Post Infection Constrictive Bronchiolitis in an Infant after SARS-CoV-2

La bronquiolitis obliterante se caracteriza por ser una enfermedad respiratoria obstructiva crónica con cambios histológicos irreversibles y de presentación inusual en la población pediátrica por lo cual usualmente es sub diagnosticada, sin embargo, en episodios broncoobstructivos de evolución atípica o severa debe ser considerada como probable diagnóstico. La bronquiolitis obliterante se considera una enfermedad crónica inflamatoria de los bronquiolos que puede presentarse de dos formas histopatológicas ya sea por afectación peribronquiolar desde el epitelio hacia la luz de forma concéntrica (constrictiva) o por ocupación del lumen del bronquiolo dado por proliferación del tejido endoluminal (proliferativa). El diagnóstico se realiza según criterios clínicos y criterios radiológicos (TC de tórax), un puntaje mayor de 7 predice con alta precisión el diagnóstico de bronquiolitis obliterante. Dado que se trata de una enfermedad inflamatoria crónica mediada por la respuesta inmune, el tratamiento esta dirigido a suprimir la respuesta inflamatoria para evitar el daño pulmonar por cambios irreversibles sin embargo, una vez instaurada la enfermedad el tratamiento será sintomático, de soporte y seguimiento de la función pulmonar. A continuación, se presenta el caso de un lactante de 2 meses de edad con antecedente en su periodo neonatal de infección respiratoria por SARS-CoV-2 (COVID-19) en quien se evidenció cambios radiológicos y clínicos compatibles con bronquiolitis constrictiva post infecciosa en su evolución clínica.Q4Neonatos con Bronquiolitis constrictivaBronchiolitis obliterans is a chronic and irreversiblepulmonary disease that leads to obstruction andobliteration of the small airways and that can present by peribronchiolar involvement, from the epitheliumtowards the lumen in a concentric (constrictive), orby occupation of the lumen of the bronchiole, given by proliferation of the endoluminal tissue (proliferative). The lesion at the level of the small airway can occurafter lung or bone marrow transplantation, infections, inhalation of toxic substances, connective tissue diseasesor secondary to drugs. In the pediatric population, the constrictive form secondary to severe respiratory tractinfections, and known as post-infectious bronchiolitisobliterans (PIBO), is the most common and its clinicalpresentation can be highly variable from mild to severe airway obstruction that does not respond to treatmentwith bronchodilators, in addition to hypoxemia, cough andtachypnea. Diagnosis is difficult given the previous need for a lung biopsy, the current absence of biomarkers, andsince its pathophysiology is not clearly understood. The CT as well as a clinical score predict with high precisionthe diagnosis of obliterative bronchiolitis. Treatment isaimed at suppressing the inflammatory response to preventlung damage. We report a case of a 2-month-old infant with a history of respiratory infection due to SARS-CoV-2(COVID-19) in his neonatal period is presented, in whomradiological and clinical changes compatible with PIBO were evidenced.https://orcid.org/0000-0002-5917-8212https://orcid.org/0000-0002-3037-9715https://orcid.org/0000-0003-1627-7971https://orcid.org/0000-0003-3870-4102https://orcid.org/0000-0002-1923-3934Revista Nacional - IndexadaS

Characterization of cytomegalovirus lung infection in non-HIV infected children

Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%), diffuse adventitious breath sounds (100%) and increased respiratory effort (93%). All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate) or histology/immunohistochemistry in lung biopsy (100% detection rate). CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes

Aspergilosis pulmonar invasiva: reporte de un caso

The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a pediatric patient with invasive pulmonary aspergillosis in the form of pseudomembranous tracheobronchitis, including the clinical course, diagnostic approach and paraclinical care provided.The patient was a 5-year-old female with a history of Fanconi anemia who presented with febrile neutropenia and pneumonia. Antibiotic treatment with cefepime provided no improvement in the patient’s condition and computed tomography of the thorax revealed bibasilar pulmonary opacities. Bronchoalveolar lavage and a lesion biopsy were performed after diagnostic bronchoscopy showed a white exophytic lesion. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. Bronchoalveolar lavage culture produced fungi of the Aspergillus flavi complex. A review of pulmonary Aspergillus spp. infection in children is also included, with emphasis on the management and treatment of clinical syndromes. In pediatric patients with hematological diseases who present with febrile neutropenia and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes. El hongo Aspergillus spp. causa infecciones oportunistas en huéspedes inmunocomprometidos. Cursa con una variedad de síndromes clínicos en el pulmón, que incluyen aspergilosis invasiva, aspergilosis pulmonar necrótica crónica, aspergilosis broncopulmonar alérgica y aspergiloma, cuya manifestación depende del tipo de relación con el huésped. El aspergiloma resulta de lesiones colonizadas por Aspergillus spp. en el árbol bronquial, en tanto que las formas invasivas se caracterizan por la presencia de hifas por debajo de la membrana basal del árbol bronquial.El objetivo de este trabajo es describir el caso de una paciente con aspergilosis pulmonar invasiva en su forma de traqueobronquitis seudomembranosa, considerando el curso clínico, el diagnóstico y el manejo paraclínico.Se trató de una paciente de cinco años de edad con antecedentes de anemia de Fanconi, que fue llevada a consulta con neutropenia febril y neumonía. Se inició el tratamiento antibiótico con cefepime, sin mejoría clínica.La tomografía computadorizada (TC) de tórax reveló opacidades parenquimatosas en ambas bases pulmonares. En una fibrobroncoscopia se encontró una lesión exofítica blanquecina en el bronquio principal derecho, que se sometió a biopsia, y se practicó un lavado broncoalveolar. En el examen de histopatología se hallaron hifas tabicadas a 45°, y el resultado del cultivo reveló la presencia del complejo Aspergillus flavi, por lo que se inició la administración de voriconazol. Se revisaron los reportes en la literatura científica sobre la infección pulmonar por Aspergillus spp. en niños, con énfasis en los síndromes clínicos, y en su manejo y tratamiento.Ante la presencia de síntomas respiratorios en pacientes pediátricos con enfermedades hematológicas que cursen con neutropenia febril, es indispensable considerar como agentes etiológicos los hongos, entre los cuales Aspergillus spp. se presenta frecuentemente causando diferentes síndromes clínicos

Covid-19 in Children and the Influence on the Employment Activity of Their Female Caregivers: A Cross Sectional Gender Perspective Study

INTRODUCTION: During the COVID-19 pandemic, women disproportionately assume more unpaid activities, affecting their employment. OBJECTIVE: Describe the influence of COVID-19 on the employment of caregivers of children and adolescents from a gender perspective. METHODS: Cross-sectional study in three high-complexity hospitals in Bogotá, Colombia from April 2020 to June 2021. A subsample of the FARA cohort was taken, including those patients with a positive test for SARS-COV2. We took as our analysis category children older than 8 years and younger than 18 years who had a positive SARS-COV2 test, as well as, caregivers of all children with a positive SARS-COV2 test. This subsample was drawn from the FARA cohort. A survey was applied to them. We carried out a descriptive and stratified analysis by age group, educational, and socioeconomic level. RESULTS: We included 60 surveys of caregivers and 10 surveys of children. The main caregiver in 94.8% of the cases was a female. At the beginning of the pandemic, 63.3% of the caregivers were employed, and 78.9% of those lost their employment. The vast majority of these caregiver were women (96.6%, CONCLUSION: Caregivers of children with COVID-19 with low educational levels and lower socioeconomic conditions, as well as those with children under 5 years showed greater likelihood of employment loss between the interviewed subsample

Burden of Respiratory Failure in Pediatric Patients: Analysis of a Prospective Multicenter Cohort in Bogotá, Colombia

BACKGROUND AND AIMS: The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. METHODS: This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. RESULTS: Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. CONCLUSION: ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients

Use of High-Flow Cannula in Pediatric Patients With Respiratory Failure: A Prospective Cohort Study in Three High-Altitude Hospitals

BACKGROUND AND AIMS: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals. METHODS: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management. RESULTS: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. CONCLUSION: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies

Pediatric sleep apnea and viral respiratory infections: what do clinicians need to know?

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing in children occurring in approximately 1% to 5% of the pediatric population (1). OSA is characterized by repetitive episodes of upper airway obstruction that cause intermittent hypoxia and/or frequent arousals (1). OSA affects all pediatric age groups with two clear peak periods. The first peak is in the preschool age, corresponding to the time of adeno-tonsillar hypertrophy, and the second is during adolescence when obesity becomes more prevalent (1). Early diagnosis of the condition is essential to reduce the occurrence of complications over time. Untreated OSA has been associated with behavioral problems, learning difficulties, cardiovascular complications, and growth retardation. Risk factors for pediatric OSA include prematurity, obesity, allergic rhinitis, and syndromic conditions (1). Investigating additional OSA risk factors in children may lead to interventions that reduce health-related costs and long-term complications of this prevalent condition

Validation of the Spanish version of the childhood asthma control test (cACT) in a population of Hispanic children

BACKGROUND: There is a critical need for additional validation studies of questionnaires designed to assess the level of control of asthma in pediatric patients. OBJECTIVE: To validate the Spanish version of the Childhood Asthma Control Test (cACT) in children aged between 4 and 11 years with physician-diagnosed asthma METHODS: In a prospective cohort validation study, asthmatic children aged between 4 and 11 years and their parents, attended both a baseline and a follow-up visit 2 to 6 weeks later. In these two visits, they completed the information required to assess the criterion validity, construct validity, test-retest reliability, sensitivity to change, internal consistency, and usability of the cACT. RESULTS: At baseline, cACT scores were significantly different between patients with controlled, partly controlled, and uncontrolled asthma [24.0 (23.0-26.0), 18.0 (18.0-22.0), and 17.5 (13.0-20.0) respectively, p<0.001], and also between patients for whom this visit resulted in a step-up, no change, or step-down in therapy [18.0 (15.0-21.0), 24.0 (23.0-24.0), and 26.0 (23.5-26.0) respectively, p<0.001]. The score of the cACT correlated positively and significantly with the score of the Pediatric Asthma Caregivers Quality of life Questionnaire - PACQLQ (Spearman’s rho = 0.50, p<0.001).The intraclass correlation coefficient of the measurements in patients with no change in clinical status was 0.849 (95% CI: 0.752-0.908). There were statistical significant differences between baseline and follow-up cACT scores in patients with an improvement in clinical status [19.0 (18.0-22.0) vs. 24.5 (24.0-25.0), p<0.001]. Cronbach’s α was 0.8276 for the questionnaire as a whole. CONCLUSION: The Spanish version of the cACT has adequate criterion validity, adequate construct validity, adequate sensitivity to change, good internal consistency, good test-retest reliability, and excellent usability when administered to asthmatic children aged between 4 and 11 years