Chronic cough in children: Recent advances

Recurrent cough in children is a very common symptom of respiratory disease. Most children who cough, however, have normal pulmonary function. This article presents a diagnostic framework for chronic cough and a recommended management plan in order to avoid over investigation and over treatment of a generally benign and self-remitting condition. Pathophysiology of cough and recent advances in treatment options are also included. © Future Drugs Ltd. All rights reserved

Ureaplasma urealyticum airway colonization and pulmonary outcome in neonates

Ureaplasma urealyticum genital tract colonization of pregnant women has been associated with an adverse pregnancy outcome, while its consequent perinatal transmission has been implicated in the development of respiratory disease of the neonate. Clinical manifestations or contributions of ureaplasmal airway colonization in newborns mainly include pneumonia, precocious dysplastic changes and chronic lung disease; although systemic disease has also been documented. This review aims to summarize current diagnostic techniques, pathogenetic mechanisms and pathological data in an attempt to establish an optimal therapeutic approach regarding neonatal U. urealyticum respiratory infection. Related morbidity and mortality, along with the high economic impact of neonatal respiratory disease worldwide, renders this topic particularly interesting and promotes further research in this field. © Future Drugs Ltd. All rights reserved

Tuberculosis in neonates and infants: Epidemiology, pathogenesis, clinical manifestations, diagnosis, and management issues

Tuberculosis is one of the leading infectious causes of death and as such represents a major global health problem. Infants may develop congenital tuberculosis from an infectious mother or, most commonly, they may acquire postnatal disease by contact with an infectious adult source. Important epidemiologic, pathogenetic, and clinical data regarding the management of infantile disease are reviewed. Diagnostic evaluation includes tuberculin skin tests, chest radiography and other imaging studies, smears and cultures, examination of the cerebrospinal fluid, and polymerase chain reaction, as well as the more recent interferon-γ assay. Pregnant women with a positive Mantoux skin test but normal chest x-ray should either start chemoprophylaxis during gestation or after delivery depending on the likelihood of being recently infected, their risk of progression to disease, as well as their clinical evidence of disease. Pregnant women with a positive Mantoux skin test and chest x-ray or symptoms indicative of active disease should be treated with non-teratogenic agents during gestation; all household contacts should also be screened. When tuberculosis is suspected around delivery, the mother should be assessed by chest x-ray and sputum smear; separation of mother and offspring is indicated only if the mother is non-adherent to medical treatment, needs to be hospitalized, or when drug-resistant tuberculosis is involved. According to the American Academy of Pediatrics, treatment of latent infection is highly effective with isoniazid administration for 9 months. This regimen may be extended to 12 months for immunocompromised patients. When drug resistance is suspected, combination therapies, which usually consist of isoniazid with rifampin (rifampicin), are administered until the results of susceptibility tests become available. Organisms resistant to isoniazid only may be treated with rifampin alone for a total of 6-9 months. All infants with tuberculosis disease should be started on four agents (isoniazid, rifampin, pyrazinamide, and ethambutol or streptomycin) until drug susceptibility is assessed. For susceptible intrathoracic tuberculosis, isoniazid, rifampin, and pyrazinamide are administered for a total of 2 months, at which point pyrazinamide is withdrawn and the other two agents are continued for another 4-10 months depending on the severity of the disease. The same regimen may be applied in extrapulmonary tuberculosis with the exception of skeletal, miliary, and CNS disease, which require daily administration of isoniazid, rifampin, pyrazinamide, and streptomycin for 1-2 months, followed by isoniazid and rifampin daily or twice weekly for another 10 months. When drug-resistant tuberculosis is suspected, a regimen of isoniazid, rifampin, and pyrazinamide plus either streptomycin or ethambutol should be initially prescribed, until the results of susceptibility tests become available. HIV-seropositive infants with pulmonary tuberculosis should receive isoniazid, rifampin, pyrazinamide, and ethambutol or an aminoglycoside for 2 months, followed by isoniazid and rifampin for a total of at least 12 months. Apart from conventional antimycobacterial agents, novel therapeutic modalities, which stimulate the host immune system such as interleukin-2 (IL-2), IL-12, interferon-γ, and tumor necrosis factor antagonists have been tested with promising results. © 2005 Adis Data Information BV. All rights reserved

Materno-fetal transfer of azlocillin

We studied 20 patients to assess transfer of azlocillin to the fetus at parturition. The elimination half-life of approximately 1.3 h in these mothers was similar to that reported for normal subjects. Azlocillin quickly reached umbilical cord blood, amniotic fluid, the placenta and the urine of the neonate, achieving substantial concentrations. Azlocillin then disappeared from umbilical cord blood with an elimination half-life of 2.3 h, i.e., similar to that of the mother. At 6 h, concentrations of azlocillin were still increasing in amniotic fluid and placenta. In addition, in two stillborn infants, azlocillin was found to reach substantial concentrations in all tissues analysed except brain. Concentrations of azlocillin achieved in fetal tissues are sufficient to have important therapeutic effects. © 1983 The British Society for Antimicrobial Chemotherapy

Intrauterine infection with parvovirus B19 and CMV: Implications in early and late gestation fetal demise

In utero viral infections have been associated with an adverse pregnancy outcome and may have a causative role in the unexplained fetal death file. Parvovirus B19 and cytomegalovirus are among the most common pathogens implicated in fetal loss cases. Parvovirus B19 has been reported to account for cases of spontaneous abortions, intrauterine fetal death and nonimmune hydrops fetalis, whereas cytomegalovirus accounts for nonimmune hydrops fetalis, intrauterine growth retardation and congenital anomalies. This review aims to summarize the current literature in an attempt to underline the need for routine screening, close follow-up and prevention. A better understanding of the pathogenetic mechanisms of viral infections during the crucial time of organogenesis, along with early detection, may contribute to the reduction in stillbirth rate. © 2005 Future Drugs Ltd

Rhinovirus infections and adenoidal hypertrophy: Do they interact with atopy in children?

Modern diagnostic methods allow the evaluation of the connection between rhinoviruses and atopy. Recent studies suggest that rhinoviruses are present in the adenoids at higher titers than in other specific sites, after inoculation of nasal mucosa or conjunctiva in volunteers. Therefore, it is possible that they might be responsible for specific local changes, while such changes may be influenced by atopy. This review focuses on the interactions between rhinoviral infection, the host's immune status and adenoidal disease. © Future Drugs Ltd. All rights reserved

Cefotaxime in the treatment of severe paediatric infections

Sixty-three paediatric patients suffering from severe bacterial infections were treated with cefotaxime. Sixteen were newborn babies, 13 were infants aged 1 month to 1 year, and 34 were children aged 1 to 12 years. Forty-seven of these patients had previously received unsuccessful therapy with other antibiotics. Cefotaxime was administered in combination with another antibiotic in sixteen of the patients, 10 of whom were neonates. Cefotaxime was administered intramuscularly in 9 patients and as intravenous bolus injection in 54, in a dosage of 25 mg/kg/dose. In neonates this dose was repeated every 12 h for the first 7 days of life, every 8 h for the first 3 weeks of life, and every 6 h for older infants and children. These doses resulted in high blood levels with no evidence of accumulation of the drug. Fifty-three of the 63 patients were cured and pathogens were eradicated. Seven patients improved clinically and pathogens were eradicated in 3, persisted in 3, and changed in one. Treatment failed in 3 patients. No side-effects or toxicity were noted. Cefotaxime proved clinically effective in treating severe infections in paediatrics. © 1980 The British Society for Antimicrobial Chemotherapy

Kawasaki disease: An overview

PURPOSE OF REVIEW: Kawasaki disease is an acute, self-limited vasculitis of childhood. The increasing frequency of the disease as well as the deficiency of specific diagnostic means renders its diagnosis and treatment an area of intense investigation. The purpose of this review is to summarize all the known features of Kawasaki disease and also give an insight to the latest findings. RECENT FINDINGS: Kawasaki disease is one of the leading causes of acquired heart disease in children while its cause remains essentially unknown. Viruses, bacterial conventional as well as superantigens, and genetic polymorphisms have been implicated in the etiology of the disease. Markers of inflammation, such as CCL2 and CCXCL10, contribute to the pathology and the diagnosis of Kawasaki disease. Intravenous administration of immunoglobulin remains the mainstay of therapy for Kawasaki disease. Nevertheless, forms of the disease refractory to intravenous administration of immunoglobulin therapy may respond to aspirin, corticosteroids, cyclophosphamide, and/or plasmapheresis. SUMMARY: The present review covers evidence regarding the history of Kawasaki disease, the epidemiology, etiology, pathology, genetic influences, and long-term sequela. It also includes an evaluation of contemporary diagnostic techniques and optimal therapeutic approaches with an emphasis on recent publications. © 2008 Lippincott Williams & Wilkins, Inc

Otitis media with effusion: An effort to understand and clarify the uncertainties

Otitis media with effusion - defined as the accumulation of middle-ear effusion behind an intact tympanic membrane without signs or symptoms of acute infection - is one of the most common causes of hearing loss in children in developed countries, potentially leading to language deficits. Although treatment of chronic or relapsing otitis media with effusion is considered imperative, none of the preventative or nonsurgical management measures currently available have proven effective. Tympanostomy tube placement remains the recommended treatment option for high-risk children or for cases of unresponsive otitis media with effusion. This can be attributed to the uncertainties surrounding its pathogenesis. Multiple factors and several possible pathogenetic models have been proposed to explain the production and persistence of middle-ear effusion; only a few of them are supported by sufficient evidence. In this review, the authors will present current knowledge on the pathogenesis, consequences, diagnosis and management of otitis media with effusion. An effort will be made to clarify those aspects sufficiently supported by evidence-based studies, and to underline those that remain unfounded. © 2005 Future Drugs Ltd