Signs Of Respiratory Distress Research Articles

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015–2016 influenza epidemics: An interventional study

AimTo evaluate the contribution of a multiplex PCR for respiratory viruses on antibiotic and antiviral prescription, ancillary test prescription, admission and length of stay of patients. MethodsTwo hundred ninety-one adult and pediatric patients visiting the emergency department during the 2015–2016 influenza epidemic were prospectively included and immediately tested 24/7 using the FilmArray Respiratory Panel. The results were communicated to the practitioner in charge as soon as they became available. Clinical and biological data were gathered and analyzed. FindingsResults from the FilmArray Respiratory Panel do not appear to impact admission or antibiotic prescription, with the exception of a lower admission rate for children who tested positive for influenza B. Parameters that account for the clinical decisions evaluated are CRP level, white blood cell count, suspected or proven bacterial infection and, for adult patients only, signs of respiratory distress. Length of stay is also not significantly different between patients with a positive and a negative result. A rapid influenza test result permits a more appropriate prescription of oseltamivir.

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

Background and Aim: Discordant results that demand clarification have been published on diagnostic lung ultrasound (LUS) signs of transient tachypnea of the neonate (TTN) in previous cross-sectional, single-center studies. This work was conducted to correlate clinical and imaging data in a longitudinal and multicenter fashion. Methods: Neonates with a gestational age of 34–40 weeks and presenting with TTN underwent a first LUS scan at 60–180 min of life. LUS scans were repeated every 6–12 h if signs of respiratory distress persisted. Images were qualitatively described and a LUS aeration score was calculated. Clinical data were collected during respiratory distress. Results: We enrolled 65 TTN patients. Thirty-one (47.6%) had a sharp echogenicity increase in the lower lung fields (the “double lung point” or DLP sign). On admission, there was no significant difference between patients with and without DLP in Silverman scores (4 ± 1.5 vs. 4 ± 2.1; p = 0.9) or LUS scores (7.6 ± 2.6 vs. 5.6 ± 3.8; p = 0.12); PaO₂/FiO₂ (249 ± 93 vs. 252 ± 125; p = 0.91). All initial LUS scans (performed at the onset of distress) and 99.5% of all scans showed a regular pleural line with no consolidation, with only 1 neonate showing consolidation in the follow-up scans. The Silverman and LUS scores were significantly correlated (rho = 0.27; p = 0.02). Conclusion: A regular pleural line with no consolidation is a consistent finding in TTN. The presence of a DLP is not essential for the LUS diagnosis of TTN. A semi-quantitative LUS score correlates well with the clinical course and could be useful in monitoring changes in lung aeration during TTN.

AB182. 141. Congenital lobar emphysema: an important diagnosis in the infant with respiratory distress

: Congenital lobar emphysema (CLE) is a rare congenital malformation of the lung characterised by hyperinflation of one or more lobes which usually presents in the neonatal period or in early infancy. Males are three times more likely to be affected than females and the left upper lobe is the area most commonly involved. The diagnosis and management are often difficult and if not detected may be mismanaged leading to significant respiratory distress and haemodynamic instability. We present the case of a six-week old male who presented to the emergency department with respiratory distress and was admitted with a diagnosis of respiratory syncytial virus positive bronchopneumonia. However after an acute deterioration on the ward he required admission to the intensive care unit where he was ventilated for management of type two respiratory failure. Further deterioration while on convential ventilation lead to commencement of high frequency oscillatory ventilation and inotropic support for persistent respiratory acidosis and hemodynamic instability. A CT Thorax was later preformed showing mediastinal shift with hyperinflation of the right middle lobe confirming the diagnosis an underlying diagnosis of congenital lobar emphysema which was likely exacerbated by ventilation. An emergency thoracotomy and right middle lobectomy was preformed with extracorporeal life support on standby. The surgery was successful and the patient had an uneventful post operative recovery. Here we emphasise the importance of early consideration of underlying congenital lung disease in cases where the clinical picture does not correlate with the working diagnosis especially in the infant population. We also look at anaesthetic challenges associated with congenital lobar emphysema and how best they can be managed.

ANTE MORTEM DIAGNOSIS OF АЕLUROSTRONGYLUS ABSTRUSUS (RAILLIET, 1898) IN DOMESTIC CAT IN REPUBLIC OF SRPSKA (BIH)

This paper describes the occurrence of verminous bronchopneumoniain a domestic cat caused by the lung nematode Aelurostrongylus abstrusus (Railliet,1898).The male cat showed some of the signs of respiratory distress in earlier clinicalexaminations, but the definitive diagnosis was not made. Since the cat has been inpoor condition, a coprological examination was recommended. After coprologicaldiagnostics and findings of larval stage of parasite A. abstrusus, clinical examinationand radiology of thorax was repeated, and therapy were applied. Based on additionalanalysis, a chronic aelurostrongylosis was recorded. This is the first description ofaelurostrongylosis in cats in Republika Srpska and Bosnia and Herzegovina, whichpoints to the need that routine coprological examinations must be carried out indaily veterinary practice.

Generalized Arterial Calcification of Infancy

A 33 weeks’ gestation female infant was in significant respiratory distress upon delivery and developed severe hypertension. An echocardiogram revealed biventricular hypertrophy and thickening of the aorta and pulmonary artery. Further imaging demonstrated calcifications in the vessels of the neck, abdomen and extremities and a diagnosis of generalized arterial calcification of infancy was made. She was treated with intravenous pamidronate but continued to deteriorate and died on day-5 of life. The autopsy confirmed heart failure and myocardial infarction as the cause of death. Molecular analysis of the ecto-nucleotide pyrophosphatase/phosphodiesterase 1 gene revealed compound heterozygous mutations, confirming the diagnosis of generalized arterial calcification of infancy.

Post-mortem Diagnosis of Heme Oxygenase-1 Deficiency by Whole Exome Sequencing in an Iranian Child.

Heme oxygenase-1 (HO-1) is an inducible enzyme involved in the catalysis of heme conversion into biliverdin. We describe a patient with a novel stop-gain mutation in the HMOX1 coding sequence resulting in HO-1 deficiency. A 17-month-old female with fever, tachypnea, and signs of respiratory distress was referred to our center. Four admissions ensued during the eight months follow up. At the first admission, she had massive pericardial effusion without any laboratory findings for tuberculosis, viral infectionsor malignancies.An abdominal ultrasound examination confirmed hepatomegaly.Laboratory findings showed leukocytosis, thrombocytosis, hemolytic anemia, elevated inflammatory markers, increased levels of the hepatic transferase, triglycerides and ferritin as well as decreased level of fibrinogen. Other laboratory investigations were negative blood cultures, normal bone marrow aspiration, and normal serology viral infections. Immunodeficiency and auto-inflammatory syndromes were ruled out. Hepatic biopsy showed iron deposits. The patient was initiated on corticosteroids; however, her clinical condition was progressively deteriorated, and she died of recurrent fever, bleeding, heart failure, and ascites. Post-mortem whole exome sequencing revealed a homozygous mutation (exon3: c.A610T, p.K204X) on the HMOX1 gene. The parents were found to be heterozygous for that mutation. The laboratory findings and clinical features of our patient were somehow similar to that of HO-1 deficient cases reported previously, as well as Hmox1 knocked out mice. We speculate that the clinical manifestations of HO-1 deficient patients can be partially dependent on the type of mutation they inherit.

Study of lung ultrasonography as a diagnostic tool in childhood pneumonia

Objective The aim of this study was to compare chest ultrasonography with chest radiography (CXR) in the diagnosis of children with pneumonia. Background In Egypt, pneumonia and other acute respiratory infections were the causes of death in ∼19% of children younger than 5 years. According to current guidelines, pneumonia is diagnosed by clinical history, respiratory rate, fever, respiratory signs, and symptoms. Patients and methods A cross-sectional study was conducted on 60 patients with fever and signs of respiratory distress, and they were divided in two groups: group I with pneumonia, which included 45 patients who were finally diagnosed as having clinically evident pneumonia, and group II without pneumonia, which included 15 patients who did not have pneumonia. Full history taken, clinical examination, laboratory investigations, CXR, and chest ultrasonography were done. Results There was no statistically significant difference between the two groups regarding age, birth order, weight, residence, parent's education, and employment. C-reactive protein level was higher in pneumonia group than nonpneumonia group (P < 0.001). Lung ultrasonography could detect consolidation in more than one lobe than CXR, which was statistically significant (P = 0.048). Conclusion Chest ultrasonography offers an important contribution to the diagnostic procedures of pleuropulmonary disorders in children, such as pneumonia and pleural effusion, with higher sensitivity, specificity, and positive predictive index compared with CXR.

Assessment of Sleep Pattern in Egyptian Elderly with Vascular Dementia

Study Objectives: Growing evidence suggests that sleep disturbances is common in vascular dementia (VaD). The goal of the current study is to assess the disturbance in sleep pattern in patients with VaD, and compare it to healthy normally cognitive elderly individuals. We next studied whether there are meaningful differences in the Subjective sleep assessment: Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and sleep measurements by polysomnography (PSG) in VaD patients. Study design: Case control study. Subject and methods: Overnight PSG recordings and self-reported sleep measures were obtained from 20 healthy elderly subjects and 20 VaD patients at the sleep laboratory. Results: This study showed abnormal subjective sleep quality in all patients and revealed that the most common sleep complaints among VaD patients were: excessive daytime sleepiness (EDS), sleep disordered breathing (SDB), insomnia, restless leg syndrome (RLS), periodic limb movements (PLMS) and REM behavioral disordered (RBD) respectively. Moreover, patients spent more time in stage I sleep, but less time in slow wave sleep (SWS) and REM sleep compared to control populations, with delayed REML and less 1st REML. Also, increased sleep fragmentation; wakefulness after sleep onset (WASO) & sleep fragmentation index (SFI), increased arousal index (AI) & PLMS index were detected in VaD patients. Finally, VaD patients had significant high Apnea, Hypopnea and Respiratory Distress Index (RDI) score with high average SpO2 Desaturation. Conclusions: Sleep is significantly impaired in patients with VaD at both the objective and subjective level, which may be used as a diagnostic marker of VaD. SDB is a common feature of VaD and leads to fragmented sleep, increased nocturnal confusion, and excessive daytime sleepiness. Subjective sleep assessment questionnaire (ESS and PSQI) can be used in VaD patients when objective sleep assessment by PSG recordings is difficult to be done. The PSG study of sleep continuity, sleep architecture, and REM sleep may help in the prevention of progression of VaD.

Occurrence of infectious bronchitis in layer birds in Plateau state, north central Nigeria.

A flock of 54 wk-old layer birds exhibiting signs of respiratory distress, greenish diarrhea, and drop in egg production was investigated. A marked drop in egg production (55%) was recorded with eggs appearing white and soft-shelled. Mortality was in the range of 1%–2% with post-mortem lesions revealing cloudy air sacs, frothy, and congested lungs. Viral RNA was extracted from pooled tissue samples (trachea, lungs, spleen, and liver) and tested for Avian influenza virus (AIV), Newcastle disease virus (NDV), and infectious bronchitis virus (IBV) by reverse transcriptase-polymerase chain reaction (RT-PCR). In addition, virus isolation was attempted in 9–11 day-old embryonating chicken eggs (ECE). In order to determine the prevalence of IBV serotype(s) in the flock, serum samples were screened by hemagglutination-inhibition (HI) test using IBV antigens and antisera (Arkansas, Connecticut, and Massachusetts). Neither AIV nor NDV but IBV was detected in the tissue samples by RT-PCR. In addition, virus isolate obtained after four serial passages in ECE produced dwarfed, stunted, and hemorrhagic embryos, and the isolate was confirmed by RT-PCR to be IBV. The serum samples were 100% seropositive for three serotypes with HI titres ranging from 5 to 12 Log2. In this study, IBV was confirmed as the causative agent of the observed respiratory distress and drop in egg production. Also, the evidence of co-circulation of multiple IBV serotypes was established, this to the best of our knowledge is the first of such report in Nigeria. We recommend extensive molecular and sero-epidemiology of circulating IBV genotypes and serotypes in Nigeria with the aim of developing better control strategies, including vaccination.

Confirmation of contagious caprine pleuropneumonia outbreak in Gaddi goats of Himachal Pradesh, India

Contagious caprine pleuropneumoniais a fatal disease of small ruminants particularly goats listed by World Organization for Animal Health. It is caused by Mycoplasma capricolum subsp. capripneumoniae, which belongs to Mycoplasma mycoides cluster, a group of closely related Mycoplasmas. The clinical lesions are mainly restricted to alveolar tissues of infected goats. The outbreak of CCPP was reported in two flocks comprising a total 1365 goats in the Kinnaur district of Himachal Pradesh. In this study, a total of 8 samples (four nasal swabs, two tracheal swabs and two thoracic fluid) were collected either from morbid goats showing respiratory symptoms or at post-mortem. None of the sheep showed any signs of respiratory distress and were not investigated. Samples were processed for MCCP isolation and identification. All samples were found positive for CCPP by PCR. These findings revealed that goats are highly vulnerable to CCPP as indicated by high rate of case fatality of 45.07%. Overall morbidity and mortality due to CCPP in goats was 19.34% and 8.71%, respectively. These findings warrants for better diagnostic and management practices to curtail economic losses.

Vitamin D supplementation for acute bronchiolitis: a double-blind randomized controlled trial

Background Vitamin D deficiency has been declared as a risk factor for acute bronchiolitis. Objective The aim was to delineate the therapeutic effect of vitamin D supplementation on the clinical course of acute bronchiolitis and to investigate the relationship between vitamin D status and the severity of acute bronchiolitis. Materials and methods A randomized double-blind controlled trial was conducted including 60 infants who required hospital-based care for acute bronchiolitis. The included infants were randomly assigned to either vitamin D3 treatment (100 IU/kg/day) (vitamin D group) or placebo (placebo group) all through the period of admission. The primary outcome was the length of hospital stay in days, and the secondary outcome measures were as follows: time to resolution of tachypnea, chest retractions, hypoxia, inability to feed/lethargy, and any adverse events. Modified Tal score was used for severity assessment. Basal serum vitamin D level was evaluated in all patients before enrollment in the randomized trial. Results The vitamin D group had significantly shorter length of hospital stay, rapid resolution of signs of respiratory distress, and shorter need for oxygen therapy. Further, patients with severe disease showed significant low basal serum vitamin D level compared with milder cases. Moreover, patients with exclusive breastfeeding and those with daily outdoor exposure for less than 1 h were found to have significantly lower serum vitamin D. Conclusion Vitamin D supplementation at a dose of 100 IU/kg/day could have a significant beneficial effect in infants with acute bronchiolitis.

Efficacy of Prednisolone in bronchiolitis with and without family history of atopy.

To determine decrease in respiratory distress and hospital stay in bronchiolitis patients with and without family history of atopy when treated with prednisolone. The multi-centre quasi-experimental study was conducted in three hospitals of Sialkot, Pakistan, from October 2017 to March 2018, and comprised patients of bronchiolitis who were divided into 2 groups on the basis of presence or absence of family history of atopy. Half of the patients in each group received oral prednisolone 2mg/kg/day for three consecutive days along with supportive care, and the remaining half received only supportive care. Patients were monitored at 12 and 24 hours for clinical response using Modified Respiratory distress Assessment Instrument score. Length of hospital stay was monitored upto 72 hours. SPSS 20 was used for data analysis. Of the 212 patients, 72(34%) were in the atopic group and 140(66%) in the non-atopic group. In atopic group, there was a significant respiratory distress difference observed between steroid and non-steroid subgroups at 24 hours (p=0.001) and all (100%) patients in the steroid subgroup got discharged at 24 hours, while only 8(22%) were discharged in the non-steroid subgroup. In non-atopic group, no significant improvement in corresponding terms was observed (p>0.05). Oral prednisolone in bronchiolitis was found to be only effective in patients with family history of atopy.

Beware of thermal epiglottis! A case report describing \u2018teapot syndrome\u2019

BackgroundThe type of scalding injury known as ‘teapot syndrome’, where hot liquid is grabbed by the child with the aim of ingestion and falls over a child causing burns on the face, upper thorax and arms, is known to cause peri-oral and facial oedema. Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion of a damaging agent or intraoral burns, Awareness of the possibility of thermal epiglottitis, also in scald burns, is imperative to ensure prompt airway protection.Case presentationWe report the case of a child with thermal epiglottitis after a scalding burn from boiling milk resulting in mixed deep burns of the face, neck and chest, but no history of ingestion. Upon presentation there was a progressive stridor and signs of respiratory distress requiring intubation. Laryngoscopy revealed epiglottis oedema, confirming the diagnosis of thermal epiglottitis. Final extubation took place 5 days after initial burn.ConclusionsThermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion and intra-oral damage. Burns to the peri-oral area should raise suspicion of additional damage to oral cavity and supraglottic structures, even in absence of intra-oral injury or initial respiratory distress. Awareness of the occurrence of thermal epiglottitis in absence of intra-oral injury is important to diagnose impending upper airway obstruction requiring intubation.

Clinical Audit on Management of Community-Acquired Pneumonia in Pediatric Intensive Care Unit

AbstractBackground: Paediatric respiratory disease is an important cause of morbidity in both the developing as well as the developed world. Community Acquired Pneumonia (CAP) means an infection of the lung caused by multiple microor-ganisms acquired outside the hospital setting, leading to inflammation of the lung tissue. It is typically associated with fever and respiratory symptoms such as cough and tachypnea, but symptoms may be non-specific in young children. Radio-graphic changes may be useful to confirm the diagnosis. It remains an important cause of death in children throughout the world, especially in developing countries.Aim of Study: To evaluate the following using the 2011 pediatric CAP guidelines in children admitted in the Pediatric Intensive Care Unit (PICU) in the period from 1st of January to 31st of December, 2016 as the reference standard where applicable and try to make Guidline for the management of Community-Acquired Pneumonia in infants and children older than 3 months of age at pediatric Intensive Care Unit (PICU), Assuit University Children Hospital.Patients and Methods: This study is a clinical audit on management of Community Acquired Pneumonia (CAP) among children admitted in the Pediatric Intensive Care Unit (PICU) in the period from 1st of January to 31st of December, 2016. Evaluation was done according to the guidelines of Community Acquired Pneumonia (CAP) in infants and children recommended by the Pediatric Infectious Disease Society and the Infectious Diseases Society of America, August, 2011.Results: Our study was done on children with Community Acquired Pneumonia admitted to the Pediatric Intensive Care Unit (PICU), Assuit University Children Hospital in in the period from 1st of January to 31st of December, 2016. Our study included sixty cases of them there were 36 males (60%) and 24 females (40%). Their ages ranged from 3 months up to 17 years. Fifty five out of sixty cases (91.7%) presented with history of fever while fourty five cases (75%) presented with history of cough. According to WHO guidelines for criteria of respiratory distress in children with pneumonia the most common sign of respiratory distress was pulse oximetry measurement <90% on room air as it was present in fifty two cases (86.7%), followed by tachypnea which was present in fourty four cases (73.3%), altered mental status in thirty five cases (58.3%), chest retraction in twenty five cases (41.7%), grunting was in twenty three cases (38.3%), dyspnea in eighteen cases (30%). Apnea was present in fifteen cases (25%) while there was no case who presented with nasal flaring.Conclusion: An accurate and rapid diagnosis of the path-ogen responsible for CAP provides for informed decision making, resulting in improved care with focused antimicrobial therapy, fewer unnecessary tests and procedures, and, for those who are hospitalized, potentially shorter inpatient stays. Unfortunately, in the diagnosis of CAP, particularly bacterial CAP, there are no single diagnostic tests that can be considered the reference standard.We decided in this clinical audit to evaluate how will the guidelines have been followed in the acute management of children with Community Acquired Pneumonia at Pediatric Intensive Care. After studying patients admitted at PICU for CAP we found that many points in the 2011 pediatric CAP guidelines was neglected and not followed the most common point was Tracheal Aspirates and it was done for only one case (1.7%) while many other points were followed strongly as Pulse Oximetry and Initial Chest Radiographs that were done for (100%) of cases.

Effects of Macrolide Treatment during the Hospitalization of Children with Childhood Wheezing Disease: A Systematic Review and Meta-Analysis.

Children are susceptible to a variety of respiratory infections. Wheezing is a common sign presented by children with respiratory infections. Asthma, bronchiolitis, and bronchitis are common causes of childhood wheezing disease (CWD) and are regarded as overlapping disease spectra. Macrolides are common antimicrobial agents with anti-inflammatory effects. We conducted a comprehensive literature search and a systematic review of studies that investigated the influences of macrolide treatment on CWD. The primary outcomes were the impact of macrolides on hospitalization courses of patients with CWD. Data pertaining to the study population, macrolide treatment, hospital courses, and recurrences were analyzed. Twenty-three studies with a combined study population of 2210 patients were included in the systematic review. Any kind of benefit from macrolide treatment was observed in approximately two-thirds of the studies (15/23). Eight studies were included in the meta-analysis to investigate the influence of macrolides on the length of stay (LOS), duration of oxygen demand (DOD), symptoms and signs of respiratory distress, and re-admission rates. Although the benefits of macrolide treatment were reported in several of the studies, no significant differences in LOS, DOD, symptoms and signs of respiratory distress, or re-admission rates were observed in patients undergoing macrolide treatment. In conclusion, any kind of benefit of macrolide treatment was observed in approximately two-thirds of the studies; however, no obvious benefits of macrolide treatment were observed in the hospitalization courses of children with CWD. The routine use of macrolides to improve the hospitalization course of children with CWD is not suggested.

Case 2: Coexisting Cystic Lesions of Lung in a Term Neonate: A Management Dilemma

A term, 38-week-gestation, small-for–gestational age female infant weighing 2,135 g is delivered vaginally by a primigravida woman with an antenatal history of deranged Doppler flows. Resuscitation is not required at birth because the infant has normal Apgar scores of 7 and 9 at 1 and 5 minutes, respectively. Prenatal ultrasonography reports the presence of congenital pulmonary airway malformation (CPAM) on the left side, which regressed after steroid treatment in the third trimester. Delivery room postnatal examination suggests that the heart sounds are prominent on the right side of the precordium with the infant maintaining target oxygen saturation on room air with no signs of respiratory distress. She is admitted to the NICU for observation and further evaluation of mediastinal shift. In the NICU, chest radiography reveals hyperinflated left lung with shifting of mediastinum to the right side (Fig 1). Computed tomographic (CT) imaging reveals left lower lobe CPAM with a posterior mediastinal cyst compressing the left main bronchus (Fig 2). Echocardiography and ultrasonography of the abdomen and cranium are performed to rule out other associated congenital anomalies, and are found to be normal. At 20 hours after delivery, she develops mild respiratory distress but does not require any respiratory support. Forty-eight hours after admission, the infant undergoes bronchoscopy to locate the site of airway obstruction, which reveals the presence of a bluish mass compressing the left main bronchus (Fig 3). This leads us to suspect a hemangioma or vascular malformation compressing the bronchus. However, CT pulmonary angiography rules out the presence of any such vascular malformation. The possibilities are thus narrowed down to …

Cocaine‐induced cardiomyopathy in a paediatric patient

SummaryA 23‐month‐old healthy female presented for irrigation of obstructed nasolacrimal ducts under general anaesthesia. Induction of anaesthesia was uneventful and a supraglottic airway device was inserted. During the surgical procedure, gauze pledgets soaked in a solution containing 4% cocaine and 1:1000 adrenaline were inserted into both nostrils. The nasolacrimal ducts were irrigated with the same solution. The procedure lasted approximately twenty minutes and the pledgets were removed at the end. No adverse intraoperative events were noted. In the recovery room, the patient became agitated and developed signs of respiratory distress. Bilateral infiltrates consistent with pulmonary oedema were evident on the chest radiograph and a bedside echocardiogram demonstrated significantly impaired left ventricular function. Lateral T‐wave inversion was seen on the electrocardiogram and cardiac troponin levels were elevated. Following the exclusion of other causes of myocardial dysfunction, ischaemic cardiomyopathy due to cocaine‐induced vasospasm was considered to be the most likely diagnosis. This case highlights the hazards associated with the systemic absorption of cocaine, particularly when used in combination with adrenaline. Safe dosing regimens were not adhered to in this case and the dose of cocaine in the irrigation solution was not calculated. We suggest that cocaine should only be used in clinical practice when no safer alternative is available.

Hyoid Hemangioma: A Rapidly Expanding Neck Mass Leading to Cardiopulmonary Arrest

Case Presentation A 14 year old male was transferred from an outside hospital with left upper neck pain and swelling one day prior to admission. The pain was described as sudden in onset, tender to touch and exacerbated by movement. Three years ago, the patient reported a similar episode, diagnosed as lymphadenitis and resolved following a course of antibiotics. He denied any other symptoms. Vital signs were stable on presentation with no signs of respiratory distress. The swelling in the left lateral neck region was described as soft, edematous, non-fluctuant and non-erythematous. All laboratory investigations were within normal limits. A neck CT revealed an expansile lesion of the left hyoid bone (1.3 …

Rare and unexpected complication after a malpositioned nasogastric tube in a neonate

A full-term newborn boy was admitted to the high dependency unit at the age of 4 hours with signs of respiratory distress, tachypnoea and recession with low oxygen saturation. There...

Plastic bronchitis associated with adenovirus infection

A previously healthy 3-year-old boy who presented with an 8-day history of persistent fever and cough was referred to our hospital. On physical examination the boy had signs of respiratory distress and a low-pitched breath sound on his left lung. He had no history of foreign-body aspiration. A chest radiograph done 2 days previously was normal. On the day of admission he had a CT scan of his chest, which revealed left lower lobe atelectasis (appendix). Results of direct immunofluorescence of nasopharyngeal swabs for the detection of respiratory syncytial virus, influenza A and B viruses, parainfluenza viruses, and adenovirus were negative. RT-PCR for Mycoplasma pneumoniae in nasopharyngeal swabs was also negative. Flexible bronchscopy and bronchoalveolar lavage showed the complete obstruction of the left lower bronchus by a whitish rubbery material. A bronchial tree-like cast was extracted via suctioning during flexible bronchoscopy (figure); it was composed of fibrinous material containing neutrophils and eosinophils on haematoxylin and eosin stain (appendix). Bronchoalveolar lavage fluid was analysed for the presence of virus by direct immunofluorescence assay and was positive for adenovirus. Next-generation sequencing for pathogens in the bronchoalveolar lavage fluid was also positive for adenovirus B1. 1 day after bronchoscopy, the boy's temperature was normal, and on the third day chest radiograph showed complete resolution (appendix).