Abstract
Respiratory tract infections (RTIs) are common in childhood because of the physiologic immaturity of the immune system, a microbial community under development in addition to other genetic, physiological, environmental and social factors. RTIs tend to recur and severe lower viral RTIs in early childhood are not uncommon and are associated with increased risk of respiratory disorders later in life, including recurrent wheezing and asthma. Therefore, a better understanding of the main players and mechanisms involved in respiratory morbidity is necessary for a prompt and improved care as well as for primary prevention. The inter-talks between human immune components and microbiota as well as their main functions have been recently unraveled; nevertheless, more is still to be discovered or understood in the above medical conditions. The aim of this review paper is to provide the most up-to-date overview on dysbiosis in pre-school children and its association with RTIs and their complications. The potential role of non-harmful bacterial-derived products, according to the old hygiene hypothesis and the most recent trained-innate immunity concept, will be discussed together with the need of proof-of-concept studies and larger clinical trials with immunological and microbiological endpoints.
Highlights
Pediatric respiratory infections (RTIs) are a burden, as they represent up to 40% of the primary health care solicitations [1]
Bacterial infection has been observed in 60% of patients with prolonged symptoms (≥10 days) of an Upper respiratory tract infections (URTIs) [5,6]
Respiratory infections and complications such as asthma are a burden in childhood and a challenge in clinical practice despite the identification of risk factors and the progress in prevention and care
Summary
Pediatric respiratory infections (RTIs) are a burden, as they represent up to 40% of the primary health care solicitations [1]. The identification of the main risk factors, as well as of patients at increased risk for this chronic inflammatory lung disease, is necessary for effective prevention and prompt care In this context, recent findings pointed out the role of the complex interplay between host microbiota and the immune system in determining chronic respiratory pediatric conditions. Understanding the processes involved in bacterial gut/airways changes and immune vulnerability might allow the identification of potential biomarkers in at-risk patients This might promote the study of alternative interventions and precise medicine strategies, aimed at reducing the risk for recurrent and chronic infectious respiratory conditions [14,15]. Our review summarizes the most recent scientific knowledge on gut and airways dysbiosis in pediatric respiratory infections and asthma In detail, it addresses the main interrelation between microbiota and immune response at mucosal level as well as the associations between gut/airways bacterial community disruption and respiratory infectious diseases. It discusses the place of bacterial-derived products in pediatric dysbiosis and associated respiratory disorders
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