Upper Respiratory Tract In Children Research Articles

Prevalence and clinical significance of common respiratory pathogens in the upper respiratory tract of children with community-acquired pneumonia in Zunyi, China.

To estimate the prevalence of common respiratory pathogens among children with community-acquired pneumonia (CAP) in Zunyi City, Guizhou, China, and to assess whether the presence of common respiratory pathogens in patients is associated with disease severity. This retrospective study assessed the prevalence of common respiratory viruses and bacteria in the upper respiratory tract of among infants and children aged 1 month to 5 years hospitalized with radiologically confirmed CAP between April 2017 and March 2018. Direct immunofluorescence assay and bacterial culture were used to identify viruses and bacteria in the upper airway specimens, respectively. The association between severe CAP and the presence of pathogens was determined using multivariate logistic regression models. Of the 685 patients enrolled, 583 cases had viral and/or bacterial pathogens detected, which included the presence of only viral pathogens, only bacterial pathogens, and mixed viral and bacterial pathogens in 34.3%, 29.7%, and 36.0% of cases, respectively. Respiratory syncytial virus (RSV) was the most common viral pathogen, with a prevalence rate of 39.9% (273/685). Haemophilus influenzae was the most commonly detected bacterial pathogen, with a prevalence rate of 15.3% (105/685). The presence of RSV (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.3-2.8) and Staphylococcus aureus (aOR, 13.7; 95% CI, 5.5-33.9) in children with CAP was associated with severe pneumonia. In a cohort of Zunyi infants and children hospitalized with CAP, RSV was the most common pathogen.

Clinical Outcomes of Montelukast Sodium in Childrenwith Adenoid Hypertrophy

Generally the blockage of upper respiratory tract in children is seen with the hypertrophy of adenoids and tonsils. Normally for patients with adenoid hypertrophy (AH), Adenoidectomy with or without Tonsillectomy is carried out, however it has its own genuine complications like haemorrhage and recurrence of adenoid tissue. Consequently, therapeutic treatment has increased extraordinary consideration rather than surgical procedure. The inflammatory process proposed for AH has prompted the utilization of anti-inflammatory drugs to treat this issue. The purpose of this study is to assess the impacts of Montelukast sodium in children with enlarged adenoids.

Imaging characteristics of the mandible and upper airway in children with Robin sequence and relationship to the treatment strategy

Some patients with Robin sequence (RS) may respond to conservative therapy, while others require surgery; however, there are currently no objective anatomical criteria to gauge surgical indication. The purpose of this study was to explore the imaging characteristics of the mandible and upper respiratory tract in children with RS and examine how individual morphometric parameters influence the treatment strategy. Cone beam computed tomography (CBCT) images were obtained from 57 children with RS. Twenty parameters were measured as potential surgical indicators. The children were divided into two groups according to surgical requirement: a non-surgical group (26 children) and a surgical group (31 children who underwent mandibular osteodistraction). Differences in the imaging parameters were compared between the groups. The mandibular ramus was shorter bilaterally (left, P = 0.047; right, P = 0.027) and the mandibular body was longer bilaterally (left, P = 0.030; right, P = 0.025) in the surgical group when compared to the non-surgical group. In addition, the mandibular angle bilaterally (left, P = 0.023; right, P = 0.003) and the cross-sectional area at the epiglottis tip (P = 0.010) were smaller in the surgical group. Compared to RS patients receiving conservative treatment, children requiring surgery have specific anatomical features of the mandible and upper airway that can be used as surgical indications.

Relationship Between Prevalence of Pneumococcal Serotypes and Their Neuraminidases in Carriers, Predictive Facts?

: Streptococcus pneumoniae is one of the leading causes of morbidity and mortality worldwide that mainly colonizes the upper respiratory tract in children and produces invasive infections such as meningitis, bacteremia, pneumonia, and otitis media. Pneumococcus species harbor a number of virulent genes that influence disease severity. Neuraminidase is a virulence factor that cleaves sialic acid. Pneumococcal nasopharyngeal carriage is common among healthy individuals and is considered an important transmission source. This topic, however, is less regarded in research from Iran. Therefore, the current study aimed at investigating the prevalence of pneumococcal nasopharyngeal carriage among Iranian children under six years of age. The study also aimed at determining the frequency of pneumococcal serotypes and the neuraminidase virulence genes (nanA, nanB, and nanC) among carriers. A total of 384 nasopharyngeal samples were collected from children under six years of age referred to healthcare centers of six provinces in Iran, including Tehran, Fars, Ardebil, Lorestan, Khorasan, and Sistan va Baluchistan from 2013 to 2016. Of these, 92 carriers were identified (24.0%; 95% confidence interval [CI]: 20.0, 28.5%). Identified pneumococcal serotypes included 6A/B (14.1%), 14, 3, and 19A (each 12.1%), 4, 19F, 23F (each 5.4%), 11 (4.3%), 18C, 22F, 9V, 19, 12, and 33F (each 2.1%), 5, 12F (each 1.1%) and non-typable (14.1%). Frequency of neuraminidase nanA, nanB, and nanC genes among 92 carriers was 100% (95% CI: 96.0, 100%), 85.9% (95% CI: 77.3, 91.6), and 62.0% (95% CI: 51.8, 71.2), respectively. The results showed that about 25% of children (n = 92) were pneumococcus carriers. A wide range of serotypes, some of which are known as virulent, were seen in the population. Prevalence of neuraminidase genes was also considerable.

New prospects for local etiotropic treatment of acute respiratory viral infections

According to WHO, the respiratory system diseases are currently inside the ten most common pathologies. The modern strategy for treating influenza and ARVI gives priority to the antiviral and immunostimulating agents, but the symptomatic drugs, which include preparations based on silver and its compounds, also play an important role. The large positive experience in using silver preparations supported by numerous clinical studies shows their high efficacy and satisfactory safety profile in the treatment of infectious and inflammatory diseases of the nose and upper respiratory tract in children and adults.

Prenatal diagnosis of lung malformations and upper respiratory tract in fetuses with trisomy 21

The features of the development of the respiratory system in children with Down syndrome and related with that diseases of lungs and upper respiratory tract in children in early childhood are presented. Two cases of prenatal diagnosis of cystic adenomatous malformation type Ш and laryngeal atresia in fetuses with trisomy 21 are described.

The detection of altered penicillin-binding protein 2b, autolysin, and pneumolysin genes in Streptococcus pneumoniae colonizing the upper respiratory tract of healthy schoolchildren in Puducherry

Background: Infections due to Streptococcus pneumoniae are responsible for morbidity and mortality in a large proportion of children in developing countries where childhood vaccination has not been widely implemented. S. pneumoniae colonizing the upper respiratory tract of children as a normal commensal is a potential pathogen when it crosses the mucosal barrier and enters the bloodstream. Aims and Objectives: The aim of the study was to analyze the carriage rate of pneumococci among healthy school children and in doing so to analyze the presence of penicillin-binding protein 2b (pbp2b) gene which is responsible for penicillin resistance using polymerase chain reaction. Methods: Nasopharyngeal swabs were collected from school children and processed according to standard microbiological procedures. The genes for penicillin resistance were detected using PCR. Results: The carriage rate was 32.2% and about 14 strains had the pbp2b gene. Conclusion: Pneumococcal carriage among children is important as they can cross the mucosal barrier and cause infection. Constant follow up of the carriage rate have to be performed to prevent further spread.

Antibacterial therapy of complications of acute respiratory viral infections in children

The incidence of acute respiratory infections (ARI) of the upper respiratory tract in children of the first 3 years of life can reach 3796.29: 1,000. Pre-school children from organized groups register up to 6–10 episodes of ARI annually, and 7–12 in primary school children. The frequency of bacterial complications (otitis, sinusitis, tracheobronchitis, pneumonia) in different age groups and socioeconomic conditions is 10–60%, which requires the appointment of antibiotics. In the case of a severe course of complications, with previously prescribed drugs of the 1st line, an unfavorable premorbid background the treatment with cefixime is preferable.

The Impact of Enzyme-Replacement Therapy on Upper Airway Obstruction in Children with Mucopolysaccharidoses: Retrospective Cohort Study

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Innate immunity gene expression by epithelial cells of upper respiratory tract in children with adenoid hypertrophy

BackgroundA major role of the innate immunity in the defence of mucosal tissue is well established. However, a balance between the main components of the immunity such as toll-like receptors (TLRs) and defensins in the pathology of upper respiratory tract in children has not been addressed yet. Our aim was to investigate the gene expression of some TLRs as well as alpha and beta-defensins in children suffered from adenoid hyperthrophy in comparison with healthy children. MethodsSamples (nasal epithelium and adenoids) from patients with hypertrophic adenoids (n = 77) and control group (n = 33) were investigated. Quantification of HBD-1 and 2 mRNA, alpha-defensin-HNP1 and toll-like receptors (TLR) 2, 4 and 9 mRNA expression was performed by real-time polymerase chain reaction (PCR). The detection of TLR4 and TLR9 was performed by immunohistochemistry. ResultsThe main finding of the study is a dramatic up-regulation of TLR2 and TLR4 expression (but down-regulation of TLR9) along with a significant reduction in the expression of the defensins in children with adenoid hyperthrophy. ConclusionThe data suggest that one of the mechanisms of mucosal involvement in the pathogenesis of upper respiratory tract infection might by a disbalance between TLRs and defensins revealed in our study.

Bovine milk oligosaccharides as anti-adhesives against the respiratory tract pathogen Streptococcus pneumoniae

Streptococcus pneumoniae is a Gram-positive pathogen, which is regularly found in the upper respiratory tract of healthy individuals. Increased numbers of S. pneumoniae have been observed colonising the upper respiratory tract of children affected by respiratory tract infections. Galβ1-4GlcNAcβ1-3Gal has been previously identified as one of the receptors involved in the adherence and translocation of S. pneumoniae. As this structure is similar to the milk oligosaccharide lacto-N-neoTetraose, many studies have investigated if free milk oligosaccharides can inhibit the adhesion of S. pneumoniae to epithelial cells of the respiratory tract. Here, we demonstrate that bovine oligosaccharides, which were extracted from demineralised whey, using a combination of membrane filtration and chromatography, were capable of reducing S. pneumoniae adhesion to pharynx and lung cells in vitro when tested at physiological concentrations. This study strengthens the potential use of bovine derived milk oligosaccharides as functional ingredients to reduce the incidence of infectious diseases.

FEATURES OF THE MICROBIOME OF THE UPPER RESPIRATORY TRACT IN CHILDREN WITH RECURRENT RESPIRATORY DISEASES

Studies of the metagenome of the upper respiratory tract in children showed the presence of five major bacterial phyla: Proteobacteria, Firmicutes, Bacteroidetes, Actinobacteria and Fusobacteria. Were revealed population differences in the distribution of weights of the above listed phyla, but subject to the dominance of the Firmicutes. Proved the role of environmental factors and time of year for representation in these biotopes of the phyla: Firmicutes, Proteobacteria, Bacteroidetes. Recurrent respiratory infections, hypertrophy of the tonsils of the lymphoid pharyngeal ring, secretory middle ear infections in children is associated with carriage of Haemophilus (H.) parainfluenzae, H. paraphrohaemolyticus, Gemella (G.) haemolysans, G. morbillorum, G. sanguinis, Streptococcus (S.) pneumoniae, S. pseudopneumoniae, S. intermedius, S. agalactiae.

Age-specific vascular organization of pharyngeal tonsil

Adenoid vegetations belong to the most common pathology of the upper respiratory tract in children. According to some authors, adenoids may also occur in adult population, producing a number of clinically significant symptoms. It is known that intraoperative bleeding in adenotomy in adult patients is more intense than in children. Therefore, to know the age-specific features of the vascular organization of adenoid tissue is necessary for development and improvement of sparing methods of surgical treatment of pharyngeal tonsil hypertrophy. The authors examined 96 patients (n = 96), divided into 4 groups: Group 1 included the patients aged 7 to 12 years (n = 25); Group 2 – the patients aged 12 to 15 years (n = 25); Group 3 – the patients aged 15 to 18 years (n = 25); Group 4 – the patients aged 18 to 42 years (n = 21). There were 58 (60%) male and 38 (40%) female patients. As a result of histological examination of adenoid tissue, the authors revealed characteristic changes in adenoid tissue vessels in each age group, especially pronounced between 15 and 18 years of age. Besides, the authors observed the development of sclerosis and hyalinosis of vascular walls with the formation of cavernously enlarged full-blooded veins with thickened rigid walls. The patients over 18 years of age have morphological reorganization of the connective tissue (basal) layer manifested by immersion of lymphoid tissue with a developed microcirculatory bloodstream, which accounts for the significant intraoperative bleeding in adenotomy. Therefore, the results of the histological examination can serve as one of the indications for application of electrophysical adenotomy methods in patients over 15 years of age.

Pan-serotype Reduction in Progression of Streptococcus pneumoniae to Otitis Media After Rollout of Pneumococcal Conjugate Vaccines.

Reductions in otitis media (OM) burden following rollout of pneumococcal conjugate vaccines (PCVs) have exceeded predictions of vaccine impact. In settings with active surveillance, reductions in OM caused by vaccine-targeted pneumococcal serotypes have co-occurred with reductions in OM caused by other pathogens carried in the upper-respiratory tract of children. To understand these changes, we investigated the progression of vaccine-targeted and non-vaccine pneumococcal serotypes from carriage to OM before and after vaccine rollout. Nasopharyngeal carriage prevalence of pneumococcus was monitored in prospective studies of Bedouin and Jewish children <3 years old in southern Israel between 2004 and 2016. Incidence of OM necessitating middle-ear fluid culture (predominantly complex OM including recurrent, spontaneously-draining, non-responsive, and chronic cases) was monitored via prospective, population-based active surveillance. We estimated rates of pneumococcal serotype-specific progression from carriage to disease before and after rollout of PCV7/13, measured as OM incidence per carrier. We pooled serotype-specific estimates using Bayesian random-effects models. On average, rates of progression declined 92% (95% credible interval: 79-97%) and 80% (46-93%) for PCV7/13 serotypes among Bedouin and Jewish children <12 months old, respectively, and 32% (-58-71%) and 61% (-5-86%) among children aged 12-35m. For non-vaccine serotypes, rates of progression among Bedouin and Jewish children aged <12m declined 74% (55-85%) and 43% (4-68%), respectively. Vaccine-targeted and non-vaccine pneumococcal serotypes showed lower rates of progression to complex OM after rollout of PCV7/13. Early-life OM episodes historically associated with vaccine-serotype pneumococci may impact the susceptibility of children to OM progression.

Is Higher Viral Load in the Upper Respiratory Tract Associated With Severe Pneumonia? Findings From the PERCH Study.

Background.The etiologic inference of identifying a pathogen in the upper respiratory tract (URT) of children with pneumonia is unclear. To determine if viral load could provide evidence of causality of pneumonia, we compared viral load in the URT of children with World Health Organization–defined severe and very severe pneumonia and age-matched community controls.Methods.In the 9 developing country sites, nasopharyngeal/oropharyngeal swabs from children with and without pneumonia were tested using quantitative real-time polymerase chain reaction for 17 viruses. The association of viral load with case status was evaluated using logistic regression. Receiver operating characteristic (ROC) curves were constructed to determine optimal discriminatory viral load cutoffs. Viral load density distributions were plotted.Results.The mean viral load was higher in cases than controls for 7 viruses. However, there was substantial overlap in viral load distribution of cases and controls for all viruses. ROC curves to determine the optimal viral load cutoff produced an area under the curve of <0.80 for all viruses, suggesting poor to fair discrimination between cases and controls. Fatal and very severe pneumonia cases did not have higher viral load than less severe cases for most viruses.Conclusions.Although we found higher viral loads among pneumonia cases than controls for some viruses, the utility in using viral load of URT specimens to define viral pneumonia was equivocal. Our analysis was limited by lack of a gold standard for viral pneumonia.

Rapid strip tests as a decision-making tool about antibiotic treatment in children – A prospective study

BackgroundAlthough three quarters of seasonal infections of the upper respiratory tract in children are of viral etiology, majority of the patients are unnecessarily prescribed antibiotics despite the availability of rapid diagnostic tests differentiating between infections. This study aimed to assess the relation between the use of rapid strip tests which detect the antigens of group A beta-hemolytic streptococcus (Streptococcus pyogenes) in pharyngitis and/or tonsillitis and the frequency of antibiotic use in children and adolescents aged 2–15 years. MethodsThe data were collected from 1307 children from the region of southeast Poland who then were divided into a sample group (n=581) in which patients received a rapid strip test before treatment plan was established by the physician, and into a control group (n=726) in which the decision whether to administer an antibiotic was made without the use of the rapid test. Based on statistical decision-making method, a pharmacoeconomic analysis of costs and effectiveness of strip tests was performed. ResultsThe use of the rapid strip test resulted in identifying the streptococcal infection in 31.7% of children and allowed to lessen the antibiotic use by 5.1%. The number of follow-up visits decreased (86.4% vs. 96.0%) and the anticipated cost of treatment decreased by 17%. ConclusionsRapid diagnostic tests used by the family physicians in initial diagnostics of seasonal upper respiratory tract infections in children allowed to differentiate between the type of infection as well as reduce the number of follow-up visits. Also, the antibiotic spending reimbursed by the insurer decreased by 17%.

Markers of immune response expression of adenotonsillar complex and physical development condition in the case of inflammatory diseases of upper respiratory tracts of children having different age

Markers of immune response expression of adenotonsillar complex and physical development condition in the case of inflammatory diseases of upper respiratory tracts of children having different age

Algorithms for the selection of etiotropic therapy for bacterial infection of the upper respiratory tract in children

The article tells about the etiology of acute tonsillitis, pharyngitis, sinusitis and acute otitis media in children; there is data on the sensitivity of the bacterial pathogens of the infectious and inflammatory diseases of the respiratory tract to the most commonly prescribed antibiotics. The focus is on the global spread of antibiotic resistance of pathogens and questions of restraining its further acceleration. Approaches to the rational use of antibiotics for bacterial infections of the upper respiratory tract are discussed. Benefits of antibiotics in dispersible tablets are demonstrated. Algorithms for the primary selection of antibiotics for acute bacterial tonsillitis, pharyngitis, sinusitis and acute otitis media in children are suggested.

Association between polymorphic markers of gene IL-10 and chronic diseases of the upper respiratory tract in children living under technogenic pressure

The study involved 189 adolescents living in a city with high levels of air pollution and 182 from a city with a moderate level of contamination. Children with chronic upper airway pathology in remission were identified. Blood samples from all children were tested for allelic variants–1082G/A,–592S/A, and ?819S/T of gene IL-10. The associations between polymorphic variants and the presence of chronic respiratory diseases were analyzed. It was found that allele C of polymorphic locus–592C/A is a marker for resistance to chronic diseases of the upper respiratory tract in children living under conditions of moderate air pollution, while in conditions of high levels of pollution the contribution of genetic factors to this pathology is eliminated.

English

Colonization of the upper respiratory tract of children by beta-haemolytic streptococci (BHS) is imperative in spreading the infection in households and in community settings. The present study was designed to investigate the prevalence of throat carriage of diverse antigenic groups of BHS and the influence of age on carrier rates in healthy children in Calabar. Throat swabs of 450 children’s were taken randomly from some government and private elementary schools and were visually examined and collected for further investigations.. The swabs were cultured aerobically on goat blood agar. Antimicrobial sensitivity testing was carried out on all BHS isolates on Muller Hinton blood agar by using the Kirby-Bauer disc diffusion method after standardizing the inoculums with a 0.5 McFarland. A total of 18(4%) BHS pharyngeal carriers were detected. BHS belonging to four streptococcal groups were isolated, groups C, F and G. The fourth group was not identified by the available grouping kit (UIDS). Group C streptococci (GCS) had the highest percentage carriage of 5/18(27.8%). Other groups were F 3/18(16.7%), G 2/18(11.2%) and the UIDS 8/18(44.4%). Carrier rate increased as age group increased and peaked at age group 10-12 years 7(36.8%). The percentage of BHS pharyngeal carriage was higher in Government aided schools (6.7%) than in private schools (1.7%). The BHS were highly resistant to Penicillin and Ceftazidime with a resistivity rate of 94.7% while Augmentine showed the lowest resistivity rate of 15.8%. The study established a high carriage of diverse antigenic groups in the throat of children with age influencing the rate of carriage in this community. A throat carrier rate of 39% of GGS/GCS among 450 children from this population indicated the etiological importance of streptococcal pharyngitis in this population. Therefore, there is need for further studies to identify the specific serotype of the group C/G streptococci circulating in this community.