Respiratory Tract Infections In Children Research Articles

Development and internal validation of a nomogram for predicting recurrent respiratory tract infections in children.

This study aimed to develop and internally validate a nomogram in predicting the risk of recurrent respiratory tract infection (RRTI) in children. A retrospective analysis was performed, involving 150 children with RRTI and 151 healthy controls, aged 0-14 years, admitted to or selected from the Pediatric Department of Yixing Hospital of Traditional Chinese Medicine between June 2022 and June 2023. Data were gathered through a comprehensive questionnaire survey on risk factors associated with RRTI. The dataset was randomly divided into a training cohort (n=211) and a validation cohort (n=90) in a 7:3 ratio. Significant variables were selected using LASSO regression in the training cohort to construct the nomogram, the performance of which was evaluated through Receiver Operating Characteristic (ROC) curves, calibration plots, and Decision Curve Analysis (DCA). The LASSO regression identified five predictors in the training cohort: picky eating, age at first antibiotic use, antibiotic use within the previous year, allergic conditions, secondhand smoke exposure. Based on them, the nomogram exhibited an excellent discriminative ability, with an AUC of 0.902 (95% CI: 0.860-0.944) and a C-index of 0.902 in the training cohort. The validation cohort showed an AUC of 0.826 (95% CI: 0.742-0.909) and a C-index of 0.826, confirming a high predictive accuracy. Calibration plots showed close alignment with the ideal reference line, and DCA indicated a significant clinical net benefit. Our nomogram can efficiently predict RRTI risk in children, thereby providing a personalized and graphical tool for early identification and intervention.

The role of IFN-γ/CXCL10 axis in Mycoplasma pneumonia infection

Mycoplasma pneumoniae caused lower respiratory tract infection in children and can exacerbate these infections through the production of various inflammatory factors, with chemokines playing a key role. However, the pathogenesis of this infection is complicated and thus has not been thoroughly studied. We clarified that cytokine expression levels were analyzed in both peripheral blood and bronchoalveolar lavage fluid (BALF), and in vitro assays were conducted using THP-1 macrophages. We discovered that, compared to control children, M. pneumoniae pneumonia (MPP) patients expressed significantly higher levels of CXCL10 both in the peripheral blood and BALF. Moreover, numbers of macrophages, predominantly with a M1 phenotype, were significantly increased in BALFs of children of MPP. In vitro, coculture with IFN-γ or activated CD4+ Th1 cells significantly promoted CXCL10 expressions in THP-1 derived macrophages, which was largely reversed by siRNA-mediated down regulation of STAT1. In addition, IFN-γ-stimulated macrophages greatly promoted the trans-migration of Th1 cells. our data show that Th1 cells-derived IFN-γ augments CXCL10 production in macrophages via the JAK-STAT1 pathway, which subsequently recruits more immune cells like Th1 cells into the infection sites, thereby constituting a positive feedback loop and aggravating the type I inflammatory responses in MPP patients.

Antibiotic Use for Acute Respiratory Infections in Children Under Five: A Study of Practices and Implications in Bangladesh

Antibiotic Use for Acute Respiratory Infections in Children Under Five: A Study of Practices and Implications in Bangladesh

Economic and Clinical Benefits of Bivalent Respiratory Syncytial Virus Prefusion F (RSVpreF) Maternal Vaccine for Prevention of RSV in Infants: A Cost-Effectiveness Analysis for Mexico.

Respiratory syncytial virus (RSV) is a leading cause of respiratory infections in children. A novel RSVpreF vaccine for use among pregnant women for the prevention of RSV in infants is expected to be licensed in Mexico. Hence, the clinical and economic burden of RSV among infants in Mexico, with and without a year-round RSVpreF maternal vaccination program, was estimated. A cohort model was developed to project clinical and economic outcomes of RSV from birth to 1 year of age for maternal vaccination and no intervention. Incremental cost-effectiveness ratios were calculated from direct cost outcomes, life years, and quality-adjusted life years (QALYs). The value per dose of the RSVpreF for which the program would be cost-effective was explored. Analyses were conducted from the healthcare system perspective, with direct costs (2024 Mexican Pesos [MXN]) and outcomes discounted at 5% annually; scenario and sensitivity analyses tested the robustness of model settings and inputs. Compared to no intervention, a year-round RSVpreF vaccine administered to 1891 M pregnant women would prevent 15,768 hospitalizations, 5505 emergency department cases, and 5505 physician office visits annually, averting MXN 1754 M in direct medical costs with an increase of 3402 life years or 3666 QALYs. The RSVpreF vaccine would be cost-saving up to MXN 1301/dose and cost-effective up to MXN 2105-MXN 3715/dose under an assumed cost-effectiveness threshold range of 1-3× the gross domestic product (GDP) per capita (MXN 247,310) per QALY gained. Year-round RSVpreF maternal vaccination would substantially reduce RSV's clinical and economic burden among infants in Mexico and likely be a cost-effective program.

Development and evaluation of a recombinant monoclonal human antibody with virus-neutralizing activity against the F glycoprotein of respiratory syncytial virus

Introduction. Respiratory syncytial virus (RSV) is the most common pathogen causing lower respiratory tract infections in children. RSV also poses a serious threat to the elderly and immunocompromised patients. Developing a therapy based on recombinant human antibodies to block the RSV fusion (F) glycoprotein is urgent to reduce the incidence of RSV infections and prevent associated complications. Aim. To design plasmid vectors for efficient production of the recombinant monoclonal antibody FM1 in a eukaryotic expression system targeting the RSV fusion (F) glycoprotein and to evaluate its activity against RSV subtypes A and B in vitro. Materials and methods. Constructs encoding the recombinant antibody FM1 were designed using genetic engineering. Recombinant antibodies were produced in the CHO-K1 cell line through transient expression. Antibody specimens were purified from the culture supernatant using affinity chromatography, with a modified protein A as the ligand. The virus-neutralizing activity of the antibody was evaluated in a microneutralization assay using several RSV strains on a Vero cell monolayer culture. Results. We developed a two-plasmid vector system to produce the recombinant FM1 antibody targeting the RSV F glycoprotein, using CHO cells as transient producers. The antibody was successfully produced, purified, and characterized, with its biological activity confirmed. The FM1 antibody demonstrated enhanced virus-neutralizing activity against reference and seasonal RSV strains of subtypes A and B compared to the control drug palivizumab. Conclusion. A recombinant FM1 antibody-based drug could address the import substitution challenge for protective measures against RSV infection. The authors are currently developing a stable FM1 producer clone with high productivity and viability and investigating the therapeutic efficacy of this antibody in a sublethal RSV infection mouse model.

The virome composition of respiratory tract changes in school-aged children with Mycoplasma pneumoniae infection

BackgroundMycoplasma pneumoniae (MP) is a common pathogen for respiratory infections in children. Previous studies have reported respiratory tract microbial disturbances associated with MP infection (MPI); however, since the COVID-19 pandemic, respiratory virome data in school-aged children with MPI remains insufficient. This study aims to explore the changes in the respiratory virome caused by MPI after the COVID-19 pandemic to enrich local epidemiological data.MethodsClinical samples from 70 children with MPI (70 throat swab samples and 70 bronchoalveolar lavage fluid (BALF) samples) and 78 healthy controls (78 throat swab samples) were analyzed using viral metagenomics. Virus reads were calculated and normalized using MEGAN.6, followed by statistical analysis.ResultsPrincipal Coordinate Analysis (PCoA) showed that viral community diversity is a significant difference between disease cohorts and healthy controls. After MPI, the number of virus species in the upper respiratory tract (URT) increased obviously, and the abundance of families Poxviridae, Retroviridae, and Iridoviridae, which infect vertebrates, rose evidently, particularly the species BeAn 58,085 virus (BAV). Meanwhile, phage alterations in the disease cohorts were predominantly characterized by increased Myoviridae and Ackermannviridae families and decreased Siphoviridae and Salasmaviridae families (p < 0.01). In addition, some new viruses, such as rhinovirus, respirovirus, dependoparvovirus, and a novel gemykibvirus, were also detected in the BALF of the disease cohort.ConclusionsThis cross-sectional research highlighted the respiratory virome characteristics of school-aged children with MPI after the COVID-19 outbreak and provided important epidemiological information. Further investigation into the impact of various microorganisms on diseases will aid in developing clinical treatment strategies.

Anti-Idiotypic Antibody as a Booster Vaccine Against Respiratory Syncytial Virus.

Background/Objectives: The respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in children and adults. With nearly everyone infected by the age of five, there is an opportunity to develop booster vaccines that enhance B-cell immunity, promoting potent and broadly neutralizing antibodies. One potential approach involves using anti-idiotypic antibodies (anti-IDs) to mimic specific antigenic sites and enhance preexisting immunity in an epitope-specific manner. RB1, a monoclonal antibody (mAb) that binds to site IV of the RSV fusion (RSV F) protein, is a potent and broadly neutralizing against RSV A and B viruses. It is the precursor for MK1654 (clesrovimab), which successfully completed a Phase III clinical trial. Methods: In this study, we isolated two anti-IDs, 1A6 and 1D4, targeting RB1 CDR regions, demonstrating that 1A6 competes fully with RSV F in binding to RB1. Results: We resolved the RB1-1A6 and RB1-1D4 Fab-Fab complex structures and proved that 1A6 mimics the RSV F site IV better than 1D4. In an immunogenicity study, mice primed with RSV F and boosted with 1A6 Fab showed a site IV-specific antibody response with a concurrent increase in RSV virus neutralization. Conclusions: These results suggest that anti-IDs could be potentially used as booster vaccines for specific epitopes.

Etiology and Clinical Prediction of Community-Acquired Lower Respiratory Tract Infection in Children.

Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and important cause for antibiotic prescription. We aimed to describe the aetiology of LRTI in children and analyse factors associated with bacterial or viral infection. Patients aged < 19 years with a diagnosis of LRTI were identified from the Observational Medical Outcomes Partnership Common Data Model Database of Seoul National University Bundang Hospital from January 2005-July 2019, and their clinical characteristics were obtained from the electronic medical records and retrospectively reviewed. Among 5,924 cases of LRTI, 74.2% were pneumonia and 25.8% were bronchiolitis/bronchitis. Patients' median age was 1.8 (interquartile range, 3.1) years and 79.9% were < 5 years old. Pathogens were identified in 37.8%; 69.1% were viral and 30.9% were bacterial/Mycoplasma pneumoniae. Respiratory syncytial virus was most common (70.9%) among viruses and M. pneumoniae (94.6%) was most common among bacteria. Viral LRTI was associated with winter, age < 2 years, rhinorrhoea, dyspnoea, lymphocytosis, thrombocytosis, wheezing, stridor, chest retraction, and infiltration on imaging. Bacteria/M. pneumoniae LRTI was associated with summer, age ≥ 2 years, fever, decreased breathing sounds, leucocytosis, neutrophilia, C-reactive protein elevation, and positive imaging findings (consolidation, opacity, haziness, or pleural effusion). In children with LRTI, various factors associated with viral or bacterial/M. pneumoniae infections were identified, which may serve as guidance for antibiotic prescription.

Vitamin D supplements reduce risk of viral upper respiratory infections in children with lower concentrations.

Vitamin D is crucial for the immune system, as it enhances pathogen-fighting cells and reduces inflammation. We reviewed serum 25-hydroxyvitamin D (25(OH)D) concentrations in children with viral upper respiratory tract infections (URTIs) and the impact of vitamin D supplements on those infections. A mini literature review was conducted from 1 January 2000 to 30 April 2024. It used PubMed, Google Scholar, Cochrane and Scopus and focused on children aged 0-18 years. The review comprised 12 studies: seven randomised controlled trials, two prospective studies, two case-control studies and one cross-sectional study. The findings included lower 25(OH)D concentrations in children more susceptible to URTIs and significantly lower levels in those with recurrent infections. One study found reduced 25(OH)D concentrations and immunoglobulin G levels in children with URTIs. Of the nine studies that examined vitamin D supplements, five reported benefits for children with URTIs, one only showed short-term effects and three found no significant reductions. Two reported that taking 2000 IU a day did not reduce URTIs any more than 400 IU and high-dose supplements may be unnecessary. Children with viral URTIs often had lower vitamin D concentrations and supplements frequently helped to reduce the risk of these infections.

Mycoplasma pneumoniae-associated severe autoimmune haemolytic anaemia in children: a case report from a resource limited setting

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia and respiratory tract infection in children. While traditionally known for its respiratory manifestations, extrapulmonary manifestations of Mycoplasma pneumoniae infections are rare, particularly autoimmune hemolytic anemia (AIHA). Emerging evidence suggests its association with AIHA in pediatric patients, especially with severe respiratory involvement. Here, we present a case of a child with cold AIHA secondary to Mycoplasma pneumoniae infection without marked pulmonary manifestations, from a resource limited setting, highlighting the importance of considering atypical presentations of this pathogen in pediatric patients. Understanding this association is crucial for timely diagnosis, appropriate management, and improved outcomes in affected children.

The frequency of detected pathogen genomes in children with acute respiratory infections

Due to the high prevalence of acute respiratory infections in children, it was of interest to determine the composition of bacterial and viral-bacterial associations for respiratory tract inhabiting microorganisms. To identify respiratory tract pathogens, especially viruses and unculturable bacteria, it is advisable to use molecular genetic research methods particularly PCR. The work was aimed at comparatively analyzing rate of genome detection for respiratory tract pathogens in children with acute respiratory infections and apparently healthy controls. Materials and methods. Children (97 people) were examined, of which 35 people — with acute respiratory infections of the upper respiratory tract (nasopharyngitis, pharyngitis, laryngitis) (ARI URT), 32 people — with acute respiratory infections of the lower respiratory tract (acute bronchitis, acute obstructive bronchitis) (ARI NDP) and 30 people — apparently healthy control at the time of examination. RNA and DNA of viral and bacterial pathogens were assessed in the oropharyngeal smears using PCR. Test systems produced by the Federal Budgetary Institution Central Research Institute of Epidemiology of Rospotrebnadzor and JSC Vector-Best were used. Results. An analysis of detection rate for DNA and RNA of bacterial and viral pathogens showed the presence of a wide range of them (20 different species/strains out of 27 identified) in oropharyngeal biomaterial from all examined children. The peak diversity and detection rate of pathogen genomes were found in apparently healthy subjects and children with ARI UDP (DNA of members from Herpesviridae family, S. pneumoniae, H. influaenzae, MSSA, MRCoNS). Associations of 4–6 pathogens prevailed in the microflora, and the “core” of both bacterial and viral-bacterial associations was the combination of S. pneumoniae and H. influenzae (in 93.3% and 60.0% of cases, respectively). In bacterial associations, staphylococci (MRSA and MRCoNS) and P. aeruginosa were also detected in healthy children, MSSA and other very rarely bacterial types were detected in children with ARI UDP. In children with NPD infections, the majority of whom (75.0±7.7%) were classified as long-term ill and had a complicated disease course, a noticeable depletion (decrease in taxonomic diversity) of the nasopharyngeal microbiota was found. Conclusion. The presented data indicate the presence in the biomaterial of the examined children of molecular genetic markers of a wide range of pathogens presented as viral-bacterial and bacterial associations, with varying composition being related to patient clinical status. Detection of pathogen genomes is important for choosing proper etiotropic therapy at early disease stages as well as prescribing probiotic drugs that can restore a balance in respiratory tract microflora.

Burden of viral respiratory infections in the pediatric intensive care unit: age, virus distribution, and the impact of the COVID-19 pandemic.

Viral respiratory infections can lead to severe complications. Their high prevalence in infants and young children highlights the need to extend vaccination age ranges for vaccine-preventable viral infections, monitor uptake in at-risk children, and implement public health interventions in daycare settings. •Viral respiratory infections in children are a significant cause of illness and mortality. •Severe infections in children beyond current vaccine eligibility suggest the need to expand vaccination to broaderage groups. •SARS-CoV-2 dominance during the COVID-19 pandemic altered disease characteristics of respiratory infections.

Artificial Intelligence and the Management of Viral Respiratory Infections inChildren

Viral respiratory infections in children are a major public health issue, with high incidence rates and a significant impact on healthcare systems. The application of artificial intelligence (AI) in the medical field offers substantial opportunities for early detection, accurate diagnosis, effective management, and prevention of these infections. Aim: This study aims to analyse the most effective AI-based approaches for managing viral respiratory infections in children, including its application in paediatric hospitals, telemedicine, and routine practices, while also identifying challenges associated with implementation. Methodology: A systematic literature review was conducted following the PRISMA guidelines. The search was performed across 10 major databases: De Gruyter, MDPI, Nature, PubMed, ScienceDirect, Elsevier, SpringerLink, Wiley Online Library, Taylor &amp; Francis, and Frontiers, focusing on articles published between 2020 and 2024. Out of 46,900 scientific articles, 17 relevant studies were selected, including original research, meta-analyses, and systematic reviews.Results: AI has shown high efficiency in the early detection of symptoms, differential diagnosis between viral and bacterial infections, monitoring disease progression, and personalising treatments. Its use in telemedicine and family education has improved accessibility to care and raised awareness. Integration of AI in paediatric hospitals has reduced diagnostic time and optimised resources. However, large-scale implementation depends on collaboration between medical professionals and IT specialists. Conclusions: AI represents a promising solution for improving the management of viral respiratory infections in children. The development of standardised protocols and addressing ethical challenges are essential for the effective integration of this technology into paediatric practice.

Prevalence and influencing factors of severe respiratory infections in childhood among residents of China, 2019-2020

Objective: To analyze the exposure level and changes in severe respiratory infection among Chinese residents aged ≥40 years in China and to provide essential data for preventing and controlling chronic respiratory diseases. Methods: The data came from chronic obstructive pulmonary disease surveillance of Chinese residents in 2014-2015 and 2019-2020. The surveillance covers 31 provinces (autonomous regions and municipalities) in China. A multi-stage stratified cluster random sampling method was used to select permanent residents aged ≥40 years. Relevant information about exposure to severe respiratory infections during childhood was collected through investigation. Rigorous complex sampling and weighted analysis were applied to estimate the exposure rate of severe respiratory infections among children with different characteristics among residents aged ≥40 years in China from 2019 to 2020. Additionally, changes in severe respiratory infections during childhood were analyzed over 2014-2015 and 2019-2020. Results: In 2019-2020, the exposure rate of severe respiratory infection before 18 for residents aged ≥40 years in China was 21.58‰ (95%CI: 17.57‰-25.59‰). The exposure rate of severe respiratory infection before the age of 14 was 19.40‰ (95%CI:15.25‰-23.55‰), the difference in the exposure rate between men and women was not statistically significant (both P>0.05), and the exposure rate of urban residents is higher than that of rural residents. The results of multivariate logistic regression analysis showed that in western rural areas, factors including being born by cesarean section, exposure to secondhand smoke before age 14 years old, and a family history of chronic respiratory diseases were associated with severe respiratory infections in childhood. Compared with 2014-2015, the proportion of residents aged 40 and older in China hospitalized for pneumonia or bronchitis before 14 from 2019 to 2020 was slightly lower than five years prior. Conclusions: Among residents in China aged ≥40 years, 21.58‰ experienced severe respiratory infection exposure during childhood, varying exposure levels across different demographic groups. The burden of chronic respiratory diseases in adulthood cannot be ignored. Efforts should be made to expand the coverage of planned immunization and to focus on early-life interventions during childhood to reduce the incidence of severe respiratory infections.

Antibiotic Choice and Outcomes for Respiratory Infections in Children With Tracheostomies.

Respiratory infections are a major cause of hospitalization in children with tracheostomies, contributing significantly to hospital expenses. Limited data exist to describe optimal diagnostic strategies or management recommendations for these infections. This study aimed to explore factors associated with antibiotic therapy, including usage, administration route, duration, variables influencing the decision to prescribe antibiotics, and outcomes in children with tracheostomies experiencing episodes of respiratory infection other than pneumonia (tracheobronchitis and nonspecific respiratory episodes [NSRE]). We conducted a retrospective cohort study using the medical records of 83 children who underwent tracheostomy and received treatment at a tertiary hospital from 2010 to 2021. A total of 164 episodes of tracheobronchitis and 98 episodes of NSRE were analyzed. Children with tracheobronchitis were more frequently treated with antibiotics: 75% in nonhospitalized cases and 76% in hospitalized cases. In NSRE, antibiotic prescription dropped to 40% and 29%, respectively. Out of 51 tracheobronchitis and 15 NSRE initially treated with oral antibiotics, a switch to intravenous administration was deemed necessary in only 7 tracheobronchitis cases (14%). Fever was significantly associated with antibiotic prescription in tracheobronchitis and NSRE, regardless of hospitalization status. Two children died within the 28-day period following the onset of tracheobronchitis symptoms. Many cases identified as tracheobronchitis, along with a greater number of NSRE cases, resolved without requiring antibiotics. Although fever was associated with increased antibiotic prescription, it does not necessarily indicate severity. Therefore, careful consideration should be given before prescribing antibiotics, especially in febrile cases, to avoid unnecessary treatments.

Correlation Between Laboratory Findings and Clinical Diagnosis of Viral Upper Respiratory Tract Infection in Children

Correlation Between Laboratory Findings and Clinical Diagnosis of Viral Upper Respiratory Tract Infection in Children

Overview of Pediatric Respiratory Syncytial Virus (RSV) infections: has risk perception for RSV changed in children with comorbid conditions?

Respiratory syncytial virus (RSV) is the primary etiology of lower respiratory tract infection in children. The fluctuating incidence of RSV, particularly in light of the COVID-19 pandemic, has shifted the spotlight onto preventive strategies. Our study aims to investigate both the risk factors and clinical symptoms of RSV. From February 2015 to February 2023, samples were analyzed during all seasons to identify viral respiratory infections. RSV was identified in a total of 835 individuals. In 2021, following the easing of limitations after the COVID-19 pandemic, the largest number of identified cases was recorded. January was the most commonly used month. The median age were 5 months (min-max: 1-204 months) and 128 (17.7%) cases had a history of prematurity. Around 24.7% of the patients had a preexisting medical condition. Neurological disease patients were followed up in the intensive care unit more often than others (53.3 vs. 35.8% p = 0.036). While the hospital stay of pediatric patients born under the 29th week of gestation is almost twice as long compared to other groups, the hospital stay is almost twice as long as that of patients between 29 and 32 weeks. (p = 0.046, p = 0.012 respectively). RSV was a powerful companion during the pandemic and a persistent reminder of its severity. Our initial data suggest that RSV prevention is difficult for children with pre-existing diseases, notably neurological abnormalities, who are not advised for preventive treatments. Given this outcome, late-premature newborns and children with medical issues should receive RSV prophylaxis first.

Bromelain Supplementation in the Management of Otitis Media with Effusion in Children.

The respiratory system is prone to infectious diseases, especially in children below five years of age. Upper respiratory tract infections in children are often associated with Eustachian tube dysfunction and complicated by otitis media with effusion (OME), an inflammatory process within the middle ear, which can lead to hearing loss. Treatment for these infections involves a combination of medication and symptom relief, depending on the severity and cause of the infection. In recent years, natural therapeutic drugs derived from herbal medicines have been gaining popularity in treating various pathologies. Bromelain, one of the most studied natural compounds, has been investigated extensively due to its numerous pharmacological properties, offering a potential new avenue for treatment. Based on these promising findings, our study was designed to examine the efficacy of supplementation with bromelain in countering symptoms associated with OME. This study was conducted on data acquired from medical records from the Section of Audiology of the University of Palermo, focusing on the period of January 2022 to June 2023 and selecting 224 children (age range 1-8 years), namely 174 males and 50 females, who were evaluated for presumed OME at the audiology pediatric ambulatory. All patients selected before initiating pharmacological treatment underwent thorough screening regarding the functionality of the tympanic cavities, otoacoustic emissions, the auditory threshold, and the ear canal's integrity. The preliminary findings of this study are significant, demonstrating that supplementation with bromelain led to notable improvements in the symptoms accompanying OME after 15 days and 60 days of therapy. Notably, patients who received the bromelain supplement reported reduced mucus secretions and improved auditory function. These results underscore the potential of naturally occurring compounds as adjuvants to standard therapeutic strategies in treating OME.

Efficacy of bioregulatory therapy for acute respiratory infections in children

Efficacy of bioregulatory therapy for acute respiratory infections in children

Modern approaches to the prevention of frequent respiratory infections in childhood

Modern approaches to the prevention of frequent respiratory infections in childhood