Recurrent Lower Respiratory Infections Research Articles

Results of a comprehensive assessment of the health status of children after a new coronavirus infection (COVID-19)

The inhabitants of the planet in the XXI century are experiencing a second pandemic. The new coronavirus SARSCoV-2 is distinguished not only by its ubiquitous spread, but also by the possibility of developing adverse outcomes, which does not cause anyone doubts today.Aim. To present the dynamic characteristics of children’s health depending on the form of severity of the new coronavirus infection (COVID-19).Material and methods. A prospective single-center clinical study of the complex state of health of children hospitalized in a monoinfective hospital on the basis of the GUZ “City Clinical Hospital” was conducted. The observation included 86 convalescents of a new coronavirus infection aged 7 to 14 years. Dynamic monitoring was carried out for children for 1.5 years from the moment of infection with SARSCoV-2, control visits were performed 1, 6 and 18 months after the disease.Results and discussion. According to the results of a comprehensive assessment of the health status of children after COVID-19, an increase in the number of registrations of recurrent upper and lower respiratory tract infections in convalescents of a moderate form of a new coronavirus infection was found. In 35 (41%) children after infection with SARSCoV-2, concomitant diseases were recorded, in contrast to 23 (26.7%) cases recorded before the pandemic. The structure of concomitant pathology in COVID-19 convalescents is represented by endocrine pathology in 30.2% of cases, in patients after moderate forms of the disease, the frequency of eating disorders (19.8%) increased by 2 times relative to the period before COVID-19, type 1 diabetes mellitus was first detected in 1 (1.2%) child. Diseases of the nervous system (20.9%) were 1.9 times more likely to be diagnosed after COVID-19. Diseases of the eye and its accessory apparatus were registered in 16.3% of children, more often after a moderate form of the disease. The number of cases of gastrointestinal pathology has not changed. Diseases of the respiratory system were recorded in 4.7% of patients, skin and subcutaneous tissue – 3.5% of the examined.Conclusion. A comprehensive assessment of the health status of children after COVID-19 for 1.5 years allows us to establish a decrease in the response of the child’s macroorganism to acute respiratory infections, an increase in the number of registered comorbidities, the relationship between the severity of COVID-19 and its consequences for children.

Smoking and Real Life Results of Children and Adolescents

Aim: Smoking is a chronic disease and children are the most affected group. In this study, we aimed to question the smoking habits of children and their parents and examine the level of exhaled carbon monoxide (eCO) to evaluate the usefulness of the method in an outpatient allergy clinic. Methods: A questionnare was applied to 29 children who were smoker or exposed to second-hand smoke (SHS) and their parents separately. eCO levels of the participants were measured with CO Smokerlyzer. Results: The median eCO level of children who smoked was 10 (7-14) ppm and was significantly higher than children exposed to SHS (P <0.001). The children who smoked were significantly older, the more they had friends who smoked. Children who were not exposed to tobacco products had lower rates of hospitalization due to recurrent lower respiratory tract infections, and family history of asthma was lower than children exposed to SHS (p <0.05). All the children were aware of the harmful effects of smoking. 34.5% of the parents were never questioned by their physicians about tobacco and its products and were not informed about smoking. Conclusions: Using eCO in the clinic is a useful method to predict smoking status in daily practice. Children's attitudes towards smoking and peer relationships and parents' ignorance of smoking and SHS are still an unresolved issue.

Congenital pulmonary malformations : Diagnosis and treatment

Congenital pulmonary malformations (CPM) are rare and can be associated with high morbidity. Clinical presentation, diagnostic procedures, imaging, and therapy of CPM are discussed. Today, most CPM can be diagnosed prenatally by ultrasound. Postnatally, respiratory symptoms up to respiratory failure and recurrent lower respiratory tract infection are typical findings. Due to low diagnostic accuracy of chest x‑ray in CPM, all children with prenatal diagnosis of CPM or postnatally suspected CPM should undergo cross-sectional imaging. Based on imaging alone, the various subtypes of CPM cannot be definitively differentiated, which is why histological confirmation remains the gold standard. Surgical resection is the standard of care with minimally invasive procedures increasingly being employed. In certain situations, awatch-and-wait approach is possible.

Experience of flexible bronchoscopy in the pediatric pulmonary diseases clinic.

Flexible bronchoscopy is a valuable method in the diagnosis and treatment of respiratory tract diseases in children. This study aimed to examine the indications for and results of flexible bronchoscopy in children. The study included patients aged 0-18 years who underwent flexible bronchoscopy between 1 January 2017 and 31 December 2022. The patients were evaluated for demographic characteristics, indications for bronchoscopy, comorbidities, bronchoscopy findings, and the results of bronchoalveolar lavage. During the defined study period, a total of 410 flexible bronchoscopy procedures were performed. 51.9% of the patient population were male, and 48.1% were female, with a mean age of 96.93 ± 63.45 months. The most common indication for flexible bronchoscopy was recurrent lower respiratory tract infection (26.8%), followed by chronic cough (19.1%). The bronchoalveolar lavage culture results showed that the most commonly isolated microorganisms were H. influenzae non-type b (7.8%) followed by M. catarrhalis (7.3%). Mucus obstruction and secretion (33.0%) constituted the most common bronchoscopic findings, while the flexible bronchoscopy examination was normal in 27% of patients. No serious complications occurred in any patient during or after the procedure. The results of this study demonstrated that the most common indication for flexible bronchoscopy was recurrent lower respiratory tract infection and the most common bronchoscopy finding was purulent secretion with mucus obstruction. Flexible bronchoscopy is an important diagnostic and treatment tool for patients with recurrent respiratory symptoms. It is a highly valuable method as it enables direct visualization of the airways and facilitates the collection of bronchoalveolar lavage samples.

Original Article--Clinical and Procedural Characteristics of Successful Transcatheter Device Closure of Ostium Secundum Atrial Septal Defect in Symptomatic Children Weighing

This retrospective study sought to determine the feasibility of transcatheter atrial septal defect device closure in patients less than 15 kg, as well as to assess complication rates and the reasons for unsuccessful device closure. In general, the risks associated with transcatheter atrial septal defect device closure are believed and reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend atrial defect closure in device closure in children <15 kg, due to limited data available for feasibility and safety of device closure in this group of patients. Retrospective review of all patients who underwent elective transcatheter closure of ostium secundum atrial septal defect between September 2013 to February 2022. We excluded all children above 15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. We identified 81 patients meeting criteria with a median procedural age of 3 years (1 year-8 years), and median weight of 12 kg (4-15 kg). Successful device closure was achieved in 95.1% (77/81) and in 4.9% (4/81), the procedure was aborted. There was 1 major (1.2%) and 1 minor (1.2%) complication, total complication rate (2.4%). 100% of the referrals had right heart enlargement and exertional dyspnoea, 18.5% had recurrent lower respiratory tract infection and 9.9% had failure to thrive. Rate of resolution of residual shunt was 95.1%. at post-procedure day 1 and 98.8% at post-procedure 3 and 6 months respectively. Percutaneous atrial septal defect closure can be done effectively and safely in symptomatic children weighing less than 15 kg in experienced centres. However, deferral for closure until the historically established timeline of around 4-5 years of age should be strongly considered in asymptomatic children.

The risk factors for silent aspiration: A retrospective case series and literature review.

Evidence shows that 20%-30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 - neurological diseases (n = 93), G2 - head and neck surgery (n = 200), G3 - gastroenterological diseases (n = 94) and G4 - other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX-X). Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery. What is already known on the subject Clinical signs of penetration or aspiration include coughing, throat clearing and voice changes, while silent penetration or aspiration patients aspirate without demonstrating any clinical symptoms. The most common consequences of silent aspiration include aspiration pneumonia, recurrent lower respiratory tract infections and respiratory failure. Additionally, malnutrition and dehydration can be indicators of silent aspiration. Patients may unknowingly reduce their oral intake and lose weight. Retrospective studies have shown that 20%-30% of patients aspirate silently (e.g. patients after stroke, acquired brain injury, head and neck cancer treatment, prolonged intubation). Clinical examination of swallowing can miss up to 50% of cases of silent aspiration. What this paper adds to existing knowledge Currently, silent aspiration is often discussed in neurological literature, but its applications to head and neck surgery are limited. In this study, we identify head and neck surgery patients who should be prioritised or considered to be in higher need of instrumental swallowing evaluation due to a higher risk of silent aspiration. What are the potential or actual clinical implications of this work? Post-treatment structural changes can result in lower cranial nerve paresis (IX, X, XII) and face injury, in which vagus and glossopharyngeal nerves are injured. After tracheostomy and radiotherapy, patients with problems swallowing saliva need careful clinical examination, particularly cranial nerve examination.

Risk Factors for Lower Respiratory Tract Infection and Recurrent Lower Respiratory Tract Infection in Children

Risk Factors for Lower Respiratory Tract Infection and Recurrent Lower Respiratory Tract Infection in Children

Ruptured sinus of Valsalva aneurysm: don’t judge a book by its cover!

Background: Ruptured Sinus of Valsalva aneurysm (RSOV) has poor prognosis and a high mortality rate. Clinical suspicion is critical for prompt diagnosis and management. Case Presentation: A 33-year-old woman with no comorbidities, presented with persistent cough and recurrent lower respiratory tract infection for 2 years. Echocardiogram showed ruptured right sinus of Valsalva into right ventricle with calci&amp;#64257; ed ruptured membrane forming wind-sock morphology. When the patient was taken to the operating room, it was discovered that the RSOV had ruptured into the right atrium. She underwent excision of calci&amp;#64257; ed wind-sock tissue along with pericardial patch closure of ruptured right sinus. Conclusions: We discuss a case of an RSOV with atypical presentation, as well as a disparity in imaging features and surgical &amp;#64257; ndings.

Selective antibody deficiency syndrome, response to vaccines, diagnosis, and treatment

Selective antibody deficiency syndrome (SAD), is a primary immunodeficiency in which immunoglobulin levels remain normal, but there is a reduced response to polysaccharide antigens after vaccination. SAD is recognized by the International Union of Immunology Societies as a primary immunodeficiency of unknown genetic cause. Patients with SAD are highly susceptible to severe respiratory tract infections with encapsulated bacteria. The infections found in SAD are similar to other antibody deficiencies; patients often present with recurrent upper and lower respiratory tract infections, otitis media, and sinusitis. The treatment of this pathology is based on preventing recurrent infections by known microorganisms, and in the case of serious infections, the use of intravenous or subcutaneous immunoglobulin.

Scimitar syndrome in a four-month-old infant

The Scimitar syndrome or pulmonary venolobar syndrome is a rare, complex and variable congenital anomaly of cardiopulmonary development characterised by an abnormal right-sided pulmonary venous drainage in the inferior vena cava, malformation of the right lung, abnormal arterial supply and sometimes cardiac malformations. These serious anomalies notwithstanding, their presentation is varied, ranging from asymptomatic to severe symptoms, particularly in the neonatal and early infantile period. Some symptomatic cases are misdiagnosed as recurrent lower respiratory tract infections or as heart failure, missing the underlying congenital anomaly. Considering associated serious complications such as pulmonary hypertension and a high mortality rate, accurate and timely diagnosis is mandatory. This requires a high index of suspicion, not only by clinicians but also by radiologists who encounter suggestive chest radiographs in asymptomatic children. Still, the classic radiological finding for which the condition is named is seen in only about 50% of all cases and only 10% in affected infants. We highlight this case to heighten clinicians’ and radiologists’ suspicions about Scimitar syndrome.

STAT5B germline heterozygous variant presenting with lymphadenopathy, atopy, and short stature

Background: Signal Transducers and Activators of Transcription (STAT) proteins are fundamental for multiple cellular processes, including immunity. STAT5B serves as a signal transducer downstream of cytokine and growth factor-mediated activation. Aberrations in STAT5B are associated with the development of atopy, immunodeficiencies, autoimmunity, cancers, hematological disease, growth disorders, and lung disease. Biallelic STAT5B variants are associated with loss-of-function of the gene, and cause a recessive disorder characterized by growth hormone insensitivity and immune dysregulation. Clinically significant heterozygous variants result in either dominant negative or gain-of-function effects; these latter variants are rare and their impact on the immune system is less clearly delineated than those responsible for the recessive form of the condition. Aim: We describe the presentation, immune workup, and genetic findings in a pediatric patient with a novel STAT5B heterozygous variant. Methods: A thorough retrospective review of the patient’s chart was performed. Results: A four-year-old male presented with history of lymphadenopathy, eczema, asthma, food allergy, short stature, and recurrent upper and lower respiratory tract infections. Clinical trio whole exome sequencing identified a novel heterozygous variant (c.1A&gt;G; p. Met1?) in STAT5B. His mother harbours the same heterozygous variant and has a history remarkable for atopy. Immune investigations on the child revealed persistent elevated IgE. The patient’s variant targets the STAT5B N-terminal domain, and represents the first case with a heterozygous variant affecting this region. Conclusion: We present a novel STAT5B variant associated with a dominantly-inherited growth and immune phenotype. This is the first report of a heterozygous variant affecting the N-terminal domain in association with a clinical phenotype, expanding the genotypic landscape of this disorder. Further investigations and follow up responses to growth hormone replacement are needed to better delineate the functional effect of the variant identified in this family. Statement of Novelty: We report a novel germline heterozygous STAT5B variant in a paediatric patient with lymphadenopathy, atopy, and short stature.

Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study

ABSTRACT Background: In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes &gt;20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure. Methods: We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing &lt;20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up. Results: We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4–7) years and median (IQR) weight of 14 (12–18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%– I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt. Conclusion: In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.

Can Scoliosis Help the Early Diagnosis of Congenital Myasthenic Syndrome?

Background Congenital myasthenic syndromes (CMS) are a group of hereditary diseases of the neuromuscular junction. CMS are extremely rare diseases that cause hypotonia; however, scoliosis may theoretically be helpful in early diagnosis of CMS. The objective of this studywas to emphasize the clinical features of the patients we followed up with the diagnosis of CMS and demonstrate that scoliosis is an important finding in the diagnosis of CMS in the presence of hypotonia/weakness. Materials and methods In this retrospective study, data were retrieved by examining the digital files of the patients who presented to Aydın Maternity and Children's Hospital and Elazığ Fethi Sekin City Hospital Pediatric Neurology Clinics between 2018 and 2023. The diagnosis of CMS was strongly supported by a combination of clinical characteristics, neurophysiological studies, genetic tests, AChR antibodies, and serum creatine kinase measurement. The presence of scoliosis was evaluated by an orthopedics and traumatology specialist. Results Eleven CMS patients with accompanying scoliosis were included in the study. The mean age of the patients was 69.4±39.28 months. The age of the patients at the time of diagnosis was 42.7±35.19 months. Among the patients, eight were males (72.7%), and three were females (27.2%). Seven patients (63.6%) had COLQ mutations. Electromyography was conducted on eight patients, with one of them showing no pathological findings, while seven exhibited decremental responses. All patients had ptosis, while six (54.5%) had bulbar signs. Ten patients (90.9%) had weakness. Nine patients (81.8%) experienced frequent recurrent lower respiratory tract infections. Both the patient with CHAT mutation and RAPSN mutation had arthrogryposis. Conclusion In this study, CMS stands out as an essential consideration in the differential diagnosis, particularly when scoliosis accompanies early-onset muscle weakness.

Incidental Finding of Mounier-Kuhn Syndrome

Tracheobronchomegaly (TBM) or Mounier - Kuhn syndrome is a rare disorder of uncertain etiology characterized by marked dilatation of the trachea and bronchi and recurrent lower respiratory tract infection. We report the case of a 56-year-old male presenting with a chronic cough.

A pan-influenza antibody inhibiting neuraminidase via receptor mimicry

Rapidly evolving influenza A viruses (IAVs) and influenza B viruses (IBVs) are major causes of recurrent lower respiratory tract infections. Current influenza vaccines elicit antibodies predominantly to the highly variable head region of haemagglutinin and their effectiveness is limited by viral drift1 and suboptimal immune responses2. Here we describe a neuraminidase-targeting monoclonal antibody, FNI9, that potently inhibits the enzymatic activity of all group 1 and group 2 IAVs, as well as Victoria/2/87-like, Yamagata/16/88-like and ancestral IBVs. FNI9 broadly neutralizes seasonal IAVs and IBVs, including the immune-evading H3N2 strains bearing an N-glycan at position 245, and shows synergistic activity when combined with anti-haemagglutinin stem-directed antibodies. Structural analysis reveals that D107 in the FNI9 heavy chain complementarity-determinant region 3 mimics the interaction of the sialic acid carboxyl group with the three highly conserved arginine residues (R118, R292 and R371) of the neuraminidase catalytic site. FNI9 demonstrates potent prophylactic activity against lethal IAV and IBV infections in mice. The unprecedented breadth and potency of the FNI9 monoclonal antibody supports its development for the prevention of influenza illness by seasonal and pandemic viruses.

Radiological Diagnosis of Atypical Case of Goldenhar Syndrome with Pulmonary Hypoplasia and Dextrocardia: A Case Report

Goldenhar Syndrome, also synonymously known as oculo-auriculo-vertebral spectrum is a rare congenital malformation involving face, eyes, ears and vertebra. The exact etiopathogenesis is not clear but maldevelopment of first and second pharyngeal arches is mentioned in literature. This syndrome is associated with abnormalities in cardiac, renal, pulmonary and nervous system. Some cases present with classic abnormalities where diagnosis is usually clinical. However, atypical cases have also been reported. We report a case of one year old boy presenting with recurrent lower respiratory tract infection and feeding diaphoresis. Extensive examination and investigations revealed left preauricular tag with radiological evidence of butterfly deformity of sixth cervical vertebra, right pulmonary hypoplasia, dextrocardia, patent foramen ovale and pulmonary artery stenonis. These abnormalities are rare but associations have been reported.

Respiratory Outcomes at 5-Year Follow-Up in Children with Mannose-Binding Lectin Deficiency: A Retrospective Cohort Study.

Mannose-binding lectin deficiency may predispose children to having increased infection susceptibility. However, there is no conclusive evidence that mannose-binding lectin deficiency is associated with adverse respiratory consequences in children. We aimed to evaluate the effects of mannose-binding lectin deficiency (defined as a level of less than 0.6 mg/L) on clinical, radiological, and microbiological characteristics in children presenting with troublesome respiratory symptoms, as compared to those who are mannosebinding lectin-sufficient. We conducted a retrospective cohort study to investigate the association between mannose-binding lectin deficiency and respiratory outcomes in children over a period of 10 years in a large teaching hospital. Children presenting with frequent or persistent respiratory symptoms such as a chronic wet cough lasting more than 4 weeks, recurrent lower respiratory tract infections (≥4 infections in a year), or severe respiratory tract infections requiring admission to intensive care or to high dependency unit were included in the study. The study showed no significant difference in clinical outcomes with mannose-binding lectin deficiency and sufficiency. Thirty-two percent of children with mannose-binding lectin deficiency and 30% of those with mannose-binding lectin sufficiency had positive respiratory microbiology. Twenty-three percent of children with mannose-binding lectin deficiency and 24% of those with mannose-binding lectin sufficiency had radiological changes on plain radiographs; also the prevalence of bronchiectasis was similar in both groups. The rates of admission to pediatric intensive care unit were comparable in the 2 groups. Children with mannose-binding lectin deficiency and sufficiency showed similar clinical, radiological, and microbiological characteristics. Our study suggests that there are no childhood adverse respiratory consequences with mannose-binding lectin deficiency.

Tracheobronchomegaly (Mounier-Kuhn Syndrome) in Old Age - A Case Report

Tracheobronchomegaly or Mounier-Kuhn syndrome is a rare condition affecting the airways and is characterized by dilatation of the trachea and major bronchi secondary to atrophic or absent elastic fibres of the cartilage and thinning of the muscles.[1] The abnormally enlarged flaccid portions of the bronchial tree collapse and fail to maintain patency during expiration and coughing, predisposing the patient to stagnation of contents and recurrent lower respiratory tract infections, emphysema, bronchiectasis and chronic pulmonary suppuration.[2] The diagnosis is usually made on basis of specific radiographic features,[3] particularly on computed tomography (CT) scan. We report a case of a 69-year-old man who presented with recurrent lower respiratory tract infections and was found to have tracheobronchomegaly as an underlying primary airway abnormality on imaging and bronchoscopy that was initially undiagnosed.

Evaluation of Immunoglobulin Levels in Children Aged 1-5 Years With Recurrent Lower Respiratory Tract Infections

Evaluation of Immunoglobulin Levels in Children Aged 1-5 Years With Recurrent Lower Respiratory Tract Infections

Primary ciliary dyskinesia: two different clinical cases

Primary ciliary dyskinesia (PSD) is a clinically and genetically heterogeneous condition characterized by defective motile cilia activity. It is a rare disease with a frequency of 1 in 15,000-20,000 people and is generally inherited in an autosomal recessive and X-linked disease pattern. The diagnosis of PSD becomes easier when the patient has situs inverus anomaly accompanying recurrent lower and upper respiratory tract infections, as in our second case. However, it becomes vice versa in the absence of a situs anomaly. In this case report, we present two PSD patients with diverse clinical characteristics, one with Kartagener’s syndrome and the other without these features