Recurrent Chest Infections Research Articles

Clinical features and treatment issues in pediatric tracheobronchomalacia

BackgroundThe purpose of this study was to outline the variable clinical presentations of tracheobronchomalacia in children, as well as the treatment options available, which may include either conservative or surgical approaches.MethodsThis is a retrospective descriptive study involving a review of medical charts for patients admitted to the Pediatric Pulmonology Unit diagnosed with airway malacia from January 2021 to December 2024. Patients were further classified according to the level of airway malacia into tracheomalacia (TM), bronchomalacia (BM), and tracheobronchomalacia (TBM).ResultsSixty-eight children with airway malacia were included in the study. Among them, thirty-eight were male. The median age of the participants was 28.0 months, with the median age at which symptoms first appeared being 14.5 months. The most common indications for flexible bronchoscopy were persistent radiological findings, observed in 36.8% of the cases, followed by recurrent chest infections at 22.1%. Other notable presentations included recurrent or persistent wheezing (17.6%), recurrent or persistent stridor (13.2%), and both wet cough and barking cough, each occurring in 11.8% of the patients. Additionally, difficult extubation was reported in 8.8% of the cases. Surgical treatment was performed in 14/68 (20.6 %) of children, with no significant difference between TM, BM, and TBM in the rate of interventions.ConclusionsEarly diagnosis of airway malacia, along with recognizing its underlying causes and associated comorbid conditions, will lead to better treatment and prevention of complications.

Case Report: Chediak Higashi Syndrome with Hemophagocytic Lymphohistiocytosis

Chediak higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by albinism, recurrent chest infections and neurological dysfunction. Although a rare disorder but is commonly encountered. Diagnosis of CHS is challenging and most infants remain undiagnosed leading to poor life quality. In this case report, we discuss a 3 years old child that presented to Chughtai institute of Pathology, Lahore. Patient was transfusion dependent and other than fair skin and greyish hair, he also had splenomegaly. His bone marrow biopsy was performed and findings were consistent with CHD with secondary HLH.

Non Tuberculous Mycobacterium Infection with Cavernolith: A Rare Case Report

Cavernolithiasis is defined as a calcified focus found inside a lung cavity. The patient can remain asymptomatic or exhibit non specific symptoms such as haemoptysis and recurrent chest infections. Its diagnosis poses a challenge to clinicians worldwide, making it a topic of interest. A collection of more than 190 various mycobacteria that cause infections in different body organs, especially the lungs, is collectively referred to as Non Tuberculous Mycobacteria (NTM). Hereby, authors report a rare case of cavernolithiasis in a 35-year-old-female patient with an NTM infection who was previously diagnosed and treated for Pulmonary Tuberculosis (PTB). This patient’s sputum was positive for Acid-fast Bacilli (AFB), and sputum culture showed growth of NTM species. High-resolution Computed Tomography (CT) of the thorax revealed bilateral cavitary lesions with the presence of calcified material inside the cavities. She did not require any surgical intervention and was managed conservatively. NTM infection poses a diagnostic challenge, making treatment milestones very difficult due to the complex treatment regimen involving multiple drugs administered for a prolonged period. Therefore, appropriate measures such as cessation of substance abuse, pulmonary hygiene, a nutritional diet, adherence to treatment, and regular follow-up must be taken to improve the quality of life.

A Missed Case of Tracheal Bronchus Leading to Difficult Lung Isolation in a Cardiac Patient: A Case Report

Abstract The tracheal bronchus, an unusual tracheobronchial anatomy with an incidence rate between 0.1% and 2%, is almost synonymous with the right upper lobe bronchus, which emerges from the right side of the tracheal wall above the carina. Although it is mostly asymptomatic, some cases may suffer from recurrent chest infection, chronic bronchitis, or even complicated with bronchiectasis. The standard anterolateral chest X-ray is often unable to detect the tracheal bronchus which is usually missed. A tracheal bronchus can significantly affect airway management, especially during lung isolation. Other coexisting respiratory or cardiac congenital anomalies may complicate the situation. We reported a case of a 19-year-old girl scheduled for minimally invasive tricuspid valve replacement who was accidentally discovered to have an ectopic bronchus during establishing lung isolation. Our approach involved the use of a Fogarty embolectomy catheter in conjunction with an endobronchial blocker, following an unsuccessful attempt to separate the right lung using a left-sided double-lumen endotracheal tube. We succeeded in isolating the right lung, and the surgical team successfully replaced the tricuspid valve without hypoxia or any other complication. This case highlights the importance of bronchoscopy examination before lung isolation and reminds anesthesiologists to be flexible in their airway management plans.

Bronchiectasis in African children: Prevalence, etiology, and clinical spectrum at a pediatric tertiary hospital in Cape Town, South Africa

Objectives: The objective of the study was to describe the disease burden, etiology, and clinical spectrum of bronchiectasis in children attending a tertiary hospital in Cape Town, South Africa. Materials and Methods: Data were collected by chart review of all patients aged 3 months to 15 years attending the respiratory clinic at Red Cross War Memorial Children’s Hospital between January 2019 and December 2019. We included children who had a diagnosis of bronchiectasis based on a history of a recurrent (>3 episodes/year) or persistent (>4 weeks) wet or productive cough and a clinical phenotype characterized by any of the following: Exertion dyspnea, recurrent chest infections, growth failure, finger clubbing, and chest deformity associated with radiographic features of bronchiectasis on chest radiograph or chest tomography reported by a pediatric radiologist. Patients with cystic fibrosis were excluded from the study. Results: Of 337 children seen at the respiratory clinic during the study period, 58 (17.2%) had bronchiectasis that was diagnosed at a mean age of 34 months (standard deviation 26), and 32 (55.0%) were female. The most common causes of bronchiectasis were post-infectious 25 (43.1%), and underlying immunodeficiencies 19 (32.8%), including 16/58 (27.6%) who were living with human immunodeficiency virus (HIV) and 3 (5.1%) with primary immunodeficiency. Other causes included aspiration syndrome 8 (13.8%) and anatomical abnormalities 4 (6.9%). Of the participants with post-infectious bronchiectasis, tuberculosis (TB) was the most common organism isolated 16 (64.0%), and most common in children living with HIV (11/16, 68.8%). Cough was common in 48 (82.8%), with wet cough being predominant in 41 (85.4%), course crepitations were found in 37 (63.8%), hyperinflation in 24 (41.4%), finger clubbing in 21 (36.2%), wheeze in 16 (29.3%), and exertional dyspnea in 7 (12.0%). Conclusion: Bronchiectasis is common in South African children, usually resulting from previous pneumonia episodes, with TB being the most common infective cause. The importance of early diagnosis and treatment of underlying causes, especially infectious diseases in low-middle-income settings, to prevent bronchiectasis is highlighted.

The long lost denture: a rare case of an acquired, non-malignant tracheo-oesophageal fistula

BackgroundIngested dental prosthesis are susceptible to impaction in the gastrointestinal tract due to their sharp edges, size and contour. Delays in presentation arise from the lack of clear history of ingestion and misdiagnosis occurs due to the radiolucency of denture material on plain radiography. An acquired, non-malignant tracheo-oesophageal fistula (TOF) may develop from a chronically impacted denture. Surgical management of a TOF secondary to denture is a challenging clinical problem that is rarely reported in the literature and no previous case reports have described the two-staged reconstruction approach that we present here.Case presentationWe report a case of a male in his early 60s who presented to an acute general hospital with symptoms ongoing for over one year of dysphagia, recurrent chest infections and weight loss. Barium swallow and computed tomography identified an ingested dental prosthesis (denture) that had caused a TOF. He was transferred to our specialist thoracic surgery unit where an attempt to remove the foreign body endoscopically was abandoned due to firm impaction and risk of further injury. The subsequent multi-disciplinary management of this complex case required a two-staged reconstruction approach. The first procedure involved extracting the foreign body, repairing the underlying defects with tracheal resection and anastomosis, and creating an oesophageal diversion with cervical oesophagostomy. The second procedure achieved continuity of the gastrointestinal tract with gastric pull-up and pharyngo-gastric anastomosis. Following rehabilitation, the patient was discharged on oral intake alongside percutaneous jejunostomy feeding.ConclusionsEarly recognition and removal of impacted dental prosthesis is essential to prevent morbidity and mortality. Delayed diagnosis can lead to acquired TOF with associated consequences such as recurrent pulmonary infection, mediastinitis and nutritional deficit. Challenges we encountered, such as failed attempts at endoscopic retrieval and the difficult dissection of fibrotic tissue, were directly due to the delayed identification of the denture. We highlight the importance of holding a high index of clinical suspicion of foreign body ingestion in dental prosthesis wearers who present with recurrent chest infections and ongoing dysphagia. We also promote the need for a collaborative multi-disciplinary approach in the surgical management of complex cases.

Fundoplication for Pediatric Gastroesophageal Reflux Disease: Indications, Techniques, and Outcomes.

Background This study aimed to evaluate the indications, techniques, and outcomes of fundoplication in pediatric patients with gastroesophageal reflux disease (GERD) at a tertiary hospital in Yemen. Methods A prospective cohort study was conducted at Al-Thawra Modern General Hospital, Sana'a, Yemen, between January 2015 and January 2022. The study included 45 pediatric patients under 18 years of age who underwent fundoplication for GERD. Data on demographic and clinical characteristics, surgical type, postoperative complications, and follow-up outcomes were collected and analyzed. Results The median age of the 45 pediatric patients was two years (range: two months to 10 years), with 25 males (56%) and 20 females (44%). The primary indications for fundoplication included GERD with hiatal hernia in 20 patients (44.4%), persistent symptoms despite medical management in 9 patients (20%), recurrent chest infections associated with neurological disorders in 7 patients (15.6%), esophageal stricture in 8 patients (17.8%), and both hiatal hernia and esophageal stricture in 1 patient (2.2%). Nissen fundoplication was performed in 36 patients (80%), and Thal fundoplication was performed in 9 patients (20%). Complete symptom resolution was achieved in 31 patients (68.89%). Dysphagia due to postoperative esophageal stricture was the most common complication, affecting 13 patients (29%). A structured dilatation protocol resulted in improvement after one session in four patients (30.8%), regular sessions in six patients (46.2%), and irregular sessions in three patients (23.1%). The mortality rate was two patients (5.56%), both of whom had cerebral palsy and died due to recurrent chest infections unrelated to GERD recurrence or esophageal stricture. Conclusions Fundoplication is a safe and effective surgical treatment for pediatric GERD, with a high success rate and manageable complications. A structured postoperative dilatation protocol is essential for managing esophageal strictures and improving outcomes. Early diagnosis and intervention, alongside adherence to postoperative protocols, are crucial for optimal results. Further research with larger sample sizes and long-term follow-up is recommended to confirm these findings and improve clinical practice.

Pediatric restrictive Cardiomyopathy presenting with congestive heart failure: Rare case report and literature review

Restrictive cardiomyopathy (RCM) is an uncommon form of cardiomyopathy and is characterized by impaired diastolic filling of the ventricles due to increased myocardial stiffness and a normal ventricular systolic functions. In India, RCM is frequently observed in the young and endemic endomyocardial diseases are seen in a significant number of cases. RCM is the least common of all the cardiomyopathies among pediatric patients. RCM has a poor prognosis and commonly requires a cardiac transplant. We are reporting here a case of seven-year-old female child presenting with recurrent chest infections and congestive heart failure since early childhood.

Common Atrium Concurrent with Atrioventricular Septal Defect: A Case Report

Common atrium accounts for 0.5% to 1% of congenital heart diseases. It is characterized by the atria septum's complete absence and atrioventricular canal defect. It may occur as an isolated malformation or associated with other extracardiac anomalies. Untreated cases are at risk of developing pulmonary hypertension. We present a case of an 18-month-old female baby with a recurrent chest infection, central cyanosis, and echocardiographic features of the common atrium concurrent with atrioventricular canal defect and features of pulmonary hypertension.

Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects.

Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause. This review consolidates the existing evidence on patient-managed interventions for adults with bronchiectasis, while also outlining areas for future research. Airway clearance techniques and hyperosmolar agents are key components of the bronchiectasis management and consistently recommended for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear. Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain whether strategies employed in other respiratory conditions can be safely and effectively adapted to bronchiectasis, particularly through identifying patient responder populations and criteria where cough may not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve research methodologies and increase research funding are needed to further advance our understanding of these interventions, and their role in optimising patient care and outcomes.

Socio-Demographic, Epidemiological and Clinical Pattern of the Egyptian Children with Cystic Fibrosis

Abstract Background Cystic fibrosis (CF) is a genetic disease; most definitely serious, transmitted in am autosomal recessive mode, that mainly affects the respiratory and gastrointestinal system. However, little is known about the characteristics of CF among the Egyptian children. Aim of the Work To record the demographic, clinical characteristics, diagnostic tools, the most frequent mutations and the outcome of the Egyptian cystic fibrosis children attending our center, paving the way for having national survey of CF children. Patients and Methods This was a cross-sectional studywhich was conducted at Pediatric Pulmonology Unit, Ain Shams University, Children’s Hospital for a period of 12 month recruiting CF patients attending Pediatric Pulmonology Clinic during their routine visits. Results Ninety-six CF patients were included whose ages was 6.44(±4.33) years, and ranged between 0.5 to 17.7 years. Gender distribution was fairly even, with 52.1% males and 47.9% females. Most lived in rural areas (56.3%), while 43.8% were in urban areas. 75% of the patients were of average socioeconomic status. A significant portion had a family history of cystic fibrosis (74%). Diverse initial complaints among participants were reported where the most common was failure to thrive in 30.22% of patients, followed by steatorrheain 29.17%. Recurrent chest infections affected 25% of patients, while delayed passage of meconium was reported in 7.3%. The most common presenting symptoms were cough (96.9%) followed by steatorrhea(92.7%) followed by expectoration(84.4%) and wheezes 81.3%. The most common genetic mutations wasF508del (30.2%) No mortality has been reported among the studied cystic fibrosis patients Conclusion the comprehensive data presented in this study provide a thorough understanding of the clinical profile, most common mutations and outcomes of the 96 pediatric patients with CF in a single center which is recommended to be done in all centers caring for CF patients to allow establishment of CF registry in Egypt

Flexible Endoscopic Management of Tracheo-oesophageal Magnet Foreign Bodies with Acquired Fistula in a Toddler.

Aerodigestive foreign bodies (FBs) aspiration is a common problem in children; however, simultaneous aerodigestive localisation is rare. Ingestion of multiple magnetic FBs can lead to serious complications, especially tracheo-oesophageal fistula and recurrent chest infections. These depend on the duration of foreign-body ingestion/aspiration, prompt intervention and adequate technique for foreign-body retrieval. A 1.8-year-old female child was found to have two magnetic FBs lodged simultaneously in the oesophagus and trachea. The magnetic FBs in the aerodigestive tract in children were removed in the same session using flexible endoscopes.

Ventricular Septal Defects in Adults: A Bedside Case Discussion for Residents

Abstract A young boy presented with palpitations and shortness of breath. He had a history of recurrent chest infections as a child. The clinical approach to such a patient along with correlation from investigations is discussed as a teaching exercise for cardiology fellows in training.

AKT question relating to management of recurrent chest infections

AKT question relating to management of recurrent chest infections

AKT answer relating to management of recurrent chest infections

AKT answer relating to management of recurrent chest infections

An Atypical Presentation of Pelvic Disseminated Tuberculosis Mimicking Ovarian Cancer; a Case Study

Purpose: This study highlights the clinical and radiological challenges in distinguishing ovarian malignancy from pelvic tuberculosis (TB), underscoring the need for precise diagnosis and appropriate treatment. Background: Pelvic TB, a rare extrapulmonary form of tuberculosis, presents diagnostic challenges, particularly in developed countries where it is less prevalent. Its symptoms, including chronic pelvic pain, menstrual irregularities, and adnexal masses, can mimic those of ovarian cancer, leading to potential misdiagnosis. Although TB is uncommon in developed nations, it remains a significant global health issue, particularly affecting individuals from endemic regions. Pelvic TB typically spreads to reproductive organs through lymphatic dissemination, direct extension, or hematogenous routes. Case Presentation: A 46-year-old woman presented with abdominal pain, abnormal vaginal bleeding, breathlessness, weight loss, and night sweats. She had a history of lung sarcoidosis, recurrent chest infections, and prior TB exposure. Initial imaging suggested advanced ovarian malignancy, but an omental biopsy revealed granulomas consistent with sarcoidosis. Further tests confirmed disseminated TB, and the patient underwent a 9-month course of anti-tuberculous therapy, which resolved most disseminated TB lesions. However, a persistent complex pelvic cyst required conservative follow-up. Conclusion: Although pelvic TB is rare in developed countries, it should be considered in the differential diagnosis of pelvic masses with ascites and elevated CA 125, especially in patients with recurrent chest infections and TB exposure.

Identification of a Novel SCN5A gene variant in a young female with atrioventricular canal defect in the absence of classical Brugada syndrome phenotype.

Brugada syndrome is generally considered a cardiac channelopathy disorder characterized by syncope or sudden cardiac death. The sodium voltage-gated channel alpha subunit 5 (SCN5A) gene is the most commonly mutated gene associated with Brugada syndrome. Recent discoveries of new variants of this gene, along with current guidance of family screening, have identified several asymptomatic carriers with potentially causative mutations. We present the case of a 25-year-old female patient without any family history of Brugada syndrome nor related congenital cardiovascular disorders, with an extensive atrioventricular canal defect, who tested positive for a novel heterozygous variant NM_198056.3: c.3169G>C (p. Asp1057 His) in the SCN5A gene. She had no history of syncope or aborted sudden cardiac death except for recurrent chest infections since her early childhood. Intriguingly, she did not show a type I Brugada electrocardiogram pattern. This report provides a novel heterozygous variant NM_198056.3: c.3169G>C (p. Asp1057 His) in the SCN5A gene, which may have a potential detrimental effect.

Transthoracic echocardiography evaluation of double outlet left ventricle: Unique case report and review of literature

Double-outlet left ventricle (DOLV) is a rare cardiac malformation in which both great arteries originate from the morphological left ventricle. DOLV is associated with high mortality, generally due to heart failure, myocardial infarction, or aortic thrombosis. With surgery, the 5-year survival rate is estimated at 70%–75%. Most patients will continue to present with residual cardiac anomalies, such as aortic or mitral valve regurgitation, arrhythmias, or hypertension. We are reporting a complex case of cyanotic congenital heart disease in a 5 month old female infant suffering from DOLV, who presented to us with recurrent chest infections and bluish colouration of skin.

Total Anomalous Pulmonary Venous Drainage with Malaligned Atrial Septum: A Case Series and Descriptive Study

Abstract Total anomalous pulmonary venous drainage (TAPVD) is a complex congenital heart anomaly characterized by abnormal venous return from the pulmonary veins. The classification of TAPVD has been a matter of debate, particularly when pulmonary veins open into the anatomically left atrium but functionally into the right atrium due to a malaligned interatrial septum. This case series aimed to assess clinical significance of malalignment of interatrial septum and to differentiate between TAPVD and total anomalous pulmonary venous connection (TAPVC) by echocardiography before sending the patient for surgery. This retrospective case series involved seven patients diagnosed as TAPVD between 2011 and 2023. The age of the patients ranged from 1 month to 3 years, mostly presenting within the first few months of life. One case was diagnosed during fetal echocardiography. The commonest complaints were failure to thrive, fast breathing and recurrent chest infection. All cases were diagnosed by echocardiography and confirmed during surgery. 5 patients had situs solitus, 1 had situs inversus and one had left isomerism. In all cases, surgical repair was done which included excision of malaligned interatrial septum and closing the interatrial defect with dacron patch, thus directing the flow of the pulmonary vein to the left atrium. In summary, TAPVD with malaligned interatrial septum and TAPVC are two completely different entities and must be differentiated before sending the patient for surgical repair. The normal anatomical connection of pulmonary veins to left atrium is preserved in TAPVD.

IJCM_83A: Primary Ciliary Dyskinesia in a child

Background: PCD is rare genetic disorder with incidence of 1:10,000. We present a 10-year-boy who came with recurrent respiratory-infections with Dextrocardia and bilateral Bronchiectasis for interesting clinical presentation. Objective: PCD is rare inherited disease with mutations which impair normal cilia function, characterized by impaired muco-ciliary clearance, causing recurrent-respiratory infections leading to bronchiectasis. Treatment includes preventing and managing complications. Methodology: 10-year-old child came cough-cold since 2 days, and hurried breathing since 1 day. Child had multiple episodes of respiratory- infections which was treated with antibiotics and nebulization on OP basis. Developmental delay also noted, currently in speech domain, can speak 2-3 words. On examination, open mouth breathing and clubbing(grade 3) present. On auscultation bilateral bronchial breath sounds with coarse crepitations. Heart sounds heard louder on right side, but no murmur was heard. Chest X-ray and 2D-ECHO showed Situs-Solitus with Dextrocardia. Child required non-invasive ventilation and IV antibiotics for treatment. Child was weaned off to room air by day 4. CT Thorax done showed bronchiectatic changes in bilateral lung with volume loss of right hemithorax with mediastinal shift to right. CT Nasopharynx and OMC done for open-mouth breathing was normal, and advised steroid nasal spray for nasal blockage. Physiotherapist counselled parents about postural drainage. Genetic testing for PCD was sent, report awaited. He is on regular follow up and doing well. Results: Primary defect in PCD is structure and/or function of cilia leading to accumulation of secretions. Diagnostic criteria includes recurrent chest infections, bronchitis, and rhinitis, with situs-inversus, infertility, decreased mucociliary clearance and cilia showing ultrastructural defect on electron microscopy. We suspected PCD with clinical features and imaging studies. Conclusion: Patients are frequently troubled by repeated infections for which they need to seek medical attention which is reason for morbidity. As there is no specific treatment, early diagnosis and prevention of complication is key to management.