History Of Recurrent Respiratory Infections Research Articles

Advanced gastric cancer, a very rare complication of Common Variable Immunodeficiency: a case report

Background : Common Variable Immunodeficiency (CVID) is associated with a broad spectrum of symptoms related to infections, chronic lung diseases, autoimmune diseases, and tumors; however, solid tumors are rare complications of CVID and gastric cancer, specially, has been reported very rarely. Case Presentation : The present case report describes a 28 years old known case of CVID male, who was referred to us because of chronic diarrhea, weight loss and abdominal pain. He had history of recurrent respiratory infections but first manifestations of his recent problem had appeared six months before the referral as epigastric pain, vomiting, and watery diarrhea. During his initial workup the patient had undergone partial gastrectomy surgery because of the pyloric stenosis. In early assessment of patient in our center, an ulcerative mass lesion with induration and regidity in body and antrum of stomach was seen during upper GI endoscopy. Endoscopic ultrasound evaluation revealed thickening in body layers, expansion of tumor in 3 rd and 4 th layers, and 2-3 perigastric lymphadenopathy. Eventually, undifferentiated adenocarcinoma of the stomach was reported by histologic examination.

Index of Suspicion

Index of Suspicion

Karyomegalic interstitial nephritis: A pitfall in urine cytology

A case of a 44-yr-old Maori female presenting with chronic renal failure due to karyomegalic interstitial nephritis is reported. To our knowledge, this is the first instance this disorder has been reported in a New Zealand Maori. Karyomegalic interstitial nephritis is a rare cause of progressive renal failure, which may be familial, and is frequently associated with a history of recurrent respiratory infections. The urine in this case contained large, pleomorphic cells, mimicking carcinoma. The case therefore illustrates a rare cause of chronic renal failure, and presents an important diagnostic pitfall in the practice of urine cytopathology.

An Interesting Case Of Cystic Adenomatoid Malformation

An interesting case of cystic adenomatoid malformation. CASE A 6 month old male infant presented with history of recurrent respiratory infections and shortness of breath. A chest skiagram was ordered and Cystic Adenomatoid Malformation of the middle lobe of the right lung was diagnosed. The affected region was dull to percussion and air entry was poor. Surgical resection of the involved lobe was advised. The patient has been lost to follow-up.

A syndrome of immunodeficiency, autoimmunity, and spondylometaphyseal dysplasia

We treated a 5-year-old boy, in our hospital in south India, who had a history of recurrent respiratory infections, tuberculosis, and severe varicella infection. He was short in build and a radiological examination revealed evidence of spondylometaphyseal dysplasia. Investigation of the immune system was suggestive of compromised cellular immunity. Immunofluorescence and immunoblot assay for antibodies detected underlying multiple disorders such as systemic lupus erythematosus (SLE), autoimmune thrombocytopenia, and juvenile rheumatoid arthritis (JRA). Roifman et al. described a similar syndrome in 2000 and 2003, which was characterized by spondylometaphyseal dyplasia, combined immunodeficiency, and autoimmunity and called it Roifman-Costa syndrome (OMIM 607944). Hence a diagnosis of Roifman-Costa syndrome was made. Ours shall be the first report of such a condition from the Indian subcontinent and hence the communication.

The role of HRCT versus CXR in children with recurrent pulmonary infections

The purpose of this study is to evaluate the role of high-resolution computed tomography (HRCT) versus chest radiography (CXR) in children with recurrent respiratory infections. Fifty-one cases, aged 2 months–13 years, who had a history of recurrent respiratory infections, were examined with CXR and HRCT. HRCT showed that 16/51 of the cases had bronchiectasis. CXR revealed findings of bronchiectasis only in 5 of the 16 cases. HRCT showed peribronchial thickening in 18 cases, whereas CXR showed the same finding in 5 patients. Overall, HRCT showed the underlying pathology and sequel of pulmonary lesions in 22 out of 51 cases, and linear densities in 12. Compared with the CXR, HRCT gives much more information.

Cough and weight loss in a patient with cystic fibrosis

HISTORY OF PRESENT ILLNESS The patient was a 26-year-old man who was diagnosed as having CF at the age of 20 years after a 3-year history of recurrent respiratory infections, chronic cough, and weight loss. Three initial sweat chloride tests produced results each greater than 60 mmol/L. A fourth test result was in the intermediate range at 47 mmol/L. At the time of diagnosis, the patient’s sputum yielded Haemophilus influenza and Staphylococcus aureus. Spirometry revealed a forced vital capacity (FVC) of 2.94 L (59% of predicted) and a forced expiratory volume in 1 second (FEV 1 ) of 1.93 L (46% of predicted) with no demonstrable bronchodilator effect. Since his diagnosis, the patient has experienced 1 lower respiratory tract illness per year. In the previous 4 months, however, he had 5 illnesses characterized by fever, cough productive of green sputum, diaphoresis, fatigue, and a 42-lb weight loss. His physician treated him with multiple courses of antibiotics (ciprofloxacin and cefuroxime), but symptoms promptly recurred after discontinuation of antiobiotic therapy. Because of treatment failure and progressive weight loss, he was referred to a pulmonologist and CF specialist, who admitted him for intravenous antibiotics. His review of symptoms was notable for decreased appetite and occasional hemoptysis and the absence of dysphagia, night sweats, chills, sinus problems, headache, joint aches, rashes, polyuria, polydipsia, abdominal pain, and diarrhea. He had 2 formed, nonoily bowel movements daily. He was a healthy child until the age of 17 years when he developed cough. At the time of his CF diagnosis, he was noted to have hepatosplenomegaly by examination, and the results of a full gastrointestinal workup, including upper and lower endoscopy and biopsy, were negative. His medical history was otherwise remarkable for psoriasis, nasal polyposis, and a nonspecific learning disability. His medications included dornase alfa, salmeterol, vitamin E, and a multivitamin. He had no drug allergies. He had no siblings, and there was no known family history of CF, atopy, immunodeficiencies, or autoimmune disease. He was unemployed, was a lifelong nonsmoker, and did not drink alcohol or use any illicit substances.

Common variable immunodeficiency in children. Cases review

Rationale To review the clinical and immunological features of a group of pediatric patients with diagnosis of common variable immunodeficiency (CVID) treated in the Vall d'Hebron Hospital of Barcelona, Spain. Methods We reviewed the clinical files of pediatric patients with diagnosis of CVID and we registered the clinical features present in each case as well as the age of the onset of symptoms, the age at the diagnosis time, and the laboratory data. Results A total of 16 patients were studied (13 males and 3 females). The symptoms began before the age of ten in all the cases and in 56.3% of the children they had begun before the age of two. The most common clinical features were the history of recurrent respiratory infections (93.7%) and the occurrence of bronchiectasis (37.5%). All of the children had low serum levels of two or more immunoglobulin isotypes. There was not evidence of autoimmune disease or cancer in any of our patients. Conclusions The clinical and immunological features in our group were similar to that previously reported. However, it seems that the incidence of autoimmunity and cancer in children with CVID are less common than that in adults.

Effectiveness of influenza vaccination of children with recurrent respiratory tract infections in reducing respiratory-related morbidity within the households

To evaluate the effectiveness of influenza vaccination in reducing respiratory-related morbidity among children with recurrent respiratory tract infections (RRTIs) and their household contacts, 127 children aged 6 months–9 years (78 males; median age, 3.7 years) with a history of RRTIs (≥6 episodes per year if aged ≥3 years; ≥8 episodes per year if aged <3 years) were randomized to receive the intranasal virosomal influenza vaccine ( n=64 with 176 household contacts) or a control placebo ( n=63 with 173 household contacts). During influenza season, the vaccinated children had fewer respiratory infections, febrile respiratory illnesses, prescribed antibiotics and antipyretics, and missed school days than the controls, and similar benefits and a reduction in the loss of parental work were observed among their household contacts. This study shows that the benefits of influenza vaccination extend to children with RRTIs and their family members and encourages to recommend its use in such children.

Heterogeneity of humoral immune abnormalities in children with Nijmegen breakage syndrome: an 8-year follow-up study in a single centre.

During an 8-year period of observation, defects of immune responses were characterized and monitored in 40 of 50 Polish children with Nijmegen breakage syndrome referred to the Children's Memorial Health Institute in Warsaw. The following parameters were determined at diagnosis: (1) concentrations of serum IgM, IgG, IgA; (2) concentrations of IgG subclasses; and (3) lymphocyte subpopulations. In addition, naturally acquired specific antibodies against Streptococcus pneumoniae were determined in 20 patients with a history of recurrent respiratory infections. During follow-up, total serum immunoglobulins and IgG subclasses were monitored systematically in 17 patients who did not receive immunomodulatory therapy. Moreover, anti-HBs antibody response was measured after vaccination of 20 children against HBV. We found that the immune deficiency in NBS is profound, highly variable, with a tendency to progress over time. Systematic monitoring of the humoral response, despite good clinical condition, is essential for early medical intervention.

Discinesia ciliar primaria, a propósito de un caso atípico

Primay ciliary dyskinesia is a rare autosomal recessive disorder, characterized by abnormal ciliary structure and function and chronic lung, sinus and middle ear disease. A 45-year-old man with a history of recurrent respiratory infections, which was developped in the adult age, and was presented with moderate clinical involvement, and spermatic hypomotility in seminogram. Diagnosis and differential diagnosis was based on the typical clinical picture and the electron microscopical demonstration of ultrastructural abnormalities. We found abnormal number of cilia on the bronchial mucosa cells and the ciliary structure was abnormal too. We observed abnormally short dynein arms and defective radial spokes.

Prevalence of, and risk factors for, physical ill-health in people with Prader-Willi syndrome: a population-based study.

The medical findings from a population-based study of Prader-Willi syndrome (PWS) are discussed (in which birth incidence of PWS was estimated at 1:22,000 and death rate at over 3% per annum). In this study the prevalence of specific medical disorders that might account for a shortened life expectancy were investigated. Of all people with a possible diagnosis of PWS, only those meeting clinical criteria and/or with a confirmed genetic diagnosis were included in the study. Sixty-six individuals, 40 males and 26 females with a mean age of 19 years (range of 0 to 46 years) agreed to participate in the population-based study group. A prevalence rate of 25% for non-insulin dependent diabetes mellitus (NIDDM) was found in adults. Mean age at onset was 20 years. Those with NIDDM had a higher past maximum body weight and a greater likelihood of positive family history. Nearly 50% across the age groups reported a history of recurrent respiratory infections. High rates of fractures (29%), leg ulceration (22% in adults), sleep disorders (20%), and severe scoliosis (15% in childhood) were also reported. It is postulated that hypotonia is a possible contributory factor to the risk of strabismus, scoliosis, and respiratory infections. Other causes of morbidity, in particular the high rates of NIDDM, may be due to a failure to manage over-eating resulting in severe obesity. Early diagnosis and clear guidance to families about these risks and how they might be prevented is recommended. It is hypothesized that the high pain threshold may result in the presence of some illness not being apparent.

Virtual endoscopy in the diagnosis of an adult double tracheal bronchi case

We report a case of ipsilateral double tracheal bronchi supplying a tracheal lobe in a 42-year-old man, who presented with a 10-year history of recurrent respiratory infections. Diagnosis was established by chest computed tomography (CCT), virtual endoscopy and bronchoscopy. Both bronchi were surgically resected along with the right upper lobe of the lung and the associated tracheal lobe. To our knowledge, this is the first report of ipsilateral double tracheal bronchi in the adult life to be diagnosed and treated on the basis of modern radiological techniques and especially virtual endoscopy findings.

Bronchial carcinoid of an accessory tracheal bronchus

We present a rare case of bronchial carcinoid tumor arising in an accessory right tracheal bronchus and involving the associated tracheal lobe in a 48-year-old man, who presented with a history of recurrent respiratory infections and recent onset of hemoptysis. Diagnosis was established on preoperative bronchoscopy and biopsy. The tumor was completely removed by right upper lobectomy with the tracheal bronchus resected flush to its origin from the right lower tracheal wall. Final histology revealed a typical carcinoid tumor.

Immune deficiency (IgG2 deficiency), minimal centromeric association and facial dysmorphism

The patient is a 16-year-old male, with a history of recurrent respiratory infections and bronchiectasis requiring lobectomy at age 7 years. His parents are first cousins. He had a brother who died at age 8 years and reportedly had similar condition and diabetes insipidus. He has three healthy sisters. The patient has failure to thrive; his weight, height and head circumference are all below the 3rd percentile for age. He has a triangular fades with wide palpebral fissures, relative hypertelorism (OC 9.5, IC 3, IP 6, PF 3.2 cm), malar hypoplasia, prominent nasal bridge, relatively large nose, long philtrum, thin upper vermilion, prominent lower lip, retromicrognathia and hepatosplenomegaly. The immunologic work-up revealed lgG2 deficiency and defective cellular killing activity. The α1 -antitrypsin level and sweat test were normal Chromosome analysis revealed 46,XY karyotype, with 11 cells out of 51 showing centromeric association of two-to-three chromosomes, but not exclusively involving chromosomes 1, 9 and 16, reported in immunodeficiency-centromeric instability-facial anomalies (ICF) syndrome. The facial features in this patient are similar to those seen in ICF syndrome, except for the prominent nasal bridge and malar hypoplasia. The type of immune deficiency in this patient is also somewhat different from those reported in ICF. Therefore, our patient may represent a variant of ICF syndrome, or a separate entity.

Risk factors for community-acquired pneumonia in children: a population-based case-control study.

Risk factors for community-acquired pneumonia were studied by collecting data from all pneumonia patients (n = 201) in a defined child population between 3 months and 15 years of age during a surveillance period of 12 months, and from randomly selected healthy controls under 15 years of age (n = 250) from the same area. A structured questionnaire was used, with 409 (176 patients and 233 controls) families responding in total. The chi-square test, and the univariate and multivariate logistic regression analyses were used. The confounding effects of gender, age and place of acquisition were standardized, and the possible interactions between these variables and each individual risk factor were calculated. In the risk factor analysis, the responders were classified into 2 age groups: under 5 years and 5-14 years of age. In children under 5 years of age the significant risk factors were a history of recurrent respiratory infections during the past year [odds ratio (OR) 5.5], a history of wheezing episodes (OR 5.3), and a history of otitis media and tympanocentesis before the age of 2 years (OR 3.6). In the older children, the significant risk factors were a history of recurrent respiratory infections during the previous year (OR 3.0), and a history of wheezing periods at any age (OR 2.1). To sum up, a susceptibility to respiratory infections was found to be significantly associated with community-acquired pneumonia, and no interactions with age, gender or place of acquisition were significant. This trend was reflected by a history of wheezing and that of acute otitis media.