Bronchiectasis in children in a high HIV and tuberculosis prevalence setting.

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<.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.

Study synopsis: What the study adds. In this retrospective descriptive study of children aged <16 years with chest computed tomography scan-confirmed bronchiectasis in Johannesburg, South Africa (SA), over a 10-year period, we report that a post-infectious cause for bronchiectasis was the most commonly described, and that HIV was an important contributor. A large proportion of children with bronchiectasis in low- and middle-income countries such as SA do not benefit from an extensive work-up for the non-infectious causes of bronchiectasis.Implications of the findings. With improved access to diagnostic techniques, including improvements in early diagnosis and access to treatment for children living with HIV, the aetiology of bronchiectasis is likely to change in the coming years.