Respiratory Tract In Children Research Articles

Longitudinal investigation of pathogenic bacterial colonization in early childhood: Emphasis on the determinants of Moraxella catarrhalis colonization.

Moraxella catarrhalis is a common, potential pathogen colonizing the respiratory tract in children. However, there is little information regarding the determinants of M. catarrhalis colonization and disease development. A population-based cohort study was conducted to collect nasopharyngeal swabs from children aged 1, 2, 4, 6, 12, 18, 24, 36, and 60 months for the detection of four common respiratory tract pathogens, including Staphylococcus aureus, M. catarrhalis, Streptococcus pneumoniae, and Haemophilus influenzae. Questionnaires on breastfeeding status were administered during each visit. A total of 921 children were enrolled between 2012 and 2018. S.aureus was the most common pathogen, although the rates declined during the initial 18 months of life; in contrast, the other three pathogens increased during the first 5 years of life. M. catarrhalis was the second most common colonizing pathogen in all age groups, with prevalence ranging from 0.8% (7/842) at one month to 20.4% (33/162) at 60 months of age. Breastfed children (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.35-0.92; P=0.02) had a lower potential for M. catarrhalis carriage; however, infants with a longer duration of exclusive breastfeeding (OR: 1.12; 95% CI: 1.01-1.25; P=0.04), especially >12 months of age, had a higher rate of M. catarrhalis carriage. Breastfeeding should be promoted because it may be correlated with a lower risk of M. catarrhalis carriage. However, an extended period of exclusive breastfeeding may be positively associated with M. catarrhalis colonization.

Foreign bodies of the lower respiratory tract in children

Foreign bodies of the lower respiratory tract in children is one of the major life-threatening emergencies in children, having a high rate in the structure of infant mortality. This patology represents about 11% of otorhinolaryngological emergencies [2]. In the USA the statistics recorded eloquent data over a year. The intra-hospital mortality rate associated with these cases accounts for 1,8%, and anoxic brain injury is reported in 2,2% of cases. Thus, foreign body aspiration was diagnosed mainly in children aged 1-3 years, with the frequency of 56%, and the death rate of 7% [5]. Foreign bodies enter to the body by natural ways and have a diverse location, depending on their size, shape and nature. The most common location of foreign bodies is in the bronchi of the right lung, followed by the left bronchial tree and most rarely, in the trachea. Very rarely, are encountered foreign bodies with multiple locations [6]. In the etiological structure, foreign bodies of organic origin predominate - 15%, especially foreign bodies of plant origin - 75-81%, less frequently metallic foreign bodies - 10% and plastic - 5% [2,5]. Statistical age analysis of foreign body aspiration cases reported that, 21% cases are determined in children after the age of 6 months, more than half cases - in child 1-3 years and 1⁄4 cases - in children older than 3 years [1,3].

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Микробиологическая характеристика хронического риносинусита у детей с муковисцидозом в сравнении с другими локусами респираторного тракта

One of the main factors determining the severity of the course and prognosis in cystic fibrosis (CF) is the severity of the infectious and inflammatory process and the species composition of the microflora in the lower respiratory tract (LRT). Studies show the important role of the nasal cavity and paranasal sinuses as a source and reservoir of microflora. Objective. To assess the species composition and correlation of microflora from the various parts of the upper and lower respiratory tract in children with cystic fibrosis. Patients and methods. 94 patients aged 2 to 18 years diagnosed with chronic rhinosinusitis with cystic fibrosis which had surgical intervention were included. The species composition of microflora was obtained from paranasal sinuses and nasal cavity, evaluated intraoperatively, from trachea during intubation in comparison with the actual (1-3 weeks before the intervention ) results of bacteriological test of induced sputum and / or material from the posterior pharyngeal wall, as well as the most "clinically significant" microflora in the anamnesis. Statistical analysis was carried out in order to search for correlations of the species composition of the bacterial flora between these parts of the respiratory tract. Results. The analysis showed no correlation between the microflora of different parts, except for the correlation between the most "clinically significant" microflora in anamnesis and obtained intraoperatively from paranasal sinuses in relation to two prognostically unfavorable species of bacteria: Sternotrophomonas maltophilia ( p = 0.001) and Pseudomonas aeruginosa (p = 0.047). In 13 (81.3%) of the 16 patients which had in anamnesis P. aeruginosa and was isolated from the maxillary sinus intraoperatively, its eradication was ascertained. Conclusion. The revealed positive correlation between the isolation of P. aeruginosa ever in anamnesis from low respiratory tract (LRT) and its presence in the paranasal sinuses during intraoperative sampling of the material indicates the important role of paranasal sinuses as a reservoir of pathogenic microflora and the possibility of long-term preservation of infectious agents after eradication courses of treatment and the achievement of eradication. Keywords: cystic fibrosis, children, chronic rhinosinusitis, microflora, Pseudomonas aeruginosa, paranasal sinuses

Bacterial Epidemiology and Antimicrobial Resistance Profiles of Respiratory Specimens of Children with Pneumonia in Hainan, China.

To investigate the bacterial species and antimicrobial susceptibility of respiratory specimens of children with pneumonia in Hainan, China. A total of 5017 specimens, including 4986 sputum samples, 19 bronchoalveolar lavage fluid samples and 12 tracheal tube tip samples from hospitalized children with pneumonia from April 1, 2021 to March 31, 2022 were studied. All the bacterial isolates were identified and confirmed with the VITEK 2 system. Antimicrobial susceptibility of all isolates was determined using the Kirby-Bauer method or the VITEK 2 Compact automatic system, following the breakpoints recommended by the Clinical and Laboratory Standards Institute. A total of 996 bacterial isolates were collected and classified into 24 species. The top 10 most frequent species were Haemophilus influenzae (356 isolates, 35.7%), Streptococcus pneumoniae (128, 12.9%), Moraxella catarrhalis (114, 11.5%), Escherichia coli (89, 8.9%), Staphylococcus aureus (89, 8.9%), Klebsiella pneumoniae (82, 8.2%), Acinetobacter baumannii (31, 3.1%), Pseudomonas aeruginosa (28, 2.8%), Enterobacter cloacae (18, 1.8%), and Streptococcus agalactiae (13, 1.3%). 70.5% strains had the resistant (R) and/or intermediate (I) phenotypes to at least one of the tested drugs, with a large proportion (54.6%) showing resistance to two or more commonly used antibiotics. In addition, 60.5% (69/114) of M. catarrhalis strains and 42.9% (153/356) of H. influenzae strains produced β-lactamases while 19.1% (17/89) E. coli and 6.1% (5/82) K. pneumoniae strains produced extended-spectrum β-lactamases. A diversity of pathogenic bacteria were isolated from the respiratory tract of children with pneumonia in Hainan, China. High-frequency resistance to first-line antimicrobial drugs was observed in Gram-negative and Gram-positive bacteria, including 544 isolates resistant to at least two antibiotics. Rapid identification and susceptibility testing should be implemented for children with bacterial pneumonia in Hainan before drug treatment is recommended.

Частота выделения и чувствительность изолятов Staphylococcus aureus и Pseudomonas aeruginosa из нижних дыхательных путей к антимикробным препаратам у детей с муковисцидозом

Частота выделения и чувствительность изолятов Staphylococcus aureus и Pseudomonas aeruginosa из нижних дыхательных путей к антимикробным препаратам у детей с муковисцидозом

Improving the clinical effectiveness of the treatment of acute inflammatory diseases of the upper respiratory tract in children with the use of silver-based medicines

Introduction. Acute respiratory viral infection (ARVI) is the most common reason for visits to the physician by both children and adults.The aim of the study was to analyse the features of the course of ARVIs in patients with different immune status, to evaluate the effectiveness of standard therapy for these groups of patients, as well as the use of silver-based medicines in the combination therapy of patients.Materials and methods. For the period from July to September 2022, 26 children (Group 1) without immunodeficiency conditions and 26 immunocompromised children (Group 2) were identified, all of them had symptoms of acute respiratory viral infections. In Group 1, 69.2% of children (n = 18) were classified as frequently ill children with ARVI rate of more than 8 times per year, 38.4% (n = 10) had allergic rhinitis, 7.7% (n = 2) had a concomitant bronchial asthma. In Group 2, the distribution of underlying immunocompromised disease was as follows: primary immunodeficiency – 7.7% (n = 2), Hurler syndrome after bone marrow transplantation – 11.5% (n = 3), acute lymphoblastic leukemia during specific therapy – 26.9% (n = 7), with graft versus host disease – 30.7% (n = 8) and currently in remission – 23% (n = 6). Among patients in this Group, only 7.7% of children (n = 2) had a history of allergic rhinitis.Results. The criterion for recovery in Group 1 was reversal of all clinical symptoms, in Group 2 – clinical improvement, normalization or significant decrease in C-reactive protein levels, improvement of paranasal sinuses pneumatization.Conclusion. During ARVI, post-viral rhinosinusitis often occurs, the ability of the mucosa to regenerate becomes disturbed, which makes it more vulnerable to adhesion of viruses, bacteria, and fungi. In this case, especially effective is the intranasal use of a silver-based medicine to form a protective protein film on the injured mucosa. The use of silver-based medicines in the combination therapy of patients with inflammatory pathologies of the nose, nasopharynx and paranasal sinuses can greatly increase the effectiveness of treatment, while shortening the duration of therapy and being safe.

Airways tissue expression of type I interferons and their stimulated genes is higher in children than adults

There is emerging evidence that age-dependent differences in susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) correlate with stronger innate immune response in the upper respiratory tract in children compared to adults. The efficient induction of interferon (IFN) alpha and beta (α and β) signaling, and interferon-stimulated genes (ISGs) is fundamental to the host antiviral response. In-silico transcriptomic analyses was conducted to determine the expression levels of IFN α/β pathway genes as well as 524 human ISGs in upper and lower airways of children and adults at baseline and post respiratory infections including coronavirus disease 2019 (COVID-19). To validate our in-silico analysis, we conducted qRT-PCR to measure ISGs levels in children and adult's nasal epithelial samples. At baseline, children had significantly higher levels of IFN α/β and ISGs genes compared to adults. More distinction was also seen in bronchial compared to nasal basal levels. Children nasal epithelial cells exhibited superior antiviral IFN α/β and associated ISGs response following ex-vivo poly (I:C) treatment model, and in clinical samples of SARS-CoV-2 infected patients. This was also confirmed in nasal epithelial samples using qRT-PCR validation. No gender-based difference in type I IFN levels across both age groups were observed. Understanding the biological basis for children resistance against severe COVID-19 is a challenge that has substantial clinical importance. More mechanistic studies are needed to carefully quantify how much of early IFN levels is needed to bypass the viral evasion mechanism and prevent its further replication and dissemination to lower airways and the rest of the body.

Pediatric respiratory tract foreign bodies in children: A systematic review

ObjectivePediatric respiratory emergencies of airway foreign body (FB) are a common cause of visits to the emergency department (ED) and respiratory failure is a major cause of cardiopulmonary arrest. The purpose of this study is to evaluate the literature and update our current understanding of pediatric respiratory tract FBs in children by clearly considering the aspect of the complications and related factors. MethodsA systematic search of PubMed and Embase yielded a total of 2035 studies related to the respiratory tract FB in children. After screening the abstracts, 118 articles were included for analysis. However, 56 articles were excluded due to the published data more than 10 years. Meanwhile, 6 articles were duplicated and 3 articles were the secondary data. Thus, 53 full text articles were assessed for eligibility. Then, 46 full text articles were excluded due to irrelevant contents. Finally, there were 7 qualitative articles in this systematic review. ResultsMost children with FBs in the aerodigestive tract are 1–3 years of age. Most FBs are organic, especially seeds. The most commonly obstructed airway is the right primary bronchus. The most common and severe complications are pneumonia, pulmonary atelectasis, lung consolidation, pneumothorax, bronchiectasis, and death. The main device for the removal of FBs from the airways is a rigid bronchoscope. Duration of diagnosis is major factors that related with severe complication. ConclusionFBs obstructive conditions in respiratory tract of children are serious and life-threatening conditions. The likelihood of death depends on the location of the obstruction, the nature of FB, time to removal, and initial resuscitation. Moreover, even after a FB has been removed, complications can lead to death. Educating parents and immediate treatment is very important. Rapid diagnosis is important factor to prevent complication.

РЕТРОСПЕКТИВНЫЙ АНАЛИЗ ЗАБОЛЕВАНИЙ ВЕРХНИХ И НИЖНИХ ДЫХАТЕЛЬНЫХ ПУТЕЙ У ДЕТЕЙ, ВАКЦИНИРОВАННЫХ ПРОТИВ ПНЕВМОКОККОВОЙ ИНФЕКЦИИ В ПЕРИОД НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

According to the WHO data, the pneumococcal infection (PI) is recognized as one of the most dangerous of all vaccine-preventable diseases due to its high mortality rates. The purpose of the study was to analyze the incidence of acute diseases of the upper and lower respiratory tract in children depending on the presence and frequency of vaccinations against PI with PREVNAR 13® vaccine during the new coronavirus infection (COVID-19) pandemic. Materials and methods of the research: a retrospective analysis of the child development histories (Form No. 112/u “Child Development History”) of 92 children (45 boys, 47 girls) aged 3.1 [2.2; 3.5] years old observed in the Treatment-and-Prophylactic Department No. 1 with the Saratov City Children's Polyclinic No. 8 (Saratov, Russia) in May 2020 - Dec. 2021. A single-center retrospective cohort study was conducted. Inclusion criteria were the absence of chronic pathology, developmental anomalies, background conditions and congenital immunodeficiency conditions. The authors analyzed the volume of cases with acute diseases of the upper and lower respiratory tract considering the most typical and the most frequent ones in children, such as: nasopharyngitis, tonsillopharyngitis, adenoiditis, acute bronchitis, and community-acquired pneumonia. Results: it was found that in children vaccinated against PI the decrease in the incidence of diseases of the upper and lower respiratory tract was recorded compared to unvaccinated children, and the maximum effectiveness of vaccination is achieved with a full vaccination course (the two consecutive vaccinations followed by a single revaccination (V1, V2, and RV). Conclusions: 1) in children who received a full course of vaccination against PI, nasopharyngitis was statistically significantly less common (3.55 cases per 1 child per year) than in children who did not receive a full course of vaccination (6.64 cases per 1 child per year) (p<0.001); adenoiditis (no cases were registered vs. 0.86 cases per 1 child per year, p<0.001); tonsillopharyngitis (0.4 cases per 1 child per year vs. 1.89 cases per 1 child per year, p<0.001), no cases of community-acquired pneumonia were detected vs. 0.22 cases per 1 child per year in children who did not receive a full course of vaccination. 2) among children vaccinated twice with the PREVNAR 13® vaccine compared to the children not vaccinated against PI there was a statistically significantly lower number of cases of adenoiditis i.e., 0.74 vs. 0.86 cases per 1 child per year, p<0.001; tonsillopharyngitis (0.6 vs. 1.89 cases per child per year, p<0.001). 3) among children who received a single shot of vaccination against PI compared to unvaccinated children there was a statistically significantly lower number of cases of nasopharyngitis (5.28 vs. 6.64 cases per 1 child per year, p<0.001).

ABOUT MODERN METHODS OF TREATMENT OF ACUTE STENOSING LARYNGOTRACHEITIS IN CHILDREN

Acute infectious and inflammatory processes in the upper respiratory tract still form the main list of diseases in childhood, which maintains the constant interest in this pathology of specialists in various fields, such as pediatricians, infectious disease specialists, otorhinolaryngologists, allergists, and immunologists. Particular attention of researchers and clinicians is attracted by the study of the etiopathogenetic mechanisms of the occurrence of laryngotracheitis, which is caused, first of all, by the development of a life-threatening condition of acute stenosis of the respiratory tract in children. According to our observations and according to the literature, there has recently been a clear trend towards an increase in the frequency of repeated episodes of acute stenosing laryngotracheitis (ASLT) in children, which makes it obvious that further study of the underlying mechanisms of not only the occurrence, but also the recurrence of ASLT is necessary. Recurrence of laryngotracheitis contributes to the formation of chronic inflammatory processes and hyperreactivity of the upper respiratory tract, negatively affects the maturation of the child's immune system, which leads to the development of secondary immunosuppression. Each new respiratory infection provokes more and more serious disorders of the immune system, contributing to the formation of both chronic inflammatory diseases of the pharynx and respiratory allergies. The modern concept of the etiopathogenesis of laryngotracheitis takes into account the action of multiple infectious and allergic trigger factors, the most significant in immunocompromised children. Currently, the primary tasks awaiting solution are timely prevention and diagnosis, the provision of highly qualified medical care, including bronchopulmonary diseases in children by expanding the use of modern methods of diagnosis and treatment, which will improve the quality of life of children.

Sore throat in children: diagnosis, treatment, prevention

Introduction. Sore throat often accompanies acute pharyngitis and tonsillitis in both children and adults. Inflammation of the posterior pharyngeal wall, acute pharyngitis, almost never occurs in isolated form in children and is often accompanied by symptoms of acute adenoiditis and / or tonsillitis.Aim. To study the effectiveness of the treatment of exacerbation of chronic non-streptococcal tonsillitis with an antiseptic herbal product in childhood.Materials and methods. We examined 58 children diagnosed with exacerbation of chronic tonsillitis for the period from June 2018 to December 2019. The age of the children ranged from 6 years 4 months up to 14 years old, the average age was 8.3 + 2.4 years, the group included 32 boys (55%) and 26 girls (45%). The duration of the disease ranged from 1 to 5.5 years. The exacerbations of chronic tonsillitis occured 3-4 times a year. The patients included in the study received the antiseptic herbal product in the form of drops at a dose of 15 drops five times/day for 7 days, and then 15 drops three times/day for another 7 days. The course of therapy was 14 days.Results. The provided course of therapy resulted in the significant positive changes overtime: reduced intensity of complaints already at the second visit, significant reduction of complaints at the third visit and actual relief of complaints by the fourth visit in the patients receiving the monotherapy with antiseptic herbal product.Conclusions. Preservation of the normal microbiome of the upper respiratory tract in children maintains effective functioning of MALT and thereby reduces the risk of the development and chronification of inflammation in the oropharynx. The antiseptic herbal medicinal product may be regarded as the alternative to antibiotic therapy in children with exacerbation of chronic tonsillitis, as it has a multifunctional effect on the mucous membranes lining upper respiratory tract, stimulates innate and adaptive immunity, and increases the resistance of mucous membranes to the pathogens.

The Correlation Between Biofilm-Forming Ability of Community-Acquired Methicillin-Resistant Staphylococcus aureus Isolated from the Respiratory Tract and Clinical Characteristics in Children.

ObjectiveThis study aimed to investigate the biofilm-forming ability, molecular typing, and antimicrobial resistance of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains isolated from the respiratory tract of children and their correlation with clinical characteristics.MethodsAll CA-MRSA strains were isolated from hospitalized children, and their presentation, molecular typing, antimicrobial susceptibility, and biofilm formation were investigated. The clinical characteristics were compared between the strong and weak biofilm producer groups.ResultsFifty-three CA-MRSA strains were isolated from the respiratory samples of 53 children, with nearly half of them being young infants (0–12 months). Approximately, 88.7% (47/53) of the isolates were resistant to four or more antibiotics, mainly β-lactam antibiotics, lincosamides, and macrolides. Twelve sequence types (STs) and 20 subtypes of staphylococcal protein A (spa) typing were identified, with ST59-t437 (39.6%, 21/53) as the predominant subtype. All strains showed the ability to form biofilms. When compared to children with weak biofilm-forming CA-MRSA strains, those with strong biofilm-forming strains had higher proportions of lower respiratory tract infections (LRTI) (88.5% vs 59.3%), obvious cough symptoms (84.6% vs 51.9%), and severe chest imaging manifestations (76.9% vs 37.0%). Furthermore, a strong biofilm-forming ability significantly increased the risk of prolonged cough in children with LRTI (44.4% vs 14.3%), and a positive correlation between the duration of cough and the extent of biofilm formation was observed. Medical history investigation revealed that the strong biofilm-forming group had a much higher percentage of macrolides intake than the weak biofilm-forming group in the last month before admission (61.5% vs 14.8%).ConclusionST59-t437 was the most prevalent clone in CA-MRSA respiratory isolates among the hospitalized children. All CA-MRSA strains formed biofilms. The stronger the biofilm-forming ability, the more serious and prolonged were the respiratory symptoms.

МЕТА-АНАЛИЗ РАСПРОСТРАНЕННОСТИ АЛЛЕРГИЧЕСКОГО РИНИТА СРЕДИ ДЕТЕЙ, ПРОЖИВАЮЩИХ В ПЯТИ РАЗЛИЧНЫХ ОБЛАСТЯХ ЦЕНТРАЛЬНОГО ФЕДЕРАЛЬНОГО ОКРУГА

Abstract. Allergic rhinitis (AR) is one of the most urgent problems of allergology and immunology, since, despite the improvement in diagnostic and treatment approaches, the number of patients suffering from allergic diseases of the respiratory tract remains very significant. AR is a common allergic disease of the upper respiratory tract in children living in the Moscow, Yaroslavl, Tver, Vologda and Vladimir regions, with a frequency of occurrence in 2021 from 1.472% to 2.684% (mean random effect 2.143 with CI: 1.599-2.763). There is an annual increase in patients with AR in each region, but at the same time, the heterogeneity of the samples allows us to state that in each specific region, the increase in AR occurs under the influence of various risk factors specific to a particular region, ignorance of which leads to an increase in the total number of patients with AR, the number children with late diagnoses, as well as a decrease in the quality of life of patients and their families, which has significant socio-economic consequences. At present, as far as we know, there have been no works devoted to a one-time analysis of statistical data on the assessment of the prevalence and incidence of AR in a multicenter study in Russia.

COVID-19-Associated Croup in Children.

As SARS-CoV-2 has evolved, so has its effects on the pediatric population.1 While early variants typically resulted in lower respiratory infections, the recently identified Omicron variant may exhibit a predilection for the upper airways.2 The relatively smaller upper respiratory tract in children compared to adults has been thought to predispose them to more severe clinical presentations resembling laryngotracheobronchitis, or croup. Caused by viral-induced subglottic airway inflammation, croup is classically characterized by sudden onset "barking cough", inspiratory stridor, and respiratory distress. Endemic coronaviruses have been linked to croup, however only sparse case reports have described croup specifically associated with SARS-CoV-2 and it remains unclear if croup cases constitute a causative relationship or result of co-infection with another virus.3-6 To address this knowledge gap, we performed a retrospective analysis of the incidence and clinical characteristics of croup associated with SARS-CoV-2 infection at a large freestanding children's hospital.

Metagenomic Analysis Reveals High Abundance of Torque Teno Mini Virus in the Respiratory Tract of Children with Acute Respiratory Illness.

Human Anelloviridae is a highly prevalent viral family, including three main genera—Alphatorquevirus (Torque teno virus, TTV), Betatorquevirus (Torque teno mini virus, TTMV), and Gammatorquevirus (Torque teno midi virus, TTMDV). To date, the characterization of Anelloviridae in the respiratory tract of children with acute respiratory infection (ARI) has been poorly reported and mainly focused on TTV. We performed a metagenomic analysis of eight respiratory samples collected from children with an ARI of unknown etiology (eight samples tested negative with a multiplex PCR assay, out of the 39 samples initially selected based on negative routine diagnostic testing). A total of 19 pediatric respiratory samples that tested positive for respiratory syncytial virus (RSV, n = 13) or influenza virus (n = 6) were also sequenced. Anelloviridae reads were detected in 16/27 samples, including 6/8 negative samples, 7/13 RSV samples and 3/6 influenza samples. For samples with a detection of at least one Anelloviridae genus, TTMV represented 87.1 (66.1–99.2)% of Anelloviridae reads, while TTV and TTMDV represented 0.8 (0.0–9.6)% and 0.7 (0.0–7.1)%, respectively (p < 0.001). Our findings highlight a high prevalence of TTMV in respiratory samples of children with an ARI of unknown etiology, as well as in samples with an RSV or influenza infection. Larger studies are needed to explore the role of TTMV in childhood respiratory diseases.

Variety of effects of silicon dioxide colloid in the treatment of antibiotic-associated diarrhea in children

Antibiotic-associated diarrhea (AAD) is a key aspect of pediatrics concerning antibiotic therapy Purpose. The article aims at investigating the effects of colloidal silicon dioxide in the treatment of antibiotic-associated diarrhea in children. Materials and methods. Using parametric and nonparametric methods of analysis, 83 patients were examined (treatment group — 41 children who used colloidal silicon dioxide and the control group — 42 children) of both sexes (mean age (13.7 ± 2.6) years) with pathology of the lower respiratory tract (acute bronchitis or community-acquired pneumonia), who developed AAD against the background of ABT. Results. When using colloidal silicon dioxide in 75.6% of children, diarrhea decreased by the 2nd day and stopped by the 4th day (median — 0 points). Against the background of taking the drug throughout the treatment, there was a marked 3-fold decrease in all AAD values. The assessment of the efficacy and safety of the drug according to the data of medical researchers was 3.4 points. Analysis of subjective data on the tolerability of the drug showed «excellent» and «good». Against the background of the full course of treatment with colloidal silicon dioxide, a 2 times more pronounced decrease in the characteristics of AAD was noted. Conclusion. The presented data are intended to focus the attention of pediatricians on the rational use of ABT, timely diagnosis of an unwanted drug reaction in the form of AAD and its correction. The studied drug showed high efficacy and safety, which makes it possible to recommend it as a symptomatic treatment of diarrhea that developed against the background of ABT treatment in the complex therapy of diseases of the lower respiratory tract in children.

Features of Technical Problems in Pediatric Rigid Bronchoscopy

Aim: Foreign body aspiration in the respiratory tract in children is a vital problem treated with rigid bronchoscopy (RB). In our study, technical problems and solutions of problems detected during RB were evaluated. Methods: Between August 2019-March 2021, 42 cases, which are operated due to foreign body aspiration, are analyzed in terms of age, gender, nature, and location of foreign body, complications, and technical problems. Results: 42 child patients (20 girls, 22 boys) were admitted to our clinic due to foreign body aspiration the respiratory tract ranged in average age from 1-16 years (average 4.6). Three of the foreign bodies were removed from the right main bronchi, 7 from the left main bronchi, and 4 from the trachea. Thirty-six were organic and 6 were inorganic. Human error was detected in 8 cases, instrument error in 27 cases, device error in 4 cases, and multiple errors in 3 cases. Conclusion: In attempts where tools and devices are used extensively, there are undesirable events and complications due to errors. We believe that analyzing error reports to reduce them is preventative

Інформативність загальноприйнятих запальних маркерів крові у верифікації гострих інфекційно-запальних процесів нижніх дихальних шляхів у дітей

Verification of acute infectious inflammatory processes of the lower respiratory tract and indication for antibiotic therapy are often based on the evaluation of the activity of inflammatory blood markers, but the data on their informative value in the diagnosis of acute pneumonia and bronchitis in children are controversial and conflicting. Purpose - to study the diagnostic value of some inflammatory blood markers in the verification of uncomplicated community-acquired pneumonia and acute obstructive bronchitis with the purpose of management’s optimization of infectious inflammatory diseases of the lower respiratory tract in children. Materials and methods. At the pulmonological department of the Regional children’s clinical hospital in Chernivtsi city 75 children have been examined. In the I clinical group 51 patients with diagnosis of «community-acquired pneumonia» were enrolled, and the second (II) group consisted of 24 children with acute obstructive bronchitis. According to the main clinical characteristics, the comparison groups have been comparable. The results of the study have been analyzed by parametric («P», Student’s criterion) and non-parametric («Рφ», Fisher’s angular transform method) calculation methods, and methods of clinical epidemiology with an evaluation of the diagnostic value of the tests has been performed taking into account their sensitivity (Se) and specificity (Sp), as well as the odd ratio (OR) of the event, taking into account their 95% confidence intervals (95% CI). Results. The analysis of the obtained dada has showed that in the patients with community-acquired pneumonia such common inflammatory blood markers (leukocytosis, relative neutrophilosis, shift of leukocyte formula to the left, elevation of erythrocyte sedimentation rate (ESR) or high level of С-reactive protein - CRP) are characterized by low sensitivity (Se in range between 11% and 63%) indicating that they are inadvisable for use as the screening tests for the verification of pneumonia. At the same time, it has been shown that these inflammatory blood markers are characterized by sufficient specificity (in the range from 75% to 93%) in the verification of pneumonia only under their significant increase (total leukocyte count &gt;15.0x10⁹, ESR &gt;10 mm/h and СRP level in blood &gt;6 mg/ml), indicating that they are relevant enough, but only for confirming inflammation of the lung parenchyma. It has been found that the normal level of leukocytes (&lt;10.0x109) in the hemogram did not have sufficient diagnostic (the number of false-negative and false-positive results was 46% and 45%, respectively) or probable predictor role (OR=1.44; 95%CI: 0.54-3.81) in the diagnosis of acute obstructive bronchitis, and therefore could not influence the composition of etiotropic treatment, namely to cancellation of antibiotic therapy. However, the number of rod neutrophils ≤5% in the common blood count has been characterized by a small number (16%) of false-positive results, which allows the use of this marker as confirming the diagnosis of acute obstructive bronchitis, and as well, as indication for antibiotic therapy discontinuation, but not as a predictor (OR=2.21; 95% CI: 0.69-7.06) or screening index (Se=29%). Conclusions. Analysis of the data has showed that in children with community-acquired pneumonia such common indicators of inflammatory response (leukocytosis, relative neutrophilia, shift of leukocyte formula to the left, acceleration of ESR or high CRP level in the blood) are characterized by a large proportion of false-negative results, and thus indicates the inexpediency of their use as screening methods to verify pneumonia. At the same time, it has been shown that these inflammatory blood markers are characterized by sufficient specificity in the verification of pneumonia under their significant increase (number of blood leukocytes &gt;15.0 x10⁹, ESR ≥10 mm/h and CRP level &gt;6mg/ml), which indicates the possibility of their use to confirm inflammation of the lung parenchyma. Herewith the number of rod neutrophils in the hemogram ≤5% is characterized by a high specificity (Sp=84%), which allows to use this marker in confirming the diagnosis of acute obstructive bronchitis and, as well as, an indication for antibiotic therapy cancellation. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: community-acquired pneumoniae; obstructive bronchitis; children; markers of a blood inflammatory response; diagnostical value.

CLINICAL AND EPIDEMIOLOGICAL FEATURES OF ENT PATHOLOGY IN CHILDREN

Relevance. The insufficiency of studies on the field study of the structure and level of ENT morbidity, which affects the quality and life expectancy of a person in all social and age-sex groups of the population, indicates the relevance of this work.&#x0D; Purpose of the study A retrospective analysis of the indicators of the appealability of pediatric patients with ENT pathology.&#x0D; Material and research methods. In accordance with the set goal and objectives, the study was conducted in the period 2015-2019. An assessment was made of the condition of the ENT organs in children.&#x0D; Results of researches. The obtained data of statistical analysis confirm the high incidence of patients with allergic and catarrhal rhinitis, chronic pharyngitis, sinusitis, inflammatory diseases of the tonsils and adenoid vegetations, etc. Along with the high prevalence of adenoid vegetations, an increase in chronic rhinosinusitis was also observed. On average for 5 years, such diseases of the paranasal sinuses as acute rhinosinusitis 20.7±1.40% and chronic rhinosinusitis 7.8±0.93% prevail. At the same time, the prevalence of injuries to the bones of the nose and nosebleeds decreased during the study period. The data obtained determine the need for timely detection of diseases of the upper respiratory tract in children at the early stages of their development and the organization of measures for systematic dispensary observation.&#x0D; Conclusions.&#x0D; &#x0D; The pathological incidence of ENT diseases in children, being high, nevertheless does not exceed the similar indicators recorded at the final stage of the research.&#x0D; In the structure of ENT pathology of preschool age, the leading place belongs to diseases of the ear.&#x0D; Considering that the lowest prevalence rates of ENT diseases fall on the last year of observation, further reorganization of ENT care for the children's population and periodic preventive medical examinations with the involvement of certain individuals in medical examinations are necessary.&#x0D;