Cause Of Recurrent Pneumonia Research Articles

Predominantly antibody deficiencies: An important underlying cause of recurrent pneumonia in adults

RATIONALE Limited information exists concerning the causes of recurrent pneumonia in adults, particularly regarding immunodeficiencies or inborn errors of immunity. OBJECTIVES This study aims to evaluate the etiology of recurrent pneumonia in the adult population, with a focus on humoral deficiency and inborn errors of immunity. METHODS A cross-sectional non-interventional study was conducted in Cali, Colombia, from January 2019 to March 2021. Consecutive patients, aged over 14 years but under 65 years, with a history of recurrent pneumonia, were included after providing consent. The study involved a thorough review of their past medical records and radiological studies. All participants underwent complete blood count and serum immunoglobulin level measurements (IgG, IgA, IgM and IgE). Further testing was carried out based on the evaluation of a clinical immunologist. RESULTS Sixty-six (66) individuals, comprising 34 females and 32 males, were enrolled in the study. The onset of symptoms occurred at an average age of 14 years (ranging from 5 to 36 years). The analysis revealed that the most prevalent cause of recurrent pneumonia was inborn errors of immunity (20 cases, 30.3%), followed by idiopathic (9 cases, 13.7%), bronchiectasis (7 cases, 10.7%), primary ciliary dyskinesia (6 cases, 9.0%), asthma (6 cases, 9.0%), and post-tuberculosis complications (5 cases, 7.6%). CONCLUSION Predominantly antibody deficiencies, along with other inborn errors of immunity, were identified as an important factor contributing to recurrent pneumonia in adults. These findings highlight the importance of these conditions as major etiological factors in the context of recurrent pneumonia in the Colombian adult population.

Underlying causes and outcomes of recurrent pneumonia in hospitalized children.

To describe the clinical characteristics and underlying causes of recurrent pneumonia (RP) among hospitalized children, and to identify risk factors associated with adverse outcomes. We reviewed the medical records of hospitalized children diagnosed with RP at the Children's Hospital of Fudan University from January 2016 to January 2021 and then described clinical characteristics and underlying causes. The associations between factors and adverse outcomes were assessed using logistic regression. Of 551 children with RP, 483 (87.7%) manifested underlying causes, with recurrent aspiration (127, 23.0%), primary immunodeficiency (PID) (91, 16.5%), and congenital heart diseases (63, 11.4%) being the most common. Genetic defects were identified in about a quarter (158, 28.7%) of the patients. PID odds ratio (OR, 7.9; 95% confidence interval [CI], 2.8-22.8), primary ciliary dyskinesia (OR, 12.9; 95% CI, 3.0-54.8), bronchiolitis obliterans (OR, 7.0; 95% CI, 1.7-28.5), and a diagnosis of RP at an age of >3 years (OR, 3.4; 95% CI, 1.3-9.0) were risk factors for severe outcomes. Aspiration (OR, 2.9; 95% CI, 1.3-6.3) and an abnormal family history (OR, 3.3; 95% CI, 1.3-8.2) were risk factors for rehospitalization. The majority (87.7%) of hospitalized children with RP exhibited underlying causes, and genetic defects were common.

YAŞLI BİREYLERDE PNÖMONİ VE YUTMA FONKSİYONLARI ARASINDAKİ İLİŞKİ

Purpose: Anatomical and physiological changes due to aging decrease the efficiency of swallowing and increase the risk of aspiration pneumonia. One of the underlying causes of recurrent pneumonia is swallowing dysfunction, with aspiration. This study aimed to compare the swallowing function in elderly patients with and without pneumonia and to investigate its association with malnutrition. Methods: A total of 44 elderly individuals with 22 aspiration pneumonia history (age=73.00±7.93 years) (study group) and 22 without aspiration pneumonia history (age=70.00±6.39 years) (control group) were included in the study. The swallowing function was evaluated using the Swallowing Ability Function Evaluation (SAFE) and water-swallowing test. Nutritional assessment was performed using the Turkish version of the Mini-Nutritional Assessment. Results: Decreased swallowing ability was observed in 59.1% of the study group and 9.1% of the control group (p<0.001). While the study group had severe disorder the 22.7% of the oral phase and 31.8% of the pharyngeal phase, the control group had no severe disorder. However, there was a 9.1% moderate disorder in the oral and pharyngeal phases in the control group (p<0.001). There was a relationship between the nutritional assessment results of the study group and the oral (r=0.498, p=0.018) and pharyngeal phases of SAFE (r=0.622, p=0.002). Conclusion: Our study showed that the swallowing function is affected in the elderly with a history of pneumonia. It was also observed in the elderly without a history of pneumonia. For this reason, a detailed swallowing evaluation must be performed both elderly patients with and without pneumonia, and a protective swallowing rehabilitation program should be developed through an interdisciplinary approach.

Clinical profile and risk factors of recurrent pneumonia in children at Qena governorate, Egypt

There is a scarce research study on recurrent pneumonia in children, particularly in the developing world. This study aimed to analyse the clinical characteristics, risk factors and underlying causes of recurrent pneumonia in children. It was a case-control study involved 87 children with ≥2 episodes of radiographically confirmed pneumonia in a single year or ≥3 episodes at any time with a radiographic clearing of densities between attacks. Controls were 87 age and gender-matched children who had never suffered pneumonia. Demographic and clinical characteristics of patients and controls were compared and evaluated for the detection of possible underlying conditions that may be the incriminated risk factor of pneumonia recurrence. During one-year study, 763 patients were admitted with pneumonia and 87 (11.4%) of them met the definition of recurrent pneumonia. There were 48 (55.2%) males and 39 (44.8%) females. The mean age at diagnosis of recurrent pneumonia was 7.15±1.72years. Prematurity, small birth weight and presence of respiratory distress at birth were significantly different between patients and controls. Aspiration, congenital heart disease, gastroesophageal reflux, oro-motor incoordination, wheezing and asthma were significant risk factors for recurrent pneumonia. Our study showed that 11.40% of children with pneumonia had recurrent form and that most of them had an underlying illness. The most common detected risk factors for recurrent pneumonia were rural residence, low socioeconomic standard, over-crowding, prematurity and presence of respiratory distress at birth. Aspiration, congenital heart diseases, wheezing and asthma were found to be the main underlying illnesses associated with pneumonia recurrences.

Algorithm for the management of chronic pulmonary aspiration in pediatrics

Pulmonary aspiration is the passage of food, gastroesophageal reflux and/or saliva to the airway in a manner sufficient to cause chronic or recurrent respiratory symptoms. It is an important cause of recurrent pneumonia, progressive lung disease, bronchiectasis and even death. Aspiration is intermittent and often occurs in children with underlying medical conditions or syndromes that cause respiratory symptoms similar to chronic pulmonary aspiration, so diagnosis of aspiration is often delayed until there is a significant lung injury. The available diagnostic methods and their limitations, and treatment options of chronic pulmonary aspiration in the pediatric population are described.

Recurrent Pneumonia in Children Admitted to Assiut University Children Hospital. Magnitude of the Problem and Possible Risk Factors

Background: Incidence data indicate that recurrent pneumonia occurs in 7.7–9% of all children with community acquired pneumonia. We aim by this study to assess the prevalence of recurrent pneumonia among the admissions with diagnosis of pneumonia in Assiut university children hospital for one year and to try to define the possible related risk factors. Patients and methods: This is a prospective hospital based study in Assiut University Children’s Hospital. Children younger than 16 years admitted with a hospital diagnosis of pneumonia to Assiut University Children’s Hospital for one year from 1 February 2017 to 31 January 2018 were included. Results: Approximately 1 in 12 children with pneumonia in our locality have recurrent pneumonia with percentage of 12.61%. Cardiac diseases especially congenital heart diseases was the cause among 25.45% of the cases, immunodeficiency diseases represented 20.9% of the cases ,while bronchial asthma was the cause of recurrent pneumonia among 16.36% of the cases. As regard to risk factors in studied group, prematurity was detected among 7.27 % of the cases while more than 50% were formula fed and more than 60% exposed to pollution. Father smoking was detected among 36.36% of cases. Patients aged > 6 years showed significantly higher frequency in risk factors as obesity, indoor and outdoor pollution and use of steroids in comparison to other age groups. However, patients aged 0-3 years exhibited significantly higher % frequency of having heart disease, oro-motor in coordination /swallowing dysfunction, gastro esophageal reflux and under nutrition as risk factors for recurrent pneumonia in comparison to other age groups. Conclusions: The most frequent underlying cause for recurrent pneumonia in Assiut University Children’s Hospital which presents the largest referral pediatric hospital in Upper Egypt for one year according to our study was cardiac diseases; the second most frequent cause was immunodeficiency diseases, followed by bronchial asthma. Risk factors for recurrent pneumonia include socio-economic status of studied cases, prematurity, exposure to passive smoking and in or outdoor pollution, obesity, under nutrition, lack of breast feeding, gastro esophageal reflux and steroids usage.

A Congenital Cause of Recurrent Pneumonia in an Adult

Pulmonary sequestration is a rare congenital abnormality especially in the adult population. It can commonly present as a cause for recurrent pneumonia or be found incidentally as an adult on imaging. We present a case of left lower lobe celiac trunk pulmonary sequestration in the setting of recurrent pneumonia to include histoplasmosis.

Non-Obstructive Middle Lobe Syndrome: An Unusual Cause of Recurrent Pneumonia in an Elderly Woman

An 84-year-old woman had five episodes of pneumonia in 4 months. Despite extensive comorbidities and advanced age, her health status was good and the recurrence seemed unjustified. Exhaustive background investigation revealed 14 episodes of right-sided pneumonias during the 3 previous years and an inconclusive investigation with CT of the thorax and bronchofibroscopy, despite some fibrotic and atelectasic alterations in the right middle lobe. A new right-sided x-ray showed a wedge-shaped density extending anteriorly and inferiorly from the hilum, and CT of the thorax revealed aggravated middle lobe abnormalities with thickening of the bronchial wall and segment atelectasis, without any visible airway obstruction. After extensive work-up had excluded other causes of recurrent pneumonia and immunodeficiency, a non-obstructive middle lobe syndrome (MLS) was deemed responsible for the repeated episodes of pneumonia. MLS is characterised by chronic hypoventilation and atelectasis of the middle lobe, facilitating secretion accumulation, chronic inflammation and repeated infection. After treatment with bronchodilators and immunostimulants was initiated, the patient experienced no recurrences for several months.LEARNING POINTSRecurrent pneumonia is common and has several possible causes. Investigation should be directed by whether or not the location of the episodes varies, suggesting a systemic condition or a local abnormality, respectively.Middle lobe syndrome (MLS) is characterised by chronic hypoventilation of the right middle lobe resulting in atelectasis and secretion accumulation, sometimes causing recurrent pneumonia, and should therefore be considered in the differential diagnosis.MLS is not unusual in children with asthma but is quite uncommon in the elderly despite age-related changes in the characteristics of airways with reduced elastic recoil and mucociliary clearance.

Underlying Causes of Persistent and Recurrent Pneumonia in Children at a Pulmonary Referral Hospital in Tehran, Iran.

There is limited data on recurrent or persistent pneumonia in children, particularly in the developing world. This is a retrospective, cross-sectional study of children with recurrent or persistent pneumonia admitted to the Pediatric Department of Massih Daneshvari Hospital, Tehran, Iran. Children under 18 years of age, who were admitted to the hospital with pneumonia between 2007 and 2013, were investigated to find out the prevalence of recurrent and persistent pneumonia and to recognize their underlying diseases. Descriptive statistics were calculated for all data. Out of 601 children admitted for pneumonia, 229 (38.1%) met the criteria for recurrent or persistent pneumonia. An underlying illness was identified in 194 patients (84.72%). The most common underlying causes of recurrent pneumonia included aspiration syndrome (51.75%), recurrent wheezing (20.17%), and congenital heart diseases (20.17%). The most common underlying illness of persistent pneumonia included pulmonary tuberculosis (38.75%), recurrent wheezing (28.75%), and aspiration syndrome (26.25%). The result showed that the majority of patients with recurrent or persistent pneumonia had an underlying illness. New strategies and guidelines are required for early diagnosis of underlying causes of recurrent or persistent pneumonia in children.

Chiari Malformation Type 1 as Cause of Recurrent Pneumonia with Failure to Thrive

Diagnosing the cause of recurrent pneumonia with failure to thrive (FTT) can be difficult. A nine months age presented with recurrent pneumonia and failure to thrive. Investigation for the same led to the diagnosis of Chiari 1 malformation. Screening for latent neurological disorders should be done in such patients.J Nepal Paediatr Soc 2016;36(3):288-290

Bifid epiglottis as a cause of recurrent pneumonia in a patient with Bardet-Biedl syndrome, a ciliopathy

Abstract Bardet-Biedel syndrome (BBS) is a rare autosomal recessive disorder and a ciliopathic disease that affects many organ systems. It is characterized by obesity, renal anomalies, polydactyly, cone-rod dystrophy, and pervasive developmental delay. Bifid epiglottis is a rare anatomic anomaly that has been reported in association with BBS. Bifid epiglottis typically presents clinically with stridor, recurrent upper respiratory infections, and/or aspiration. A child with BBS presented for evaluation of recurrent pneumonia and was subsequently found to have a bifid epiglottis. This case report highlights the importance of upper airway evaluation in BBS patients.

A rare cause of recurrent pneumonia: Scimitar syndrome

Scimitar syndrome is characterized by partial or total anomalous pulmonary venous return from the right lung along with hypoplasia of the lung. This syndrome has varied presentations, from an asymptomatic state to severe pulmonary hypertension and/or heart failure. Newer diagnostic modalities have improved our understanding of this rare syndrome and hence providing newer treatment options to be tried. Here, we present a case of a 4-year-old child with recurrent pneumonia with Scimitar syndrome. We are reporting this case in view of the rarity of this syndrome and its presentation as recurrent pneumonia.

An unusual cause of recurrent pneumonia in adults.

Selective IgM deficiency is a rare primary immunodeficiency defined as isolated low levels of IgM. It presents with recurrent infections and has been described as first presenting in adulthood with recurrent respiratory tract infections. Unlike its better known counterpart of IgA deficiency, this particular immunodeficiency is often overlooked. We present a case of selective IgM deficiency who presented with recurrent respiratory infections.

Causes of recurrent pneumonia in children in a general hospital

Because the few previous studies on underlying causes of recurrent pneumonia in children have come from tertiary care referral centres where selection bias may be important, the aim of this study was to examine underlying causes of recurrent pneumonia in children in a general hospital. We performed a retrospective chart review in a general hospital of 62 children with recurrent pneumonia over a 7.5 years period. In 19 patients (30.6%), no cause was identified, commonly because favourable natural history obviated the need for a full and invasive diagnostic work-up. Other underlying causes included recurrent aspiration in 16 patients (25.7%), lung disease (airway stenosis, bronchiectasis, middle lobe syndrome or tracheooesophageal fistula) in 10 patients (16.1%) and immune deficiency in 10 patients (16.1%). In contrast to previous studies, asthma was never diagnosed as an underlying cause, but diagnostic confusion between asthma (or recurrent upper respiratory tract infections) and recurrent pneumonia was common. The cause of recurrent pneumonia in children remains elusive in almost a third of patients, partly because the favourable natural history consistent with immune system maturation eliminates the need for further diagnostic procedures. Asthma is more likely a differential diagnostic consideration than an underlying cause of recurrent pneumonia in children. A standardised diagnostic guideline is needed to improve knowledge on causes of recurrent pneumonia in children.

Esophageal bronchus in an infant—a rare cause of recurrent pneumonia

A 4-month-old female infant presented to our institute with recurrent pneumonia and was diagnosed with a right lower lobe esophageal bronchus. This congenital anomaly is extremely rare with very few cases reported in the literature. We describe the diagnostic workup and management that led to a successful outcome.

Death of a 6-Month-Old Due to a Tracheal Bronchus

The death of an infant younger than 1 year requires a thorough scene investigation and autopsy. Most infant deaths investigated by forensic pathologists can be placed into 2 general categories: sudden infant death syndrome and accidental asphyxial deaths. Despite the fact that most infant deaths occur within these 2 categories, it is important to remember that other entities may be responsible for death. In this report, we present a developmental pulmonary abnormality that was ultimately responsible for the death of an infant. A 6-month-old male infant with a prior history of pneumonia was brought to an emergency department for evaluation of fever. Antibiotics were prescribed, and the child was discharged and sent home with instructions to his mother to follow up with his pediatrician. Later that evening, the infant seemed to be in respiratory distress. His mother again transported him to the emergency department, where, on arrival, he became apneic. Despite vigorous resuscitative efforts, the infant died. Of note at autopsy was the presence of low-set abnormal ears and bilateral inward-turning ankles. Internally, an abnormality of the tracheobronchial tree was evident, with the right upper lobe bronchus arising from the distal trachea, proximal to the carina. In addition, the right upper lobe was discolored and firm. Microscopically, pneumonia was present. The cause of death was pneumonia due to a right tracheal bronchus. Childhood pneumonia is a known cause of childhood hospitalization, morbidity, and mortality. Identifying the causes of recurrent pneumonia, be it structural, metabolic, or syndromic, aids in preventing recurrent infections and reducing the incidence of childhood mortality. A tracheal bronchus, also known as bronchus suis or "pig bronchus," is an anatomic variant of the tracheobronchial tree in which a bronchus arises proximal to the carina, most commonly on the right and predominantly in males. The incidence is around 0.2%. Although the tracheal bronchus is sometimes a clinically silent entity, some patients may exhibit certain signs and symptoms, including hemoptysis, coughing, stridor, wheezing, and pain. The typical consequences of the tracheal bronchus are recurrent pneumonias. The recurrent pneumonia is thought to be due to a stasis of secretions and an abnormal pulmonary clearing mechanism. Treatment for the condition varies, based on symptoms. For asymptomatic patients, conservative management is adequate. For symptomatic patients with persistent atelectasis or right upper lobe consolidation, surgical excision is advised.

Association between Gastroesophageal Reflux and Endobronchial Carcinoid: A Case Report

Children with neurological disorders may suffer from gastroesophageal reflux disease (GERD). Typical symptoms are vomiting, regurgitation and hematemesis. Patients present with respiratory symptoms only in cases with swallowing disorders causing chronic airway aspiration. We report the case of a patient affected by chromosome 8 p deletion syndrome with mental retardation, referred to our unit for suspected GERD. Chest X-ray, performed at admission for coexisting respiratory complaints, showed left lower lobe pneumonia; esophageal pH monitoring and upper endoscopy were normal for GERD. To rule out chronic airway aspiration, gastroesophageal 99 mTc scintigraphy with lung scan 18 to 24 h after a test meal and video fluoroscopy swallowing study were performed, both negative. Two months later, a second episode of left lower lobe pneumonia occurred. A chest CT scan was performed and showed an endobronchial mass; the biopsy taken during the broncoscopy was not conclusive. Surgical excision resulted in a diagnosis of pulmonary carcinoid. Bronchial carcinoids, although rare, should be taken into consideration as a potential cause of recurrent pneumonia even in the presence of demonstrated GERD where severe respiratory infections only occur with coexisting chronic pulmonary aspiration, even in neurologically impaired people.

Evaluating the child with recurrent lower respiratory tract infections

We review the limited available evidence on underlying causes of recurrent pneumonia in children, supplemented by our own clinical experience. Diagnosing recurrent pneumonia in children is difficult. Diagnostic confusion is possible with recurrent upper respiratory tract infections and asthma. In our series of children with recurrent pneumonia, we never identified asthma as an underlying cause. Because the frequency or severity of recurrent pneumonia does not always justify additional invasive investigations, the diagnostic work-up may be incomplete in a number of cases. This may help to explain why an underlying cause for recurrent pneumonia cannot be found in approximately 30% of cases. Finally, the paradigm that recurrent pneumonia in the same lung lobe has a differential diagnosis different from those recurring in multiple lobes was not borne out in our case series. A stepwise and pragmatic approach to evaluating children with recurrent lower respiratory tract infections is recommended.

Communicating oesophageal duplication cyst with heterotopic pancreatic tissue – an unusual cause of recurrent pneumonia in an infant

Communicating oesophageal duplication cyst with heterotopic pancreatic tissue is rare congenital anomaly and unusual cause of recurrent pneumonia in children. We report a 10-month-old boy who presented with history, examination and investigations suggestive of aspiration pneumonia since birth. The imaging studies revealed a thin walled cavity communicating with the oesophageal lumen that was excised by surgery. Histopathology showed squamous epithelial lining of cyst with heterotopic pancreatic tissue. Communicating oesophageal cyst causing persistent signs and symptoms can be an unusual cause of recurrent pneumonia in an infant that can be diagnosed by further imaging studies.

Common Variable Immunodeficiency in Horses is Characterized by B Cell Depletion in Primary and Secondary Lymphoid Tissues

Common variable immunodeficiency (CVID) in horse patients is characterized by late-onset B cell lymphopenia or depletion, hypo- or agammaglobulinemia, impaired humoral response to tetanus toxoid vaccination, and recurrent fevers and bacterial infections. This study describes the clinical and immunologic findings of 14 affected horses (average age 10.7 +/- 4.4 years) of both genders (six females, eight males) and different breeds (eight Thoroughbreds, four Quarter Horses, one Warmblood, one Pony). Serial immunological testing in peripheral blood revealed persistent, severe B cell lymphopenia (mean 1.3 +/- 2.3% positive cells) in all patients. Serum IgG (range <200 to 800 mg/dL) and IgM (<or=25.0 mg/dL) deficiency was common to all horses. Serum IgA concentrations declined with time. Histopathology and immunohistochemistry revealed absence of lymphoid follicles and B cells in primary and secondary lymphoid tissues. CVID is a cause of recurrent pneumonia, septicemia, and meningitis in adult horses and has a grave prognosis for clinical management and survival.