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Respiratory syncytial virus and adenovirus in acute lower respiratory infections in hospitalized infants and children  [PDF]
Salvatore Barberi, Mario Barreto, Francesco La Penna, Bernardina Mazzarella, Maria-Elena Liverani, Ottavia De Luca, Maurizio Simmaco, Maria Pia Villa
Open Journal of Pediatrics (OJPed) , 2012, DOI: 10.4236/ojped.2012.21004
Abstract: Background: Lower respiratory tract infection (LRTI) is a main cause of hospitalization in infants and children. These patients’ nasopharyngeal swabs more frequently contain respiratory syncytial virus (RSV) than human adenovirus (HAdV) in cold seasons; recent data suggest that oropharyngeal swabs more frequently contain HAdV than RSV. Knowing more about virus detection with oropharyngeal swabs, seasonal fluctuations and age-related distribution of RSV and HAdV would help treat children hospitalized for LRTI more effectively. We investigated the seasonal virus-related frequency (as assessed by oropharyngeal swabs) and environmental and clinical features in infants and children hospitalized for LRTI from autumn to spring. Methods: We studied 98 subjects hospitalized for LRTI in our Pediatric Unit, from November 2006 to May 2007. RSV and HAdV in oropharyngeal swabs were assessed by real-time polymerase chain reaction (PCR) assay. Results: PCR assays more frequently detected HAdV (29.6% of patients) than RSV (25.5%). The seasonal incidence also differed (RSV, narrow peak in December and HAdV, wide peak from April to May). Most patients infected with RSV were aged 2 yrs or younger (23/25: 88%); no difference was found in age between subjects who tested HAdV-positive (13/29: 45%) or undetectable-virus (23/44: 52%). Bronchiolitis was more frequently associated with RSV than HAdV or undetectable-virus oropharyngeal swabs. No difference was found in risk factors (school attendance, atopic parents, exposure to cigarette smoking, home dampness or exposure to animals) or clinical features (vital parameters or duration of hospital stay) among the three viral groups. Conclusions: Our findings show a high frequency of HAdV-positive oropharyngeal swabs during acute LRTIs in infants and children and differences in the seasonal distribution of RSV and HAdV in Rome.
Hyponatremia is Associated with Increased Severity of Disease in Critically Ill Children with Bronchiolitis  [PDF]
Michael E. Seifert, Scott R. Welak, Christopher L. Carroll
International Journal of Clinical Medicine (IJCM) , 2010, DOI: 10.4236/ijcm.2010.12007
Abstract: INTRODUCTION: Hyponatremia is the most common electrolyte abnormality seen in the intensive care unit (ICU), and is associated with increased morbidity and mortality. Critically ill children with bronchiolitis are at risk of developing hyponatremia, due to impaired renal free water excretion and exogenous sources of excess free water intake. We hypothesize that the development of hyponatremia is associated with a more complicated clinical course in critically ill children with bronchiolitis. METHODS: A retrospective case-control study was conducted that included all children admitted to the ICU with bronchiolitis over a two year period (n = 59). Patients were divided into two clinical groups: those that were hyponatremic (serum sodium < 136 mmol/L) during their ICU stay and those that remained normonatremic (serum sodium ≥ 136 mmol/L). RESULTS: Forty-three children (73%) developed hyponatremia while in the ICU. Hyponatremic children were intubated more often than normonatremic children (OR 16.7; 95% CI 4.1-68.5); however, hyponatremia rarely developed before intubation (2%). Hyponatremic children also had a longer ICU length of stay (209 ± 137 hrs vs. 130 ± 85 hrs, p = 0.01). In a subset of intubated children (n = 44), thirty-eight (88%) developed hyponatremia. These intubated children had a lower mean serum sodium concentration (132.8 mmol/L vs. 137.3 mmol/L, p < 0.0001) than non-intubated children. CONCLUSIONS: Hyponatremia is a common comorbidity in children admitted to the ICU with bronchiolitis, and is associated with increased illness severity, as evidenced by a higher frequency of intubation and a longer ICU length of stay.
Lymphocytic Bronchiolitis as Presenting Disorder in an Undiagnosed Adult Patient with Chronic Granulomatous Disease
Payam Tabarsi,Mehdi Mirsaeidi,Shirin Karimi,Behzad Banieghbal
Iranian Journal Of Allergy, Asthma and Immunology , 2007,
Abstract: Chronic Granulomatous Disease (CGD) is a rare primary immunodeficiency disease. Although the most affected patients are diagnosed in childhood, there are several reports of the disease presenting in adult patients. Here we present a 40 years old man who was admitted in hospital due to respiratory symptoms and ground glass pattern in high resolution computed tomography of lung. Open lung biopsy revealed lymphocytic bronchiolitis. Because of past medical history of granulomatous lesion in lung and recurrent abscesses of skin and soft tissue, NBT test was conducted which its result revealed that the disorder was compatible with CGD and then it was confirmed by fluorescent cytometry.
Chronic Enterovirus D68 Bronchiolitis Causing Severe Respiratory Insufficiency  [PDF]
John Chia, Andrew Chia, David Wang, Rabiha El-Habbal, Deren Sinkowitz
Open Journal of Respiratory Diseases (OJRD) , 2016, DOI: 10.4236/ojrd.2016.63007
Abstract: Human enteroviruses are less well-known causes of acute bronchiolitis. In recent years, Enterovirus D68 [EV D68] has emerged as significant cause of epidemic viral bronchiolitis and pneumonia in the United States and other countries. Chronic bronchiolitis has not been previously attributed to EV D68. We documented EV D68 in open lung biopsies of a young adult patient who was frequently admitted to the hospital for severe exacerbation of respiratory infections and subsequently developed progressive respiratory insufficiency. The difficulty of diagnosis and potential economic impact of this illness is discussed.
Child Acute Lower Respiratory Tract Infection in Pediatrics Intensive Care Unit at University Hospital of Brazzaville (Congo)  [PDF]
Engoba Moyen, Judica?l Kambourou, Annie Rachelle Okoko, Lori Bertrand Nguelongo, Verlem Bomelefa-Bomel, Kadidja Grace Nkounkou, Georges Moyen, Jean-Louis Nkoua
Open Journal of Pediatrics (OJPed) , 2018, DOI: 10.4236/ojped.2018.81005
Abstract: In order to contribute to reduction of morbidity and mortality due to low acute respiratory infections in pediatrics, the objective of this study was to determine the epidemiological profile and to identify the factors favoring and those associated with the risk of deceased. We reviewed the cases of children aged between 1 and 59 months hospitalized between January and December 2015 in the pediatric intensive care unit of the CHU of Brazzaville and retained those whose diagnosis of discharge was an ALRI. The study variables were: epidemiological, clinical, paraclinic, diagnostic, therapeutic and evolutionary. For 2012 hospitalized children, 400 (19.8%) were hospitalized for an ALRI. There were 235 boys (58.8%) and 165 girls (41.2%) of average age. Infants aged 1 to 11 months were the most affected n = 260 (65%). They were insufficiently immunized with haemophilus influenza B and pneumococcus n = 378 (94.5%); Fully immunized n = 20 (5%), the average delay for consultation after the first symptom was 5.03 ± 3.86 days; Denutrition was rated n = 180 (45%), positive retroviral serology n = 19 cases (4.8%). The main nosological varieties were: bronchiolitis n = 223 (55.7%), pneumonia n = 145 (36.2%). One death was rated n = 65 (16.3%). The mortality determinants were: prematurity, vaccination status and HIV/AIDS infection. The frequency and severity of ALRIs necessitates a strengthened program of integrated management of childhood illnesses, and public health actions targeting the factors that promote and contribute to the risk of death.
Bronquiolite obliterante com pneumonia em organiza??o
Addor, Gabriela;Monteiro, Andreia Salarini;Nigri, David Henrique;Torres, Wilhermo;Franco, Carlos Alberto de Barros;
Jornal Brasileiro de Pneumologia , 2004, DOI: 10.1590/S1806-37132004000200014
Abstract: 48 years-old woman, asymptomatic, presented with radiographic findings of patchy airspace consolidation with nodular opacities in the upper right lobe, middle lobe and lingula. the differential diagnoses of neoplasms, sarcoidosis, granulomatous diseases and tuberculosis were considered. diagnosis of bronchiolitis obliterans organizing pneumonia was made by means of videothoracoscopy whereupon treatment with corticosteroids was begun. the patient had a positive evolution with resolution of the radiographic finding.
Seqüelas respiratórias de doen?as virais: do diagnóstico ao tratamento
Teper, Alejandro;Fischer, Gilberto Bueno;Jones, Marcus Herbert;
Jornal de Pediatria , 2002, DOI: 10.1590/S0021-75572002000800009
Abstract: objective: the objective of the present article is to present a review of the main clinical issues faced by pediatricians while defining the diagnosis, management and prognosis of postinfectious bronchiolitis obliterans. sources: data from national and international scientific journals selected from the lilacs and medline databases. summary of the findings: with the purpose of establishing the diagnosis, a radiological investigation shows high levels of pulmonary insufflation, thickened bronchovascular bundles and, less often, bronchiectasis, atelectasis and pulmonary hyperlucency. the ct exam allows the visualization of structural and functional findings, such as air trapping, bronchiectasis and mosaic pattern. lung function tests in children and infants always reveal significant reduction of expiratory flows. pulmonary biopsy is not mandatory in order to confirm bronchiolitis obliterans. diagnosis can be established through the combination of history of bronchiolitis, chronic obstructive pulmonary disease and typical tomographic findings. the treatment used by most services includes oral and inhaled corticosteroids and bronchodilators for long periods. the management of exacerbated conditions often requires antibiotics and physical therapy. conclusions: most patients present a favorable outcome with slow improvement of the pulmonary function and reduced necessity for supplementary oxygen. some patients present progressive worsening of hypoxemia and co2 retention, which leads to pulmonary hypertension and cor pulmonale. postinfectious bronchiolitis obliterans is mild and moderate in most patients, with consequent good prognosis and low mortality.
Antibiotic prescribing pattern in paediatric in patients with first time wheezing
Soumya Patra, Varinder Singh, Harish K Pemde, Jagdish Chandra
Italian Journal of Pediatrics , 2011, DOI: 10.1186/1824-7288-37-40
Abstract: To evaluate the effect of clinical, laboratory and radiological data on the decision to prescribe antibiotics to paediatric patients with first time wheezing as well as to seek criteria that would justify antibiotic use.A prospective study was made of 47 previous healthy children admitted to our hospital with first time wheezing in life between October 2008- March 2009. All the patients were treated as per the treating unit's protocol with oxygen, bronchodilators with or without antibiotics. The cases were analyzed after discharge and the characteristics of those treated with antibiotics (n = 23) were compared with those who were not (n = 24) and analyzed statistically to find the predictors for antibiotic usage.The mean age of the study groups was 5.8 (+/- 5.1) months. Among the clinical and investigational parameters, presence of predominant crackles and abnormalities on radiograph were the major determinants for antibiotic usage. There were no significant differences in final outcome between these groups.Antibiotic usage in first time wheezers is still quite prevalent. Presence of crackles and radiological abnormalities often prompt the usage of antibiotics in such cases.Bronchiolitis is a commonly caused viral infection and is the predominant cause of acute wheezing in infants. It is characterized by acute inflammation, oedema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm. The most common etiology is the respiratory syncytial virus (RSV), with the highest incidence of RSV infection occurring between December and March [1]. Therapies currently in the treatment of Bronchiolitis include bronchodilator, nasal clearance, ribavarine and/or corticosteroids. While bronchiolitis is an important cause of wheezing in young children, it can also occur, albeit less commonly, with bacterial infections as well. Further, the WHO driven national guidelines on clinical diagnosis and management of pneumonia in the developing n
Bronquiolite associada à exposi??o a aroma artificial de manteiga em trabalhadores de uma fábrica de biscoitos no Brasil
Cavalcanti, Zaida do Rego;Albuquerque Filho, Alfredo Pereira Leite de;Pereira, Carlos Alberto de Castro;Coletta, Ester Nei Aparecida Martins;
Jornal Brasileiro de Pneumologia , 2012, DOI: 10.1590/S1806-37132012000300016
Abstract: objective: to report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in brazil. methods: we described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients. results: all four patients were young male nonsmokers and developed persistent airflow obstruction (reduced fev1/fvc ratio and fev1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. the hrct findings were indicative of bronchiolitis. in one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells. conclusions: bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in brazil.
Avalia??o funcional durante o exercício em crian?as e adolescentes com bronquiolite obliterante pós-infecciosa
Mattiello, Rita;Sarria, Edgar E.;Stein, Ricardo;Fischer, Gilberto Bueno;Mocelin, Helena Teresinha;Barreto, Sergio Saldanha Menna;Lima, Jo?o Ant?nio Bonfadini;Brandenburg, Diego;
Jornal de Pediatria , 2008, DOI: 10.1590/S0021-75572008000400009
Abstract: objective: to assess functional capacity during exercise in children and adolescents with post-infectious bronchiolitis obliterans (pibo). methods: 20 children with pibo, aged 8-16 years old, and in follow-up at an outpatient clinic carried out cardiopulmonary exercise testing (cpet), a 6-minute walk test (6mwt) and pulmonary function tests (pft), according to american thoracic society (ats), european respiratory society (ers) and american college of chest physicians (accp) guidelines. results were expressed as percentages of predicted reference values: armstrong's for cpet, geiger's for 6mwt, knudson's for spirometry, and zapletal's for plethysmography. results: mean age (± sd) was 11.4±2.2 years; 70% were boys; mean weight: 36.8±12.3 kg; mean height: 143.8±15.2 cm. when compared to reference values, pft detected lower airflows (spirometry) and higher volumes (plethysmography). eleven patients had reduced peak vo2 values in cpet (< 84% predicted). the mean distance walked (6mwt) was 77.0±15.7% of predicted (512±102 m). peak vo2 was not correlated with 6mwt, but it was correlated with fvc (l) (r = 0.90/p = 0.00), with fev1 (l) (r = 0.86/p = 0.00) and with rv/tlc, both in absolute values (r = -0.71/p = 0.02) and as percentages of predicted values (r = -0.63/p = 0.00). conclusion:the majority of these post-infectious bronchiolitis obliterans patients exhibited reduced functional capacity, exhibited during both cpet and the 6mwt. due to its greater feasibility, 6mwt could be an alternative where cpet is not available.
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