Prolonged Respiratory Infections Research Articles

Outcomes of surgical treatment of tracheobronchomalacia in children.

Tracheobronchomalacia (TBM) is characterized by excessive dynamic airway collapse. Severe TBM can be associated with substantial morbidity. Children with secondary TBM associated with esophageal atresia/tracheoesophageal fistula (EA/TEF) and vascular-related airway compression (VRAC) demonstrate clinical improvement following airway pexy surgery. It is unclear if children with severe primary TBM, without secondary etiologies (EA/TEF, vascular ring, intrinsic pulmonary pathology, or complex cardiac disease) demonstrate clinical improvement following airway pexy surgery. The study cohort consisted of 73 children with severe primary TBM who underwent airway pexy surgery between 2013 and 2020 at Boston Children's Hospital. Pre- and postoperative symptomsas well as bronchoscopic findings were compared with Fisher exact test for categorical data and Student'st-test for continuous data. Statistically significant improvements in clinical symptoms were observed, including cough, noisy breathing, prolonged respiratory infections, pneumonias, exercise intolerance, cyanotic spells, brief resolved unexplained events (BRUE), and noninvasive positive pressure ventilation (NIPPV) dependence. No significant differences were seen regarding oxygen dependence, ventilator dependence, or respiratory distress requiring NIPPV. Comparison of pre- and postoperative dynamic bronchoscopy findings revealed statistically significant improvement in the percent of airway collapse in all anatomic locations except at the level of the upper trachea (usually not malacic). Despite some initial improvements, 21 (29%) patients remained symptomatic and underwent additional airway pexies with improvement in symptoms. Airway pexy surgery resulted in significant improvement in clinical symptoms and bronchoscopic findings for children with severe primary TBM; however, future prospective and long-term studies are needed to confirm this benefit.

Torakoskopska plikacija ošita u dojenčeta s eventracijom dijafragme

Diaphragmatic eventration is an abnormal elevation of part or the entire hemidiaphragm. It can be congenital or acquired. It occurs in 2 to 7 in 100000 live births and it is more common among boys. Symptomatic eventration is presented with different respiratory or gastrointestinal symptoms. The diagnosis is based on radiological images. Surgical treatment is indicated for all symptomatic patients. The goal is to strengthen the thin and weak diaphragm by plicating the diaphragm itself. Surgical approaches may differ. We present an eight month old boy with eventration who was diagnosed during prolonged respiratory infection. Our treatment approach was thoracoscopic plication of the diaphragm with good long-term outcome.

Atopic children are more susceptible to viral respiratory infection at the age of 2-5 years old.

The susceptibility of the atopic population to respiratory infections (RI) has not been fully elucidated. This susceptibility is attributed to the immune dysregulation that characterizes atopic diseases. Although, the exact mechanisms involved are not fully understood, there is evidence that shows that the maturation of innate immunity progresses differently in patients with atopy. The aim of the study was to evaluate the susceptibility to viral RIs (VRI) based on the number and duration of them in different age groups in subjects with atopy and subjects without atopy. Seventy-eight subjects (39 healthy and 39 with atopy) were included in the study. All the subjects were evaluated by a specialist and defined as being atopic if they had a clinical history and/or symptoms compatible with any allergic diseases and relevant sensitizations. Epidemiologic data were recorded based on a standardized questionnaire, which included recording habits, conditions, and living environment as well as the history of viral infections during the last year. In our population, children with atopy were found to be more susceptible to viral RIs than children without atopy (p = 0.02), whereas there was no difference in susceptibility between healthy adults and adults with atopy (18-45 years old). More specifically, the atopic age group 2-5 years old showed the higher susceptibility to VRIs. This study provided evidence that children with atopy, especially at ages 2-5 years old, had more numerically and prolonged RIs than did the subjects without atopy. These clinical findings support the hypothesis of distracted maturation of innate immunity in subjects with atopy.

Фактори імунодефіциту у дітей з трисомією за 21-ю хромосомою (синдром Дауна): сучасна парадигма імунних і неімунних механізмів

Синдром Дауна — найчастіше генетичне захворювання. Діти з трисомією за 21-ю хромосомою часто хворіють на тяжкі, тривалі респіраторні інфекції, що є ознакою дефекту імунної системи. Анатомічні та функціональні дефекти респіраторної, серцево-судинної, травної системи у дітей із синдромом Дауна можуть порушувати природні бар’єри та сприяти розвитку інфекційного захворювання, що необхідно враховувати при лікуванні пацієнтів. Природжені аномалії імунної системи, що асоціюються з трисомією за 21-ю хромосомою, включають легку або середньотяжку Т- та В-клітинну лімфопенію зі значним зниженням нативних лімфоцитів, мітогеніндукованої Т-клітинної проліферації, специфічної відповіді антитіл на імунізацію та дефект хемотаксису нейтрофілів. На сьогодні доведена роль підвищеної експресії генів, зокрема SOD1 та RCAN1, у розвитку первинного імунодефіциту, дефіциту цинку та метаболічних факторів, що роблять різний внесок в імунологічні аномалії, підвищуючи ризик інфекції, та потребують подальших досліджень при синдромі Дауна.

Tracheomalacia and Tracheobronchomalacia in Pediatrics: An Overview of Evaluation, Medical Management, and Surgical Treatment.

Tracheobronchomalacia (TBM) refers to airway collapse due to typically excessive posterior membrane intrusion and often associated with anterior cartilage compression. TBM occurs either in isolation or in association with other congenital or acquired conditions. Patients with TM typically present non-specific respiratory symptoms, ranging from noisy breathing with a typical barking cough to respiratory distress episodes to acute life-threatening events and recurrent and/or prolonged respiratory infections. There are no definitive standardized guidelines for the evaluation, diagnosis, and treatment of TBM; therefore, patients may be initially misdiagnosed and incorrectly treated. Although milder cases of TBM may become asymptomatic as the diameter of the airway enlarges with the child, in cases of severe TBM, more aggressive management is warranted. This article is an overview of the clinical presentation, evaluation, diagnosis, medical management, and surgical treatment options in pediatric tracheomalacia.

Acute and Recurrent Respiratory Tract Infections: Possible Reduction of the Patient’s Pill Burden

Acute and recurrent respiratory tract infections in children are often the reason for seeking medical help. Frequent and prolonged respiratory infections in childhood may lead to the subsequent formation of chronic respiratory diseases in adults. Susceptibility to respiratory infections is common in children with allergic diseases and other chronic diseases accompanied by a decrease in immune reactivity. In the case of acute respiratory infection, these patients, in addition to the basic treatment of the underlying disease, have to take additional cough medicines that increase the pill burden on the body. The main causative agents of acute respiratory infections are viruses. Inosine pranobex is a drug with antiviral and immunomodulatory effects. The article describes the pharmacological properties and the results from studying the efficacy of inosine pranobex in the treatment of acute respiratory viral infections in children.

Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects

Allergic disorders are characterized by type 2 helper T cell (Th2)-polarization, thus physiological type 1 helper T cell (Th1)-dependent mechanisms involved in fighting respiratory infections (RI) may be defective. It has previously been reported that allergic children have more numerous and severe RI than nonallergic ones. The aim of the study was to evaluate the number and duration of RI in adult allergic and nonallergic subjects. Six hundred and twenty-four subjects were studied; 202 of them were allergic (i.e. suffering from allergic rhinitis). The number of RI as well as the duration of the disease were recorded for 2 years. Allergic subjects showed a significantly higher rate of RI episodes [adjusted incidence rate ratio (IRR) = 2.16, 95% confidence interval (CI) 1.94-2.41, P < 0.001] than subjects without allergy. The number of mild RI episodes was slightly higher in allergic subjects (IRR = 1.68, 95% CI 1.50-1.89, P < 0.001), while the number of severe episodes was markedly higher (IRR = 15.71, 95% CI 10.35-23.84, P < 0.001) when compared with nonallergic subjects. Moreover, allergic patients showed a longer total duration of RI than nonallergic subjects, with a mean difference of 17.4 days (95% CI 15.5-19.4, P < 0.001). This study provides evidence that adult allergic patients have more numerous and prolonged RI than nonallergic subjects.

Homozygous deletion of the CYP21A-TNXA-RP2-C4B gene region conferring C4B deficiency associated with recurrent respiratory infections

The central class III region of the human major histocompatibility complex contains highly polymorphic genes that are associated with immune disorders and may serve as susceptibility factors for viral infections. Many HLA haplotype specific rearrangements, duplications, conversions and deletions, occur frequently in the C4 gene region. Genetic deficiencies of complement components are associated with recurrent occurrence of bacterial infections. We have studied the complement profile and the class III genes 5′-RP1-C4A-CYP21A-TNXA-RP2-C4B-CYP21B-TNXB-3′ in a 4-year-old Caucasian patient. He has suffered from several pneumonias caused by respiratory viruses, eight acute otitis media, prolonged respiratory infections and urinary tract infection. Complement C4 was constantly low, but the other complement components, from C1 to C9, C1INH, factor B and properdin, were within normal limits. Immunological evaluation gave normal lymphocyte numbers and functions with the exception of subnormal T cell response to pokeweed mitogen. Molecular studies of the C4 gene region in the patient revealed homozygous deletion of CYP21A-TNXA-RP2-C4B generating total deficiency of C4B and the flanking 5′ region up to C4A, and in the father a missing CYP21A gene. Further investigations are needed to elucidate the relationship between C4B deficiency and susceptibility to infections.

Infantile Herpes Zoster

AbstractA rare occurrence of herpes zoster is reported in a prematurely born 7-month-old infant without signs of previous varicella. The clinical picture was characteristic and the course uneventful. There were no known factors precipitating herpes zoster, but a prolonged respiratory infection preceding the appearance of the rash may be significant Theoretically, appendectomy at the age of 6 weeks might be involved in disturbance of the development of immunological capacity. The levels of immunoglobulins were normal, but these did not increase at a normal rate during the next 6 months. The blood lymphocyte and granulocyte counts were normal, the number of monocytes was increased. The titer of complement-fixing (CF) antibodies to varicella-zoster virus was at the beginning 4 and one week later 256. All the CF antibody resided in the 7S fraction of immunoglobulins. Varicella-zoster specific precipitating antibodies were also present during the active phase.