Zdravljenje akutnega bronhiolitisa s kisikom

Akutni bronhiolitis je najpogostejša okužba spodnjih dihal pri otrocih, mlajših od dveh let. Zdravljenje akutnega bronhiolitisa je podporno. Poleg skrbi za primerno hidracijo je dodatek kisika otrokom s hipoksemijo praktično edini način zdravljenja teh otrok. Vrednost, ki jo dobimo s pulznim oksimetrom, je le posredna meritev dejanske vrednosti kisika v krvi in ne odrazi resnosti bolezni. Z dodatkom kisika sicer povišamo zasičenost hemoglobina s kisikom in tako zmanjšamo hipoksemijo, ne zdravimo pa osnovnega vzroka za njen nastanek. Kljub vsemu pulzna oksimetrija ostaja odločilna preiskava pri odločitvi glede zdravljenja s kisikom, saj z nobenim kliničnim znakom ne moremo natančno oceniti, ali gre pri otroku za hipoksemijo. Študije so pokazale, da pediatri pri oceni resnosti bolezni vse bolj zaupajo vrednosti zasičenosti kisika v krvi (SpO2) kot pa klinični oceni. Odkar je pulzna oksimetrija v uporabi, se je odstotek hospitaliziranih zaradi akutnega bronhiolitisa zvišal za približno 250 %. Smernice za obravnavo otrok z akutnim bronhiolitisom niso enotne glede vrednosti SpO2, ki zahtevajo zdravljenje s kisikom. V prispevku smo jih kritično ovrednotili in predstavili lastne izkušnje glede zdravljenja akutnega bronhiolitisa s kisikom

​The impact of Mycoplasma pneumoniae genotypes on clinical characteristics of infection in children

Uvod in namen: Mycoplasma pneumoniae (Mp) je pogost povzročitelj okužb spodnjih dihal pri otrocih, a lahko povzroča tudi izvenpljučne okužbe. Dejavniki, ki določajo klinično sliko okužbe z Mp, so le deloma poznani. Seve Mp lahko glede na genski zapis za adhezin P1 razvrstimo v dve genetski skupini, imenovani P1 tip 1 (P1-1) in P1 tip 2 (P1-2). Večjo sposobnost razlikovanja sevov nam omogoča metoda multilokusne analize spremenljivega števila tandemskih ponovitev (angl. Multiple-Locus Variable number tandem repeat Analysis, MLVA). Vpliv genotipa Mp na klinično sliko okužbe pri otrocih še ni poznan. S preučevanjem kliničnih značilnosti bolnikov z znano okužbo z Mp smo želeli opredeliti, ali so genotipi Mp P1 in MLVA povezani s klinično sliko akutne okužbe pri otrocih. Metode: V retrospektivni klinični raziskavi smo pregledali zdravstveno dokumentacijo otrok, ki so bili od januarja do decembra 2014 obravnavani na Pediatrični kliniki, Univerzitetnem kliničnem centru Ljubljana (UKCL), in na Kliniki za infekcijske bolezni in vročinska stanja UKCL zaradi akutne okužbe z Mp. Vključitveni kriteriji za študijo so bili starost ? 18 let in dokazana navzočnost bakterije Mp v brisu žrela z molekularnim testom PCR. Izključitveni kriteriji so bili odsotnost znakov akutne okužbe in ugotovljeni drugi povzročitelj okužbe. Bolnike smo nato razvrstili glede na klinično sliko okužbe po organskih sistemih in glede na dokazan genotip Mp P1 in MLVA. Za posamezne klinične slike okužbe smo ocenili demografske, epidemiološke in klinične podatke ter porazdelitev genotipov Mp P1-1/-2 oziroma MLVA in jih statistično opredelili. Primerjali smo epidemiološke in klinične podatke pri pacientih z akutno okužbo spodnjih dihal z Mp genotipom P1-1 ali s P1-2 in znanimi genotipi MLVA. Primerjali smo epidemiološke in klinične podatke pacientov s kožno klinično sliko, okuženih z Mp P1-1 ali P1-2, ter med posameznimi genotipi MLVA. Izsledke smo primerjali s podatki kontrolne skupine otrok, ki niso imeli potrjene okužbe z Mp s testom PCR. Rezultati: Leta 2014 je bilo v naši bolnišnici napotenih 1621 otrok z znaki akutne okužbe z Mp. Glede na vključitvene in izključitvene kriterije smo v naši študiji pregledali podatke 482 bolnikov (260 (54 %) fantov in 222 deklic (46 %), povprečna starost 6,9 leta, standardna deviacija (SD) 3,4 leta). Najpogostejša klinična slika okužbe z Mp pri naših bolnikih je bila okužba spodnjih dihal, ki je bila prisotna pri 88 % bolnikov (425/482). Izvenpljučno klinično sliko okužbe je imelo 13 % (62/482) otrok, med katerimi je bila najpogostejša kožna, in sicer pri 9 % (45/482) otrok. V naši skupini bolnikov z mikoplazemsko okužbo nismo potrdili povezave genotipa Mp z določeno pljučno ali izvenpljučno klinično sliko. Primerjali smo podatke 310 bolnikov z okužbo spodnjih dihal z genotipom Mp P1-1 s podatki 110 bolnikov, okuženih z Mp P1-2. Bolniki, okuženi s P1-2, ki so bili starejši od pet let, so imeli višje kazalce vnetja in so pogosteje potrebovali bolnišnično obravnavo. Dodatno smo primerjali podatke bolnikov z okužbo spodnjih dihal s tremi najpogostejšimi genotipi MLVA, in sicer MLVA-3,5,6,2, MLVA-3,6,6,2 in MLVA-4,5,7,2. Vnetni kazalci so bili pomembno višji pri bolnikih, starejših od pet let, okuženih z MLVA-3,5,6,2. Bolnišnično obravnavo zaradi izpuščaja so pogosteje potrebovali mlajši otroci, okuženi s sevom MLVA-3,6,6,2. Z uporabo modela logistične regresije smo opredelili, da imajo pri obravnavi otroka s sumom na atipično pljučnico starost, trajanje simptomov in spremembe na RTG p.c. najvišjo napovedno vrednost za mikoplazemsko okužbo spodnjih dihal. Zaključki: V naši raziskavi nismo potrdili povezave genotipa Mp P1 in MLVA z določeno pljučno ali izvenpljučno klinično sliko. Kljub temu pa rezultati naše velike kohortne raziskave kažejo na to, da so verjetno različni genotipi Mp različno virulentni, saj so imele okužbe spodnjih dihal in kožne bolezni, povzročene z določenimi Mp genotipi, težji potek. Vpliv genotipa Mp na kazalce resnosti bolezni smo opredelili predvsem pri otrocih, starejših od pet let.Background and aim: Mycoplasma pneumoniae (Mp) is a common cause of lower respiratory tract infections (LRTI) in children. Nevertheless, it can also cause several extrapulmonary manifestations. Factors determining clinical outcome and clinical severity of Mp infections are only partly understood. Mp strains can be classified into two genetic groups called P1 type 1 (P1-1) and P1 type 2 (P1-2) based on the DNA sequence of the P1 adhesion protein gene. Multiple-Locus Variable number tandem repeat Analysis (MLVA) offers a more discriminative categorization of strains. It is mainly unknown if Mp genotype is associated with the clinical outcome of Mp infections in children. By investigating clinical features of patients with an acute Mp infection, we aimed to determine if Mp genotype is associated with the presentation and severity of acute infection in children. Methods: We performed a retrospective study of children referred to University Children’s Hospital Ljubljana and Department of Infectious Diseases Ljubljana with signs of acute Mp infection from January 2014 to December 2014. All patients 䁤18 years who were PCR-positive for Mp from pharyngeal swabs were recruited for the study. We excluded patients who did not show signs of acute infection and cases where additional testing provided evidence that other infectious or non-infectious agents were the more likely cause of the disease. The patients were further divided into groups according to clinical outcome and Mp P1 and MLVA genotype. Firstly, we assessed the association between Mp P1 and MLVA genotype and a specific clinical outcome. Secondly, we compared epidemiological and clinical data of patients with LRTI, infected with either P1-1 or P1-2, and between the most frequent MLVA strains. Thirdly, we compared epidemiological and clinical data of patients with cutaneous disease, infected with either P1-1 or P1-2, and between the most frequent MLVA strains. Lastly, the characteristics of patients with PCR-positive Mp infection were compared to those of patients who tested PCR-negative for Mp. Results: In the study period, 1621 children were referred to our hospitals with signs of acute Mp infection. After applying the inclusion and exclusion study criteria, we evaluated data from 482 patients (260 (54 %) boys and 222 girls (46 %), mean age 6,9 yearsstandard deviation (SD) 3,4 years). The most frequent clinical outcome in our patients were LRTI, observed in 88 % of cases (425/482). Thirteen percent of children (62/482) presented with an extrapulmonary clinical outcome. Of those, cutaneous disease was the most frequent, observed in 9 % of cases (45/482). We found no association between Mp genotype and a specific pulmonary and extrapulmonary clinical outcome in our sample of patients with acute Mp infection. Data from 310 patients with LRTI infected with P1-1 were compared with 110 patients infected with P1-2. P1-2-infected children over five years presented with significantly higher inflammatory marker levels and were admitted to the hospital more often. In addition, we compared the data of patients with LRTI infected with the three most common MLVA types: MLVA-3,5,6,2, MLVA-3,6,6,2, and MLVA-4,5,7,2. MLVA-3,5,6,2-infected patients older than five years presented with significantly higher inflammatory marker levels than MLVA-3,6,6,2- and MLVA-4,5,7,2-infected patients. Infections with MLVA-3,6,6,2 strains were more frequent in admitted patients with cutaneous disease compared to other MLVA strains. Age, duration of symptoms, and chest radiographic findings had the highest predictive value for Mp LRTI in a multivariable logistic regression model. Conclusions: In our research we found no association between Mp P1 and MLVA genotype and a specific pulmonary and extrapulmonary clinical outcome. However, the results from our large cohort indicate that Mp genotypes may have different pathogenic potentials, which was especially observed when comparing markers of disease severity of patients with LRTI and cutaneous disease older than five years

The Association between Mycoplasma pneumoniae Genotype and Cutaneous Disease

Mycoplasma pneumoniae (Mp) can cause several extrapulmonary manifestations, most frequently dermatological ones. It is largely unknown whether Mp genotype determines Mp-induced cutaneous disease. The aim of our study was to assess the association between Mp genotype and this clinical outcome. We performed a retrospective study of children referred with signs of acute Mp infection from 1 January 2014 to 31 December 2014. We compared the characteristics of children presenting as cutaneous disease, upper (URTI) and lower respiratory tract infection (LRTI). In addition, we separately analyzed the data of patients presenting with Mp-induced cutaneous disease. We evaluated data from 435 patients (mean age 7.3 years, SD 3.4 years; 52.0% boys) who had Mp PCR-positive pharyngeal swab, P1 genotype and/or multilocus variable-number tandem-repeat analysis (MLVA) genotype defined and no viral co-detection, presenting as cutaneous disease (38/435), URTI (46/435) or LRTI (351/435). The majority of patients had urticarial (55%, 21/38) or maculopapular eruptions (37%, 14/38). We found no association between Mp genotype and clinical outcome of cutaneous disease, nor any specific dermatological presentation. In the group with cutaneous disease, 18% (7/38) required hospital admission because of rash. We found that infection with MLVA-3,6,6,2 strains was more common in admitted patients than in outpatients (40% vs. 4%, p = 0.017) and significantly affected the likelihood of hospital admission in a logistic regression model. The results of our cohort study suggest that Mp genotype does not determine Mp-induced cutaneous disease or a specific dermatological presentation. Nevertheless, infections with certain MLVA strains could induce more severe cutaneous disease requiring hospitalization

Clinical characteristics of infections caused by Mycoplasmapneumoniae P1 genotypes in children

AbstractMycoplasma pneumoniae (M. pneumoniae) isolates can be classified into two major genetic groups, P1 type 1 (MP1) and P1 type2 (MP2), based on the DNA sequence of the P1 adhesion protein gene. The aim of our study was to determine if M. pneumoniaeP1 genotype is associated with disease manifestation and severity of acute M. pneumoniae infection. We compared epidemiologicaland clinical data of children infected with either MP1 or MP2. In addition, we separately analysed data of patientspresenting with individual manifestations of M. pneumoniae infection. Data of 356 patients infected with MP1 were comparedwith those of 126 patients infected with MP2. MP2-infected children presented with higher median baseline C-reactive proteinlevels and were admitted to the hospital more often. The distribution of P1 genotype varied among groups of patients withdifferent manifestations of M. pneumoniae infection. MP2 was more common than MP1 among patients with neurological andcardiovascular manifestations, whereas MP1 was more prevalent in other manifestations. The results from our large cohortindicate that the two P1 subtypes may have different pathogenic potential and that infections with MP2 strains could be morevirulent than those with MP1 strains.Keywords Mycoplasma pneumoniae . Genotype . Paediatrics . Infectio

The Association between <i>Mycoplasma pneumoniae</i> Genotype and Cutaneous Disease

Mycoplasma pneumoniae (Mp) can cause several extrapulmonary manifestations, most frequently dermatological ones. It is largely unknown whether Mp genotype determines Mp-induced cutaneous disease. The aim of our study was to assess the association between Mp genotype and this clinical outcome. We performed a retrospective study of children referred with signs of acute Mp infection from 1 January 2014 to 31 December 2014. We compared the characteristics of children presenting as cutaneous disease, upper (URTI) and lower respiratory tract infection (LRTI). In addition, we separately analyzed the data of patients presenting with Mp-induced cutaneous disease. We evaluated data from 435 patients (mean age 7.3 years, SD 3.4 years; 52.0% boys) who had Mp PCR-positive pharyngeal swab, P1 genotype and/or multilocus variable-number tandem-repeat analysis (MLVA) genotype defined and no viral co-detection, presenting as cutaneous disease (38/435), URTI (46/435) or LRTI (351/435). The majority of patients had urticarial (55%, 21/38) or maculopapular eruptions (37%, 14/38). We found no association between Mp genotype and clinical outcome of cutaneous disease, nor any specific dermatological presentation. In the group with cutaneous disease, 18% (7/38) required hospital admission because of rash. We found that infection with MLVA-3,6,6,2 strains was more common in admitted patients than in outpatients (40% vs. 4%, p = 0.017) and significantly affected the likelihood of hospital admission in a logistic regression model. The results of our cohort study suggest that Mp genotype does not determine Mp-induced cutaneous disease or a specific dermatological presentation. Nevertheless, infections with certain MLVA strains could induce more severe cutaneous disease requiring hospitalization

Exploring Clinical Predictors of Severe Human Metapneumovirus Respiratory Tract Infections in Children: Insights from a Recent Outbreak

Human metapneumovirus (hMPV) is an important pathogen that causes both upper (URTIs) and lower respiratory tract infections (LRTIs) in children. The virus can be implicated in severe bronchiolitis and pneumonia, necessitating hospitalization, with certain cases requiring intensive care unit intervention. As part of a retrospective observational study, we aimed to identify indicators of severe hMPV respiratory tract infections in children referred to the University Children’s Hospital Ljubljana and the Department of Infectious Diseases Ljubljana, Slovenia, during a recent outbreak. We analyzed clinical data from November 2022 to January 2023 and compared the characteristics of children presenting with URTIs and LRTIs. We also examined the characteristics of children with hMPV LRTIs, distinguishing between children with and without LRTI-associated hypoxemia. Of 78 hMPV-PCR-positive pediatric patients (mean age 3.1 years; 60.3% boys), 36% had a URTI, and 64% had an LRTI. Hospitalization was required in 64% (50/78), with 42% (21/50) requiring oxygen therapy. LRTI-associated hypoxemia was more common in patients with atopy who showed dyspnea, tachypnea, crackles, and wheezing on lung auscultation. In a multivariable logistic regression analysis, wheezing detected on lung auscultation was a significant predictive factor for hypoxemic hMPV-LRTI. Specifically, children presenting with wheezing were found to be ten times more likely to experience hypoxemia. Prematurity and chronic conditions did not influence the presentation or severity of hMPV infection. This study highlights wheezing and atopy as crucial indicators of severe hMPV LRTI in children, emphasizing the importance of early recognition and intervention

Physical fitness trajectories from childhood to adolescence in extremely preterm children

Objective: Cohort studies on physical fitness (PF) in former extremely preterm children are scarce and yield conflicting results. Therefore, this study aimed to assess the effect of extremely preterm birth on PF in school‐age with a focus on bronchopulmonary dysplasia (BPD). Methods: Eighty school‐aged children were enrolled in the longitudinal cohort study. Fifty were born extremely preterm (<completed 28 weeks of gestation): 19 had BPD, and 31 did not30 term‐born healthy children were included as controls. They were monitored annually throughout primary school (ages 7–14 years) with eight annual fitness testings within the Slovenian national surveillance system of children\u27s somatic and motor development (SLOfit). The physical fitness index (PFI), calculated as the mean of percentiles of eight fitness tests, was used as an indicator of overall PF. Generalised estimating equations were used to compare changes in PFI between ages 7 and 14 in the three cohort groups: preterm children with BPD, preterm children without BPD and term controls. Results: Preterm children with BPD had significantly and persistently lower PFI than preterm children without BPD and term‐born children throughout primary school age. Their PFI was less than half that of national median values (15.1st–19.7th percentile). Preterm children without BPD experienced progressive improvement in PFI during their school age (from 32.6th to 44.7th percentile of national median PFI values), while the ones with BPD did not. Conclusion: Extreme prematurity per se is not a risk factor for lower PF at school age. However, if complicated by BPD, PF is significantly and sustainably reduced

Better COVID-19 Outcomes in Children with Good Asthma Control

Factors associated with COVID-19 presentation in children with asthma are poorly defined. Our study aimed to assess the clinical course of COVID-19 in children with asthma, with particular attention to possible risk factors for severe disease and long-term sequelae in this group of patients. We assessed the occurrence of SARS-CoV-2 infection in children with asthma six months before their regular outpatient visit to the asthma clinic. Characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI) were compared. We focused on factors previously associated with COVID-19 severity. Twenty-seven percent of patients (57/210) reported exposure to SARS-CoV-2 infection. In the symptomatic group, 36% (15/42) reported symptoms of LRTI and 64% (27/42) of URTI. Poorer asthma control was observed in patients with LRTI compared to URTI (80% vs. 7%, p p = 0.026). We found no PFT deterioration post-COVID-19 in either group of patients. Our results suggest good asthma control and treatment adherence prior to infection are associated with better COVID-19 outcomes in children with asthma

ERS international congress 2022: Highlights from the paediatrics assembly

This review has been prepared by the Early Career Members and Chairs of the European Respiratory Society (ERS) Assembly 7: Paediatrics. We here summarise the highlights of the advances in paediatric respiratory research presented at the ERS International Congress 2022. The eight scientific groups of this Assembly cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis (CF), respiratory infection and immunology, neonatology and intensive care, respiratory epidemiology, bronchology, and lung and airway developmental biology. Specifically, we report on abstracts presented at the congress on the effect of high altitude on sleep, sleep disorders, the hypoxic challenge test, and measurements of ventilation inhomogeneity. We discuss prevention of preschool wheeze and asthma, and new asthma medications. In children with CF, we describe how to monitor the effect of CF transmembrane conductance regulator modulator therapy. We present respiratory manifestations and chronic lung disease associated with common variable immunodeficiency. Furthermore, we discuss how to monitor respiratory function in neonatal and paediatric intensive care units. In respiratory epidemiology, we present the latest news from population-based and clinical cohort studies. We also focus on innovative and interventional procedures for the paediatric airway, such as cryotherapy. Finally, we stress the importance of better understanding the molecular mechanisms underlying normal and abnormal lung development