[Nosocomial respiratory syncytial virus bronchiolitis in preterm infants: characteristics of the course, treatment and prevention in clinical practice]

OBJECTIVE

To study the clinical, laboratory and radiological features of the course of nosocomial bronchiolitis respiratory syncytial viral (RSV) etiology and effectiveness of the therapy in preterm infants in the neonatal hospital conditions.

PATIENTS AND METHODS

We analyzed case histories of 10 hospitalized patients who had RSV etiology bronchiolitis established by RIF/PCR in neonatal Moscow hospitals in 2011-2013.

RESULTS

RSV infection in hospitalized preterm infants with and without bronchopulmonary dysplasia runs hardly, requiring treatment in the intensive care unit, oxygen therapy and lungs mechanical ventilation. The respiratory failure is the symptom of the of RSV bronchiolitis severity. X-ray picture of the disease is characterized by peribronchial changes, emphysematous swelling, segmental infiltration and bronchial obstruction (atelectasis, hypoventilation). The frequency of bacterial complications of RSV bronchiolitis is low. In clinical practice newborns with severe RSV bronchiolitis are treated with antibiotics, bronchodilators, steroids. The timely isolation of patients can prevent the extention of the infection in the hospital,

CONCLUSIONS

The preventive measures are needed to prevent the extention of RSV in neonatal hospitals, including specific immune prophylaxis of RSV infection in children at risk.

Creola bodies in infancy with respiratory syncytial virus bronchiolitis predict the development of asthma

BACKGROUND

Creola bodies (CrBs) in the sputum are an indicator of respiratory epithelial damage and appear specifically in bronchial asthma. We studied the presence and clinical significance of CrBs in infants with respiratory syncytial virus (RSV) bronchiolitis contributing to the development of asthma.

METHODS

Aspirated sputum samples were collected from 33 infants admitted with acute RSV bronchiolitis. The samples were then examined for the presence (or absence) of CrBs and classified into the RSV-CrB group and RSV-non-CrB group. Eosinophil cationic protein (ECP) and neutrophil elastase (NE) concentrations in the sputum were compared between the two groups. History of wheeze and asthma was collected at 2 years and 5 years after their discharge from hospital.

RESULTS

CrBs were detected in 23 of the 33 subjects (69.7%). No significant difference in the ECP and the NE concentration were observed between the RSV-CrB group and RSV-non-CrB group. A significant relationship was observed between CrBs detected with RSV bronchiolitis and the development of recurrent wheezing and asthma (after 2 years: relative risk [RR], 3.09; p = 0.002; after 5 years: RR 7.00; p = 0.019).

CONCLUSIONS

These findings suggest that a high rate of CrBs in the sputum is present in infants with RSV bronchiolitis, and notably the CrBs are associated with the progression to recurrent wheezing and asthma.

Value of rigid bronchoscopy in the management of critically ill children with acute lung collapse

OBJECTIVE

To describe the potential uses of a rigid bronchoscopy in pediatric patients, as well as explaining the advantage of a rigid bronchoscopy versus a flexible bronchoscopy in pediatric patients with acute lung collapse.

DESIGN

Case report.

SETTING

Pediatric intensive care unit.

PATIENT

A 16-month-old male infant with a 5-day history of cough, congestion, and "wheezing" that progressively worsened.

INTERVENTIONS

A rigid bronchoscopy.

MEASUREMENTS AND MAIN RESULTS

The evolution of the patient's acute lobar collapse to his final discharge is described. This includes the initial presentation, primary methods employed to improve the patient's condition, the use of a rigid bronchoscopy in removing a mucous plug, and the patient's results up to his final discharge.

CONCLUSION

This report demonstrates the value of rigid bronchoscopy in pediatric patients with severe atelectasis and pneumonia. Although bronchoscopy may not be indicated as an initial procedure to remove respiratory tract secretions, it may provide a beneficial option in cases where less invasive methods prove ineffective in removing secretions and mucous plugs.

Smoking in parents of children with asthma and bronchiolitis in a pediatric emergency department

OBJECTIVES

To determine smoking habits, levels of nicotine-addiction, readiness to quit, and beliefs about the effects of environmental tobacco smoke (ETS) of parents of children with bronchiolitis and asthma who present to a children's emergency department (ED).

DESIGN/METHODS

This was a cross-sectional prevalence study of parents or legal guardians of children with asthma or bronchiolitis presenting to a pediatric ED.

RESULTS

Two hundred forty-nine parents/legal guardians comprised the study group. The mean age (+/-SD) was 30.0 (+/-8.9) years; 88% were female; 51% were nonwhite; 37% were educated beyond high school. The self-reported smoking prevalence was 41% (95% CI = 32-51). Smoking prevalence among parents of wheezing children varied according to education, income, and race, but not according to gender, age, or employment status. Of the 102 smokers in the sample, 84 (82.4%, 95% CI = 73-88) reported that they wanted to quit; 78 (76.5%, 95% CI = 68-84) stated that they wanted to quit within the next month. Forty-nine percent (95% CI = 39-59) scored above 4 on the Fagerstrom Test for Nicotine Dependence and were considered nicotine-dependent. The majority of smokers admitted to smoking around their children (66.7%, 95% CI = 57-75). Many parents knew that ETS might contribute to the development of the following illnesses: colds/upper respiratory tract infections - 77.5%, otitis media - 68.6%, pneumonia - 50%, wheezing/asthma attacks - 86.3%, and SIDS - 31.4%.

CONCLUSION

The prevalence of smoking and nicotine addiction among parents of children with asthma or bronchiolitis who bring their children to a pediatric ED is high. Many parents have some knowledge about the effects of ETS, and the majority would like to quit. Future studies to help determine the best way to deliver advice to parents on ETS exposure reduction and smoking cessation are warranted.

Increased production of IFN-gamma and cysteinyl leukotrienes in virus-induced wheezing

BACKGROUND

An imbalance of production of T-helper lymphocyte cytokines, favoring overproduction of IL-4, is believed to be important in the pathogenesis of allergic asthma. However, less is known about the cytokine response in virus-induced wheezing, which is a major cause of morbidity in asthma.

OBJECTIVE

We undertook this study to determine the magnitude of IFN-gamma, IL-4 and IL-10, and leukotriene (LT) responses in infants and children with virus-induced wheezing.

METHODS

We measured the concentrations of IFN-gamma, IL-4 and IL-10, and cysteinyl LTs in respiratory secretions of 82 infants and young children during acute episodes of virus-induced wheezing. Control subjects were 47 infants and children with uncomplicated upper respiratory infections and 18 normal healthy infants.

RESULTS

Ratios of IFN-gamma to IL-4 were higher (due to increased quantities of IFN-gamma) in subjects with wheezing than in those with upper respiratory infection alone (P =. 003). Quantities of LTs were also increased in wheezing subjects in comparison with those with upper respiratory infections (P =.009). There was a significant correlation between measured concentrations of IFN-gamma and LTs (correlation coefficient =.451, P =.007). Quantities of IL-4 were slightly suppressed in the wheezing groups.

CONCLUSIONS

An imbalance favoring overproduction of IFN-gamma appears to be associated temporarily with virus-induced wheezing. A possible mechanism is the enhanced release of LTs from eosinophils or mast cells after sensitization by IFN-gamma.

Airway involvement in hypersensitivity pneumonitis

Exposure to organic particles causes, in a susceptible host, diffuse inflammation of the lung acinus. However, immunopathologic response may not be confined to the alveoli and may also involve the large and peripheral airways. Therefore, after allergen inhalation a clinical spectrum of respiratory disorders may be observed, including hypersensitivity pneumonitis, asthma, chronic airway obstruction, and simple chronic bronchitis. Hypersensitivity pneumonitis is not a uniform disease but a complex syndrome, and the involvement of the airways may occur alone, simultaneously with, or after the parenchymal disease.