Chronic Pulmonary Infiltrates Research Articles

Pediatric fiberoptic bronchoscopy: Clinical experience with 2,836 bronchoscopies.

OBJECTIVE: To report 21 yrs of experience with pediatric flexible fiberoptic bronchoscopy in infants and children, explore newer applications, delineate potential complications, and make recommendations for its future application. DESIGN: Retrospective review. SETTING: A 20-bed pediatric critical care unit in a tertiary care, university-based children's hospital. PATIENTS: A total of 2,836 pediatric and infant fiberoptic bronchoscopies, performed over a course of 21 yrs, were reviewed. Measurement and MAIN RESULTS: A total of 2,836 children (1,536 girls) were subjected to flexible fiberoptic bronchoscopy. Of those, laryngeal mask airway was incorporated in 92 procedures (3.2%) and general anesthesia was applied in 198 cases (7%). The youngest subject was a 1-wk-old, 600-g, premature infant. The procedure resulted in diagnoses that modified patient care, particularly in tracheostomized infants and those with upper airway obstruction, plastic bronchitis of acute chest syndrome, dyskinetic cilia syndrome, immunocompromised individuals, and those with unexplained chronic cough and recurrent pulmonary infiltrates. Microbiologic and cytologic data from bronchoalveolar lavage helped confirm the diagnoses of pulmonary hemosiderosis and gastroesophageal reflux and validated the presence, or lack of, bacterial or viral pathogens. A total of 21 patients (<1%) experienced life-threatening hypoxemia, prompting termination of the procedure. Laryngospasm or bronchospasm was observed in 17 individuals (<1%) undergoing bronchoalveolar lavage, and 4% of the total population experienced mild nasopharyngeal bleeding. No fatalities were encountered. CONCLUSIONS: Pediatric flexible fiberoptic bronchoscopy is a safe diagnostic and interventional tool, even in young or extremely premature infants. Although the rate of serious complications in this report is low, general anesthetic agents and incorporation of laryngeal mask airway is advocated for severe mucoid impaction, transbronchial biopsy, and chronic pulmonary infiltrates, which may necessitate extensive bronchoalveolar lavage.

Alveolar cell carcinoma complicating sickle cell anemia: A chance occurrence?

Alveolar cell carcinoma, a neoplasm associated with pre-existing inflammatory lung disease, has not been reported previously in patients with sickle cell disease. We present such a patient and suggest that chronic pulmonary scarring in this setting predisposed to development of his malignancy. As survival increases in individuals with sickle cell disease, alveolar cell carcinoma must be considered in these differential diagnosis of otherwise unexplained chronic pulmonary infiltrates.

Acquired Immunodeficiency Syndrome in Infants

Fourteen infants with clinical and laboratory features of an acquired immunodeficiency syndrome were identified in a single metropolitan area from November 1980 to July 1983. Patients were predominantly of Haitian parentage, although two cases occurred in offspring of non-Haitian intravenous drug abusers. Only one patient had received a blood transfusion before the development of clinical findings. The predominant clinical findings included failure to thrive, persistent infection of the oral mucosa by Candida albicans, chronic pulmonary infiltrates, hepatosplenomegaly, lymphadenopathy, and diarrhea. Immunologic studies showed most of the infants to have inverted ratios of T-cell subsets, greatly increased immunoglobulin levels, and circulating immune complexes. Lymphopenia was not common, as it is in adult patients. Infectious agents responsible for opportunistic infections in this series included Pneumocystis carinii, herpesviruses, particularly cytomegalovirus, and C. albicans. Bacterial infections were common, and gram-negative sepsis was the major cause of death in the seven infants who have died. At autopsy, two infants had disseminated lymphadenopathic Kaposi's sarcoma. These observations suggest the likelihood of transplacental, perinatal, or postnatal transmission of an as yet unidentified infectious agent that causes this disease.

REVERSAL OF SIGNS AND SYMPTOMS OF ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) WITH PREDNISONE

We describe in detail the case of a male infant of a prostitute and IV drug abuser. The child presented at 9 mo of age with severely delayed growth (6.6 kg) and development, recurrent bacterial infections, lymphadenopathy, hepatosplenomegaly (8 cm), persistent oral candidiasis, and chronic pulmonary infiltrates. Immunologic studies showed polyclonal hypergammaglobulinemia and inverted T-cell T4/T8 ratios. Skin tests to Candida and phytohemagglutinin were positive. Lung biopsy showed peribronchiolar lymphocytic infiltrates. Axillary lymph nodes contained obliterated margins with increased plasmacytes centrally. Liver biopsy demonstrated mild ballooning of hepatocytes. Bone marrow biopsy revealed hypercellularity with increased plasmacytes. EB virus was repeatedly isolated from lymph node, bone marrow, and blood lymphocytes, although antibodies to EBV did not appear for another 4 mo. Sera from both mother and child did contain antibody to human T-cell leukemia virus. Multiple sera were negative for antibody to cytomegalovirus and herpes virus. These viruses failed repeatedly to grow from tissue specimens. Initially, the child's course was observed off all treatment. After 8 wks of slow deterioration, he became lethargic, tachypneic, and febrile without apparent source of infection. At that point, he was begun on oral prednisone (PDR), 2 mg/kg/day. After 1 wk, he became afebrile with normal respirations. His adenopathy dissolved along with resolution of interstitial infiltrates. After 4 wks of PDR therapy, weight was 8.7 kg, serum immunoglobulins were normal, and spleen tip was just palpable. After tapering of PDR, all indicators of disease reverted toward pre-PDR values. Reinstitution of PDR again changed all parameters in a beneficial manner. We conclude that PDR may be effective in treatment of the AIDS prodrome.

Acquired immunodeficiency syndrome in infants.

Fourteen infants with clinical and laboratory features of an acquired immunodeficiency syndrome were identified in a single metropolitan area from November 1980 to July 1983. Patients were predominantly of Haitian parentage, although two cases occurred in offspring of non-Haitian intravenous drug abusers. Only one patient had received a blood transfusion before the development of clinical findings. The predominant clinical findings included failure to thrive, persistent infection of the oral mucosa by Candida albicans, chronic pulmonary infiltrates, hepatosplenomegaly, lymphadenopathy, and diarrhea. Immunologic studies showed most of the infants to have inverted ratios of T-cell subsets, greatly increased immunoglobulin levels, and circulating immune complexes. Lymphopenia was not common, as it is in adult patients. Infectious agents responsible for opportunistic infections in this series included Pneumocystis carinii, herpesviruses, particularly cytomegalovirus, and C. albicans. Bacterial infections were common, and gram-negative sepsis was the major cause of death in the seven infants who have died. At autopsy, two infants had disseminated lymphadenopathic Kaposi's sarcoma. These observations suggest the likelihood of transplacental, perinatal, or postnatal transmission of an as yet unidentified infectious agent that causes this disease.

Radiologic changes in the thymoma-hypogammaglobulinemia syndrome

Radiologic findings in the thymoma-hypogammaglobulinemia syndrome are encountered in three stages reflecting the natural history of the syndrome. Initially, a mediastinal mass is apparent on chest x-ray in an asymptomataic patient. At this stage a failing immune system has apparently induced compensatory thymic hyperplasia which progresses to frank neoplasia. In 55% of the cases this thymic tumor is paracardiac in location. With progressive failure of immunoglobulin production, acute and chronic pulmonary infiltrates occur secondary to infection. Markedly, decreased IgA in the bowel may eventually be manifested by radiologic changes of exudative enteropathy.

Chronic Pulmonary Infiltration

To the Editor:— In the QUESTIONS AND ANSWERS section200:1190, 1967), there appears a case of chronic pulmonary infiltration in a 19-year-old boy. The presence ofHemophilus influenzaand staphylococcus in the sputum suggests some underlying pulmonary or systemic illness and Noehren in his reply mentions some possibilities. There are others that might be considered. Cystic fibrosis is present in about one of every 100 to 2,000 persons, the recessive gene being present in about one of every 16. Many dysgammaglobulinemias have been described (New Eng J Med275:709, 769, 1966). Another review of y-globulin deficiency presents a case of a 14-year-old boy with recurrent pneumonia whose sputum contained Hinfluenza. X-ray films of his nasopharynx showed a decreased amount of lymphoid tissue, and his serum μg globulin was only 170 mg/100 ml. Lastly, bronchiectasis is a possibility, even if acquired as a complication of some other underlying

Pulmonary infiltration with blood eosinophilia

1. 1. A case of chronic pulmonary infiltration with blood eosinophilia of unknown etiology is presented. 2. 2. Similar cases are relatively rare in the American literature and etiologic mechanisms are poorly understood. 3. 3. Loeffler's syndrome and tropical eosinophilia, two diseases which bear certain similarities to this clinical syndrome, are discussed. 4. 4. Further investigation is needed not only to clarify the etiology of this syndrome but also to determine the role of arsenicals, antihistaminic drugs and desensitization technics as therapeutic agents.

PULMONARY HEMOSIDEROSIS IN A SIX YEAR OLD BOY

Judging from a study of the literature, chronic interstitial pulmonary infiltration and hemosiderosis1must be rare in children and the diagnosis of this disease must be difficult to make while the patient is living. In the case here reported a diagnosis of chronic pulmonary infiltration was made from clinical and roentgenographic observation, and, although hemosiderosis was considered, after Anspach's report of a case of this condition2had been read, the patient presented such a different clinical picture that a diagnosis of hemosiderosis was not definitely made clinically. The essential features of this report are as follows: An undernourished but otherwise normal 5 year old white boy passed through a period, of a few months' duration, of rather severe anemia of unknown origin, associated with great fatigability and muscular weakness. Aside from this general condition, for some months the only positive sign was diffuse mottling of the pulmonary fields

PART I.: EXPERIMENTAL PNEUMONIA

PART I.: EXPERIMENTAL PNEUMONIA