Viral Pneumonia In Children Research Articles

Sonication-Assisted Self-Assembled Resveratrol Nanoparticles with Enhanced Antiviral and Anti-inflammatory Activity against Respiratory Syncytial Virus-Induced Pneumonia.

Respiratory syncytial virus (RSV)-induced viral pneumonia in children is common worldwide. Its high occurrence and lack of an effective vaccine make it a leading cause of death in children. Severe RSV infection can trigger uncontrolled inflammatory responses in patients, so the development of small molecule drugs with the dual function of "direct antivirus" and "inflammatory response regulation" is welcome. Resveratrol (Res) has been reported to have antiviral and anti-inflammatory pharmacological effects, but its application is limited because of its poor water solubility and oral bioavailability. Based on small-molecule nanotechnology, we developed a sonication-assisted self-assembly method for preparing insoluble Res into highly soluble resveratrol nanoparticles (Res NPs). The obtained Res NPs exhibited a higher water solubility and a faster dissolution rate, which was more conducive to the effectiveness of Res in addressing RSV-induced viral pneumonia. In vitro studies had shown that Res NPs played an antiviral role by inhibiting RSV replication and reducing the production of pro-inflammatory cytokines. Nebulized inhalation administration of Res NPs prolonged the drug's residence time in the lungs, which appears to increase the accumulation and effectiveness of Res NPs. Additionally, in vivo studies had demonstrated significant benefits of Res NPs in inhibiting RSV viral load and improving the pulmonary microenvironment in RSV-infected mice. Both antiviral and anti-inflammatory experiments had confirmed that the pharmacological activity of Res NPs is superior to that of Res. This suggested that nanosizing Res was an effective way to enhance the original pharmacological activity of Res and also offered a new formulation strategy for treating viral pneumonia.

Epidemiological characteristics and early predict model of children Mycoplasma Pneumoniae Pneumonia outbreaks after the COVID-19 in Shandong

Since October 2023, a significant outbreak of Mycoplasma Pneumoniae Pneumonia (MPP) has been observed in children in northern China. Chinese health authorities have attributed this epidemiological to immune debt resulting from the relaxation of coronavirus disease 2019 (COVID-19) control measures. This study described the epidemiological features of Mycoplasma pneumoniae (MP) prevalence in children and developed a straightforward prediction model to differentiate between MPP and viral pneumonia in children. The infection rate of MP in children notably increased from 8.12 in 2022 to 14.94% in 2023, peaking between October and November, especially among school-age children. Logistic regression screening identified four key indicators: Age, D-Dimer levels, erythrocyte sedimentation rate, and gender. The developed nomogram exhibited a receiver operator characteristic curve-area under the curve (ROC-AUC) of 0.858, with external validation confirming an ROC-AUC of 0.794. This study examined the epidemiological characteristics of MPP prevalence in children in Shandong Province during and after the COVID-19 pandemic. An early predict model was developed and validated to differentiate between Mycoplasma Pneumoniae and viral infections.

Distinguishing types and severity of pediatric pneumonia using modified lung ultrasound score.

This study aimed to investigate the diagnostic utility of the modified lung ultrasound score (MLUS) in distinguishing between Mycoplasma pneumonia and viral pneumonia in children and evaluate their severity. A prospective collection of 137 suspected cases of community-acquired pneumonia in children admitted to the Quanzhou Maternity and Children's Hospital in Quanzhou City, Fujian Province, from January 2023 to December 2023 constituted the study cohort. All patients underwent lung ultrasound examinations, and MLUS scores were assigned based on ultrasound findings, including pleural lines, A-lines, B-lines, and lung consolidations. Based on the pathogenic results, the patients were categorized into the Mycoplasma pneumonia (74 cases) and viral pneumonia (63 cases) groups. The severity was classified as mild (110 cases) or severe (27 cases). The diagnostic value of MLUS for Mycoplasma pneumonia and viral pneumonia in children was analyzed. (1) MLUS scores were significantly different between the Mycoplasma pneumonia (15, 10-21) and viral pneumonia (8, 5-16) groups (P = 0.002). ROC curve analysis indicated that using a cut-off value of 11, MLUS exhibited a sensitivity of 70.3%, specificity of 58.7%, and an area under curve (AUC) of 0.653 for diagnosing Mycoplasma pneumonia. Furthermore, large-area lung consolidation on ultrasound images demonstrated good diagnostic performance for predicting Mycoplasma pneumonia, with an AUC of 0.763, a sensitivity of 71.6%, and a specificity of 81.0%. (2) MLUS scores were significantly different between the mild pneumonia (10.5, 5-17) and severe pneumonia (21, 16-29) groups (P < 0.001). ROC curve analysis using a cut-off value of 16 showed a sensitivity of 77.8%, specificity of 73.6%, and AUC of 0.818 for diagnosing severe pneumonia. Multivariate regression analysis revealed that both MLUS and white blood cell count were independent factors influencing the severity. The constructed nomogram model demonstrated robust stability with a sensitivity of 85.2%, a specificity of 74.5%, and an AUC of 0.858 for predicting severe childhood pneumonia. MLUS, coupled with ultrasound signs of large-area lung consolidation, had reference significance for the differential diagnosis of Mycoplasma pneumonia and viral pneumonia in children and can be a preliminary assessment of the severity of viral pneumonia or mycoplasma pneumonia in children.

Efficacy of budesonide/formoterol inhalation powder in treating viral pneumonia in children.

Respiratory viruses are increasingly detected in children with community-acquired pneumonia. Further strategies to limit antibiotic use in children with viral pneumonia are warranted. To explore clinical efficacy of budesonide/formoterol inhalation powder for viral pneumonia in children and its impact on cellular immunity and inflammatory factor production. A total of 60 children with viral pneumonia were recruited: 30 receiving budesonide/formoterol inhalation powder and 30 conventional symptomatic treatment. Outcome measures included peripheral blood levels of inflammatory cytokines, CD4+, CD8+, Th1, Th2, Th17 and Treg, clinical efficacy, and incidence of adverse reactions. Compared with the control group, the observation group showed a significant reduction in interleukin-6 and high-sensitivity C-reactive protein levels after treatment. Compared with the control group, the observation group showed a significant increase in CD4+/CD8+ and Th1/Th2 levels, and a decrease in Th17/Treg levels after treatment. The total effective rates in the observation group and the control group were 93.75% and 85.00%, respectively, which was a significant difference (P = 0.003). Budesonide/formoterol inhalation powder significantly improved therapeutic efficacy for viral pneumonia in children. The mechanism of action may be related to downregulation of the inflammatory response and improved cellular immune function.

Urine metabolites and viral pneumonia among children: a case-control study in China.

Viral pneumonia in children is common and has grave consequences. The study aims to better understand the pathophysiological processes involved in the onset and progression of viral pneumonia and identify common effects or biomarkers across different viruses. This study collected urine samples from 96 patients with viral pneumonia including respiratory syncytial virus (RSV) (n=30), influenza virus (IV) (n=23), parainfluenza virus (PIV) (n=24), and adenovirus (ADV) (n=19), and 31 age- and sex-matched normal control (NC) subjects. The samples were analyzed using liquid chromatography coupled with mass spectrometry (LC-MS) to identify endogenous substances. The XCMS Online platform was utilized for data processing and analysis , including feature detection, retention time correction, alignment, annotation, and statistical analysis for difference between groups and biomarker identification. A total of 948 typical metabolites were identified using the XCMS Online platform with the Mummichog technique. After analyzing the data, 24 metabolites were selected as potential biomarkers for viral pneumonia, of which 16 were aspartate and asparagine metabolites, byproducts of alanine, leucine, and isoleucine degradation, and butanoate metabolites. This study specific metabolites and altered pathways in children with viral pneumonia and propose that these findings could contribute to the discovery of new treatments and the development of antiviral drugs.

Proteomic profiling of urinary small extracellular vesicles in children with pneumonia: a pilot study.

Small extracellular vesicles (sEV) play a crucial role in immune responses to viral infection. However, the composition of sEV derived from children with viral pneumonia remains ill defined. First, we performed mass spectrometry-based label-free proteomic analysis of urinary sEV in 7 children with viral pneumonia, 4 children with Mycoplasma pneumoniae pneumonia and 20 healthy children. Then a total of 33 proteins were selected to validate by multiple reaction monitoring analysis in an independent cohort of 20 healthy children and 29 children with pneumonia. In the discovery phase, a total of 1621 proteins were identified, while 260 proteins have differential expression in children with viral pneumonia compared to healthy children. Biological pathways primarily associated with neutrophil degranulation, carbohydrate metabolism and endocytosis were enriched in children with viral pneumonia. Finally, the abundance of eight proteins was verified to be significantly higher in children with viral pneumonia than in healthy children. This pilot study with proteomic profiles of urinary sEV provided insights to the host response to viral pathogen exposure and potential diagnostic biomarkers for children with viral pneumonia, and served as the basis for understanding the fundamental biology of infection. There were significant differences in the proteomic features of urinary sEV between children with viral pneumonia and those with Mycoplasma pneumoniae pneumonia. Many viral infection-related proteins were identified in urinary sEV and overrepresented in children with viral pneumonia, which facilitates our understanding of the fundamental biology of viral infection. A total of eight proteins (ANPEP, ASAH1, COL11A1, EHD4, HEXB, LGALS3BP, SERPINA1 and SERPING1) were verified as potential biomarkers for the diagnosis of viral pneumonia in children.

The Role of Computed Tomography in Diagnosing and Treating Community-Acquired Bacterial or Viral Pneumonia in Children

Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.

Prevalence of viral pathogens in a sample of hospitalized Egyptian children with acute lower respiratory tract infections: a two-year prospective study

BackgroundViral pneumonias are a major cause of childhood mortality. Proper management needs early and accurate diagnosis. This study objective is to investigate the viral etiologies of pneumonia in children.ResultsThis prospective study enrolled 158 and 101 patients in the first and second year, respectively, and their mean age was 4.72 ± 2.89. Nasopharyngeal swabs were collected and subjected to virus diagnosis by reverse transcription polymerase chain reaction (RT-PCR). Viral etiologies of pneumonia were evidenced in 59.5% of the samples in the first year, all of them were affirmative for influenza A, 2 samples were affirmative for Human coronavirus NL63, and one for Human coronavirus HKU1. In the second year, 87% of patients had a viral illness. The most prevalent agents are human metapneumovirus which was detected in 44 patients (43.6%) followed by human rhinovirus in 35 patients (34.7%) and then parainfluenza–3 viruses in 33 patients (32.7%), while 14 patients had a confirmed diagnosis for both Pan coronavirus and Flu-B virus.ConclusionsViral infection is prevalent in the childhood period; however, the real magnitude of viral pneumonia in children is underestimated. The reverse transcriptase polymerase chain reaction has to be a vital tool for epidemiological research and is able to clear the gaps in-between clinical pictures and final diagnoses.

Fewer non-COVID-19 respiratory tract infections and gastrointestinal infections during the COVID-19 pandemic.

For preventing the spread of the coronavirus disease 2019 (COVID‐19) pandemic, measures like wearing masks, social distancing, and hand hygiene played crucial roles. These measures may also have affected the expansion of other infectious diseases like respiratory tract infections (RTI) and gastro‐intestinal infections (GII). Therefore, we aimed to investigate non‐COVID‐19 related RTI and GII during the COVID‐19 pandemic. Patients with a diagnosis of an acute RTI (different locations) or acute GII documented anonymously in 994 general practitioner (GP) or 192 pediatrician practices in Germany were included. We compared the prevalence of acute RTI and GII between April 2019–March 2020 and April 2020–March 2021. In GP practices, 715,440 patients were diagnosed with RTI or GII in the nonpandemic period versus 468,753 in the pandemic period; the same trend was observed by pediatricians (275,033 vs. 165,127). By GPs, the strongest decrease was observed for the diagnosis of influenza (−71%, p < 0.001), followed by acute laryngitis (−64%, p < 0.001), acute lower respiratory infections (bronchitis) (−62%, p < 0.001), and intestinal infections (−40%, p < 0.001). In contrast, the relatively rare viral pneumonia strongly increased by 229% (p < 0.001). In pediatrician practices, there was a strong decrease in infection diagnoses, especially influenza (−90%, p < 0.001), pneumonia (−73%, p < 0.001 viral; −76%, p < 0.001 other pneumonias), and acute sinusitis (−66%, p < 0.001). No increase was observed for viral pneumonia in children. The considerable limitations concerning social life implemented during the COVID‐19 pandemic to combat the spread of SARS‐CoV‐2 also resulted in an inadvertent but welcome reduction in other non‐Covid‐19 respiratory tract and gastro‐intestinal infections.

Traditional Chinese medicine injection for the treatment of viral pneumonia in children: A protocol for systematic review and meta-analysis.

Background:In recent years, more and more reports are focused on the application of traditional Chinese medicine injection (TCMJ) for the treatment of viral pneumonia. There are about 200 million cases of viral pneumonia worldwide every year, half of which are children. At present, many kinds of TCMJ are created for the treatment of viral pneumonia in children, with good therapeutic effects. However, there are many kinds of TCMJ, and the treatment advantages are different, thus bringing difficulties to the selection of clinical drugs. In order to provide evidence-based evidence support for the clinical selection of TCMJ for the treatment of viral pneumonia in children, this study selected the commonly used TCMJ for clinical treatment of viral pneumonia for meta-analysis to evaluate its efficacy.Methods:The Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, Viper information databases, Cochran library Web of Science, PubMed, MEDLINE and EMBASE will be searched. The literature will be searched, with language restriction in English and Chinese. The related reference will be retrieved as well. Two reviewers will independently extract data and perform quality assessment of included studies. Review Manager 5.3 will be applied to conduct this meta-analysis.Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal once we finish this study.Conclusions:This study provides reliable evidence-based evidence for the efficacy of TCMJ in the treatment of viral pneumonia in children.Ethics and dissemination:We will not be allowed to publish private information from individuals. This kind of systematic review should not harm the rights of participants. No ethical approval was required. The results can be published in peer-reviewed journals or at relevant conferences.OSF Registration number:DOI 10.17605/OSF.IO/795MB.

Can lung ultrasound differentiate between bacterial and viral pneumonia in children?

This study evaluates whether LUS can differentiate between bacterial and viral pneumonia in children and thus affect their management. The prospective, cross-sectional, analytical study included 200 children under 12 years of age (excluding neonates) with clinical suspicion of pneumonia who had undergone a chest radiograph (CR). The CR and LUS findings were classified as bacterial or viral pneumonia. The final diagnosis was made on the basis of a combination of clinical profile, available routine laboratory investigations and CR diagnosis which was taken as the gold standard for the study and LUS was compared with the gold standard. LUS has a high sensitivity (91%; 95% CI [84-96]) and specificity (91.3%; 95% CI [84-96]) in diagnosing bacterial pneumonia with a high positive predictive value (91.9%; 95% CI [85-96]) and negative predictive value (90.3%; 95% CI [82-95]). For diagnosing viral pneumonia, the sensitivity of LUS was 78.4%; (95% CI [68-86]), specificity was high (90.4%; 95% CI [83-95]) and so was the positive predictive value (87.3%; 95% CI [78-94]) and negative predictive value (91.3%; 95% CI [84-96]). LUS has a high accuracy in differentiating between bacterial and viral pneumonia in children and can help in their management by avoiding an ill-advised use of antibiotic therapy.

Rapid Detection of Viral Pneumonia in Children with Primary Immunodeficiency

Background: In children with primary immunodeficiency (PID), the most common types of infection are respiratory tract infections, among which viral pneumonia representing the majority. Early diagnosis and treatment can prevent or diminish the respiratory complications. Multiplex polymerase chain reaction (Multiplex PCR) can permit amplification of a lot of viruses all together in a single reaction mixture. Objective: Determining different viruses causing pneumonia in children with PID by multiplex PCR. Methodology: A cross-sectional study included 33 nasopharyngeal swabs collected from children suffering from PID with clinical respiratory signs of pneumonia. For each collected sample, nucleic acid extraction and multiplex PCR were done using primers specific for influenza A, influenza B, adenovirus, respiratory syncytial virus (RSV), cytomegalovirus (CMV), parainfluenza virus 1 (PIV1), parainfluenza virus 2 (PIV2), parainfluenza virus 3 (PIV3) and human coronavirus (HCoV-NL63). Results: Viruses were detected in 11 nasopharyngeal samples (11/33, 33.33%). Viral pneumonia was mostly found in children with severe combined immune deficiency (5/11; 45.45%), followed by children with common variable immunodeficiency (3/11; 27.27%) and children with hyper Ig E syndrome, hyper Ig M syndrome and selective Ig A deficiency (1/11; 9.09%) for each. RSV and CMV were the most common detected viruses; each virus was detected in 3 cases. Influenza virus A was detected in 2 cases and adenovirus, PIV1 and PIV3 each was detected in one case. Influenza virus B, PIV2 and HCoV-NL63 were not detected in any sample. No viruses were detected in the nasopharyngeal swabs taken from children with chronic granulomatous disease. No mixed viral infection was detected in any sample. Conclusion: Severe viral pneumonia is frequent in the children with PID. Multiplex PCR has a major benefit, as it allows simultaneous amplification of several viruses in a single reaction mixture with cost-effective diagnosis.

Rapid Detection of Viral Pneumonia in Children with Primary Immunodeficiency

Background: In children with primary immunodeficiency (PID), the most common types of infection are respiratory tract infections, among which viral pneumonia representing the majority. Early diagnosis and treatment can prevent or diminish the respiratory complications. Multiplex polymerase chain reaction (Multiplex PCR) can permit amplification of a lot of viruses all together in a single reaction mixture. Objective: Determining different viruses causing pneumonia in children with PID by multiplex PCR. Methodology: A cross-sectional study included 33 nasopharyngeal swabs collected from children suffering from PID with clinical respiratory signs of pneumonia. For each collected sample, nucleic acid extraction and multiplex PCR were done using primers specific for influenza A, influenza B, adenovirus, respiratory syncytial virus (RSV), cytomegalovirus (CMV), parainfluenza virus 1 (PIV1), parainfluenza virus 2 (PIV2), parainfluenza virus 3 (PIV3) and human coronavirus (HCoV-NL63). Results: Viruses were detected in 11 nasopharyngeal samples (11/33, 33.33%). Viral pneumonia was mostly found in children with severe combined immune deficiency (5/11; 45.45%), followed by children with common variable immunodeficiency (3/11; 27.27%) and children with hyper Ig E syndrome, hyper Ig M syndrome and selective Ig A deficiency (1/11; 9.09%) for each. RSV and CMV were the most common detected viruses; each virus was detected in 3 cases. Influenza virus A was detected in 2 cases and adenovirus, PIV1 and PIV3 each was detected in one case. Influenza virus B, PIV2 and HCoV-NL63 were not detected in any sample. No viruses were detected in the nasopharyngeal swabs taken from children with chronic granulomatous disease. No mixed viral infection was detected in any sample. Conclusion: Severe viral pneumonia is frequent in the children with PID. Multiplex PCR has a major benefit, as it allows simultaneous amplification of several viruses in a single reaction mixture with cost-effective diagnosis.

Retrospective Analysis of 61 Cases of Children Died of Viral Pneumonia.

Objective To retrospectively analyze the forensic pathological postmortem examination and clinical data of children who died of viral pneumonia in identification of cause of death cases and to discuss the clinical characteristics and pathological features of viral pneumonia in children, in order to provide reference to pathological diagnosis of viral pneumonia in children caused by 2019 novel coronavirus （2019-nCoV） infection. Methods Postmortem examination data from 61 cases of children whose causes of death were identified as viral pneumonia in recent years were collected from the Center of Forensic Identification, Southern Medical University. The gender, age, clinical symptoms and pathological features were comparatively analyzed. Results Among the 61 cases of children who died of viral pneumonia, most were within 2 years old （83.61%）, and a large proportion died within 2 weeks after the onset of the disease （91.80%）. Gross changes in postmortem examination included respiratory mucosal hyperemia, pleural effusion, pulmonary swelling, variegated pulmonary pleura and serosa, as well as focal pulmonary hemorrhage and pulmonary edema. A large proportion of sick children had enlarged mesenteric lymph nodes （83.61%） and thymic dysplasia （21.31%）. Histopathological changes included edema of alveoli and interstitial substance, pneumorrhagia，shedding of alveolar epithelial cells, serous and （or） fibrous exudation in the alveoli, formation of viral inclusions, formation of transparent membranes, infiltration of inflammatory cells that mainly consisted of macrophages and lymphocytes in interstitial substance and alveoli. Viral infections often affected the heart and gastrointestinal tract. Conclusion The clinical symptoms of children with viral pneumonia are difficult to notice, and because the immune systems of children are not fully developed and they have poor immunity, they can easily become severely ill and even die. Analyzing the forensic autopsies and the histopathological characteristics could provide reference for pathological diagnosis of viral pneumonia.

Differential Evolution Analysis of Clinical Characteristics of Severe Viral Pneumonia in Children

Differential Evolution Analysis of Clinical Characteristics of Severe Viral Pneumonia in Children

2624. Viral Pneumonia in Children: Facing the Challenge Using the Host Response

BackgroundDiagnosing viral pneumonia in children is challenging. Chest radiographic imaging and clinical findings cannot reliably distinguish viral from bacterial pneumonia. Furthermore, pathogen-based diagnosis is limited by inaccessible site of infection and high asymptomatic detection rates. The objectives of this analysis were twofold: first, to establish pneumonia etiology by applying a rigorous expert panel process, and second, to evaluate whether a novel host-immune signature that integrates viral induced proteins TRAIL and IP-10 together with bacterial CRP, can accurately differentiate viral from bacterial pneumonia.MethodsThis analysis included 1025 febrile children enrolled in two multi-center clinical studies that evaluated the host-immune signature performance: ‘Curiosity’ study (Oved et al., PLoS One 2015) and ‘Pathfinder’ study (Srugo et al., Pediatrics 2017). Pneumonia etiology – viral or bacterial – was determined by a panel of 3 independent experts, after reviewing patients’ clinical, laboratory, microbiological, and radiological data. Only cases with majority panel assignment were included. The host-signature generated one of the three results: viral, equivocal or bacterial, based on predetermined cut-offs.ResultsA total of 709 children were eligible for analysis and had an expert panel etiology determination. Of them, 114 were diagnosed with pneumonia: 51 assigned viral and 63 assigned bacterial (Figure 1). The signature separated viral from bacterial pneumonia with a sensitivity of 94% (95% CI: 85%–99%) and specificity of 95% (85%–99%) with 14% equivocal test results. Out of the 51 children diagnosed with viral pneumonia by the expert panel, 40 (78%) were given antibiotics, and 43 (83%) underwent chest x-ray evaluation. The signature correctly classified 42 of these 51 viral children, indicating its potential to reduce antibiotic overuse rates by 4.4-fold (from 78% to 18%; P < 0.001) and chest x-ray examination by 4.8-fold (from 83% to 18%; P < 0.001).ConclusionThe TRAIL/IP-10/CRP signature exhibits high accuracy for diagnosing viral pneumonia in children. The signature’s potential to safely decrease unnecessary antibiotics and chest radiographic imaging should be examined in future utility studies. Disclosures All authors: No reported disclosures.

Clinical usefulness of serum procalcitonin to distinguish between viral pneumonia and Mycoplasma pneumonia in children: A multicenter, cross-sectional study

Purpose: The aim of this study was to compare the clinical usefulness of serum procalcitonin (PCT) levels in Mycoplasma pneu moniae pneumonia (M. pneumonia) and viral pneumonia in children. Methods: We retrospectively analyzed the medical records of 348 patients admitted between June 2015 and December of 2015. There were 162 patients with M. pneumonia without virus coinfection (group 1) and 186 patients with viral pneumonia (group 2). All subjects had radiographic evidence of pneumonia with available specimens for both M. pneumonia and viral testing, and levels of serum PCT, white blood cell counts (WBC), neutrophil portion, and C-reactive protein (CRP). Fifty-eight children who performed follow-up sampling at the time of no fever for more than 48 hours were subdivided into group 3 (M. pneumonia with follow-up sampling, n=41) and group 4 (viral pneumonia with follow-up sampling, n=17). Results: No difference was noted in the levels of serum PCT (P=0.168), CRP (P=0.296), WBC (P=0.732), and neutrophil proportion (P=0.069) between groups 1 and 2, after adjusting for age. Serial changes in serum PCT levels between the first and second samples were significant in group 3 (P=0.046). Serial changes in serum CRP levels between the first and second samples were significant in group 4 (P=0.008). Conclusion: Serum PCT and CRP levels may change differently after infection according to the etiology of pneumonia. (Allergy Asthma Respir Dis 2019;7:22-27)

Respiratory syncytial virüs infections in neonates and infants.

Respiratory syncytial virus is one of the major causes of respiratory tract infections during infancy with high rates of hospitalization and mortality during the first years of life. It is the most common cause of acute bronchiolitis and viral pneumonia in children below two years of age and second the most common cause of postneonatal infant mortality all around the world following malaria. In addition, the virus has been causally linked to recurrent wheezing and associated with pediatric asthma. The respiratory syncytial virus infections tend to be severe in high risk patients such as patients below six months of age, with prematurity, congenital heart diseases, neuromuscular diseases and immune deficiencies. No specific treatment is available for respiratory syncytial virus infections to date. Severe cases require supportive therapy, mainly oxygen supplementation and hydration, and less frequently, ventilatory support. Because there is no vaccine to prevent respiratory syncytial virus infections or clinically effective treatment to administer to children with respiratory syncytial virus infection, immunoprophylaxis with palivizumab is currently the only method for reducing morbidity associated with severe respiratory syncytial virus in high-risk infants.

Incidence and severity profile of viral respiratory tract infections in children admitted to the tertiary level pediatric intensive care unit

Background : Viruses cause a significant percentage of community acquired pneumonia (CAP) especially in children less than 2 years of age. Respiratory syncytial virus (RSV), influenza A, and para-influenza types 1 are the most common causes of viral pneumonia in children. Other viral pathogens include adenovirus, rhinovirus, influenza B, and enteroviruses Methods : This is a retrospective chart review of all patients aged 1 month to 16 years admitted to PICU at Sir Ganga Ram Hospital with the diagnosis of viral pneumonia during 6 months. Patients were excluded if their nasopharyngeal and oropharyngeal secretions had not been sent for viral studies within 24 hours of admission. DNA and RNA real time PCR test was performed using Respi-Finder kit and Quisymphony extraction machine (Qaigen, Germany). Results : During the study period, 306 patients were admitted to our PICU out of which 67 (11.6%) were admitted with diagnosis of pneumonia. 25 children were excluded from the study as 12 had bacterial pneumonia, viral DNA/RNA PCR was not sent in nine patients and in four patients, the etiological agent could not be determined. The final study group comprised of 42 patients with a median age of 9.5 months (Range 6 weeks -10 years) with a male to female ratio of 2.5:1. Average duration of symptoms prior to admission was 4.3 days. Most common symptom was cough seen in around 90% of patients followed by fever (80 %); fast breathing (73%), decreased feeding (30 %).Blood culture sent at admission was sterile in all patients. RSV was the most common virus isolated in 57 of the patients followed by Rhinovirus/ enterovirus in 26%, H1N1 (9.5%), influenza B (9.5%), Boca virus (7.1%), parainfluenza virus (7.1%), coronavirus and adenovirus in 2.3 % each. Infection with a single virus was seen in 28 children and co-infection with two or more of the viruses were seen in 14 children. Supplemental oxygen therapy was used in 15 children (35.7%) and 17 children (35.7%) needed some form of ventilator assistance. Non — invasive ventilation was used in 11 children (26.2%) and invasive mechanical ventilation in 14.2 % of the study subjects. ET aspirates sent for cultures immediately after intubation were sterile in all patients. Four (9.5%) children had hypotension at the time of admission requiring inotropic support, from whom influenza B was isolated from two patients and RSV A and Adenovirus were isolated from one patient each. Two children had evidence of multiple organ dysfunction requiring continuous renal replacement therapy. Adenovirus and influenza B was isolated from these patients. OUTCOME — In our cohort of children with viral pneumonia, three patients had in-hospital mortality. Among them, two had superadded bacterial infection (Acinetobacter baumanii) and one had Severe combined immunodeficiency. Conclusion : RSV was the most common etiological agent of viral pneumonia in our study. Around 1/3 of our patients’ with viral pneumonia required ventilator assistance.

Does atopy affect the course of viral pneumonia?

BackgroundThe presence of atopy is considered as a risk factor for severe respiratory symptoms in children. The objective of this study was to examine the effect of atopy on the course of disease in children hospitalised with viral pneumonia. MethodsChildren between the ages of 1 and 6 years hospitalised due to viral pneumonia between the years of 2013 and 2016 were included to this multicentre study. Patients were classified into two groups as mild–moderate and severe according to the course of pneumonia. Presence of atopy was evaluated with skin prick tests. Groups were compared to evaluate the risk factors associated with severe viral pneumonia. ResultsA total of 280 patients from nine centres were included in the study. Of these patients, 163 (58.2%) were male. Respiratory syncytial virus (29.7%), Influenza A (20.5%), rhinovirus (18.9%), adenovirus (10%), human metapneumovirus (8%), parainfluenza (5.2%), coronavirus (6%), and bocavirus (1.6%) were isolated from respiratory samples. Eighty-five (30.4%) children had severe pneumonia. Atopic sensitisation was found in 21.4% of the patients. Ever wheezing (RR: 1.6, 95% CI: 1.1–2.4), parental asthma (RR: 1.5, 95% CI: 1.1–2.2), other allergic diseases in the family (RR: 1.8, 95% CI: 1.2–2.9) and environmental tobacco smoke (RR: 1.6, 95% CI: 1.1–3.5) were more common in the severe pneumonia group. ConclusionsWhen patients with mild–moderate pneumonia were compared to patients with severe pneumonia, frequency of atopy was not different between the two groups. However, parental asthma, ever wheezing and environmental tobacco smoke exposure are risk factors for severe viral pneumonia in children.