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Gallucci M, Pedretti M, Giannetti A, di Palmo E, Bertelli L, Pession A, Ricci G. When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children. Front Pediatr 2020; 8:433. [PMID: 32850546 PMCID: PMC7426454 DOI: 10.3389/fped.2020.00433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022] Open
Abstract
Chronic cough is defined as a daily cough that persists longer than 4 weeks. Protracted bacterial bronchitis (PBB) is a common cause of chronic wet cough in preschool children with no symptoms or signs of other specific causes, and resolution usually follows a 2-week course of an appropriate oral antibiotic. The diagnosis is mainly clinical; generally, no instrumental examinations are necessary. The most common bacteria found in the bronchoalveolar lavage (BAL) of subjects with PBB include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Nowadays, there is no certain evidence of the role of viruses in PBB pathogenesis even though different types of viruses have been detected in BAL from children with PBB. Airway malacia is commonly found in children with PBB; conversely, there is no correlation with any type of immunodeficiency. Amoxicillin-clavulanate acid is the most commonly used antibiotic, as first-line, prolonged therapy (longer than 2 weeks) is sometimes required to cough resolution. When the wet cough does not improve despite prolonged antibiotic treatment, an underlying disease should be considered. Moreover, there are several hypotheses of a link between PBB and bronchiectasis, as recent evidences show that recurrent PBB (>3 episodes/years) and the presence of H. influenzae infection in the lower airways seem to be significant risk factors to develop bronchiectasis. This underlines the importance of a close follow-up among children with PBB and the need to consider chest computerized tomography (CT) in patients with risk factors for bronchiectasis. In this brief review, we summarize the main clinical and pathogenetic findings of PBB, a disease that may be related to a relevant morbidity and decreased quality of life during the pediatric age.
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Affiliation(s)
- Marcella Gallucci
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Melissa Pedretti
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Arianna Giannetti
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Emanuela di Palmo
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Bertelli
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Department of Paediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Pal K, Feng X, Steinke JW, Burdick MD, Shim YM, Sung SS, Teague WG, Borish L. Leukotriene A4 Hydrolase Activation and Leukotriene B4 Production by Eosinophils in Severe Asthma. Am J Respir Cell Mol Biol 2019; 60:413-419. [PMID: 30352167 DOI: 10.1165/rcmb.2018-0175oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Asthma is associated with the overproduction of leukotrienes (LTs), including LTB4. Patients with severe asthma can be highly responsive to 5-lipoxygenase (5-LO) inhibition, which blocks production of both the cysteinyl LTs and LTB4. Production of LTB4 has traditionally been ascribed to neutrophils, mononuclear phagocytes, and epithelial cells, and acts as a chemoattractant for inflammatory cells associated with asthma. The source of LTB4 is unclear, especially in eosinophilic asthma. We speculated that the benefit of 5-LO inhibition could be mediated in part by inhibition of eosinophil-derived LTB4. LTB4 concentrations were assayed in BAL fluid from patients with severe asthma characterized by isolated neutrophilic, eosinophilic, and paucigranulocytic inflammation. Expression of LTA4 hydrolase (LTA4H) by airway eosinophils was determined by immunohistochemistry (IHC). Subsequently, peripheral blood eosinophils were activated and secreted LTB4 was quantified by enzyme immunoassay. Blood eosinophil LTA4H expression was determined by flow cytometry, qPCR, and IHC. LTB4 concentrations were elevated in BAL fluid from patients with severe asthma, including those with isolated eosinophilic inflammation, and these eosinophils displayed LTA4H via IHC. LTA4H expression by blood eosinophils was confirmed by flow cytometry, IHC, and qPCR. Robust LTB4 production by blood eosinophils was observed in response to some, but not all, stimuli. We demonstrated that eosinophils express LTA4H transcripts and protein, and can be stimulated to secrete LTB4. We speculate that in many patients with asthma, eosinophil-derived LTB4 is increased, and this may contribute to the efficacy of 5-LO inhibition.
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Affiliation(s)
- Kavita Pal
- 1 Division of Pulmonary and Critical Care Medicine
| | - Xin Feng
- 2 Department of Otorhinolaryngology, QiLu Hospital of Shandong University, Jinan, Shandong, China
| | | | | | - Yun M Shim
- 1 Division of Pulmonary and Critical Care Medicine
| | | | | | - Larry Borish
- 3 Division of Asthma Allergy and Immunology, and.,6 Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia; and
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53
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Deterding RR, Wagner BD, Harris JK, DeBoer EM. Pulmonary Aptamer Signatures in Children's Interstitial and Diffuse Lung Disease. Am J Respir Crit Care Med 2019; 200:1496-1504. [PMID: 31409098 PMCID: PMC6909841 DOI: 10.1164/rccm.201903-0547oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/13/2019] [Indexed: 01/10/2023] Open
Abstract
Rationale: Biomarker signatures are needed in children with children's interstitial and diffuse lung disease (chILD) to improve diagnostic approaches, increase our understanding of disease pathogenesis, monitor disease progression, and develop new treatment strategies. Proteomic technology using SOMAmer (Slow Off-rate Modified Aptamer) nucleic acid-based protein-binding reagents allows for biomarker discovery.Objectives: We hypothesized that proteins and protein pathways in BAL fluid (BALF) would distinguish children with neuroendocrine cell hyperplasia of infancy (NEHI), surfactant dysfunction mutations, and other chILD diagnoses and control subjects.Methods: BALF was collected for clinical indications and banked in patients with chILD and disease control subjects using standardized protocols over 10 years. BALF supernatant was analyzed using an aptamer assay to measure 1,129 protein levels. Protein levels were compared between groups using an ANOVA and adjusted for multiple comparisons using false discovery rate. Proteins were classified into pathways. Hierarchical clustering was used to define endotypes in the group of children with NEHI.Measurements and Main Results: After correcting for multiple testing, children with NEHI (n = 22) had 202 aptamers that were significantly different (P < 0.05) in BALF compared with control subjects (n = 9). Children with surfactant mutation (n = 8) had 51 aptamers significantly different (P < 0.05) in BALF compared with control subjects (n = 9). Proteins associated with pulmonary fibrosis and inflammation were associated with the surfactant dysfunction group but not the NEHI group. Using hierarchical clustering analysis, two distinct NEHI endotypes were identified.Conclusions: Distinct proteins and protein pathways can be determined from BALF of children with chILD, and these hold promise to further our understanding of chILD.
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Affiliation(s)
- Robin R. Deterding
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Brandie D. Wagner
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - J. Kirk Harris
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Emily M. DeBoer
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and
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Dell'Orto V, Raschetti R, Centorrino R, Montane A, Tissieres P, Yousef N, De Luca D. Short- and long-term respiratory outcomes in neonates with ventilator-associated pneumonia. Pediatr Pulmonol 2019; 54:1982-1988. [PMID: 31456358 DOI: 10.1002/ppul.24487] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/09/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critical care settings and might have important long-term consequences in neonates. Our aim is to clarify the short- and long-term respiratory outcomes of neonates affected by VAP. METHODS Prospective, population-based, cohort study with 12 months follow-up based on clinical examinations and diary-based respiratory morbidity score, conducted in an academic tertiary referral neonatal unit with dedicated follow-up program. RESULTS A total of 199 inborn neonates consecutively ventilated for at least 48 hours were eligible for the study. One hundred fifty-one were finally enrolled and classified as "exposed" or "unexposed" to VAP, if they fulfilled (or not) VAP criteria once during their stay. Bronchopulmonary dysplasia (BPD) incidence was significantly higher in exposed (75%) than in unexposed babies (26.8%; relative risk [RR]: 2.8 [1.9-4.0]; Adj RR: 3.5 [1.002-12.7]; P = .049; number needed to harm = 2.07), although the composite BPD/mortality did not differ. Exposed patients showed longer intensive care unit stay (87 [43-116] vs 14 [8-52] days; St.β = 0.24; P < .0001) and duration of ventilation (15 [10-25] vs 5 [4-8] days; St.β = 0.29; P < .0001) than unexposed neonates. Exposed patients also showed less ventilator-free days (11 [5-17.7] vs 22 [14-24] days; St.β = -0.15; P = .05) compared to unexposed. Respiratory infections, use of drugs, rehospitalization for respiratory reasons, home oxygen therapy, their composite outcome, and diary-based clinical respiratory morbidity score were similar between the cohorts. CONCLUSION Neonatal VAP seems associated to higher incidence of BPD, longer ventilation, and intensive care stay but it does not affect long-term respiratory morbidity.
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Affiliation(s)
- Valentina Dell'Orto
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Roberto Raschetti
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Roberta Centorrino
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Amelie Montane
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Pierre Tissieres
- Institute for Integrative Biology (I2BC), South Paris-Saclay University, Orsay, France
| | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A.Béclère", South Paris University Hospitals, APHP, Paris, France.,Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
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55
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Spengler D, Rintz N, Krause MF. An Unsettled Promise: The Newborn Piglet Model of Neonatal Acute Respiratory Distress Syndrome (NARDS). Physiologic Data and Systematic Review. Front Physiol 2019; 10:1345. [PMID: 31736777 PMCID: PMC6831728 DOI: 10.3389/fphys.2019.01345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022] Open
Abstract
Despite great advances in mechanical ventilation and surfactant administration for the newborn infant with life-threatening respiratory failure no specific therapies are currently established to tackle major pro-inflammatory pathways. The susceptibility of the newborn infant with neonatal acute respiratory distress syndrome (NARDS) to exogenous surfactant is linked with a suppression of most of the immunologic responses by the innate immune system, however, additional corticosteroids applied in any severe pediatric lung disease with inflammatory background do not reduce morbidity or mortality and may even cause harm. Thus, the neonatal piglet model of acute lung injury serves as an excellent model to study respiratory failure and is the preferred animal model for reasons of availability, body size, similarities of porcine and human lung, robustness, and costs. In addition, similarities to the human toll-like receptor 4, the existence of intraalveolar macrophages, the sensitivity to lipopolysaccharide, and the production of nitric oxide make the piglet indispensable in anti-inflammatory research. Here we present the physiologic and immunologic data of newborn piglets from three trials involving acute lung injury secondary to repeated airway lavage (and others), mechanical ventilation, and a specific anti-inflammatory intervention via the intratracheal route using surfactant as a carrier substance. The physiologic data from many organ systems of the newborn piglet—but with preference on the lung—are presented here differentiating between baseline data from the uninjured piglet, the impact of acute lung injury on various parameters (24 h), and the follow up data after 72 h of mechanical ventilation. Data from the control group and the intervention groups are listed separately or combined. A systematic review of the newborn piglet meconium aspiration model and the repeated airway lavage model is finally presented. While many studies assessed lung injury scores, leukocyte infiltration, and protein/cytokine concentrations in bronchoalveolar fluid, a systematic approach to tackle major upstream pro-inflammatory pathways of the innate immune system is still in the fledgling stages. For the sake of newborn infants with life-threatening NARDS the newborn piglet model still is an unsettled promise offering many options to conquer neonatal physiology/immunology and to establish potent treatment modalities.
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Affiliation(s)
- Dietmar Spengler
- Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nele Rintz
- Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Martin F Krause
- Department of Pediatrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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56
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Tschiedel E, Goralski A, Steinmann J, Rath PM, Olivier M, Mellies U, Kottmann T, Stehling F. Multiplex PCR of bronchoalveolar lavage fluid in children enhances the rate of pathogen detection. BMC Pulm Med 2019; 19:132. [PMID: 31319825 PMCID: PMC6639929 DOI: 10.1186/s12890-019-0894-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/10/2019] [Indexed: 12/23/2022] Open
Abstract
Background Culturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia. However, the sensitivity is low, especially in patients pre-treated with anti-infective agents. The early detection of a pathogen is crucial for the outcome of respiratory tract infections. For bloodstream infections, a multiplex polymerase chain reaction (PCR) assay (SeptiFast®, SF) is available for improved pathogen detection from blood. Objective The aim of the present study was to determine whether the SF assay is applicable to the BAL of children with pulmonary infections and whether the frequency of pathogen detection is enhanced by the use of this multiplex PCR method. Methods We investigated 70 BAL samples of 70 children simultaneously by culture and multiplex PCR. The frequency of pathogen detection was compared. Results Pathogens were detected more frequently by SF than by culture (83% vs. 31%; p < 0.001). This advantage was shown for immunocompetent patients (p = 0.001) as well as for immunocompromised patients (p = 0.003). The majority (38/44; 86%) of the Gram positive cocci were only detected by SF. Fungal organisms were detected in 7/70 patients (10%) by SF and in 2/70 (3%) by culture (p = 0.125). Conclusion Compared to conventional culture, the use of the SF assay on the BAL of children with pneumonia increases pathogen detection rates and therefore adds important information to guide anti-infective therapy.
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Affiliation(s)
- Eva Tschiedel
- Department of Pediatrics I, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - Arkadius Goralski
- Department of Pediatrics III, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Jörg Steinmann
- Institute for Medical Microbiology, University of Duisburg-Essen, Essen, Germany.,Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Peter-Michael Rath
- Institute for Medical Microbiology, University of Duisburg-Essen, Essen, Germany
| | - Margarete Olivier
- Department of Pediatrics III, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Uwe Mellies
- Department of Pediatrics III, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Tanja Kottmann
- Private Institute of Medical Statistics, 59077, Hamm, Westfalen, Germany
| | - Florian Stehling
- Department of Pediatrics III, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
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57
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Hare KM, Chang AB, Smith-Vaughan HC, Bauert PA, Spain B, Beissbarth J, Grimwood K. Do combined upper airway cultures identify lower airway infections in children with chronic cough? Pediatr Pulmonol 2019; 54:907-913. [PMID: 31006971 DOI: 10.1002/ppul.24336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/11/2019] [Accepted: 03/07/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obtaining lower airway specimens is important for guiding therapy in chronic lung infection but is difficult in young children unable to expectorate. While culture-based studies have assessed the diagnostic accuracy of nasopharyngeal or oropharyngeal specimens for identifying lower airway infection, none have used both together. We compared respiratory bacterial pathogens cultured from nasopharyngeal and oropharyngeal swabs with bronchoalveolar lavage (BAL) cultures as the "gold standard" to better inform the diagnosis of lower airway infection in children with chronic wet cough. METHODS Nasopharyngeal and oropharyngeal swabs and BAL fluid specimens were collected concurrently from consecutive children undergoing flexible bronchoscopy for chronic cough and cultured for bacterial pathogens. RESULTS In cultures from 309 children (median age, 2.3 years) with chronic endobronchial suppuration, all main pathogens detected (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) were more prevalent in nasopharyngeal than oropharyngeal swabs (37%, 34%, and 23% vs 21%, 6.2%, and 3.2%, respectively). Positive and negative predictive values for lower airway infection by any of these three pathogens were 63% (95% confidence interval [95% CI] 55, 70) and 85% (95% CI, 78, 91) for nasopharyngeal swabs, 65% (95% CI, 54, 75), and 66% (95% CI, 59, 72) for oropharyngeal swabs, and 61% (95% CI, 54,68), and 88% (95% CI, 81, 93) for both swabs, respectively. CONCLUSIONS Neither nasopharyngeal nor oropharyngeal swabs, alone or in combination, reliably predicted lower airway infection in children with chronic wet cough. Although upper airway specimens may be useful for bacterial carriage studies and monitoring antimicrobial resistance, their clinical utility in pediatric chronic lung disorders of endobronchial suppuration is limited.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Paul A Bauert
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Brian Spain
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
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58
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Schouten LR, van Kaam AH, Kohse F, Veltkamp F, Bos LD, de Beer FM, van Hooijdonk RT, Horn J, Straat M, Witteveen E, Glas GJ, Wieske L, van Vught LA, Wiewel MA, Ingelse SA, Cortjens B, van Woensel JB, Bos AP, Walther T, Schultz MJ, Wösten-van Asperen RM. Age-dependent differences in pulmonary host responses in ARDS: a prospective observational cohort study. Ann Intensive Care 2019; 9:55. [PMID: 31089908 PMCID: PMC6517452 DOI: 10.1186/s13613-019-0529-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/06/2019] [Indexed: 12/27/2022] Open
Abstract
Background Results from preclinical studies suggest that age-dependent differences in host defense and the pulmonary renin–angiotensin system (RAS) are responsible for observed differences in epidemiology of acute respiratory distress syndrome (ARDS) between children and adults. The present study compares biomarkers of host defense and RAS in bronchoalveolar lavage (BAL) fluid from neonates, children, adults, and older adults with ARDS. Methods In this prospective observational study, we enrolled mechanical ventilated ARDS patients categorized into four age groups: 20 neonates (< 28 days corrected postnatal age), 29 children (28 days–18 years), 26 adults (18–65 years), and 17 older adults (> 65 years of age). All patients underwent a nondirected BAL within 72 h after intubation. Activities of the two main enzymes of RAS, angiotensin converting enzyme (ACE) and ACE2, and levels of biomarkers of inflammation, endothelial activation, and epithelial damage were determined in BAL fluid. Results Levels of myeloperoxidase, interleukin (IL)-6, IL-10, and p-selectin were higher with increasing age, whereas intercellular adhesion molecule-1 was higher in neonates. No differences in activity of ACE and ACE2 were seen between the four age groups. Conclusions Age-dependent differences in the levels of biomarkers in lungs of ARDS patients are present. Especially, higher levels of markers involved in the neutrophil response were found with increasing age. In contrast to preclinical studies, age is not associated with changes in the pulmonary RAS. Electronic supplementary material The online version of this article (10.1186/s13613-019-0529-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura R Schouten
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Franziska Kohse
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany.,Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork, Ireland
| | - Floor Veltkamp
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lieuwe D Bos
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Friso M de Beer
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Roosmarijn T van Hooijdonk
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marleen Straat
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Esther Witteveen
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gerie J Glas
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lonneke A van Vught
- Center of Experimental Molecular Medicine (CEMM), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Maryse A Wiewel
- Center of Experimental Molecular Medicine (CEMM), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Sarah A Ingelse
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Bart Cortjens
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Job B van Woensel
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Albert P Bos
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Thomas Walther
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany.,Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork, Ireland
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Roelie M Wösten-van Asperen
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands. .,Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
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59
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Mackanjee HR, Naidoo L, Ramkaran P, Sartorius B, Chuturgoon AA. Neonatal bronchoscopy: Role in respiratory disease of the newborn-A 7 year experience. Pediatr Pulmonol 2019; 54:415-420. [PMID: 30620142 DOI: 10.1002/ppul.24243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bronchoalveolar lavage (BAL) is a standardized method to obtain specimen samples from the airway lumen of the respiratory system. BAL is used to diagnose lung infection and infection markers in neonates. OBJECTIVES The aim was to evaluate the utility of flexible fiberoptic bronchoscopy in term and preterm neonates and to evaluate the use of BAL obtained by bronchoscopy in neonatal lung disease. METHODS A retrospective analysis of Neonatal Intensive Care Unit (NICU) babies, during a 7-year period was conducted on 599 neonates who underwent the BAL procedure. Characteristics of the patients, indications, complications, and results of the procedure were recorded. RESULTS The main indications were nosocomial pneumonia (140) and unilateral lung disease (74). A normal finding was most prevalent (201), followed by tracheitis (65). Microbiology on BAL fluid was positive in 33% of bronchoscopies (195/599); most common organisms isolated were Acinetobacter, Klebsiella, and Pseudomonas. CONCLUSIONS Neonatal bronchoscopy can serve as an important diagnostic and therapeutic tool in the management of neonatal lung disease, BAL specimen microbiology from bronchoscopy directs clinical decision making in the management of neonatal lung infection. Individual common markers of infection have poor correlation to BAL. A combination of the markers, however, improves correlation with BAL but their utility in clinical management of lung infection is subject to caution. A negative BAL may shift management emphasis on minimizing lung injury especially in neonates who are ventilator dependent; BAL has the potential to critically affect the management of babies with significant lung disease especially when ventilator dependent.
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Affiliation(s)
- Harshavadan R Mackanjee
- Neonatal Intensive Care Unit-Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Lerusha Naidoo
- Neonatal Intensive Care Unit-Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Prithiksha Ramkaran
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences University of KwaZulu-Natal, Durban, South Africa
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences University of KwaZulu-Natal, Durban, South Africa
| | - Anil A Chuturgoon
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences University of KwaZulu-Natal, Durban, South Africa
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Autilio C, Shankar-Aguilera S, Minucci A, Touqui L, De Luca D. Effect of cooling on lung secretory phospholipase A2 activity in vitro, ex vivo, and in vivo. Am J Physiol Lung Cell Mol Physiol 2019; 316:L498-L505. [DOI: 10.1152/ajplung.00201.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hypothermia can modify surfactant composition and function. Secretory phospholipase A2 (sPLA2) hydrolyses surfactant phospholipids and is important in the pathobiology of several critical respiratory disorders. We hypothesize that sPLA2 activity might be influenced by the temperature partially explaining surfactant changes. This study aims to evaluate comprehensively the effect of hypothermia on sPLA2 activity. We measured sPLA2 activity at different temperatures, alone or combined with bile acids, in vitro (incubating human recombinant sPLA2-IIA and porcine sPLA2-IB), ex vivo (by cooling bronchoalveolar lavage samples from neonates with respiratory distress syndrome or no lung disease), and in vivo (using lavage samples obtained before and after 72 h of whole body cooling in neonates with hypoxic-ischemic encephalopathy). We also measured concentrations of various sPLA2 subtypes and natural sPLA2 inhibitors in in vivo cooled samples. Results were corrected for protein content and dilution. In vitro cooling did not show any effect of hypothermia on sPLA2. Ex vivo cooling did not alter total sPLA2 activity, and the addition of bile acids increased sPLA2 activity irrespective of the temperature and the type of sampled patient. In vivo hypothermia reduced median sPLA2 activity from 16.6 [15.2–106.7] IU/mg to 3.3 [2.7–8.5] IU/mg ( P = 0.026) and mean sPLA2-IIA from 1.1 (0.8) pg/μg to 0.6 (0.4) pg/μg ( P = 0.047), whereas dioleylphosphatidylglycerol increased from 8.3 (3.9)% to 12.8 (5.1)% ( P = 0.02). Whole body hypothermia decreases in vivo global sPLA2 activity in bronchoalveolar lavage fluids through the reduction of sPLA2-IIA and increment of dioleylphosphatidylglycerol. This effect is absent during in vitro or ex vivo hypothermia.
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Affiliation(s)
- Chiara Autilio
- Laboratory of Clinical Molecular Biology, Department of Laboratory Medicine, University Hospital “A.Gemelli,” Catholic University of the Sacred Heart, Rome, Italy
- Dept of Biochemistry and Molecular Biology, Faculty of Biology, Complutense University, Madrid, Spain
| | - Shivani Shankar-Aguilera
- Division of Pediatrics and Neonatal Critical Care, Medical Center “A.Béclère,” South Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, France
- Respiratory Physiopathology Unit, Institut Pasteur, Paris, France
| | - Angelo Minucci
- Laboratory of Clinical Molecular Biology, Department of Laboratory Medicine, University Hospital “A.Gemelli,” Catholic University of the Sacred Heart, Rome, Italy
| | | | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Medical Center “A.Béclère,” South Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, France
- Physiopathology and Therapeutic Innovation Unit, South Paris-Saclay University, Paris, France
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61
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Gut G, Armoni Domany K, Sadot E, Soferman R, Fireman E, Sivan Y. Eosinophil cell count in bronchoalveolar lavage fluid in early childhood wheezing: is it predictive of future asthma? J Asthma 2019; 57:366-372. [PMID: 30795692 DOI: 10.1080/02770903.2019.1579829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Increased eosinophil level in bronchoalveolar lavage fluid (BALF) characterizes asthma in school-age children and adults and has been suggested as a marker for disease severity and response to treatment. We aimed to investigate the occurrence and yield of BALF eosinophil cell count in preschool children with recurrent wheezing and its possible relation to future diagnosis of asthma. Methods: BALF was retrospectively studied in young wheezy children and its relation to asthma at age 6 years was evaluated. BALF from children aged 1-48 months (mean = 20.4) was analyzed in preschool wheezy children. Children with anatomical airway obstruction and other lower airway/lung diseases who underwent BALF served as controls. Assessment of asthma was accomplished at 6 years. Results: Eighty-two children were included. The mean age during bronchoscopy and BAL was 20.4 ± 14.4 months (range: 1-48 months). Twenty-six patients had recurrent preschool wheezing, 13 anatomical airway obstruction and 43 had other lower airways/lung diseases. Groups were comparable for age during bronchoscopy and gender. No difference was found between groups for any of the BALF cell types. Eosinophils were very low in all three groups [mean (interquartile range): 0 (0-0.4), 0 (0-0.8), and 0.4 (0-1), respectively, p = 0.25]. No difference in eosinophil levels during bronchoscopy was found between asthmatic children to non-asthmatic as defined at age 6 years. Conclusions: Wheezing in preschool children is not associated with increased BALF eosinophils; hence, at this age, the diagnostic yield of BALF for cell count analysis for diagnosing asthma is limited and is not routinely indicated.
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Affiliation(s)
- Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Keren Armoni Domany
- The Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Efraim Sadot
- The Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ruth Soferman
- The Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Elizabeth Fireman
- Institute for Pulmonary and Allergic Diseases, and National Laboratory Service for Interstitial Lung Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yakov Sivan
- Department of Pediatric Pulmonology, Safra Children's Hospital, Sheba Medical Center, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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62
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Piersigilli F, Lam TT, Vernocchi P, Quagliariello A, Putignani L, Aghai ZH, Bhandari V. Identification of new biomarkers of bronchopulmonary dysplasia using metabolomics. Metabolomics 2019; 15:20. [PMID: 30830433 DOI: 10.1007/s11306-019-1482-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify new biomarkers of bronchopulmonary dysplasia (BPD) in preterm neonates. STUDY DESIGN Metabolomic study of prospectively collected tracheal aspirate (TA) samples from preterm neonates admitted in 2 neonatal intensive care units measured by a mass spectroscopy-based assay and analysed using partial least squares-discriminant analysis. RESULTS We evaluated 160 TA samples from 68 neonates, 44 with BPD and 24 without BPD in the first week of life. A cluster of 53 metabolites was identified as characteristic of BPD, with 18 select metabolites being highly significant in the separation of BPD versus No BPD. To control for the gestational age (GA) differences, we did a sub-group analyses, and noted that the amino acids histidine, glutamic acid, citrulline, glycine and isoleucine levels were higher in neonates with BPD. In addition, acylcarnitines C16-OH and C18:1-OH were also higher in neonates who developed BPD, but especially in the most preterm infants (neonates with GA < 27 weeks). CONCLUSION Metabolomics is a promising approach to identify novel specific biomarkers for BPD.
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Affiliation(s)
- Fiammetta Piersigilli
- Division of Perinatal Medicine, and Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
- Division of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - TuKiet T Lam
- Department of Molecular Biophysics & Biochemistry, Yale University, New Haven, CT, USA
- Keck MS & Proteomics Resource, WM Keck Foundation Biotechnology Resource Laboratory, New Haven, CT, USA
| | - Pamela Vernocchi
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Quagliariello
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lorenza Putignani
- Unit of Human Microbiome, Genetic and Rare Diseases Area, Bambino Gesù Children's Hospital, Rome, Italy
- Unit of Parasitology, Department of Laboratory and Immunological Diagnostics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Zubair H Aghai
- Section of Neonatology, Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vineet Bhandari
- Division of Perinatal Medicine, and Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, 160 East Erie Avenue, 19134, Philadelphia, PA, USA.
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63
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Teague WG, Lawrence MG, Shirley DAT, Garrod AS, Early SV, Payne JB, Wisniewski JA, Heymann PW, Daniero JJ, Steinke JW, Froh DK, Braciale TJ, Ellwood M, Harris D, Borish L. Lung Lavage Granulocyte Patterns and Clinical Phenotypes in Children with Severe, Therapy-Resistant Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1803-1812.e10. [PMID: 30654199 DOI: 10.1016/j.jaip.2018.12.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with severe asthma have frequent exacerbations despite guidelines-based treatment with high-dose corticosteroids. The importance of refractory lung inflammation and infectious species as factors contributing to poorly controlled asthma in children is poorly understood. OBJECTIVE To identify prevalent granulocyte patterns and potential pathogens as targets for revised treatment, 126 children with severe asthma underwent clinically indicated bronchoscopy. METHODS Diagnostic tests included bronchoalveolar lavage (BAL) for cell count and differential, bacterial and viral studies, spirometry, and measurements of blood eosinophils, total IgE, and allergen-specific IgE. Outcomes were compared among 4 BAL granulocyte patterns. RESULTS Pauci-granulocytic BAL was the most prevalent granulocyte category (52%), and children with pauci-granulocytic BAL had less postbronchodilator airflow limitation, less blood eosinophilia, and less detection of BAL enterovirus compared with children with mixed granulocytic BAL. Children with isolated neutrophilia BAL were differentiated by less blood eosinophilia than those with mixed granulocytic BAL, but greater prevalence of potential bacterial pathogens compared with those with pauci-granulocytic BAL. Children with isolated eosinophilia BAL had features similar to those with mixed granulocytic BAL. Children with mixed granulocytic BAL took more maintenance prednisone, and had greater blood eosinophilia and allergen sensitization compared with those with pauci-granulocytic BAL. CONCLUSIONS In children with severe, therapy-resistant asthma, BAL granulocyte patterns and infectious species are associated with novel phenotypic features that can inform pathway-specific revisions in treatment. In 32% of children evaluated, BAL revealed corticosteroid-refractory eosinophilic infiltration amenable to anti-TH2 biological therapies, and in 12%, a treatable bacterial pathogen.
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Affiliation(s)
- W Gerald Teague
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va.
| | - Monica G Lawrence
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Debbie-Ann T Shirley
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Andrea S Garrod
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Stephen V Early
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Jackie B Payne
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Julia A Wisniewski
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Peter W Heymann
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - James J Daniero
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - John W Steinke
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Deborah K Froh
- Child Health Research Center, Division of Respiratory Medicine, Allergy, and Immunology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
| | - Thomas J Braciale
- Beirne Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va
| | - Michael Ellwood
- University Physicians Group, University of Virginia School of Medicine, Charlottesville, Va
| | - Drew Harris
- Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Larry Borish
- Division of Allergy, Asthma, and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va; Beirne Carter Immunology Center, University of Virginia School of Medicine, Charlottesville, Va; Department of Microbiology, University of Virginia School of Medicine, Charlottesville, Va
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Verhulst S, Boel L, Van Hoorenbeeck K. Protracted bacterial bronchitis: bronchial aspirate versus bronchoalveolar lavage findings: a single-centre retrospective study. BMJ Paediatr Open 2019; 3:e000507. [PMID: 31321323 PMCID: PMC6598549 DOI: 10.1136/bmjpo-2019-000507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/05/2019] [Indexed: 11/04/2022] Open
Abstract
Retrospective chart review of 133 children who underwent bronchoscopy because of possible protracted bacterial bronchitis to compare the results of bronchial aspirates with those of bronchoalveolar lavage (BAL). When comparing BAL and bronchial aspirate in 70 patients where both samples were available, the result was comparable in 46 cases (65%). If only bronchial aspirates would have been available, seven patients (10%) would have been overtreated, four children (6%) undertreated and three (4%) would have received a different treatment. Although, BAL and bronchial aspirate are comparable in the majority of cases, differences exist with an impact on treatment decision, underlying the uncertainties in the pathophysiology of protracted bacterial bronchitis.
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Affiliation(s)
- Stijn Verhulst
- Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Lab of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | - Lieve Boel
- Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Lab of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | - Kim Van Hoorenbeeck
- Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Lab of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
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65
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Geanacopoulos AT, Savla JJ, Pogoriler J, Piccione J, Phinizy P, DeWitt AG, Blinder JJ, Pinto E, Itkin M, Dori Y, Goldfarb SB. Bronchoscopic and histologic findings during lymphatic intervention for plastic bronchitis. Pediatr Pulmonol 2018; 53:1574-1581. [PMID: 30207430 PMCID: PMC6309194 DOI: 10.1002/ppul.24161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/13/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Percutaneous lymphatic intervention (PCL) is a promising new therapy for plastic bronchitis (PB). We characterized bronchoalveolar lavage (BAL) and cast morphology in surgically repaired congenital heart disease (CHD) patients with PB during PCL. We quantified respiratory and bronchoscopic characteristics and correlated them with post-intervention respiratory outcomes. METHODS We retrospectively reviewed patients with PB and surgically repaired CHD undergoing PCL and bronchoscopy at our institution. Pre-intervention characteristics, bronchoscopy notes, BAL cell counts, virology, and cultures were collected. A pathologist blinded to clinical data reviewed cast specimens. Respiratory outcomes were evaluated through standardized telephone questionnaire. RESULTS Sixty-two patients were included with a median follow-up of 20 months. No patients experienced airway bleeding, obstruction, or prolonged intubation related to bronchoscopy. Of BAL infectious studies, the positive results were 4 (8%) fungal, 6 (11%) bacterial, and 6 (14%) viral. Median BAL count per 100 cells for neutrophils, lymphocytes, and eosinophils were 13, 10, and 0, respectively. Of 23 bronchial casts analyzed, all contained lymphocytes, and 19 (83%) were proteinaceous, with 14 containing neutrophils and/or eosinophils. Median BAL neutrophil count was greater in patients with proteinaceous neutrophilic or eosinophilic casts compared to casts without neutrophils or lymphocytes (P = 0.030). Post-intervention, there was a significant reduction in respiratory medications and support and casting frequency. CONCLUSIONS The predominance of neutrophilic proteinaceous casts and high percentage of positive BAL infectious studies support short-term fibrinolytic and anti-infective therapies in PB in select patients. Flexible bronchoscopy enables safe assessment of cast burden. PCL effectively treats PB and reduces respiratory therapies.
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Affiliation(s)
| | - Jill J Savla
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Pogoriler
- Division of Anatomic Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Piccione
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pelton Phinizy
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aaron G DeWitt
- Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua J Blinder
- Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erin Pinto
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maxim Itkin
- Division of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yoav Dori
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Samuel B Goldfarb
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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66
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de Winter-de Groot KM, Janssens HM, van Uum RT, Dekkers JF, Berkers G, Vonk A, Kruisselbrink E, Oppelaar H, Vries R, Clevers H, Houwen RH, Escher JC, Elias SG, de Jonge HR, de Rijke YB, Tiddens HA, van der Ent CK, Beekman JM. Stratifying infants with cystic fibrosis for disease severity using intestinal organoid swelling as a biomarker of CFTR function. Eur Respir J 2018; 52:13993003.02529-2017. [DOI: 10.1183/13993003.02529-2017] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 07/20/2018] [Indexed: 12/18/2022]
Abstract
Forskolin-induced swelling (FIS) of intestinal organoids from individuals with cystic fibrosis (CF) measures function of the cystic fibrosis transmembrane conductance regulator (CFTR), the protein mutated in CF.We investigated whether FIS corresponds with clinical outcome parameters and biomarkers of CFTR function in 34 infants diagnosed with CF. Relationships with FIS were studied for indicators of pulmonary and gastrointestinal disease.Children with low FIS had higher levels of immunoreactive trypsinogen (p=0.030) and pancreatitis-associated protein (p=0.039), more often had pancreatic insufficiency (p<0.001), had more abnormalities on chest computed tomography (p=0.049), and had lower z-scores for maximal expiratory flow at functional residual capacity (p=0.033) when compared to children with high FIS values. FIS significantly correlated with sweat chloride concentration (SCC) and intestinal current measurement (ICM) (r= −0.82 and r=0.70, respectively; both p<0.001). Individual assessment of SCC, ICM and FIS suggested that FIS can help to classify individual disease severity.Thus, stratification by FIS identified subgroups that differed in pulmonary and gastrointestinal outcome parameters. FIS of intestinal organoids correlated well with established CFTR-dependent biomarkers such as SCC and ICM, and performed adequately at group and individual level in this proof-of-concept study.
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67
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Marsh RL, Nelson MT, Pope CE, Leach AJ, Hoffman LR, Chang AB, Smith-Vaughan HC. How low can we go? The implications of low bacterial load in respiratory microbiota studies. Pneumonia (Nathan) 2018; 10:7. [PMID: 30003009 PMCID: PMC6033291 DOI: 10.1186/s41479-018-0051-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background Culture-independent sequencing methods are increasingly used to investigate the microbiota associated with human mucosal surfaces, including sites that have low bacterial load in healthy individuals (e.g. the lungs). Standard microbiota methods developed for analysis of high bacterial load specimens (e.g. stool) may require modification when bacterial load is low, as background contamination derived from sterile laboratory reagents and kits can dominate sequence data when few bacteria are present. Main body Bacterial load in respiratory specimens may vary depending on the specimen type, specimen volume, the anatomic site sampled and clinical parameters. This review discusses methodological issues inherent to analysis of low bacterial load specimens and recommends strategies for successful respiratory microbiota studies. The range of methods currently used to process DNA from low bacterial load specimens, and the strategies used to identify and exclude background contamination are also discussed. Conclusion Microbiota studies that include low bacterial load specimens require additional tests to ensure that background contamination does not bias the results or interpretation. Several methods are currently used to analyse the microbiota in low bacterial load respiratory specimens; however, there is scant literature comparing the effectiveness and biases of different methods. Further research is needed to define optimal methods for analysing the microbiota in low bacterial load specimens.
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Affiliation(s)
- Robyn L Marsh
- 1Child Health Division, Menzies School of Health Research, Darwin, Northern Territory Australia
| | - Maria T Nelson
- 2Respiratory Medicine, Seattle Children's Hospital and University of Washington, Seattle, Washington USA
| | - Chris E Pope
- 2Respiratory Medicine, Seattle Children's Hospital and University of Washington, Seattle, Washington USA
| | - Amanda J Leach
- 1Child Health Division, Menzies School of Health Research, Darwin, Northern Territory Australia
| | - Lucas R Hoffman
- 2Respiratory Medicine, Seattle Children's Hospital and University of Washington, Seattle, Washington USA
| | - Anne B Chang
- 1Child Health Division, Menzies School of Health Research, Darwin, Northern Territory Australia.,3Department of Respiratory and Sleep Medicine, Children's Health Queensland and Queensland University of Technology, Brisbane, QLD Australia
| | - Heidi C Smith-Vaughan
- 1Child Health Division, Menzies School of Health Research, Darwin, Northern Territory Australia
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68
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Turner S, Custovic A, Ghazal P, Grigg J, Gore M, Henderson J, Lloyd CM, Marsland B, Power UF, Roberts G, Saglani S, Schwarze J, Shields M, Bush A. Pulmonary epithelial barrier and immunological functions at birth and in early life - key determinants of the development of asthma? A description of the protocol for the Breathing Together study. Wellcome Open Res 2018; 3:60. [PMID: 30191183 PMCID: PMC6097397 DOI: 10.12688/wellcomeopenres.14489.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 01/30/2023] Open
Abstract
Background. Childhood asthma is a common complex condition whose aetiology is thought to involve gene-environment interactions in early life occurring at the airway epithelium, associated with immune dysmaturation. It is not clear if abnormal airway epithelium cell (AEC) and cellular immune system functions associated with asthma are primary or secondary. To explore this, we will (i) recruit a birth cohort and observe the evolution of respiratory symptoms; (ii) recruit children with and without asthma symptoms; and (iii) use existing data from children in established STELAR birth cohorts. Novel pathways identified in the birth cohort will be sought in the children with established disease. Our over-arching hypothesis is that epithelium function is abnormal at birth in babies who subsequently develop asthma and progression is driven by abnormal interactions between the epithelium, genetic factors, the developing immune system, and the microbiome in the first years of life. Methods. One thousand babies will be recruited and nasal AEC collected at 5-10 days after birth for culture. Transcriptomes in AEC and blood leukocytes and the upper airway microbiome will be determined in babies and again at one and three years of age. In a subset of 100 individuals, AEC transcriptomes and microbiomes will also be assessed at three and six months. Individuals will be assigned a wheeze category at age three years. In a cross sectional study, 300 asthmatic and healthy children aged 1 to 16 years will have nasal and bronchial AEC collected for culture and transcriptome analysis, leukocyte transcriptome analysis, and upper and lower airway microbiomes ascertained. Genetic variants associated with asthma symptoms will be confirmed in the STELAR cohorts. Conclusions. This study is the first to comprehensively study the temporal relationship between aberrant AEC and immune cell function and asthma symptoms in the context of early gene-microbiome interactions.
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Affiliation(s)
- Steve Turner
- Child Health, University of Aberdeen, Aberdeen, AB25 2ZG, UK
| | - Adnan Custovic
- Department of Paediatrics, Imperial College and Royal Brompton Hospital, London, SW3 6NP, UK
| | - Peter Ghazal
- Division of Infection and Pathway Medicine, Deanery of Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, EH16 4TJ, UK
| | - Jonathan Grigg
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Mindy Gore
- Department of Paediatrics, Imperial College and Royal Brompton Hospital, London, SW3 6NP, UK
| | - John Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TH, UK
| | - Clare M Lloyd
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Ben Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, 3004 , Australia
| | - Ultan F Power
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, PO30 5TG, UK
| | - Sejal Saglani
- Department of Paediatrics, Imperial College and Royal Brompton Hospital, London, SW3 6NP, UK
| | - Jurgen Schwarze
- Child Life and Health and MRC-Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH9 1UW, UK
| | - Michael Shields
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - Andrew Bush
- Department of Paediatrics, Imperial College and Royal Brompton Hospital, London, SW3 6NP, UK
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69
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The CF-Sputum Induction Trial (CF-SpIT) to assess lower airway bacterial sampling in young children with cystic fibrosis: a prospective internally controlled interventional trial. THE LANCET RESPIRATORY MEDICINE 2018; 6:461-471. [PMID: 29778403 PMCID: PMC5971213 DOI: 10.1016/s2213-2600(18)30171-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 01/10/2023]
Abstract
Background Pathogen surveillance is challenging but crucial in children with cystic fibrosis—who are often non-productive of sputum even if actively coughing—because infection and lung disease begin early in life. The role of sputum induction as a diagnostic tool for infection has not previously been systematically addressed in young children with cystic fibrosis. We aimed to assess the pathogen yield from sputum induction compared with that from cough swab and single-lobe, two-lobe, and six-lobe bronchoalveolar lavage. Methods This prospective internally controlled interventional trial was done at the Children's Hospital for Wales (Cardiff, UK) in children with cystic fibrosis aged between 6 months and 18 years. Samples from cough swab, sputum induction, and single-lobe, two-lobe, and six-lobe bronchoalveolar lavage were matched for within-patient comparisons. Primary outcomes were comparative pathogen yield between sputum induction and cough swab for stage 1, and between sputum induction, and single-lobe, two-lobe, and six-lobe bronchoalveolar lavage for stage 2. Data were analysed as per protocol. This study is registered with the UK Clinical Research Network (14615) and with the International Standard Randomised Controlled Trial Network Registry (12473810). Findings Between Jan 23, 2012, and July 4, 2017, 124 patients were prospectively recruited to the trial and had 200 sputum induction procedures for stage 1. 167 (84%) procedures were successful and the procedure was well tolerated. Of the 167 paired samples, 63 (38%) sputum-induction samples were pathogen positive compared with 24 (14%) cough swabs (p<0·0001; odds ratio [OR] 7·5; 95% CI 3·19–17·98). More pathogens were isolated from sputum induction than cough swab (79 [92%] of 86 vs 27 [31%] of 86; p<0·0001). For stage 2, 35 patients had a total of 41 paired sputum-induction and bronchoalveolar lavage procedures. Of the 41 paired samples, 28 (68%) were positive for at least one of the concurrent samples. 39 pathogens were isolated. Sputum induction identified 27 (69%) of the 39 pathogens, compared with 22 (56%; p=0·092; OR 3·3, 95% CI 0·91–12·11) on single-lobe, 28 (72%; p=1·0; OR 1·1, 95% CI 0·41–3·15) on two-lobe, and 33 (85%; p=0·21; OR 2·2, 95% CI 0·76–6·33) on six-lobe bronchoalveolar lavage. Interpretation Sputum induction is superior to cough swab for pathogen detection, is effective at sampling the lower airway, and is a credible surrogate for bronchoalveolar lavage in symptomatic children. A substantial number of bronchoscopies could be avoided if sputum induction is done first and pathogens are appropriately treated. Both sputum induction and six-lobe bronchoalveolar lavage provide independent, sizeable gains in pathogen detection compared with the current gold-standard two-lobe bronchoalveolar lavage. We propose that sputum induction and six-lobe bronchoalveolar lavage combined are used as standard of care for comprehensive lower airway pathogen detection in children with cystic fibrosis. Funding Health and Care Research Wales—Academic Health Science Collaboration and Wellcome Trust Institutional Strategic Support Fund.
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70
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Chen ACH, Tran HB, Xi Y, Yerkovich ST, Baines KJ, Pizzutto SJ, Carroll M, Robertson AAB, Cooper MA, Schroder K, Simpson JL, Gibson PG, Hodge G, Masters IB, Buntain HM, Petsky HL, Prime SJ, Chang AB, Hodge S, Upham JW. Multiple inflammasomes may regulate the interleukin-1-driven inflammation in protracted bacterial bronchitis. ERJ Open Res 2018; 4:00130-2017. [PMID: 29594175 PMCID: PMC5868518 DOI: 10.1183/23120541.00130-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/08/2018] [Indexed: 11/21/2022] Open
Abstract
Protracted bacterial bronchitis (PBB) in young children is characterised by prolonged wet cough, prominent airway interleukin (IL)-1β expression and infection, often with nontypeable Haemophilus influenzae (NTHi). The mechanisms responsible for IL-1-driven inflammation in PBB are poorly understood. We hypothesised that the inflammation in PBB involves the NLRP3 and/or AIM2 inflammasome/IL-1β axis. Lung macrophages obtained from bronchoalveolar lavage (BAL), peripheral blood mononuclear cells (PBMCs), blood monocytes and monocyte-derived macrophages from patients with PBB and age-matched healthy controls were cultured in control medium or exposed to live NTHi. In healthy adult PBMCs, CD14+ monocytes contributed to 95% of total IL-1β-producing cells upon NTHi stimulation. Stimulation of PBB PBMCs with NTHi significantly increased IL-1β expression (p<0.001), but decreased NLRC4 expression (p<0.01). NTHi induced IL-1β secretion in PBMCs from both healthy controls and patients with recurrent PBB. This was inhibited by Z-YVAD-FMK (a caspase-1 selective inhibitor) and by MCC950 (a NLRP3 selective inhibitor). In PBB BAL macrophages inflammasome complexes were visualised as fluorescence specks of NLRP3 or AIM2 colocalised with cleaved caspase-1 and cleaved IL-1β. NTHi stimulation induced formation of specks of cleaved IL-1β, NLRP3 and AIM2 in PBMCs, blood monocytes and monocyte-derived macrophages. We conclude that both the NLRP3 and AIM2 inflammasomes probably drive the IL-1β-dominated inflammation in PBB. Airway IL-1β activation in protracted bacterial bronchitishttp://ow.ly/ut9r30iqim2
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Affiliation(s)
- Alice C-H Chen
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Joint first authors
| | - Hai B Tran
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Joint first authors
| | - Yang Xi
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia
| | - Melanie Carroll
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Kate Schroder
- Institute for Molecular Bioscience, Brisbane, Australia
| | | | | | - Greg Hodge
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Dept of Medicine, The University of Adelaide, Adelaide, Australia
| | - Ian B Masters
- Respiratory and Sleep Medicine, Lady Cilento Children's Hospital and Children's Centre for Health Research, Queensland University of Technology, Brisbane, Australia
| | | | - Helen L Petsky
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Sandra Hodge
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Dept of Medicine, The University of Adelaide, Adelaide, Australia.,Joint senior authors
| | - John W Upham
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Joint senior authors
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71
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Boesch RP, Baughn JM, Cofer SA, Balakrishnan K. Trans-nasal flexible bronchoscopy in wheezing children: Diagnostic yield, impact on therapy, and prevalence of laryngeal cleft. Pediatr Pulmonol 2018; 53:310-315. [PMID: 28910519 DOI: 10.1002/ppul.23829] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/22/2017] [Indexed: 11/07/2022]
Abstract
AIM Persistent or recurrent wheezing is a common indication for flexible bronchoscopy, as anatomic and infectious or inflammatory changes are highly prevalent. We sought to evaluate the prevalence of anatomic, infectious, and inflammatory disease in a cohort of children undergoing flexible bronchoscopy for wheezing or poorly controlled asthma. METHODS We retrospectively reviewed all children <18 years old who underwent flexible bronchoscopy at our center from October 29, 2012-December 31, 2016 for the primary or secondary indication of wheezing (persistent, frequently recurring, or atypical) or poorly controlled asthma. RESULTS A total of 101 procedures were identified in 94 patients, aged 3 months to 18 years. Potential anatomic causes for wheezing identified in 45.7% of patients and inflammatory changes in 49.5% of procedures. This included the identification of a laryngeal cleft in 17% for which half required medical or surgical management. Tracheobronchomalacia was the most commonly identified anatomic lesion. Thirty children from this cohort had poorly controlled asthma. Among this subgroup, 54% had increased neutrophils on BAL and 30% had an anatomic contributor to wheezing, including one with a laryngeal cleft. Based on findings from flexible bronchoscopy, management changes made in 63.8% of patients. This included medication changes in 54 and surgical intervention in 9. DISCUSSION We conclude that transnasal flexible bronchoscopy has high yield in children with recurrent, persistent, or atypical wheezing and those with poorly controlled asthma. Laryngeal cleft has a reasonably high prevalence that warrants specific evaluation in this population.
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Affiliation(s)
- Richard P Boesch
- Mayo Clinic Children's Center, Division of Pediatric Pulmonology, Rochester, Minnesota
| | - Julie M Baughn
- Mayo Clinic Children's Center, Division of Pediatric Pulmonology, Rochester, Minnesota
| | - Shelagh A Cofer
- Mayo Clinic Minnesota, Department of Otorhinolaryngology-Head and Neck Surgery, Rochester, Minnesota
| | - Karthik Balakrishnan
- Mayo Clinic Minnesota, Department of Otorhinolaryngology-Head and Neck Surgery, Rochester, Minnesota
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72
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Autilio C, Echaide M, De Luca D, Pérez-Gil J. Controlled hypothermia may improve surfactant function in asphyxiated neonates with or without meconium aspiration syndrome. PLoS One 2018; 13:e0192295. [PMID: 29420583 PMCID: PMC5805292 DOI: 10.1371/journal.pone.0192295] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/22/2018] [Indexed: 01/14/2023] Open
Abstract
Background Whole-body hypothermia (WBH) is used to improve neurological outcomes in perinatal asphyxia. Recent studies suggested a beneficial effect of hypothermia for some types of acute respiratory failure. However, no data are available about the biophysical function of human surfactant during WBH. We investigated whether WBH improves surfactant biophysical properties in asphyxiated neonates with or without meconium aspiration syndrome (MAS). Methods Non-bronchoscopic bronchoalveolar lavage (BAL) has been collected from 10 asphyxiated neonates (2 with MAS, 8 with no lung disease (NLD)) at different time-points (pre-WBH, 24h, 48h, 72h of WBH and post-WBH). Surfactant was extracted and tested by captive bubble surfactometry (CBS) in triplicate, at 37°C and 33.5°C, through initial adsorption and dynamic compression-expansion cycling. Phosphatidylcholine and cholesterol were assayed using enzymatic methods. Clinical data were recorded in real-time. Results Minimum surface tension under dynamic testing was significantly improved as assessed at 33.5°C compared with its behavior at 37°C in NLD neonates: the difference was evident after at least 72h of WBH and remained significant at 6h after rewarming (72h: p = 0.009; rewarming: p = 0.040). Similar results were obtained in MAS patients whose surfactant activity improved already at 48h of hypothermia. Total cholesterol showed a trend to increase at the first 24-48h of hypothermia in NLD patients. Conversely, hypothermia seemed to reduce the excess of exogenous cholesterol in MAS surfactant. Conclusions Surfactant biophysical properties may improve after 48-72h of WBH in asphyxiated neonates and the improvement is maintained shortly after rewarming. Due to study limitations, further studies are warranted to better clarify the effects of hypothermia on surfactant activity.
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Affiliation(s)
- Chiara Autilio
- Department of Biochemistry, Faculty of Biology and Research Institute Hospital 12 de Octubre, Complutense University, Madrid, Spain
- Laboratory of Clinical Molecular Biology, Department of Laboratory Medicine, “A. Gemelli” University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Mercedes Echaide
- Department of Biochemistry, Faculty of Biology and Research Institute Hospital 12 de Octubre, Complutense University, Madrid, Spain
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Medical Center, South Paris University Hospitals, APHP, Paris, France
| | - Jesús Pérez-Gil
- Department of Biochemistry, Faculty of Biology and Research Institute Hospital 12 de Octubre, Complutense University, Madrid, Spain
- * E-mail:
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73
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Hare KM, Pizzutto SJ, Chang AB, Smith-Vaughan HC, McCallum GB, Beissbarth J, Versteegh L, Grimwood K. Defining lower airway bacterial infection in children with chronic endobronchial disorders. Pediatr Pulmonol 2018; 53:224-232. [PMID: 29265639 PMCID: PMC7167837 DOI: 10.1002/ppul.23931] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Differentiating lower airway bacterial infection from possible upper airway contamination in children with endobronchial disorders undergoing bronchoalveolar lavage (BAL) is important for guiding management. A diagnostic bacterial load threshold based on inflammatory markers has been determined to differentiate infection from upper airway contamination in infants with cystic fibrosis, but not for children with protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD), or bronchiectasis. METHODS BAL samples from children undergoing bronchoscopy underwent quantitative bacterial culture, cytologic examination, and respiratory virus testing; a subset also had interleukin-8 examined. Geometric means (GMs) of total cell counts (TCCs) and neutrophil counts were plotted by respiratory pathogen bacterial load. Logistic regression determined associations between age, sex, Indigenous status, antibiotic exposure, virus detection and bacterial load, and elevated TCCs (>400 × 103 cells/mL) and airway neutrophilia (neutrophils >15% BAL leukocytes). RESULTS From 2007 to 2016, 655 children with PBB, CSLD, or bronchiectasis were enrolled. In univariate analyses, Indigenous status and bacterial load ≥105 colony-forming units (CFU)/mL were positively associated with high TCCs. Viruses and bacterial load ≥104 CFU/mL were positively associated with neutrophilia; negative associations were seen for Indigenous status and macrolides. In children who had not received macrolide antibiotics, bacterial load was positively associated in multivariable analyses with high TCCs at ≥104 CFU/mL and with neutrophilia at ≥105 CFU/mL; GMs of TCCs and neutrophil counts were significantly elevated at 104 and 105 CFU/mL compared to negative cultures. CONCLUSIONS Our findings support a BAL threshold ≥104 CFU/mL to define lower airway infection in children with chronic endobronchial disorders.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Lesley Versteegh
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
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74
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Thorburn K, Fulton C, King C, Ramaneswaran D, Alammar A, McNamara PS. Transaminase levels reflect disease severity in children ventilated for respiratory syncytial virus (RSV) bronchiolitis. Sci Rep 2018; 8:1803. [PMID: 29379110 PMCID: PMC5789039 DOI: 10.1038/s41598-018-20292-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/15/2018] [Indexed: 12/16/2022] Open
Abstract
Bronchiolitis, often caused by respiratory syncytial virus (RSV), is the commonest cause of hospitalisation in infancy. Serum transaminases are sometimes raised in children with bronchiolitis. We tested the hypothesis that raised transaminases are associated with increased disease severity in children ventilated for bronchiolitis. Prospective observational cohort study of mechanically ventilated children with community-acquired RSV bronchiolitis. Alanine transaminase (ALT) and aspartate transaminase (AST) levels were measured daily. Children with normal transaminases were compared with those with elevated levels. Over 11 consecutive winters, 556 children with RSV bronchiolitis were mechanically ventilated – 226 had comorbidities and therefore excluded; 313 of remaining 330 were under 2 years age; 305 had early transaminase measurements. 57/305 (19%) had elevated transaminase (AST and/or ALT) levels. For the first time we show that duration of ventilation and length of admission were both significantly longer, and paediatric index of mortality and C-reactive protein higher, in those with elevated AST levels on admission (but not those with elevated ALT levels). Furthermore, transaminase elevations were transient, generally having normalised by seven days following admission. RSV bronchiolitis was more severe in children with early elevated AST levels and could be used early in the illness as a predictor for disease severity.
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Affiliation(s)
- Kentigern Thorburn
- Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK. .,Department of Clinical Infection, Microbiology & Immunology, The University of Liverpool, Liverpool, L69 7BE, UK.
| | - Crawford Fulton
- Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Charlotte King
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Difijah Ramaneswaran
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Abdulaziz Alammar
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Paul S McNamara
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK.,Paediatric Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
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75
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Griffiths JS, Thompson A, Stott M, Benny A, Lewis NA, Taylor PR, Forton J, Herrick S, Orr SJ, McGreal EP. Differential susceptibility of Dectin-1 isoforms to functional inactivation by neutrophil and fungal proteases. FASEB J 2018; 32:3385-3397. [PMID: 29401615 PMCID: PMC5956239 DOI: 10.1096/fj.201701145r] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Patients with cystic fibrosis (CF) experience chronic or recurrent bacterial and fungal lung infections. Many patients with CF cannot effectively clear Aspergillus from their lungs. This may result in IgE sensitization and the development of allergic bronchopulmonary aspergillosis, or invasive infections, such as Aspergillus bronchitis. Lung disease in patients with CF is associated with neutrophil-dominated inflammation and elevated levels of the serine protease, neutrophil elastase (NE). Various C-type lectin-like receptors (CLRs), including Dectin-1 and Dectin-2, are involved in the immune response to Aspergillus. Here, we show that purified NE cleaves Dectin-1 in an isoform-specific manner. Bronchoalveolar lavage fluid from patients with CF, which contains high NE activity, induces Dectin-1 cleavage. Similarly, filtrate from a protease-producing strain of Aspergillus fumigatus induces isoform-specific cleavage of Dectin-1. Dectin-1 knockout (KO) cells and NE-treated cells demonstrated reduced phagocytosis of zymosan, a fungal cell wall preparation. In addition, NE cleaves 2 other CLRs, Dectin-2 and Mincle, and fungal-induced cytokine production was reduced in Dectin-1 KO cells, Dectin-2 KO cells, and NE-treated cells. Thus, Dectin-1 and Dectin-2 cleavage by NE and/or A. fumigatus–derived proteases results in an aberrant antifungal immune response that likely contributes to disease pathology in patients with CF.—Griffiths, J. S., Thompson, A., Stott, M., Benny, A., Lewis, N. A., Taylor, P. R., Forton, J., Herrick, S., Orr, S. J., McGreal, E. P. Differential susceptibility of Dectin-1 isoforms to functional inactivation by neutrophil and fungal proteases.
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Affiliation(s)
- James S Griffiths
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Aiysha Thompson
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Matthew Stott
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Ankita Benny
- School of Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Natalie A Lewis
- School of Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Philip R Taylor
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Julian Forton
- Children's Hospital for Wales, Cardiff, United Kingdom
| | - Sarah Herrick
- School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Selinda J Orr
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Eamon P McGreal
- Centre for Medical Education, Cardiff University School of Medicine, Cardiff, United Kingdom
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76
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Laguna TA, Williams CB, Nunez MG, Welchlin-Bradford C, Moen CE, Reilly CS, Wendt CH. Biomarkers of inflammation in infants with cystic fibrosis. Respir Res 2018; 19:6. [PMID: 29310632 PMCID: PMC5759377 DOI: 10.1186/s12931-017-0713-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background There are urgent needs for clinically relevant biomarkers to identify children with cystic fibrosis (CF) at risk for more progressive lung disease and to serve as outcome measures for clinical trials. Our objective was to investigate three targeted biomarkers in a population of asymptomatic CF infants. Methods Urine, blood and lung function data were collected for 2 years from clinically stable infants diagnosed with CF by newborn screening. A subset of CF infants had bronchoscopy with lavage performed at 6 months and 1 year. Urine was collected quarterly from healthy control infants. Expectorated sputum and urine were collected quarterly for 2 years from clinically stable CF adults. Desmosine, club cell secretory protein (CCSP) and cathepsin B concentrations were measured and compared. Mixed effects models were used to identify associations between biomarker concentrations and clinical characteristics. Receiver operator characteristic curves were generated to investigate the sensitivity and specificity of the biomarkers. Results Urinary cathepsin B was significantly higher in CF infants compared to healthy infants (p = 0.005). CF infant airway and urinary cathepsin B concentrations were significantly lower compared to adult CF subjects (p = 0.002 & p = 0.022, respectively). CF infant airway CCSP was significantly higher than adult CF subjects (p < 0.001). There was a significant correlation between CF infant plasma CCSP and BALF CCSP (p = 0.046). BALF CCSP was negatively associated with IL-8 (p = 0.017). There was no correlation between biomarker concentration and FEV0.5. Conclusions Cathepsin B and CCSP show promise as biomarkers of inflammation in CF infants. Further study is needed. Electronic supplementary material The online version of this article (10.1186/s12931-017-0713-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Theresa A Laguna
- Minnesota CF Center, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 420 Delaware St. SE; MMC-742, Minneapolis, MN, 55455, USA.
| | - Cynthia B Williams
- Minnesota CF Center, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 420 Delaware St. SE; MMC-742, Minneapolis, MN, 55455, USA
| | - Myra G Nunez
- Minnesota CF Center, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 420 Delaware St. SE; MMC-742, Minneapolis, MN, 55455, USA
| | - Cole Welchlin-Bradford
- Minnesota CF Center, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 420 Delaware St. SE; MMC-742, Minneapolis, MN, 55455, USA
| | - Catherine E Moen
- Minnesota CF Center, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 420 Delaware St. SE; MMC-742, Minneapolis, MN, 55455, USA
| | - Cavan S Reilly
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Chris H Wendt
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota and Veterans Administration Medical Center, Minneapolis, MN, USA
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Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain. Eur J Pediatr 2018; 177:181-192. [PMID: 29285648 PMCID: PMC5758651 DOI: 10.1007/s00431-017-3044-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
Abstract
UNLABELLED This cross-sectional study assessed the prevalence of bacteria isolated from Spanish children with suspected chronic lower respiratory tract infection (LRTI) for whom bronchoalveolar lavage (BAL) was indicated. BAL fluid (BALF) was collected from 191 children (aged ≥ 6 months to < 6 years, with persistent or recurrent respiratory symptoms, non-responders to usual treatment) and cultured. Nasopharyngeal swabs (NPSs) were also obtained and cultured to assess concordance of BALF and NPS findings in the same patient. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were identified from BALF with a bacterial load indicative of infection (> 104 colony-forming units/mL) in 10.5, 8.9, and 6.3% of children, respectively. Clinical characteristics were similar among participants, regardless of positivity status for any of the bacteria. Approximately 26% of pneumococcal isolates were PCV13 serotypes, and 96% of H. influenzae isolates were non-typeable (NTHi). Concordance between BALF and NPS isolates was 51.0% for S. pneumoniae, 52.1% for H. influenzae, and 22.0% for M. catarrhalis. CONCLUSION S. pneumoniae, NTHi, and M. catarrhalis were the main bacteria detected in BALF and NPS. Children with suspected chronic LRTI may benefit from a vaccine protecting against NTHi. What is Known: • Chronic lower respiratory tract infection (LRTI) in children can cause high morbidity and is a major use of healthcare resources worldwide. Despite this, their etiology or potential preventive measures are poorly assessed. • Bronchoalveolar lavage can be used to determine bacterial etiology of chronic LRTI. What is New: • We used conventional and molecular techniques to show that Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were present in the LRT of Spanish children with suspected chronic LRTI • Concordance between isolates from bronchoalveolar lavage fluid and nasopharyngeal swabs was low, suggesting that samples from the upper respiratory tract could not reliably predict the bacterial etiology of suspected chronic LRTI.
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78
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Di Filippo P, Scaparrotta A, Petrosino MI, Attanasi M, Di Pillo S, Chiarelli F, Mohn A. An underestimated cause of chronic cough: The Protracted Bacterial Bronchitis. Ann Thorac Med 2018; 13:7-13. [PMID: 29387250 PMCID: PMC5772114 DOI: 10.4103/atm.atm_12_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Chronic cough in childhood is associated with a high morbidity and decreased quality of life. Protracted bacterial bronchitis (PBB) seems to be the second most common cause of chronic cough in children under 6 years of age. Its main clinical feature is represented by wet cough that worsens when changing posture and improves after the introduction of antibiotics. Currently, the mainstay of PBB treatment is a 2-week therapy with a high dose of antibiotics, such as co-amoxiclav, to eradicate the infection and restore epithelial integrity. It is very important to contemplate this disease in a child with chronic cough since the misdiagnosis of PBB could lead to complications such as bronchiectasis. Clinicians, however, often do not consider this disease in the differential diagnosis and, consequently, they are inclined to change the antibiotic therapy rather than to extend it or to add steroids. Data sources of this review include PubMed up to December 2016, using the search terms “child,” “chronic cough,” and “protracted bacterial bronchitis.”
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Affiliation(s)
- Paola Di Filippo
- Department of Pediatrics, University of Chieti, 66100 Chieti, Italy
| | | | | | - Marina Attanasi
- Department of Pediatrics, University of Chieti, 66100 Chieti, Italy
| | - Sabrina Di Pillo
- Department of Pediatrics, University of Chieti, 66100 Chieti, Italy
| | | | - Angelika Mohn
- Department of Pediatrics, University of Chieti, 66100 Chieti, Italy
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79
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Hammoud MS, Raghupathy R, Barakat N, Eltomi H, Elsori D. Cytokine profiles at birth and the risk of developing severe respiratory distress and chronic lung disease. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:62. [PMID: 28616049 PMCID: PMC5461589 DOI: 10.4103/jrms.jrms_1088_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 01/21/2017] [Accepted: 02/03/2017] [Indexed: 11/17/2022]
Abstract
Background: Neonates with the diagnosis of respiratory distress syndrome (RDS) were studied to investigate possible associations between cytokine levels at birth and developing severe RDS or chronic lung disease (CLD). Materials and Methods: This was a cross-sectional study on serum and bronchoalveolar lavage (BAL) samples collected within hours of birth from infants with moderate and severe RDS. Twenty infants with moderate RDS and 20 infants with severe RDS were studied. RDS was diagnosed on the basis of radiographic findings, respiratory distress, and an increasing oxygen requirement. RDS severity was graded based on the radiological findings and Downe's Score. CLD was diagnosed when infants were still on supplemented O2 by at least 28 days of age. Levels of the cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor alpha were measured using enzyme-linked immunosorbent assay. “Statistical analysis was performed using the SPSS for Windows, (SPSS Inc., Chicago, IL, USA).” Results: Levels of the proinflammatory cytokines IL-8 and IL-1β were significantly higher in BAL of infants with severe RDS than those with moderate RDS (P = 0.007 and P = 0.02, respectively). IL-8 levels were also significantly higher in BAL and serum of infants who later progressed to CLD than in those who did not (P = 0.03 for both). The IL-8/IL-10 cytokine ratio was significantly higher in the BAL of severe RDS infants than in moderate RDS (P = 0.01) and in the serum of infants who progressed to CLD than in those who did not (P = 0.03). Conclusion: Levels of IL-8 and the IL-8/IL-10 ratio measured soon after birth were associated with severity of RDS as well as progression to CLD. Early measurement of cytokines levels and ratios may contribute to the prognosis and management of RDS and CLD.
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Affiliation(s)
- Majeda S Hammoud
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait
| | - Raj Raghupathy
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Nahla Barakat
- Department of Neonatology, Maternity Hospital, Kuwait
| | - Hoda Eltomi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Deena Elsori
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
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80
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Prevaes SMPJ, de Steenhuijsen Piters WAA, de Winter-de Groot KM, Janssens HM, Tramper-Stranders GA, Chu MLJN, Tiddens HA, van Westreenen M, van der Ent CK, Sanders EAM, Bogaert D. Concordance between upper and lower airway microbiota in infants with cystic fibrosis. Eur Respir J 2017; 49:49/3/1602235. [PMID: 28356374 DOI: 10.1183/13993003.02235-2016] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/23/2016] [Indexed: 12/29/2022]
Abstract
Nasopharyngeal and oropharyngeal samples are commonly used to direct therapy for lower respiratory tract infections in non-expectorating infants with cystic fibrosis (CF).We aimed to investigate the concordance between the bacterial community compositions of 25 sets of nasopharyngeal, oropharyngeal and bronchoalveolar lavage (BAL) samples from 17 infants with CF aged ∼5 months (n=13) and ∼12 months (n=12) using conventional culturing and 16S-rRNA sequencing.Clustering analyses demonstrated that BAL microbiota profiles were in general characterised by a mixture of oral and nasopharyngeal bacteria, including commensals like Streptococcus, Neisseria, Veillonella and Rothia spp. and potential pathogens like Staphylococcus aureus, Haemophilus influenzae and Moraxella spp. Within each individual, however, the degree of concordance differed between microbiota of both upper respiratory tract niches and the corresponding BAL.The inconsistent intra-individual concordance between microbiota of the upper and lower respiratory niches suggests that the lungs of infants with CF may have their own microbiome that seems seeded by, but is not identical to, the upper respiratory tract microbiome.
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Affiliation(s)
- Sabine M P J Prevaes
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Wouter A A de Steenhuijsen Piters
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.,Both authors contributed equally
| | - Karin M de Winter-de Groot
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.,Both authors contributed equally
| | - Hettie M Janssens
- Dept of Paediatric Pulmonology and Allergology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerdien A Tramper-Stranders
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mei Ling J N Chu
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Harm A Tiddens
- Dept of Paediatric Pulmonology and Allergology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mireille van Westreenen
- Dept of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Cornelis K van der Ent
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elisabeth A M Sanders
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Debby Bogaert
- Dept of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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81
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Laube M, Amann E, Uhlig U, Yang Y, Fuchs HW, Zemlin M, Mercier JC, Maier RF, Hummler HD, Uhlig S, Thome UH. Inflammatory Mediators in Tracheal Aspirates of Preterm Infants Participating in a Randomized Trial of Inhaled Nitric Oxide. PLoS One 2017; 12:e0169352. [PMID: 28046032 PMCID: PMC5207654 DOI: 10.1371/journal.pone.0169352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ventilated preterm infants frequently develop bronchopulmonary dysplasia (BPD) which is associated with elevated inflammatory mediators in their tracheal aspirates (TA). In animal models of BPD, inhaled nitric oxide (iNO) has been shown to reduce lung inflammation, but data for human preterm infants is missing. METHODS Within a European multicenter trial of NO inhalation for preterm infants to prevent BPD (EUNO), TA was collected to determine the effects of iNO on pulmonary inflammation. TA was collected from 43 premature infants randomly assigned to receive either iNO or placebo gas (birth weight 530-1230 g, median 800 g, gestational age 24 to 28 2/7 weeks, median 26 weeks). Interleukin (IL)-1β, IL-6, IL-8, transforming growth factor (TGF)-β1, interferon γ-induced protein 10 (IP-10), macrophage inflammatory protein (MIP)-1α, acid sphingomyelinase (ASM), neuropeptide Y and leukotriene B4 were measured in serial TA samples from postnatal day 2 to 14. Furthermore, TA levels of nitrotyrosine and nitrite were determined under iNO therapy. RESULTS The TA levels of IP-10, IL-6, IL-8, MIP-1α, IL-1β, ASM and albumin increased with advancing postnatal age in critically ill preterm infants, whereas nitrotyrosine TA levels declined in both, iNO-treated and placebo-treated infants. The iNO treatment generally increased nitrite TA levels, whereas nitrotyrosine TA levels were not affected by iNO treatment. Furthermore, iNO treatment transiently reduced early inflammatory and fibrotic markers associated with BPD development including TGF-β1, IP-10 and IL-8, but induced a delayed increase of ASM TA levels. CONCLUSION Treatment with iNO may have played a role in reducing several inflammatory and fibrotic mediators in TA of preterm infants compared to placebo-treated infants. However, survival without BPD was not affected in the main EUNO trial. TRIAL REGISTRATION NCT00551642.
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Affiliation(s)
- Mandy Laube
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents, Division of Neonatology, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Elena Amann
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Ulrike Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Yang Yang
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Hans W. Fuchs
- Department of Pediatrics, University Medical Center Freiburg, Freiburg, Germany
| | - Michael Zemlin
- Department of Pediatrics, University of Marburg, Marburg, Germany
- Department of Pediatrics, University of Saarland, Homburg, Germany
| | | | - Rolf F. Maier
- Department of Pediatrics, University of Marburg, Marburg, Germany
| | - Helmut D. Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Stefan Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Ulrich H. Thome
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents, Division of Neonatology, University of Leipzig, Leipzig, Germany
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82
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Pizzutto SJ, Hare KM, Upham JW. Bronchiectasis in Children: Current Concepts in Immunology and Microbiology. Front Pediatr 2017; 5:123. [PMID: 28611970 PMCID: PMC5447051 DOI: 10.3389/fped.2017.00123] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 12/26/2022] Open
Abstract
Bronchiectasis is a complex chronic respiratory condition traditionally characterized by chronic infection, airway inflammation, and progressive decline in lung function. Early diagnosis and intensive treatment protocols can stabilize or even improve the clinical prognosis of children with bronchiectasis. However, understanding the host immunologic mechanisms that contribute to recurrent infection and prolonged inflammation has been identified as an important area of research that would contribute substantially to effective prevention strategies for children at risk of bronchiectasis. This review will focus on the current understanding of the role of the host immune response and important pathogens in the pathogenesis of bronchiectasis (not associated with cystic fibrosis) in children.
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Affiliation(s)
- Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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83
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Gentner S, Laube M, Uhlig U, Yang Y, Fuchs HW, Dreyhaupt J, Hummler HD, Uhlig S, Thome UH. Inflammatory Mediators in Tracheal Aspirates of Preterm Infants Participating in a Randomized Trial of Permissive Hypercapnia. Front Pediatr 2017; 5:246. [PMID: 29209598 PMCID: PMC5702441 DOI: 10.3389/fped.2017.00246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/06/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ventilator-induced lung injury is considered to be a main factor in the pathogenesis of bronchopulmonary dysplasia (BPD). Optimizing ventilator strategies may reduce respiratory morbidities in preterm infants. Permissive hypercapnia has been suggested to attenuate lung injury. We aimed to determine if a higher PCO2 target range results in less lung injury compared to the control target range and possibly reduces pro-inflammatory cytokines and acid sphingomyelinase (ASM) in tracheal aspirates (TA), which has not been addressed before. METHODS During a multicenter trial of permissive hypercapnia in extremely low birthweight infants (PHELBI), preterm infants (birthweight 400-1,000 g, gestational age 23 0/7-28 6/7 weeks) requiring mechanical ventilation within 24 h of birth were randomly assigned to a high PCO2 target or a control group. The high target group aimed at PCO2 values of 55-65, 60-70, and 65-75 mmHg and the control group at PCO2 values of 40-50, 45-55 and 50-60 mmHg on postnatal days 1-3, 4-6, and 7-14, respectively. TA was analyzed for pro-inflammatory cytokines from postnatal day 2-21. BPD was determined at a postmenstrual age of 36 weeks ± 2 days. MAIN FINDINGS Levels of inflammatory cytokines and ASM were similar in both groups: interleukin (IL)-6 (p = 0.14), IL-8 (p = 0.43), IL-10 (p = 0.24), IL-1β (p = 0.11), macrophage inflammatory protein 1α (p = 0.44), albumin (p = 0.41), neuropeptide Y (p = 0.52), leukotriene B4 (p = 0.11), transforming growth factor-β1 (p = 0.68), nitrite (p = 0.15), and ASM (p = 0.94). Furthermore, most inflammatory mediators were strongly affected by the age of the infants and increased from postnatal day 2 to 21. BPD or death was observed in 14 out of 62 infants, who were distributed evenly between both groups. CONCLUSION The results suggest that high PCO2 target levels did not result in lower pulmonary inflammatory activity and thus reflect clinical results. This indicates that high PCO2 target ranges are not effective in reducing ventilator-induced lung injury in preterm infants, as compared to control targets. TRIAL REGISTRATION ISRCTN56143743.
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Affiliation(s)
- Sarah Gentner
- Division of Vascular Surgery, University of Ulm, Ulm, Germany
| | - Mandy Laube
- Center for Pediatric Research Leipzig, Hospital for Children and Adolescents, Division of Neonatology, University of Leipzig, Leipzig, Germany
| | - Ulrike Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Yang Yang
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Hans W Fuchs
- Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Helmut D Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Stefan Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Ulrich H Thome
- Center for Pediatric Research Leipzig, Hospital for Children and Adolescents, Division of Neonatology, University of Leipzig, Leipzig, Germany
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84
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Pourakbari B, Mahmoudi S, Jafari AH, Bahador A, Keshavarz Valian S, Hosseinpour Sadeghi R, Mamishi S. Clinical, cytological and microbiological evaluation of bronchoalveolar lavage in children: A referral hospital-based study. Microb Pathog 2016; 100:179-183. [PMID: 27666511 DOI: 10.1016/j.micpath.2016.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/22/2016] [Accepted: 09/21/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Diffuse lung diseases (DLD) in children involve a group of heterogeneous, rare disorders. In spite of the low diagnostic yield in pediatric DLD, bronchoalveolar lavage (BAL) can be used to diagnose specific disorders. There are few studies about microbial and cellular profiles of BAL samples in these patients. This study was conducted to evaluate the clinical, cytological and microbiological evaluation of BAL in children with DLD. METHODS The clinical, cytological and microbiological profiles of BAL samples of all patients with DLD who underwent the fiberoptic bronchoscopy (FOB) at Children's Medical Center, an Iranian referral pediatrics Hospital during a year were evaluated. RESULTS In 18 patients (18.4%) of the 98 cases studied, 22 pathogens were obtained as etiologic agents. The mean total cells count of BAL was 23.9 × 104 ± 12.9 × 104/ml. The mean percentages of cellular components were macrophages (70.2%), neutrophils (16.3%), lymphocytes (11.8%) and eosinophils (1.4%), respectively. The type of lung disease was significantly associated with the mean percentage of lymphocytes (p = 0.005) and the percentage of neutrophils (p = 0.042). CONCLUSION FOB and BAL evaluation in combination with clinical and radiographic imaging data may be helpful for identifying of presumptive diagnosis of DLD in children.
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Affiliation(s)
- Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jafari
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Bahador
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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85
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Gu W, Jiang W, Zhang X, Chen Z, Yan Y, Huang L, Wang M, Shao X, Wang S, Ji W. Refractory wheezing in Chinese children under 3 years of age: bronchial inflammation and airway malformation. BMC Pediatr 2016; 16:145. [PMID: 27568177 PMCID: PMC5002096 DOI: 10.1186/s12887-016-0680-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Wheezing is a common symptom in early childhood. However, refractory wheezing is difficult to treat, and it may thus account for extensive use of medical resources. It is therefore important to improve our understanding of the pathophysiology of refractory childhood wheezing. Methods In this descriptive study, we studied 156 children with refractory wheezing using fiberoptic bronchoscopy and bronchoalveolar lavage (BAL), and compared the results with a control group of 46 children with various pulmonary diseases but no wheezing. Etiology and cell classification were analyzed for each BAL sample. Results Overall, 21.8 % of children with refractory wheezing had airway malformations including tracheomalacia, airway stenosis, and tracheal bronchus. The incidence of airway malformations increased to 31 % in infants under 12 months of age. A significant increase in neutrophil ratio and decrease in macrophage ratio were observed in BAL from children with refractory wheezing compared with controls. Pathogen infection led to a higher ratio of neutrophils in the wheezing group compared with controls. However, there were no significant differences in neutrophil ratios among children with various pathogen infections. Furthermore, children with refractory wheezing had a high rate of Mycoplasma pneumoniae infection. Conclusions Airway malformations might play an important role in children under 3 years of age with refractory wheezing, especially in infants under 12 months of age. Neutrophil-mediated airway inflammation was characteristic of refractory wheezing in children under 3 years of age. In addition, infections such as M. pneumoniae may aggravate airway inflammation and affect refractory wheezing.
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Affiliation(s)
- Wenjing Gu
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Wujun Jiang
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Xinxing Zhang
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Zhengrong Chen
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Yongdong Yan
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Li Huang
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Meijuan Wang
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Xuejun Shao
- Department of Clinical laboratory, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Shuhui Wang
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China
| | - Wei Ji
- Department of Respiration, Children's Hospital of Soochow University, Suzhou, 215003, China.
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86
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Hackett AP, Trinick RE, Rose K, Flanagan BF, McNamara PS. Weakly acidic pH reduces inflammatory cytokine expression in airway epithelial cells. Respir Res 2016; 17:82. [PMID: 27422381 PMCID: PMC4947271 DOI: 10.1186/s12931-016-0399-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023] Open
Abstract
Background Aspiration lung disease (ALD) is a common cause of respiratory morbidity in children and adults with severe neurodisability (sND). Recent studies suggest that chronic microaspiration of gastric contents is associated with mild rather than low, airway acidification. We investigated inflammatory responses to infection by airway epithelial cells (AECs) exposed to weakly acidic media. Methods Using pH measurements from children with sND at high risk of ALD as a guide, we incubated AECs in weakly acidic (pH5.5–7.4) media alone; in combination with lipopolysaccharide (LPS); or prior to LPS stimulation at normal pH. Interleukin (IL) -6 and IL-8 expression were measured. Results IL-6/8 expression in AECs simultaneously exposed to weakly acidic media and LPS for 4 h was reduced with no effect on cell viability. Pre-incubation of AECs at weakly acidic pH also reduced subsequent LPS-induced cytokine expression. Suppression of inflammation was greatest at lower pHs (pH 5.5–6.0) for prolonged periods (16/24 h), but this also adversely affected cell viability. Conclusion AEC inflammatory responses to bacterial stimuli is markedly reduced in a mildly acidic environment.
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Affiliation(s)
- A P Hackett
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - R E Trinick
- Alder Hey Children's Hospital NHS Foundation Trust, Eaton Rd, Liverpool, UK
| | - K Rose
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - B F Flanagan
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - P S McNamara
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. .,Alder Hey Children's Hospital NHS Foundation Trust, Eaton Rd, Liverpool, UK.
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87
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Marsh RL, Kaestli M, Chang AB, Binks MJ, Pope CE, Hoffman LR, Smith-Vaughan HC. The microbiota in bronchoalveolar lavage from young children with chronic lung disease includes taxa present in both the oropharynx and nasopharynx. MICROBIOME 2016; 4:37. [PMID: 27388563 PMCID: PMC4936249 DOI: 10.1186/s40168-016-0182-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/24/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Invasive methods requiring general anaesthesia are needed to sample the lung microbiota in young children who do not expectorate. This poses substantial challenges to longitudinal study of paediatric airway microbiota. Non-invasive upper airway sampling is an alternative method for monitoring airway microbiota; however, there are limited data describing the relationship of such results with lung microbiota in young children. In this study, we compared the upper and lower airway microbiota in young children to determine whether non-invasive upper airway sampling procedures provide a reliable measure of either lung microbiota or clinically defined differences. RESULTS The microbiota in oropharyngeal (OP) swabs, nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) from 78 children (median age 2.2 years) with and without lung disease were characterised using 16S rRNA gene sequencing. Permutational multivariate analysis of variance (PERMANOVA) detected significant differences between the microbiota in BAL and those in both OP swabs (p = 0.0001, Pseudo-F = 12.2, df = 1) and NP swabs (p = 0.0001; Pseudo-F = 21.9, df = 1) with the NP and BAL microbiota more different than the OP and BAL, as indicated by a higher Pseudo-F value. The microbiota in combined OP and NP data (upper airways) provided a more comprehensive representation of BAL microbiota, but significant differences between the upper airway and BAL microbiota remained, albeit with a considerably smaller Pseudo-F (PERMANOVA p = 0.0001; Pseudo-F = 4.9, df = 1). Despite this overall difference, paired BAL and upper airway (OP and NP) microbiota were >50 % similar among 69 % of children. Furthermore, canonical analysis of principal coordinates (CAP analysis) detected significant differences between the microbiota from clinically defined groups when analysing either BAL (eigenvalues >0.8; misclassification rate 26.5 %) or the combined OP and NP data (eigenvalues >0.8; misclassification rate 12.2 %). CONCLUSIONS Upper airway sampling provided an imperfect, but reliable, representation of the BAL microbiota for most children in this study. We recommend inclusion of both OP and NP specimens when non-invasive upper airway sampling is needed to assess airway microbiota in young children who do not expectorate. The results of the CAP analysis suggest lower and upper airway microbiota profiles may differentiate children with chronic suppurative lung disease from those with persistent bacterial bronchitis; however, further research is needed to confirm this observation.
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Affiliation(s)
- R. L. Marsh
- />Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0810 Australia
| | - M. Kaestli
- />Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0810 Australia
- />Research Institute for the Environment and Livelihoods, Charles Darwin University, Darwin, NT Australia
| | - A. B. Chang
- />Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0810 Australia
- />Queensland Children’s Medical Research Institute, Queensland University of Technology, Brisbane, QLD Australia
| | - M. J. Binks
- />Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0810 Australia
| | - C. E. Pope
- />Department of Pediatrics, University of Washington, Seattle, WA USA
- />Department of Microbiology, University of Washington, Seattle, WA USA
| | - L. R. Hoffman
- />Department of Pediatrics, University of Washington, Seattle, WA USA
- />Department of Microbiology, University of Washington, Seattle, WA USA
| | - H. C. Smith-Vaughan
- />Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0810 Australia
- />School of Medicine, Griffith University, Gold Coast, QLD Australia
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88
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Wang LL, Zheng SY, Ren L, Xiao QY, Long XR, Luo J, Li QB, Deng Y, Xie XH, Liu EM. [Levels of surfactant proteins A and D in bronchoalveolar lavage fluid of children with pneumonia and their relationships with clinical characteristics]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:386-390. [PMID: 27165584 PMCID: PMC7390360 DOI: 10.7499/j.issn.1008-8830.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/04/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To observe the levels of pulmonary surfactant proteins A and D (SP-A, SP-D) in bronchoalveolar lavage fluid (BALF) of children with pneumonia, and to explore their relationships with clinical characteristics. METHODS Thirty-five children with pneumonia were enrolled in this study. Differential cell counts were obtained by Countstar counting board. The levels of SP-A and SP-D in BALF were detected using ELISA. RESULTS In children with pneumonia, SP-D levels were significantly higher than SP-A levels (P<0.001). SP-D levels were negatively correlated with the neutrophil percentage in BALF (r(s)=-0.5255, P<0.01). SP-D levels in BALF in children with increased blood C-reactive protein levels (>8 mg/L) were significantly lower than in those with a normal level of C-reactive protein (P<0.05). Compared with those in children without wheezing, SP-D levels in children with wheezing were significantly lower (P<0.01). There was no correlation between SP-A levels and clinical characteristics. CONCLUSIONS SP-D levels in BALF are significantly higher than SP-A levels, and have a certain correlation with clinical characteristics in children with pneumonia. As a protective factor, SP-D plays a more important role than SP-A in regulating the immune and inflammatory responses.
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Affiliation(s)
- Li-Li Wang
- Pediatric Research Institute of Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
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89
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Selimovic A, Mujicic E, Milisic S, Pejicic T, Rancic M, Mesihovic-Dinarevic S, Lukic-Bilela L, Moro M. The Significance of Bronchoalveolar Lavage Fluid Cytology in Diagnosing Lung Infiltrates in Children. Med Arch 2016; 70:27-30. [PMID: 26980927 PMCID: PMC4779357 DOI: 10.5455/medarh.2016.70.27-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/05/2015] [Indexed: 11/03/2022] Open
Abstract
AIM The aim of this research is to show why is it important in diagnosing children with lung infiltrates. METHODS Our study included 50 children with lung infiltrates during period 2005-2012, and was conducted on Pediatric Clinic of the University Clinical Center Sarajevo. We sent all cytological BAL analyses to the University Clinical Center Sarajevo. Cytology was performed by direct microscopy. BAL cytology was performed by the principle of sending samples for centrifuging, 12000 revolutions during a 10 min Shandon-cyto spin. Then the centrifuged sample is dried in the air during 1-2 hours, and is then dyed under the May-Grünwald-Giemsa staining, and analyzed under the Olympus BX41 microscope. RESULTS Nosocomial pneumonia has occurred in 32% children, acquired pneumonia in 38%, and 30% children had a lung infiltrates. 6 (12%) of children were younger then 1 year old, 23 (46%) children were between 1 to 5 years, 14 (28%) of children were between 5 to 10 ages, and 7 (14%) of children were between 10-15 ages. The most of the changes in observed children took place on the right lung, 34%, while 26% occurred on the left side, 22% were normal and 18% changes have affected both lungs, right and left. Percentage of cells in cytological smear in children with BAL were: cylindrical cells 28%, lung macrophage 26%, lymphocytes 17%, detritus 17% and phlegm 12%. Erythrocyte sedimentation rate (ESR) in children with BAL was up to 10-52%, to 50-30%, while ESR after first hour was above 50-18 %. CONCLUSION Clinical parameters and local inflammation of the affected lobe are associated with positive bronchoalveolar cytology lavage findings.
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Affiliation(s)
- Amina Selimovic
- Pediatric Clinic of the University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ermina Mujicic
- Department for Cardioanesthesiology, Clinic for anesthesiology, reanimatology and intensive care of the University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Selma Milisic
- Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Tanja Pejicic
- Clinic for Lung Diseases and TB "Knez Selo", Clinical Center Niš, Serbia
| | - Milan Rancic
- Clinic for Lung Diseases and TB "Knez Selo", Clinical Center Niš, Serbia
| | | | - Lada Lukic-Bilela
- Department of Biology, Faculty of Science, University of Sarajevo, Sarajevo, Bosnia and Hezegovina
| | - Mahir Moro
- Department of Orthopedic Surgery, General Hospital "Prim.dr.Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
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90
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Hypoxic-ischemic brain damage induces distant inflammatory lung injury in newborn piglets. Pediatr Res 2016; 79:401-8. [PMID: 25950454 DOI: 10.1038/pr.2015.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/26/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to investigate whether neonatal hypoxic-ischemic (HI) brain injury induces inflammatory lung damage. METHODS Thus, hypoxic (HYP, FiO2 10% for 30 min), ischemic (ISC, bilateral carotid flow interruption for 30 min), or HI event was performed in 1-2-d-old piglets. Dynamic compliance (Cdyn), oxygenation index (OI), and extravascular lung water (EVLW) were monitored for 6 h. Then, histologic damage was assessed in brain and lung (lung injury severity score). Total protein content (TPC) was determined in broncoalveolar lavage fluid (BALF), and IL-1β concentration was measured in lung and brain tissues and blood. RESULTS Piglets without hypoxia or ischemia served as controls (SHM). HI-induced brain damage was associated with decreased Cdyn, increased OI and EVLW, and histologic lung damage (interstitial leukocyte infiltration, congestive hyperemia, and interstitial edema). BALF TPC was increased, suggesting inflammatory damage. In agreement, tissue IL-1β concentration increased in the brain and lung, in correspondence with increased IL-1β serum concentration. Neither HYP nor ISC alone led to brain or lung damage. CONCLUSION HI brain damage in newborn piglets led to inflammatory lung damage, suggesting an additional mechanism accounting for the development of lung dysfunction after neonatal HI encephalopathy.
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91
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Nicolai T, Schramm D, Hammer J, Eber E, Eich CB, Hinrichs B. Bronchoskopie bei Kindern. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0046-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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92
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Terkawi RS, Altirkawi KA, Terkawi AS, Mukhtar G, Al-Shamrani A. Flexible bronchoscopy in children: Utility and complications. Int J Pediatr Adolesc Med 2016; 3:18-27. [PMID: 30805463 PMCID: PMC6372410 DOI: 10.1016/j.ijpam.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 12/02/2022]
Abstract
Background and objectives The flexible bronchoscope has become widely used by pediatric pulmonologists as a diagnostic and therapeutic tool. Nevertheless, there are several gaps in our knowledge to help refine its use and reduce its complications. In this study, we aimed to evaluate the utility and complications of pediatric bronchoscopy. Design and setting We conducted a retrospective review of bronchoscopy cases between March 2006 and April 2015 at a tertiary care medical center (King Fahad Medical City). One-hundred forty nine patients were studied. Patients and methods We evaluated how bronchoscopy contributed to the patients' diagnosis, assessed the accuracy of bronchoalveolar lavage white blood cell count (BAL WBC) to differentiate between infectious and non-infectious conditions, assessed the ability of clinical factors to predict high risk of desaturation during bronchoscopy, and finally summarized the reported procedural complications. Results We found pediatric bronchoscopy was a crucial diagnostic (confirming, ruling out, and discovering unexpected diagnosis) and therapeutic tool. The accuracy of BAL WBC counts is poor (AUC (95% CI) = 0.609 (0.497–0.712)); however, using two cutoff values (≤10 WBCs (sensitivity = 84.44% and specificity = 29.27%) to rule out, and ≥400 WBCs (sensitivity = 33.33% and specificity 81.49%) to rule in infection) helped in early differentiation between infectious and non-infectious conditions. From the factors that we test, none we found predictive of desaturation. The most common procedural complication was desaturation (pooled incidence (95% CI) = 13 (8–19)%) followed by cough, mild airway bleeding, and spasm. Conclusions Flexible bronchoscopy is an important and relatively safe diagnostic and therapeutic tool in pediatric medicine, and utilization of this service should be encouraged after a careful consideration of which patient needs this procedure and a rigorous estimate of its pros and cons.
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Affiliation(s)
- Rayan S Terkawi
- Department of Surgery, Sanad Hospital, Riyadh, Saudi Arabia.,Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Abdullah S Terkawi
- Department of Anaesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.,Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Gawahir Mukhtar
- Department of Pediatric Pulmonology, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al-Shamrani
- Department of Pediatric Pulmonology, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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93
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Abstract
The respiratory tract, once believed to be sterile, harbors diverse bacterial communities. The role of microorganisms within health and disease is slowly being unraveled. Evidence points to the neonatal period as a critical time for establishing stable bacterial communities and influencing immune responses important for long-term respiratory health. This review summarizes the evidence of early airway and lung bacterial colonization and the role the microbiome has on respiratory health in the short and long term. The challenges of neonatal respiratory microbiome studies and future research directions are also discussed.
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Affiliation(s)
- David J Gallacher
- Department of Child Health, School of Medicine, Cardiff University , Cardiff , UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University , Cardiff , UK
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94
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Lezmi G, Gosset P, Deschildre A, Abou-Taam R, Mahut B, Beydon N, de Blic J. Airway Remodeling in Preschool Children with Severe Recurrent Wheeze. Am J Respir Crit Care Med 2015; 192:164-71. [PMID: 25961111 DOI: 10.1164/rccm.201411-1958oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Airway wall structure in preschoolers with severe recurrent wheeze is poorly described. OBJECTIVES To describe airway wall structure and inflammation in preschoolers with severe recurrent wheeze. METHODS Flexible bronchoscopy was performed in two groups of preschoolers with severe recurrent wheeze: group 1, less than or equal to 36 months (n = 20); group 2, 36-59 months (n = 29). We assessed airway inflammation, reticular basement membrane (RBM) thickness, airway smooth muscle (ASM), mucus gland area, vascularity, and epithelial integrity. Comparisons were then made with biopsies from 21 previously described schoolchildren with severe asthma (group 3, 5-11.2 yr). MEASUREMENTS AND MAIN RESULTS RBM thickness was lower in group 1 than in group 2 (3.3 vs. 3.9 μm; P = 0.02), was correlated with age (P < 0.01; ρ = 0.62), and was higher in schoolchildren than in preschoolers (6.8 vs. 3.8 μm; P < 0.01). ASM area was lower in preschoolers than in schoolchildren (9.8% vs. 16.5%; P < 0.01). Vascularity was higher in group 1 than in group 2 (P = 0.02) and group 3 (P < 0.05). Mucus gland area was higher in preschoolers than in schoolchildren (16.4% vs. 4.6%; P < 0.01). Inflammatory cell counts in biopsies were not correlated with airway wall structure. ASM area was higher in preschoolers with atopy than without atopy (13.1% vs. 7.7%; P = 0.01). Airway morphometrics and inflammation were similar in viral and multiple-trigger wheezers. CONCLUSIONS In preschoolers with severe recurrent wheeze, markers of remodeling and inflammation are unrelated, and atopy is associated with ASM. In the absence of control subjects, we cannot determine whether differences observed in RBM thickness and vascularity result from disease or normal age-related development.
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Affiliation(s)
- Guillaume Lezmi
- 1 AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France.,2 Université Paris Descartes, Paris, France
| | - Philippe Gosset
- 3 Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Lille, France.,4 Université Lille Nord de France, Lille, France.,5 Centre National de la Recherche Scientifique, UMR 8204, Lille, France.,6 Institut National de la Santé et de la Recherche Médicale, U1019, Lille, France.,7 Institut Fédératif de la Recherche 142, Lille, France
| | - Antoine Deschildre
- 8 Unité de Pneumologie-Allergologie Pédiatrique, Clinique de Pédiatrie Jeanne de Flandre, CHRU de Lille, Université Nord de France, Lille, France
| | - Rola Abou-Taam
- 1 AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France
| | | | - Nicole Beydon
- 10 APHP, Hôpital Armand Trousseau, Service d'Explorations Fonctionnelles Respiratoires, Paris, France
| | - Jacques de Blic
- 1 AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France.,2 Université Paris Descartes, Paris, France
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95
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Kitazawa H, Kure S. Interstitial Lung Disease in Childhood: Clinical and Genetic Aspects. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:57-68. [PMID: 26512209 PMCID: PMC4603523 DOI: 10.4137/ccrpm.s23282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 12/16/2022]
Abstract
Interstitial lung disease (ILD) in childhood is a heterogeneous group of rare pulmonary conditions presenting chronic respiratory disorders. Many clinical features of ILD still remain unclear, making the treatment strategies mainly investigative. Guidelines may provide physicians with an overview on the diagnosis and therapeutic directions. However, the criteria used in different clinical studies for the classification and diagnosis of ILDs are not always the same, making the development of guidelines difficult. Advances in genetic testing have thrown light on some etiologies of ILD, which were formerly classified as ILDs of unknown origins. The need of genetic testing for unexplained ILD is growing, and new classification criteria based on the etiology should be adopted to better understand the disease. The purpose of this review is to give an overview of the clinical and genetic aspects of ILD in children.
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Affiliation(s)
- Hiroshi Kitazawa
- Department of General Pediatrics, Division of Allergy, Miyagi Children's Hospital, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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96
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Simpson SJ, Ranganathan S, Park J, Turkovic L, Robins-Browne RM, Skoric B, Ramsey KA, Rosenow T, Banton GL, Berry L, Stick SM, Hall GL. Progressive ventilation inhomogeneity in infants with cystic fibrosis after pulmonary infection. Eur Respir J 2015; 46:1680-90. [PMID: 26381521 DOI: 10.1183/13993003.00622-2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 06/28/2015] [Indexed: 12/28/2022]
Abstract
Measures of ventilation distribution are promising for monitoring early lung disease in cystic fibrosis (CF). This study describes the cross-sectional and longitudinal impacts of pulmonary inflammation and infection on ventilation homogeneity in infants with CF.Infants diagnosed with CF underwent multiple breath washout (MBW) testing and bronchoalveolar lavage at three time points during the first 2 years of life.Measures were obtained for 108 infants on 156 occasions. Infants with a significant pulmonary infection at the time of MBW showed increases in lung clearance index (LCI) of 0.400 units (95% CI 0.150-0.648; p=0.002). The impact was long lasting, with previous pulmonary infection leading to increased ventilation inhomogeneity over time compared to those who remained free of infection (p<0.05). Infection with Haemophilus influenzae was particularly detrimental to the longitudinal lung function in young children with CF where LCI was increased by 1.069 units for each year of life (95% CI 0.484-1.612; p<0.001).Pulmonary infection during the first year of life is detrimental to later lung function. Therefore, strategies aimed at prevention, surveillance and eradication of pulmonary pathogens are paramount to preserve lung function in infants with CF.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Judy Park
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Roy M Robins-Browne
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Billy Skoric
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Kathryn A Ramsey
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Tim Rosenow
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Georgia L Banton
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Luke Berry
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, Australia School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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97
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Wang Y, Hao C, Chi F, Yu X, Sun H, Huang L, Wang M, Ji W, Yan Y, Zhu H, Shao X. Clinical characteristics of protracted bacterial bronchitis in Chinese infants. Sci Rep 2015; 5:13731. [PMID: 26338462 PMCID: PMC4559899 DOI: 10.1038/srep13731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/04/2015] [Indexed: 12/19/2022] Open
Abstract
Protracted bacterial bronchitis (PBB) is the common cause of chronic cough in children worldwide, but its etiology has not been fully recognized in China. We retrospectively investigated a total of 66 hospitalized infants under the age of three years with chronic wet cough enrolled in the Affiliated Children's Hospital of Soochow University from October 2010 to March 2014. All patients underwent bronchoscopy and broncho-alveolar lavage (BAL) samples were processed for microbiological and cytological analysis. Of 66 patients with wet cough, 50 (75.8%) were diagnosed with PBB. In the PBB group, wet cough was accompanied by wheezing (90%). Airway malacia were identified in 22 cases (44%). The clinical manifestations of PBB with airway malacia did not differ from those without malacia. Haemophilus influenzae (47.4%) and Streptococcus pneumoniae (36.8%) were the most commonly identified pathogens. Furthermore, CD3(+) and CD3(+)CD4(+) cells were significantly lower in the PBB group (p < 0.01), while CD19(+), CD16(+)CD56(+) and CD23(+) cells were elevated (p < 0.01) in the PBB group. Our study revealed PBB is an important cause of chronic wet cough in Chinese infants, and that changes of lymphocyte subsets are observed in children with PBB. Airway malacia frequently co-existed with PBB, but did not exacerbate the disease.
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Affiliation(s)
- Yuqing Wang
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Chuangli Hao
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - FanFan Chi
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Xingmei Yu
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Huiquan Sun
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Li Huang
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Meijuan Wang
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Wei Ji
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Yongdong Yan
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Hong Zhu
- Department of Laboratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
| | - Xuejun Shao
- Department of Laboratory Medicine, The Affiliated Children's Hospital, Soochow University, Jingde Road No. 303, Suzhou 215003, China
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99
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Carpio C, Albi G, Rayón-Aledo JC, Álvarez-Sala R, Girón R, Prados C, Caballero P. Changes in structural lung disease in cystic fibrosis children over 4 years as evaluated by high-resolution computed tomography. Eur Radiol 2015; 25:3577-85. [DOI: 10.1007/s00330-015-3782-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/02/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
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100
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Garratt LW, Sutanto EN, Ling KM, Looi K, Iosifidis T, Martinovich KM, Shaw NC, Kicic-Starcevich E, Knight DA, Ranganathan S, Stick SM, Kicic A. Matrix metalloproteinase activation by free neutrophil elastase contributes to bronchiectasis progression in early cystic fibrosis. Eur Respir J 2015; 46:384-94. [PMID: 25929954 DOI: 10.1183/09031936.00212114] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/04/2015] [Indexed: 12/14/2022]
Abstract
Neutrophil elastase is the most significant predictor of bronchiectasis in early-life cystic fibrosis; however, the causal link between neutrophil elastase and airway damage is not well understood. Matrix metalloproteinases (MMPs) play a crucial role in extracellular matrix modelling and are activated by neutrophil elastase. The aim of this study was to assess if MMP activation positively correlates with neutrophil elastase activity, disease severity and bronchiectasis in young children with cystic fibrosis.Total MMP-1, MMP-2, MMP-7, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-2 and TIMP-1 levels were measured in bronchoalveolar lavage fluid collected from young children with cystic fibrosis during annual clinical assessment. Active/pro-enzyme ratio of MMP-9 was determined by gelatin zymography. Annual chest computed tomography imaging was scored for bronchiectasis.A higher MMP-9/TIMP-1 ratio was associated with free neutrophil elastase activity. In contrast, MMP-2/TIMP-2 ratio decreased and MMP-1 and MMP-7 were not detected in the majority of samples. Ratio of active/pro-enzyme MMP-9 was also higher in the presence of free neutrophil elastase activity, but not infection. Across the study cohort, both MMP-9/TIMP-1 and active MMP-9 were associated with progression of bronchiectasis.Both MMP-9/TIMP-1 and active MMP-9 increased with free neutrophil elastase and were associated with bronchiectasis, further demonstrating that free neutrophil elastase activity should be considered an important precursor to cystic fibrosis structural disease.
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Affiliation(s)
- Luke W Garratt
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Erika N Sutanto
- Telethon Kids Institute, University of Western Australia, Perth, Australia Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia
| | - Kak-Ming Ling
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kevin Looi
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Thomas Iosifidis
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | - Nicole C Shaw
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Elizabeth Kicic-Starcevich
- Telethon Kids Institute, University of Western Australia, Perth, Australia Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia
| | - Darryl A Knight
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, Newcastle, Australia Dept of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Sarath Ranganathan
- Dept of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia Murdoch Childrens Research Institute, Melbourne, Australia Dept of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Stephen M Stick
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia Telethon Kids Institute, University of Western Australia, Perth, Australia Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Anthony Kicic
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia Telethon Kids Institute, University of Western Australia, Perth, Australia Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
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