lung field and mucus plugs in the right bronchus. The patient’s respiratory condition improved rapidly after removal of the plugs. Quantitative real-time RT-PCR performed with nasal and aspirated sputum samples obtained at hospitalization revealed a higher viral RNA load in the upper rather than in the lower respiratory tract. Viral replication in the lower respiratory was not found to be a major contributor toward mucus plug formation. The finding of increased serum IgE in the absence of a history of allergic disease suggests that an allergic reaction contributed to the formation of mucus plugs.

1. Brogan TV, Finn LS, Pyskaty DJ Jr, Redding GJ, Ricker D, Inglis A, et al. Plastic bronchitis in children:a case series and review of the medical literature. Pediatr Pulmonol, 34: 482-487, 2002. https://doi.org/10.1002/ppul.10179

2. Terano C, Miura M, Fukuzawa R, Saito Y, Arai H, Sasaki M, et al. Three children with plastic bronchitis associated with 2009 H1N1 influenza virus infection. Pediatr Infect Dis J, 30:80-82, 2011. https://doi.org/10.1097/INF.0b013e3181f10fff

3. Deng J, Zheng Y, Li C, Ma Z, Wang H, Rubin BK. Plastic bronchitis in three children associated with 2009 influenza A(H1N1) virus infection. Chest, 138:1486-1488, 2010. https://doi.org/10.1378/chest.10-0548

4. Uda K, Shoji K, Koyama-Wakai C, Furuichi M, Iwase N, Fujisaki S, et al. Clinical characteristics of influenza virus-induced lower respiratory infection during the 2015 to 2016 season. J Infect Chemother, 24:407-413, 2018. https://doi.org/10.1016/j.jiac.2018.01.002

5. Kirito Y, Matsubayashi T, Ohsugi K. Plastic bronchitis:Three cases caused by influenza B virus Yamagata lineage. Pediatr Int, 61: 421-423, 2019. https://doi.org/10.1111/ped.13799

6. Zhang J, Kang X. Plastic bronchitis associated with influenza virus infection in children: a report on 14 cases. Int J Pediatr Otorhinolaryngol, 79:481-486, 2015. https://doi.org/10.1016/j.ijporl.2015.01.002

7. Sato M, Honzumi K, Sato T, Hashimoto K, Watanabe M, Miyazaki K, et al. Sequential influenza B viral load and susceptibility in children treated with oseltamivir and zanamivir. Pediatr Infect Dis J, 33:e168-172, 2014. https://doi.org/10.1097/INF.0000000000000266

8. Bowen A, Oudjhane K, Odagiri K, Liston SL, Cumming WA, Oh KS. Plastic bronchitis:large, branching, mucoid bronchial casts in children. AJR Am J Roentgenol, 144: 371-375, 1985. https://www.ajronline.org/doi/10.2214/ajr.144.2.371

9. Li Y, Williams RJ, Dombrowski ND, Watters K, Daly KP, Irace AL, et al. Current evaluation and management of plastic bronchitis in the pediatric population. Int J Pediatr Otorhinolaryngol, 130:109799, 2020. https://doi.org/10.1016/j.ijporl.2019.109799

10. Seear M, Hui H, Magee F, Bohn D, Cutz E. Bronchial casts in children:a proposed classification based on nine cases and a review of the literature. Am J Respir Crit Care Med, 155:364-370, 1997. https://doi.org/10.1164/ajrccm.155.1.9001337

11. Liu Y, Childs RA, Matrosovich T, Wharton S, Palma AS, Chai W, et al. Altered receptor specificity and cell tropism of D222G hemagglutinin mutants isolated from fatal cases of pandemic A(H1N1) 2009 influenza virus. J Virol, 84:12069-12074, 2010. https://doi.org/10.1128/JVI.01639-10

12. Ibricevic A, Pekosz A, Walter MJ, Newby C, Battaile JT, Brown EG, et al. Influenza virus receptor specificity and cell tropism in mouse and human airway epithelial cells. J Virol, 80:7469-7480, 2006. https://doi.org/10.1128/JVI.02677-05

13. Suyama K, Kawasaki Y, Suzuki Y, Ishii K, Sakai N, Sato M, et al. Treatment with oseltamivir and prone positioning for a 9-year-old boy with ARDS caused by pandemic H1N1 2009 influenza. Pediatr Int, 55: e77-80, 2013. https://doi.org/10.1111/ped.12055

14. Suzuki S, Suzuki Y, Yamamoto N, Matsumoto Y, Shirai A, Okubo T. Influenza A virus infection increases IgE production and airway responsiveness in aerosolized antigen-exposed mice. J Allergy Clin Immunol, 102:732-740, 1998. https://doi.org/10.1016/S0091-6749(98)70012-0

15. Birmingham JM, Gillespie VL, Srivastava K, Li XM, Busse PJ. Influenza A infection enhances antigen induced airway inflammation and hyperresponsiveness in young but not aged mice. Clin Exp Allergy, 44:1188-1199, 2014. https://doi.org/10.1111/cea.12365

16. Sanerkin NG, Seal RM, Leopold JG. Plastic bronchitis, mucoid impaction of the bronchi and allergic broncho-pulmonary aspergillosis, and their relationship to bronchial asthma. Ann Allergy, 24:586-594, 1966.