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Kuklinski CA, Blatter JA. Interstitial lung disease as an indication for pediatric lung transplant. Pediatr Pulmonol 2024; 59:2313-2320. [PMID: 38131509 DOI: 10.1002/ppul.26812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 11/09/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Interstitial lung disease can be an indication for lung transplant at any age, but it is a particularly common indication for lung transplant in infants. Nevertheless, not all interstitial lung diseases will lead to lung transplant in childhood. Genetic testing has aided the identification of these diseases in children. In severely affected patients, however, definitive diagnosis is not always necessary to consider referral to a transplant center. At experienced transplant centers, a multidisciplinary team educates patient families and aids in the transplant evaluation of children with interstitial lung disease. Children who have undergone transplant require lifetime immunosuppression and close surveillance, but can enjoy good quality of life for years following surgery.
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Affiliation(s)
- Cadence A Kuklinski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua A Blatter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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2
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Teper A, Colom AJ, Schubert R, Jerkic PS. Update in postinfectious bronchiolitis obliterans. Pediatr Pulmonol 2024; 59:2338-2348. [PMID: 37378463 DOI: 10.1002/ppul.26570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
Postinfectious bronchiolitis obliterans (PiBO) is a rare and severe form of chronic obstructive lung disease caused by an infectious injury to the lower respiratory tract. The most commonly recognized inciting stimuli leading to PiBO are airway pathogens, such as adenovirus and Mycoplasma. PiBO is characterized by persistent and nonreversible airway obstruction, with functional and radiological evidence of small airway involvement. The literature has limited information on the aetiology, clinical profile, treatment, and outcome of PiBO.
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Affiliation(s)
- Alejandro Teper
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Alejandro J Colom
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Ralf Schubert
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Pera-Silvija Jerkic
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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3
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Casey A, Fiorino EK, Wambach J. Innovations in Childhood Interstitial and Diffuse Lung Disease. Clin Chest Med 2024; 45:695-715. [PMID: 39069332 DOI: 10.1016/j.ccm.2024.04.002] [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] [Indexed: 07/30/2024]
Abstract
Children's interstitial and diffuse lung diseases (chILDs) are a heterogenous and diverse group of lung disorders presenting during childhood. Infants and children with chILD disorders present with respiratory signs and symptoms as well as diffuse lung imaging abnormalities. ChILD disorders are associated with significant health care resource utilization and high morbidity and mortality. The care of patients with chILD has been improved through multidisciplinary care, multicenter collaboration, and the establishment of patient research networks in the United Stated and abroad. This review details past and current innovations in the diagnosis and clinical care of children with chILD.
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Affiliation(s)
- Alicia Casey
- Department of Pediatrics, Division of Pulmonary Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Elizabeth K Fiorino
- Department of Science Education and Pediatrics, Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Jennifer Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
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Meric Z, Gemici Karaaslan B, Yalcin Gungoren E, Bektas Hortoglu M, Cavas T, Aydemir S, Bilgic Eltan S, Firtina S, Kendir Demirkol Y, Eser M, Cekic S, Kilic S, Karasu G, Yesilipek MA, Eke Gungor H, Karakoc-Aydiner E, Ozen A, Baris S, Yucel E, Cokugras H, Kiykim A. Artemis deficiency: A large cohort including a novel variant with increased radiosensitivity. Pediatr Allergy Immunol 2024; 35:e14171. [PMID: 38860449 DOI: 10.1111/pai.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Artemis deficiency is an autosomal recessive disorder characterized by a combined immunodeficiency with increased cellular radiosensitivity. In this review, the clinical and genetic characteristics of 15 patients with DCLRE1C variants are presented. METHODS The demographic, clinical, immunologic, and genetic characteristics of patients with confirmed DCLRE1C variants diagnosed between 2013 and 2023 were collected retrospectively. Three patients were evaluated for radiosensitivity by the Comet assay, compared with age- and sex-matched healthy control. RESULTS Seven patients who had severe infections in the first 6 months of life were diagnosed with T-B-NK+ SCID (severe combined immunodeficiency). Among them, four individuals underwent transplantation, and one of those died due to post-transplant complications in early life. Eight patients had hypomorphic variants. Half of them were awaiting a suitable donor, while the other half had already undergone transplantation. The majority of patients were born into a consanguineous family (93.3%). Most patients had recurrent sinopulmonary infections (73.3%), and one patient had no other infection than an acute respiratory infection before diagnosis. Two patients (13.3%) had autoimmunity in the form of autoimmune hemolytic anemia. Growth retardation was observed in only one patient (6.6%), and no malignancy was detected in the surviving 11 patients during the median (IQR) of 21.5 (12-45) months of follow-up. Three patients who had novel variants exhibited increased radiosensitivity and compromised DNA repair, providing a potential vulnerability to malignant transformation. CONCLUSION Early diagnosis, radiation avoidance, and careful preparation for transplantation contribute to minimizing complications, enhancing life expectancy, and improving the patient's quality of life.
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Affiliation(s)
- Zeynep Meric
- Faculty of Medicine, Division of Pediatric Immunology and Allergy, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Betul Gemici Karaaslan
- Faculty of Medicine, Division of Pediatric Immunology and Allergy, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Ezgi Yalcin Gungoren
- Division of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Melika Bektas Hortoglu
- Faculty of Sciences and Arts, Department of Biology, Cell Culture and Genetic Toxicology Laboratory, Bursa Uludag University, Bursa, Turkey
| | - Tolga Cavas
- Faculty of Sciences and Arts, Department of Biology, Cell Culture and Genetic Toxicology Laboratory, Bursa Uludag University, Bursa, Turkey
| | - Sezin Aydemir
- Faculty of Medicine, Division of Pediatric Immunology and Allergy, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Sevgi Bilgic Eltan
- Division of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Sinem Firtina
- Faculty of Medicine, Department of Medical Genetics, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Metin Eser
- Department of Medical Genetics, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Sukru Cekic
- Division of Pediatric Immunology and Allergy, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Suar Kilic
- Department of Pediatric Hematology-Oncology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gulsun Karasu
- Department of Pediatric Bone Marrow Transplantation Unit, Medical Park Göztepe Hospital, İstanbul, Turkey
| | - Mehmet Akif Yesilipek
- Department of Pediatric Bone Marrow Transplantation Unit, Medical Park Göztepe Hospital, İstanbul, Turkey
| | - Hatice Eke Gungor
- Division of Pediatric Allergy and Immunology, Kayseri City Training and Research Hospital, University of Health Sciences, Kayseri, Turkey
| | - Elif Karakoc-Aydiner
- Division of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Ahmet Ozen
- Division of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Safa Baris
- Division of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Esra Yucel
- Faculty of Medicine, Division of Pediatric Immunology and Allergy, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Haluk Cokugras
- Faculty of Medicine, Division of Pediatric Immunology and Allergy, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Ayca Kiykim
- Faculty of Medicine, Division of Pediatric Immunology and Allergy, Istanbul University- Cerrahpasa, Istanbul, Turkey
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Wannes Daou A, Wallace C, Barker M, Ambrosino T, Towe C, Morales DLS, Wikenheiser-Brokamp KA, Hayes D, Burg G. Flexible bronchoscopy in pediatric lung transplantation. Pediatr Transplant 2024; 28:e14757. [PMID: 38695266 DOI: 10.1111/petr.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/09/2024] [Accepted: 04/01/2024] [Indexed: 05/14/2024]
Abstract
Pediatric lung transplantation represents a treatment option for children with advanced lung disease or pulmonary vascular disorders who are deemed an appropriate candidate. Pediatric flexible bronchoscopy is an important and evolving field that is highly relevant in the pediatric lung transplant population. It is thus important to advance our knowledge to better understand how care for children after lung transplant can be maximally optimized using pediatric bronchoscopy. Our goals are to continually improve procedural skills when performing bronchoscopy and to decrease the complication rate while acquiring adequate samples for diagnostic evaluation. Attainment of these goals is critical since allograft assessment by bronchoscopic biopsy is required for histological diagnosis of acute cellular rejection and is an important contributor to establishing chronic lung allograft dysfunction, a common complication after lung transplant. Flexible bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy plays a key role in lung transplant graft assessment. In this article, we discuss the application of bronchoscopy in pediatric lung transplant evaluation including historical approaches, our experience, and future directions not only in bronchoscopy but also in the evolving pediatric lung transplantation field. Pediatric flexible bronchoscopy has become a vital modality for diagnosing lung transplant complications in children as well as assessing therapeutic responses. Herein, we review the value of flexible bronchoscopy in the management of children after lung transplant and discuss the application of novel techniques to improve care for this complex pediatric patient population and we provide a brief update about new diagnostic techniques applied in the growing lung transplantation field.
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Affiliation(s)
- Antoinette Wannes Daou
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carolyn Wallace
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mitzi Barker
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Teresa Ambrosino
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher Towe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David L S Morales
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathryn A Wikenheiser-Brokamp
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Pulmonary Biology, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Don Hayes
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Transplant Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gregory Burg
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Yilmaz Aİ, Gül Y, Kapaklı H, Ünal G, Çağlar HT, Ercan F, Reisli İ, Keleş S, Poyraz N, Pekcan S. Successful treatment of postinfectious bronchiolitis obliterans with gamma globulin in a tertiary center: 10 years of experience. Pediatr Pulmonol 2023; 58:2769-2776. [PMID: 37469295 DOI: 10.1002/ppul.26577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/23/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Bronchiolitis obliterans is characterized by partial or total occlusion of the bronchioles due to inflammation and fibrosis, and the most common form is postinfectious bronchiolitis obliterans (PIBO). This study aimed to retrospectively present our intravenous immunoglobulin (IVIG) treatment experience in PIBO patients with a clinically severe course despite receiving commonly used treatment protocols. MATERIALS AND METHODS The study included patients aged 0-18 with subtle immunological abnormalities who were followed up in our center for PIBO between 2010 and 2021. Clinical evaluation, body mass index (BMI), computerized tomography (CT) image scoring, and immunological parameters were recorded before and after IVIG treatment. RESULTS Of the 11 patients included in the study, 90% were male, the mean age at diagnosis was 27.1 months (range: 5-68 months) and the mean current age was 81.4 months (range: 15-188 months). The number of hospital visits due to infection and the frequency of hospitalizations decreased markedly in the patients who underwent IVIG therapy. Oxygen therapy was discontinued in all patients, and improvements in radiological severity scores were observed. BMI z-scores improved over the baseline values after IVIG therapy. CONCLUSION Corticosteroids are considered the best first-line treatment to control inflammation in PIBO. In our study group, PIBO patients showed favorable clinical and radiological responses to regular IVIG treatment, possibly due to minor immune deficiency secondary to steroids or as a result of undetected adaptive and innate immune defects involved in the etiology of severe PIBO.
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Affiliation(s)
- Aslı İmran Yilmaz
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Yahya Gül
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Hasan Kapaklı
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Gökçen Ünal
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Hanife Tuğçe Çağlar
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Fatih Ercan
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - İsmail Reisli
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Sevgi Keleş
- Department of Pediatric Allergy and Immunology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Necdet Poyraz
- Department of Radiology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
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Jerkic SP, Bächle L, Duecker RP, Gronau L, Chiocchetti AG, Zielen S, Schubert R. Association between Polyunsaturated Fatty Acid Profile and Bronchial Inflammation in Bronchiolitis Obliterans. Mediators Inflamm 2023; 2023:3406399. [PMID: 37448886 PMCID: PMC10338129 DOI: 10.1155/2023/3406399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/23/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Bronchiolitis obliterans (BO) is a chronic lung disease, which occurs after an insult to the lower airways, in particular after airway infections or after stem cell transplantation, and which results in persistent inflammation. N-3 and n-6 polyunsaturated fatty acids (PUFA) have been shown to influence the inflammatory processes in chronic inflammatory conditions. Since BO is maintained by persistent pulmonary inflammation, a disbalanced n-6/n-3 fatty acid profile could support the inflammatory process in patients with BO and therefore, could become an approach to new therapeutic options. Methods Twenty-five patients with BO (age: 13; 7-39) and 26 healthy controls (age: 19; 7-31) participated in the study. Lung function (forced viral capacity (FVC), forced expiratory volume 1 (FEV1), residual volume (RV)), and lung clearance index (LCI) were measured. Induced sputum was analyzed for cytology and cytokine levels (IL-1ß, IL-6, IL-8, TNF-α) using cytometric bead array (CBA). The PUFA profile was determined in the serum and induced sputum by gas chromatography. Results Patients presented with significantly lower FVC and FEV1 as well as higher RV and LCI measurements compared to the control group. Apart from a massive airway inflammation indicated by elevated numbers of total cells and neutrophils, the CBA analysis showed significantly increased levels of IL-1β, IL-6, and IL-8. The analysis of PUFA in sputum and serum revealed a significant difference in the ratio between the n-6 PUFA arachidonic acid (AA) and the n-3 PUFA docosahexaenoic acid (DHA) (AA : DHA). Furthermore, the AA : DHA ratio significantly correlated with the inflammatory cytokines in induced sputum. Conclusion Lung function in BO is significantly impaired and associated with uncontrolled neutrophil-dominated airway inflammation. Furthermore, the imbalance in the AA/DHA ratio in favor of n-6 PUFA demonstrates a pro-inflammatory microenvironment in the cell membrane, which correlates with the inflammatory cytokines in induced sputum and might be an option for an anti-inflammatory therapy in BO.
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Affiliation(s)
- Silvija P. Jerkic
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Laura Bächle
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Ruth Pia Duecker
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Lucia Gronau
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
- Department of Food Technology, University of Applied Science, Fulda, Germany
| | - Andreas G. Chiocchetti
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe-University, Frankfurt am Main 60590, Germany
| | - Stefan Zielen
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Ralf Schubert
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
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Yan S, Sun C, Jiang K. A Diagnostic Nomogram for Early Prediction of Post-Infectious Bronchiolitis Obliterans in Severe Pneumonia. J Inflamm Res 2023; 16:2041-2050. [PMID: 37215378 PMCID: PMC10198271 DOI: 10.2147/jir.s406375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
Objective The study aimed to set up and validate a predictive nomogram for post-infectious bronchiolitis obliterans in severe pneumonia. Methods We retrospectively analyzed data of 228 patients diagnosed with severe pneumonia and constructed a prediction nomogram. The least absolute shrinkage and selection operator (LASSO) regression model was utilized to optimize the selection of features for the clinical characteristics of post-infectious bronchiolitis obliterans. Individual nomograms of bronchiolitis obliterans incorporating clinical factors were developed using the multivariate logistic model. The C-index, calibration plot, and decision curve analysis were used to verify the calibration, discrimination, and clinical utility. The bootstrapping method was used for the internal validation of the model. Results Predictors in the individualized predictive nomogram included age of patients (odds ratio [OR], 0.994; 95% confidence interval; [CI], 0.990-0.998), length of stay (OR, 1.043; 95% CI: 1.015-1.073), mechanical ventilation (OR, 1.865; 95% CI: 1.236-2.817), human adenoviral infection (OR, 1.671; 95%, CI: 1.201-2.326), and the level of interleukin (IL)-2 (OR, 0.947; 95% CI: 0.901-0.955). The model discriminated reasonably well, with a C-index of 0.907 (C-index, 0.888 and 0.926) with good calibration and internal validation, which was not statistically significant by the Hosmer-Lemeshow test (P = 0.5443). Decision curve analysis showed that nomograms were useful in clinical settings. Conclusion In this study, a model was developed and presented as a nomogram with relatively good accuracy to help clinicians accurately and early diagnose post-infectious bronchiolitis obliterans in children with severe pneumonia.
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Affiliation(s)
- Silei Yan
- Department of Respiratory Medicine, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Chao Sun
- Department of Respiratory Medicine, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Kun Jiang
- Department of Respiratory Medicine, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
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Lee HJ, Kim HS, Yoon JS. Impulse oscillometry system for assessing small airway dysfunction in pediatric bronchiolitis obliterans; association with conventional pulmonary function tests. PLoS One 2023; 18:e0280309. [PMID: 36749747 PMCID: PMC9904454 DOI: 10.1371/journal.pone.0280309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/27/2022] [Indexed: 02/08/2023] Open
Abstract
Impulse oscillometry system (IOS) is a simple, and less invasive method for assessing small to total airway resistance in children. We analyzed the correlation between IOS, spirometry, and plethysmographic parameters performed for the diagnosis of pediatric BO patients. A total of 89 IOS assessments of pediatric BO patients or children without lung disease were included, and the relationship between pulmonary function tests (PFTs) and diagnostic performance was analyzed. R5, R5-20, X5, and AX were statistically significantly worse in the BO group. In general linear correlation analysis, R5% (adjusted β [aβ], -0.59; p < 0.001) and AX % (aβ, -0.9; p < 0.001) showed the strongest correlation with conventional PFT parameters. R5% and AX % also showed the highest correlation with FEF25-75% (aβ, -0.48; p < 0.001 and aβ, -0.83; p < 0.001), and sRaw % (aβ, -0.73; p = 0.003 and aβ, -0.59; p = 0.008, respectively). Multivariate logistic regression analysis showed that R5 Z-score showed the highest ORs with FEV1 (OR = 3.94, p = 0.006), FEF25-75% (OR = 5.96, p = 0.005), and sRaw % (OR = 4.85, p = 0.022). Receiver operating curve analysis suggested AX % and R5% as the most optimal IOS parameters for BO diagnostic performance with the area under the curve of 0.915 and 0.882, respectively. In conclusion, R5 and AX are the parameters that can independently identify the severity of airway obstruction in pediatric BO patients without conventional lung function tests. IOS is an easy-to-perform, and reliable diagnostic method capable of detecting pathological obliteration of the small airways in children with BO.
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Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
| | - Hwan Soo Kim
- Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong-seo Yoon
- Department of Pediatrics, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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10
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Efferocytosis in lung mucosae: implications for health and disease. Immunol Lett 2022; 248:109-118. [PMID: 35843361 DOI: 10.1016/j.imlet.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/15/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022]
Abstract
Efferocytosis is imperative to maintain lung homeostasis and control inflammation. Populations of lung macrophages are the main efferocytes in this tissue, responsible for controlling immune responses and avoiding unrestrained inflammation and autoimmunity through the expression of a plethora of receptors that recognize multiple 'eat me' signals on apoptotic cells. Efferocytosis is essentially anti-inflammatory and tolerogenic. However, in some situations, apoptotic cells phagocytosis can elicit inflammatory and immunogenic immune responses. Here, we summarized the current knowledge of the mechanisms of efferocytosis, and how any abnormality in this process may have an important contribution to the lung pathophysiology of many chronic inflammatory lung diseases such as asthma, acute lung injury, chronic obstructive pulmonary disease, and cystic fibrosis. Further, we consider the consequences of the dual role of efferocytosis on the susceptibility or resistance to pulmonary microbial infections. Understanding how efferocytosis works in different contexts will be useful to the development of new and more effective strategies to control the diversity of lung diseases.
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Lee HJ, Kim SK, Lee JW, Im SA, Chung NG, Cho B. Quantitative CT lung densitometry as an obstructive marker for the diagnosis of bronchiolitis obliterans in children. PLoS One 2022; 17:e0271135. [PMID: 35797398 PMCID: PMC9262182 DOI: 10.1371/journal.pone.0271135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to evaluate the quantitative diagnostic performance of computed tomography (CT) densitometry in pediatric patients with bronchiolitis obliterans (BO). We measured the mean lung density (MLD) and represented the difference of MLD in inspiratory and expiratory phases (MLDD), the ratio of the MLD (E/I MLD), and the relative volume percentage of lung density at 50-Hounsfield unit (HU) interval threshold (E600 to E950). We calculated the sensitivity, specificity, and diagnostic accuracy of the lung density indices for the diagnosis of BO. A total of 81 patients, including 51 patients with BO and 30 controls, were included in this study. In the BO patients, expiratory (EXP) MLD and MLDD were significantly lower, and E/I MLD and expiratory low attenuation areas below the threshold of −850 HU to −950 HU (E850, E900, and E950) were statistically significantly higher than controls. Multivariate logistic regression analysis showed that MLDD (odds ratio [OR] = 0.98, p < .001), E/I MLD (OR = 1.39, p < .001), and E850 to E950 were significant densitometry parameters for BO diagnosis. In a receiver-operating characteristic analysis, E900 (cutoff, 1.4%; AUC = 0.920), E/I MLD (cutoff, 0.87; AUC = 0.887), and MLDD (cutoff, 109 HU; AUC = 0.867) showed high accuracy for the diagnosis of BO. In conclusion, the lung CT densitometry can serve as a quantitative marker providing additional indications of expiratory airflow limitation in pediatric patients with BO.
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Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Koo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Ah Im
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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12
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Flanagan F, Casey A, Reyes-Múgica M, Kurland G. Post-infectious bronchiolitis obliterans in children. Paediatr Respir Rev 2022; 42:69-78. [PMID: 35562287 DOI: 10.1016/j.prrv.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Frances Flanagan
- Division of Pulmonary Medicine, Boston Children's Hospital, 333 Longwood Ave, 5(th) Floor, Boston, MA 02115, United States.
| | - Alicia Casey
- Division of Pulmonary Medicine, Boston Children's Hospital, 333 Longwood Ave, 5(th) Floor, Boston, MA 02115, United States.
| | - Miguel Reyes-Múgica
- Department of Pathology, UPMC Children's Hospital ofPittsburgh, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh PA 1522, United States.
| | - Geoffrey Kurland
- Division of Pediatric Pulmonology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
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13
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Duecker RP, De Mir Messa I, Jerkic S, Kochems A, Gottwald G, Moreno‐Galdó A, Rosewich M, Gronau L, Zielen S, Geburtig‐Chiocchetti A, Kreyenberg H, Schubert R. Epigenetic regulation of inflammation by microRNAs in post‐infectious bronchiolitis obliterans. Clin Transl Immunology 2022; 11:e1376. [PMID: 35228871 PMCID: PMC8859819 DOI: 10.1002/cti2.1376] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 11/14/2021] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ruth P Duecker
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Ines De Mir Messa
- Allergy, Pulmonology and Cystic Fibrosis Section Department of Pediatrics Vall d’Hebron Hospital Universitari Universitat Autònoma de Barcelona Barcelona Spain
| | - Silvija‐Pera Jerkic
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Annalena Kochems
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Gabriele Gottwald
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Antonio Moreno‐Galdó
- Allergy, Pulmonology and Cystic Fibrosis Section Department of Pediatrics Vall d’Hebron Hospital Universitari Universitat Autònoma de Barcelona Barcelona Spain
- CIBER of Rare Diseases (CIBERER) Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Martin Rosewich
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Lucia Gronau
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Stefan Zielen
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Andreas Geburtig‐Chiocchetti
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Goethe University Frankfurt Germany
| | - Hermann Kreyenberg
- Division for Stem Cell Transplantation and Immunology Department for Children and Adolescence Goethe University Frankfurt Germany
| | - Ralf Schubert
- Division for Allergy, Pneumology and Cystic Fibrosis Department for Children and Adolescence Goethe University Frankfurt Germany
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14
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Choi YJ, Lee S, Kim HR, Suh DI. Immunologic analysis of patients with postinfectious bronchiolitis obliterans. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.2.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Yun Jung Choi
- Department of Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Soyoung Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Hang-Rae Kim
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
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15
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Hyun JH, Jeong JE, Kim YH, Jang YY, Chung HL. Clinical characteristics of bronchiolitis obliterans without preceding severe lower respiratory tract infection. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jong Hyo Hyun
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Eun Jeong
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yoon Young Jang
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hai Lee Chung
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
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16
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Zheng H, Yu X, Chen Y, Lin W, Liu L. Effects of Inhaled Corticosteroids on Lung Function in Children With Post-infectious Bronchiolitis Obliterans in Remission. Front Pediatr 2022; 10:827508. [PMID: 35620151 PMCID: PMC9127380 DOI: 10.3389/fped.2022.827508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Post-infectious bronchiolitis obliterans (PIBO) is a rare and irreversible chronic obstructive pulmonary disease with no specific treatment, especially for patients with PIBO in remission. In this study, we evaluated the effects of continuous inhaled corticosteroids (ICSs) and intermittent ICSs on lung function in the remission of PIBO. METHODS This was a retrospective study, and all the subjects we included were divided into continuous ICS group and intermittent ICS group according to treatment regimens. Patients in continuous ICS group received continuous ICSs (2 times a day), and patients in intermittent ICS group received intermittent ICSs (inhaled corticosteroids after acute respiratory tract infection or wheezing). Different lung function tests were performed at different ages. Tidal breathing lung function tests were performed in patients with PIBO aged ≤ 5 years, and the lung ventilation function test and the bronchial dilation test were performed in patients with PIBO aged more than 5 years. Lung function was assessed at the beginning of follow-up and at the end of follow-up (1 year of ICSs). RESULTS After 1 year of ICSs, patients aged more than 5 years, forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1) were significantly higher than at the beginning of follow-up. After 1 year of ICSs, the difference in VT/Kg, TPTEF/TE, and VPEF/VE between the end and the beginning of follow-up in continuous ICS group shows an upward trend. But those showed a downward trend in intermittent ICS group. FVC, FEV1, and maximal mid-expiratory flow velocity 25-75% (MMEF25-75%) of continuous ICS group were significantly higher than at the beginning of follow-up. The difference in FEV1 and MMEF25-75% between the end of follow-up and the beginning of follow-up in continuous ICS group was significantly higher than that in intermittent ICS group. A total of 52.94% of patients with PIBO aged more than 5 years were positive for bronchial dilation tests. CONCLUSION Inhaled corticosteroids can effectively improve lung function and relieve airway obstruction in patients aged more than 5 years in PIBO remission, especially continuous ICSs. Patients with PIBO may have reversible airflow limitations.
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Affiliation(s)
- Haoqi Zheng
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Xiuhua Yu
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Yuquan Chen
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenying Lin
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Li Liu
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
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17
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Zou M, Zhai Y, Mei X, Wei X. Lactate dehydrogenase and the severity of adenoviral pneumonia in children: A meta-analysis. Front Pediatr 2022; 10:1059728. [PMID: 36776678 PMCID: PMC9909094 DOI: 10.3389/fped.2022.1059728] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Children with severe adenoviral pneumonia (ADVP) have poor prognosis and high risk of mortality. We performed a meta-analysis to evaluate the association between pretreatment lactate dehydrogenase (LDH) and severity, postinfectious bronchiolitis obliterans (PIBO), and mortality in children with ADVP. METHODS Relevant observational studies were identified by search of PubMed, Embase, Web of Science, Wanfang, and CNKI databases from inception to August 3, 2022. A random effect model was used to pool the results by incorporating the potential between-study heterogeneity. RESULTS Overall, 23 studies with 4,481 children with ADVP were included in this meta-analysis. Results of meta-analysis showed that children with severe ADVP had a significantly higher level of pretreatment LDH as compared to those with non-severe ADVP (standard mean difference [SMD]: 0.51, 95% confidence interval [CI]: 0.36 to 0.66, p < 0.001; I 2 = 69%). Besides, pooled results also suggested that the pretreatment LDH was significantly higher in children who developed PIBO as compared to those who did not (SMD: 0.47, 95% CI: 0.09 to 0.84, p = 0.02, I 2 = 80%). Finally, results of the meta-analysis also confirmed that a higher pretreatment LDH (>500 IU/L) was a risk factor of increased mortality during hospitalization (odds ratio: 3.10, 95% CI: 1.62 to 5.92, p < 0.001, I 2 = 0%). Sensitivity analyses by excluding one dataset at a time showed consistent results. CONCLUSION High pretreatment LDH may be associated with disease severity, development of PIBO, and increased risk of mortality in children with ADVP.
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Affiliation(s)
- Min Zou
- Department of Pediatrics, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Yang Zhai
- Guangxi Key Laboratory of Chinese Medicine Foundation Research, Guangxi University of Chinese Medicine, Nanning, China.,International Medical Department, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Xiaoping Mei
- Department of Endocrinology, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Xing Wei
- Zhuang Medical College, Guangxi University of Chinese Medicine, Nanning, China
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18
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Stevens-Johnson Syndrome in Children: Consider Monitoring for Bronchiolitis Obliterans. J Pediatr 2021; 236:307-311. [PMID: 34022249 DOI: 10.1016/j.jpeds.2021.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022]
Abstract
We reviewed patients with Stevens-Johnson syndrome (SJS) evaluated at Children's Hospital Colorado and investigated the occurrence of bronchiolitis obliterans (BO). Approximately 9% of patients with SJS developed BO. Pediatricians should consider monitoring patients with SJS for BO, especially those with recurrent SJS and patients treated with mechanical ventilation.
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19
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du Plessis AM, Andronikou S, Zar HJ. Chest imaging findings of chronic respiratory disease in HIV-infected adolescents on combined anti retro viral therapy. Paediatr Respir Rev 2021; 38:16-23. [PMID: 33139219 DOI: 10.1016/j.prrv.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022]
Abstract
Early treatment with combination antiretroviral therapy (cART) has improved survival of children perinatally infected with HIV into adolescence. This population is at risk of long term complications related to HIV infection, particularly chronic respiratory disease. Limited data on chest imaging findings in HIV-infected adolescents, suggest that the predominant disease is of small and large airways: predominantly bronchiolitis obliterans or bronchiectasis. Single cases of emphysema have been reported. Lung fibrosis, lymphocytic interstitial pneumonitis, post tuberculous apical fibrocystic changes and malignancies do not feature in this population. Chest radiograph (CXR) is easily accessible and widely used, especially in resource limited settings, such as sub Saharan Africa, where the greatest burden of HIV disease occurs. Lung ultrasound has been described for the diagnosis of pneumonia in children, pulmonary oedema and interstitial lung disease [1-3]. The use of this modality in chronic respiratory disease in adolescents where the predominant finding is small airway disease and bronchiectasis has however not been described. CXR is useful to evaluate structural/post infective changes, parenchymal opacification and nodules, hyperinflation or extensive bronchiectasis. CXR however, is inadequate for diagnosing small airway disease, for which high resolution computed tomography (HRCT) is the modality of choice. Where available, low dose HRCT should be used early in the course of symptomatic disease in adolescents and for follow up in children who are non responsive to treatment or clinically deteriorating. This article provides a pictorial review of the spectrum of CXR and HRCT imaging findings of chronic pulmonary disease in perinatally HIV-infected adolescents on cART and guidelines for imaging.
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Affiliation(s)
- Anne-Marie du Plessis
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and SA-Medical Research Council Unit on Child & Adolescent Health, USA
| | - Savvas Andronikou
- Department of Paediatric Radiology, Children's Hospital of Philadelphia, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and SA-Medical Research Council Unit on Child & Adolescent Health, USA
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20
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Matar M, Kessler R, Olland A, Falcoz P, Desprez P, Roche A, Collange O, Chenard MP, Renaud-Picard B, Porzio M. End-Stage Respiratory Failure Secondary to Bronchiolitis Obliterans Syndrome Induced by Toxic Epidermal Necrosis, Also Known as Lyell Syndrome: A Case Report. Transplant Proc 2021; 53:1371-1374. [PMID: 33896544 DOI: 10.1016/j.transproceed.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious dermatologic diseases. They can be associated with systemic manifestations such as bronchiolitis obliterans syndrome (BOS). SJS/TEN-induced BOS is associated with a poor prognosis, and no guidelines exist regarding its management. Several case reports have described the association between SJS/TEN and BOS, with few patients undergoing lung transplantation as a last resort therapy. Unfortunately, in the published reports, none of the transplanted patients were observed for a long period of time after the transplantation; therefore, the long-term mortality as well as the risk of recurrence of BOS could not be inferred from these reports. CASE REPORT We present the case of a young patient diagnosed with SJS complicated by BOS and end-stage respiratory failure refractory to corticosteroid therapy. She underwent bilateral lung transplantation with an outstanding outcome at 5-year follow-up. CONCLUSION SJS/TEN-induced BOS might have a favorable evolution and long-term outcomes following lung transplantation. However, prospective studies are needed to confirm this finding.
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Affiliation(s)
- Maroun Matar
- Strasbourg Lung Transplant Program, University Hospital, Strasbourg, France.
| | - Romain Kessler
- Strasbourg Lung Transplant Program, University Hospital, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale-Université de Strasbourg, Unité Mixte de Recherche 1260 Regenerative Ranomedecine, Strasbourg, France
| | - Anne Olland
- Strasbourg Lung Transplant Program, University Hospital, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale-Université de Strasbourg, Unité Mixte de Recherche 1260 Regenerative Ranomedecine, Strasbourg, France
| | - Pierre Falcoz
- Strasbourg Lung Transplant Program, University Hospital, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale-Université de Strasbourg, Unité Mixte de Recherche 1260 Regenerative Ranomedecine, Strasbourg, France
| | - Philippe Desprez
- Pediatric Intensive Care Unit, University Hospital, Strasbourg, France
| | - Anne Roche
- Surgical Intensive Care Unit, University Hospital, Strasbourg, France
| | - Olivier Collange
- Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Surgical Intensive Care Unit, University Hospital, Strasbourg, France
| | | | - Benjamin Renaud-Picard
- Strasbourg Lung Transplant Program, University Hospital, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Institut National de la Santé et de la Recherche Médicale-Université de Strasbourg, Unité Mixte de Recherche 1260 Regenerative Ranomedecine, Strasbourg, France
| | - Michele Porzio
- Strasbourg Lung Transplant Program, University Hospital, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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21
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Khanal UP, Roy A, Sharma AK. Bronchiolitis obliterans following toxic epidermal necrolysis: a case report. J Med Case Rep 2021; 15:159. [PMID: 33781322 PMCID: PMC8008694 DOI: 10.1186/s13256-021-02739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Toxic epidermal necrolysis (TEN) is a rare, acute and potentially fatal skin condition usually induced by drugs. Although much attention is focused on the life threatening acute cutaneous and sight threatening ocular manifestations of this disease, chronic pulmonary complications like bronchiolitis obliterans are occasionally encountered. However, little is known about its incidence, pathogenesis, clinical course and outcome in children recovering from TEN. Case presentation We report a five-year-old boy who presented four months after the first manifestation of drug-induced TEN with cough and shortness of breath and was subsequently diagnosed with bronchiolitis obliterans. He was treated with supportive therapy that improved his hypercapnia allowing him to be discharged on domiciliary oxygen, chest physiotherapy and bronchodilators. Conclusions This case highlights the need to be vigilant for adverse drug reactions and consider chronic pulmonary complications like Bronchiolitis Obliterans in children recovering from TEN.
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Affiliation(s)
| | - Akash Roy
- Institute of Medicine, Tribhuwan University, Kathmandu, Nepal
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22
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Chan KC, Yu MW, Cheung TWY, Lam DSY, Leung TNH, Tsui TK, Ip KI, Chau CSK, Lee SL, Yip AYF, Wong TW, Mak VCW, Li AM. Childhood bronchiolitis obliterans in Hong Kong-case series over a 20-year period. Pediatr Pulmonol 2021; 56:153-161. [PMID: 33174693 DOI: 10.1002/ppul.25166] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Bronchiolitis obliterans (BO) is a rare but serious condition. The natural history and outcomes remain poorly understood. In this clinical review, we aimed to describe the clinical characteristics and outcomes of children diagnosed with BO in Hong Kong (HK). METHODS This was a retrospective study of pediatric patients with BO under the care of six respiratory units in HK from January 1996 to December 2015. Information was retrieved from medical records. RESULTS Fifty-six patients were included with a male predominance (67.9%). The median age at diagnosis was 1.98 years (interquartile range [IQR]: 0.84-4.99 years). Postinfectious BO (PIBO) was the commonest cause (64.3%) followed by posthematopoietic stem-cell transplant (21.4%). Adenovirus (63.2%) was the commonest causative pathogen among PIBO. The median follow-up duration was 9.7 years (IQR: 2.9-14.3 years). Twenty-five patients (44.6%) could achieve symptom-free recovery at the time of follow-up. Five (8.9%) and three (5.4%) were oxygen or ventilator dependent, respectively. There were two deaths, both had posttransplant BO. Patients who developed BO after transplant had significantly worse lung function than those with PIBO. There were no risk factors significantly associated with worse clinical outcomes (oxygen/ventilator dependence or death) by logistic regression. Among patients with PIBO, coinfection at presentation was significantly associated with persistent symptoms at follow-up (p = .028). CONCLUSIONS The most common cause of childhood BO in HK is postinfectious and coinfection at presentation was associated with persistent symptoms at follow-up. Further studies are needed to better elucidate disease progression, treatment options and long term outcomes.
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Affiliation(s)
- Kate C Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Michelle W Yu
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Tammy W Y Cheung
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - David S Y Lam
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Theresa N H Leung
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Tak K Tsui
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Ka I Ip
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Christy S K Chau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - So L Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Ada Y F Yip
- Department of Paediatrics, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Tak W Wong
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Vivien C W Mak
- Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Albert M Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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23
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Huang F, Ma YC, Wang F, Li YN. Clinical analysis of adenovirus postinfectious bronchiolitis obliterans and nonadenovirus postinfectious bronchiolitis obliterans in children. Lung India 2021; 38:117-121. [PMID: 33687003 PMCID: PMC8098888 DOI: 10.4103/lungindia.lungindia_374_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objective: Postinfectious bronchiolitis obliterans (PIBO) is an uncommon and severe form of chronic obstructive lung disease in children. Adenovirus (ADV) is the main pathogen of PIBO in children. However, the risk factors of ADV-PIBO are not fully understood. This study aims to analyze the clinical characteristics of PIBO caused by ADV and compared with non-ADV-PIBO. Materials and Methods: A retrospective study of children under the age of 14 years diagnosed PIBO was performed in 56 ADV-PIBO cases, 29 non-ADV-PIBO, and 39 healthy controls to determine clinical characteristics of PIBO. Results: There was no difference between ADV-PIBO and non-ADV-PIBO cases in gender, age, individual and family atopy or history of asthma, and previous history of wheezing and no difference in the clinical manifestations and signs between the two groups. However, the hospital stay, duration of ventilator use, and multifocal pneumonia incidence of ADV-PIBO group have a significant differences compared with non-ADV-PIBO. Notably, inflammatory markers lactic dehydrogenase (LDH), interleukin 8 (IL-8), and interferon-gamma (IFN-γ) were significantly increased in PIBO patients, and those expressed in ADV-PIBO patients were higher than those in non-ADV-PIBO patients. In addition, ADV-PIBO children required a longer duration of oral prednisone and azithromycin than non-ADV-PIBO cases. Conclusions: Compared with non-ADV-PIBO, ADV-PIBO has a longer hospital stay, longer duration of ventilator use, increased LDH, IL-8, and IFN-γ expressions, and longer duration of oral prednisone and azithromycin treatment. Further research is needed to determine why PIBO caused by ADVs are more severe than those caused by other pathogens.
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Affiliation(s)
- Fei Huang
- Department of Orthopedics, China Japan Union Hospital of Jilin University, Changchun, Jilin, PR China
| | - Yu-Cong Ma
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Fang Wang
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Ya-Nan Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin; Department of Molecular Biology, Basic Medical College of Jilin University, Changchun, PR China
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Zhang BD, Cheng JX, Zhang CF, Bai YD, Liu WY, Li W, Koike K, Akihisa T, Feng F, Zhang J. Sauropus androgynus L. Merr.-A phytochemical, pharmacological and toxicological review. JOURNAL OF ETHNOPHARMACOLOGY 2020; 257:112778. [PMID: 32205260 DOI: 10.1016/j.jep.2020.112778] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sauropus androgynus L. Merr is an underexploited perennial shrub traditionally used as a medicinal plant in South Asia and Southeast Asia. The plant is regarded as not just a green vegetable for diet, but as a traditional herb for certain aliments. For instance, it has traditionally been used to relieve fever, to treat ulcers and diabetes, to promote lactation and eyesight, and to reduce obesity. AIM OF THE STUDY This paper aims to review the botany, phytochemistry, ethnopharmacology, and pharmacological activities of S. androgynus, and discuss the known chemical constituents at work in S. androgynus-induced bronchiolitis obliterans for providing new ideas to the mechanism of the disease and pharmacology research of the plant. MATERIALS AND METHODS The data presented in this review were collected from published literatures as well as the electronic databases of PubMed, CNKI, Web of Science, SCI finder, ACS, Science Direct, Wiley, Springer, Taylor, Google Scholar, and a number of unpublished resources, (e.g. books, and Ph.D. and M.Sc. dissertations). RESULTS The scientific literature indicates that S. androgynus is a valuable and popular herbal medicine whose nutritional value is also higher than that of other commonly used vegetables. Phytochemical analyses identified high content of fatty acids, flavonoids, and polyphenols as the major bioactive components in S. androgynus. Crude extracts and phytochemical compounds isolated from S. androgynus show a wide spectrum of in vitro and in vivo pharmacological activities such as antioxidant, anti-inflammatory, anti-ulcer, skin whitening, anti-diabetic, and immunoregulatory activities. The traditional use, such as increasing lactation, treating ulcers and diabetes, and reducing obesity, have been evaluated and studied with various methods. Numerous reports have revealed the unusual link between the consumption of S. androgynus and the induction of a chronic and irreversible obstructive disease (namely, bronchiolitis obliterans), indicating that the toxicity and side effects of this plant that is presently used in health care and medicine are a major area of concern. CONCLUSION Though little importance was attached to this green plant, S. androgynus has notable phytochemical constituents and various pharmacological activities including antioxidant, anti-inflammatory, and anti-obesity activities. Studies have firmly established the association between excessive consumption of the uncooked S. androgynus juice over a period of time and the occurrence of bronchiolitis obliterans. It is inadvisable to ingest excessive amounts of S. androgynus before fully understanding the pathogenesis and induction mechanism of this fatal disease. The phytochemistry of S. androgynus, its pharmacology for traditional use, S. androgynus-induced bronchiolitis obliterans still need further investigation.
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Affiliation(s)
- Bo-Dou Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Jia-Xin Cheng
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Chao-Feng Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China
| | - Yi-Dan Bai
- School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Wen-Yuan Liu
- School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Wei Li
- Faculty of Pharmaceutical Sciences, Toho University, Miyama 2-2-1, Funabashi, Chiba, 274-8510, Japan
| | - Kazuo Koike
- Faculty of Pharmaceutical Sciences, Toho University, Miyama 2-2-1, Funabashi, Chiba, 274-8510, Japan
| | - Toshihiro Akihisa
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China; Research Institute for Science and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba, 278-8510, Japan
| | - Feng Feng
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China; Jiangsu Food and Pharmaceutical Science College, Huaian, Jiangsu, 223003, China.
| | - Jie Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, 24 Tongjiaxiang, Nanjing, 210009, China; Jiangsu Food and Pharmaceutical Science College, Huaian, Jiangsu, 223003, China.
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Calprotectin as a New Sensitive Marker of Neutrophilic Inflammation in Patients with Bronchiolitis Obliterans. Mediators Inflamm 2020; 2020:4641585. [PMID: 32410855 PMCID: PMC7211255 DOI: 10.1155/2020/4641585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/10/2020] [Accepted: 04/04/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Bronchiolitis obliterans (BO) is a chronic disease in which persistent inflammation leads to obstruction and obliteration of the small airways. The aim of this study was to evaluate the value of calprotectin as an inflammatory marker in induced sputum. Methods Twenty-eight patients suffering from BO and 18 healthy controls were examined. Lung function was measured by spirometry, body plethysmography, and lung clearance index (LCI). The induced sputum was obtained, cell counts were performed, and cytokines were measured using cytometric bead array (CBA). Calprotectin was quantified in the sputum and serum samples using commercially available sandwich ELISA. Results Spirometry parameters including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximum expiratory flow rate at 25% vital capacity (MEF25) were significantly lower in BO patients than in healthy controls, whereas the reserve volume (RV), RV to total lung capacity ratio (RV/TLC), and LCI were significantly increased. In sputum, calprotectin levels, neutrophils, and IL-8 were significantly elevated. Calprotectin levels correlated strongly with IL-8 and other biomarkers, neutrophils FEV1 and MEF25. In serum, calprotectin was significantly diminished in BO patients compared to controls. Conclusion Lung function is severely impaired in BO patients. Calprotectin is significantly elevated in the sputum of BO patients and reflects ongoing neutrophilic inflammation.
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Liang TIH, Lee EY. Interstitial Lung Diseases in Children, Adolescents, and Young Adults: Different from Infants and Older Adults. Radiol Clin North Am 2020; 58:487-502. [PMID: 32276699 DOI: 10.1016/j.rcl.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Childhood interstitial lung disease (chILD) in children, teenagers, and young adults presents a challenge to the clinicians and radiologist, given its rarity, diverse imaging manifestations, and often nonspecific clinical examination findings. This article discusses the utility of available imaging techniques and associated characteristic imaging findings, and reviews the 2015 chILD classification scheme, with clinical examples highlighting the imaging features to help the radiologist aid in an efficient and accurate multidisciplinary diagnosis of chILD.
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Affiliation(s)
- Teresa I-Han Liang
- Department of Radiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Postinfectious Bronchiolitis Obliterans in Children: Diagnostic Workup and Therapeutic Options: A Workshop Report. Can Respir J 2020; 2020:5852827. [PMID: 32076469 PMCID: PMC7013295 DOI: 10.1155/2020/5852827] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 12/23/2022] Open
Abstract
Bronchiolitis obliterans (BO) is a rare, chronic form of obstructive lung disease, often initiated with injury of the bronchiolar epithelium followed by an inflammatory response and progressive fibrosis of small airways resulting in nonuniform luminal obliteration or narrowing. The term BO comprises a group of diseases with different underlying etiologies, courses, and characteristics. Among the better recognized inciting stimuli leading to BO are airway pathogens such as adenovirus and mycoplasma, which, in a small percentage of infected children, will result in progressive fixed airflow obstruction, an entity referred to as postinfectious bronchiolitis obliterans (PIBO). The present knowledge on BO in general is reasonably well developed, in part because of the relatively high incidence in patients who have undergone lung transplantation or bone marrow transplant recipients who have had graft-versus-host disease in the posttransplant period. The cellular and molecular pathways involved in PIBO, while assumed to be similar, have not been adequately elucidated. Since 2016, an international consortium of experts with an interest in PIBO assembles on a regular basis in Geisenheim, Germany, to discuss key areas in PIBO which include diagnostic workup, treatment strategies, and research fields.
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Sarria EE, Mundstock E, Mocelin HT, Fischer GB, Torres RR, Garbin JGM, Leal LF, de F Arend MHR, Stein R, Booij L, de Araújo RMF, Mattiello R. Health-related quality of life in post-infectious bronchiolitis obliterans: agreement between children and their proxy. J Pediatr (Rio J) 2019; 95:614-618. [PMID: 31327498 DOI: 10.1016/j.jped.2018.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the level of agreement in health-related quality of life between children with Post-infectious Bronchiolitis Obliterans and their parent (so-called proxy). METHODS Participants aged between 8and 17 years who had been previously diagnosed with Post-infectious Bronchiolitis Obliterans were regularly followed up at a pediatric pulmonology outpatient clinic. Parents or legal guardians (caregivers) of these patients were also recruited for the study. A validated and age-appropriate version of the Pediatric Quality of Life Inventory 4.0 was used for the assessment of health-related quality of life. Caregivers completed the corresponding proxy versions of the questionnaire. The correlation between self and proxy reports of health-related quality of life was determined by intra-class correlation coefficient and dependent t-tests. RESULTS The majority of participants were males (79.4%), and the average age was 11.8 years. Intra-class correlations between each of the Pediatric Quality of Life Inventory 4.0 domains and the total score were all lower than 0.6, with a range between 0.267 (poor) and 0.530 (fair). When the means of each domain and the total score of the questionnaires were compared, caregivers were observed to have a significantly lower health-related quality of life score than children, with the exception of the social domain in which the difference was not significant. However, the differences in score exceeded the critical threshold difference of four points in all other domains. CONCLUSION Proxies of children and adolescents with Post-infectious Bronchiolitis Obliterans appear to consistently perceive their children as having lower health-related quality of life than how the patients perceive themselves.
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Affiliation(s)
- Edgar E Sarria
- Universidade de Santa Cruz do Sul (Unisc), Departamento de Biologia e Farmácia, Santa Cruz do Sul, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Eduardo Mundstock
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Prefeitura de Canela, Canela, RS, Brazil
| | - Helena T Mocelin
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
| | - Gilberto B Fischer
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
| | - Renato R Torres
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - João G M Garbin
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Escola de Medicina, Porto Alegre, RS, Brazil
| | - Lisiane F Leal
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Marcia H R de F Arend
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil
| | - Linda Booij
- Concordia University, Department of Psychology, Montreal, Canada; University of Montreal, CHU Sainte-Justine & Department of Psychiatry, Montreal, Canada
| | - Rafael M F de Araújo
- Universidade do Vale do Taquari (UNIVATES), Centro de Ciências Médicas, Lajeado, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, RS, Brazil
| | - Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil.
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Health‐related quality of life in post‐infectious bronchiolitis obliterans: agreement between children and their proxy. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Seccombe EL, Ardern‐Jones M, Walker W, Austin S, Taibjee S, Williams S, Hossain P, Shenoy D, Fityan A. Bronchiolitis obliterans as a long‐term sequela of Stevens–Johnson syndrome and toxic epidermal necrolysis in children. Clin Exp Dermatol 2019; 44:897-902. [DOI: 10.1111/ced.13969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 01/10/2023]
Affiliation(s)
- E. L. Seccombe
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - M. Ardern‐Jones
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - W. Walker
- Paediatric Respiratory Department University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - S. Austin
- Department of Dermatology Dorset County Hospital NHS Foundation Trust Dorchester Dorset UK
| | - S. Taibjee
- Department of Dermatology Dorset County Hospital NHS Foundation Trust Dorchester Dorset UK
| | - S. Williams
- Department of Paediatrics University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - P. Hossain
- Department of Ophthalmology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - D. Shenoy
- Department of Paediatrics University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - A. Fityan
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
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Sisman Y, Buchvald FF, Ring AM, Wassilew K, Nielsen KG. Long-Term Lung Function and Exercise Capacity in Postinfectious chILD. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:4-11. [PMID: 31032143 PMCID: PMC6484343 DOI: 10.1089/ped.2018.0973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/10/2019] [Indexed: 11/12/2022]
Abstract
Background: Severe postinfectious diffuse pulmonary disease may clinically mimic other entities of children's interstitial lung disease and is clinically challenging comprising various disease severities despite treatment. Long-term lung function trend and physical capacity in children with postinfectious diffuse pulmonary disease are rarely reported. We investigated trends in pulmonary function by long-term follow-up and assessed physical capacity in such patients. Methods: We performed a descriptive, single-center follow-up study in children with biopsy-verified postinfectious diffuse pulmonary disease. Patients with completed primary treatment course were eligible for follow-up, including pulmonary function and exercise (VO2peak) testing. Results: Thirty patients with postinfectious diffuse pulmonary disease were identified and included. Median (range) age at diagnose was 27.5 (2–172) months after a mean lag time of 23 months. H. influenzae and rhinovirus were the most frequent pathogens. Fifteen patients were available for follow-up after mean (range) 7.6 (2–15) years of treatment completion. Lung clearance index (LCI2.5), forced expiratory volume in 1 second (FEV1), and bronchodilator responsiveness were abnormal in 80%, 53%, and 44%, respectively. Diffusion capacity for monoxide was abnormal in 7% and total lung capacity in 33%. Only 8% demonstrated low VO2peak, while 40% reported difficulties during physical exertion. Longitudinal data on spirometry (n = 14) remained unchanged from end of treatment throughout follow-up. A significant association was found between zLCI2.5 and zFEV1 (multiple linear regression; r2 = 0.61; P = 0.0003). Conclusion: Postinfectious diffuse pulmonary disease in children carries a varying degree of chronic pulmonary impairment with onset of symptoms in the first months of life and a typical considerable lag time before diagnosis. Follow-up several years after the initial injury demonstrated moderate-to-severe peripheral airway impairment although no further lung function decline was found years after completion of treatment. Despite acceptable VO2peak, a considerable proportion struggled during heavy exercise.
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Affiliation(s)
- Yagmur Sisman
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik F Buchvald
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Astrid Madsen Ring
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katharina Wassilew
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Abstract
INTRODUCTION Bronchiolitis obliterans (BO) is a chronic and irreversible obstructive lung disease leading to the obstruction and/or obliteration of the small airways. Three main BO entities are distinguished: post-infectious BO (PIBO); BO post lung transplantation; and BO after bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT). All three entities are separate, however, there are similarities in histopathological characteristics and possibly in aspects of the development pathway. Areas covered: We review current evidence of bronchiolitis obliterans diagnosis and management in children. The diagnosis of BO is usually based on a combination of history, clinical and radiological findings, although lung biopsy and histopathology remain the gold standard approaches to confirm BO. Expert opinion: At present, we do not have a clear understanding of the mechanisms of the development of BO and lack strong evidence for treatment. Although most BO in children is post-infectious, most of the current evidence for treatment originates from studies analyzing BO in adult lung transplant and HSCT patients. BO management requires multidisciplinary approach and care in specialized centers.
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Affiliation(s)
- Ema Kavaliunaite
- a Respiratory Unit , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Paul Aurora
- a Respiratory Unit , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK.,b Respiratory Critical Care and Anaesthesia Section , Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health , London , UK
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Githinji LN, Gray DM, Zar HJ. Lung function in HIV-infected children and adolescents. Pneumonia (Nathan) 2018; 10:6. [PMID: 29984134 PMCID: PMC6016126 DOI: 10.1186/s41479-018-0050-9] [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] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/13/2018] [Indexed: 12/18/2022] Open
Abstract
Background The advent of antiretroviral therapy has led to the improved survival of human immunodeficiency virus (HIV)-infected children to adulthood and to HIV becoming a chronic disease in older children and adolescents. Chronic lung disease is common among HIV-infected adolescents. Lung function measurement may help to delineate the spectrum, pathophysiology and guide therapy for HIV-related chronic lung disease. Aim The aim of this study was to review the available data on the spectrum and determinants of lung function abnormalities and the impact of antiretroviral therapy on lung function in perinatally HIV-infected children and adolescents. Methods Electronic databases “PUBMED”, “African wide” and “CINAHL” via EBSCO Host, using the MeSH terms “Respiratory function” AND “HIV” OR “Acquired Immunodeficiency Syndrome” AND “Children” OR “Adolescents”, were searched for relevant articles on lung function in HIV-infected children and adolescents. The search was limited to English language articles published between January 1984 and September 2017. Results Eighteen articles were identified, which included studies from Africa, the United States of America (USA) and Italy, representing 2051 HIV-infected children and adolescents, 68% on antiretroviral therapy, aged from 50 days to 24 years. Lung function abnormalities showed HIV-infected participants had increased irreversible lower airway expiratory obstruction and reduced functional aerobic impairment on exercise, compared to HIV-uninfected participants. Mosaic attenuation, extent of bronchiectasis, history of previous pulmonary tuberculosis or previous lower respiratory tract infection and cough for more than 1 month were associated with low lung function. Pulmonary function tests in children established on antiretroviral therapy did not show aerobic impairment and had less severe airway obstruction. Conclusion There is increasing evidence that HIV-infected children and adolescents have high prevalence of lung function impairment, predominantly irreversible lower airway obstruction and reduced aerobic function.
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Affiliation(s)
- Leah N Githinji
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Research Unit on Child and Adolescent Health, University of Cape Town, Rondebosch, Klipfontein Road 7700, Cape Town, South Africa
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Research Unit on Child and Adolescent Health, University of Cape Town, Rondebosch, Klipfontein Road 7700, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Research Unit on Child and Adolescent Health, University of Cape Town, Rondebosch, Klipfontein Road 7700, Cape Town, South Africa
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Liptzin DR, DeBoer EM, Giller RH, Kroehl ME, Weinman JP. Evaluating for Bronchiolitis Obliterans with Low-Attenuation Computed Tomography Three-Dimensional Reconstructions. Am J Respir Crit Care Med 2018; 197:814-815. [DOI: 10.1164/rccm.201707-1340im] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | | | - Roger H. Giller
- Division of Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, and
| | - Miranda E. Kroehl
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Jason P. Weinman
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado; and
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Lee E, Yoon J, Cho HJ, Hong SJ, Yu J. Respiratory reactance in children aged three to five years with postinfectious bronchiolitis obliterans is higher than in those with asthma. Acta Paediatr 2017; 106:81-86. [PMID: 27743492 DOI: 10.1111/apa.13632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 11/27/2022]
Abstract
AIM We investigated airway function in preschoolers with postinfectious bronchiolitis obliterans (PIBO) using impulse oscillometry (IOS). METHODS This study enrolled 182 children aged three to five years: 12 with PIBO, 135 with asthma and 35 nonatopic controls. Respiratory resistance and reactance were assessed using IOS. RESULTS The percentage predicted (% predicted) of prebronchodilator respiratory resistance at 5 Hz was significantly higher in children with PIBO (177.9 ± 118.4%) than the asthma (126.1 ± 30.5%, p = 0.013) or control (121.1 ± 21.8%, p = 0.014) groups. After bronchodilator use, children with PIBO did not reach the values of Rrs5% predicted in the asthma and control groups. Respiratory reactance (Xrs5% predicted) in children with PIBO (337.1 ± 478.5%) was significantly higher than both asthma (130.0 ± 80.0%, p = 0.004) and control (105.1 ± 30.8%, p < 0.001) groups before bronchodilator use and significantly higher than the two groups after bronchodilator use (p = 0.010 and p = 0.004, respectively). The changes in Rrs5 and Xrs5 were not significantly different between the children with PIBO and asthma. CONCLUSION Measuring Rrs5 and Xrs5 before and after bronchodilator use may help to discriminate PIBO from asthma in children aged three to five years with chronic or recurrent respiratory symptoms.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics; Inje University Haeundae Paik Hospital; Busan Korea
| | - Jisun Yoon
- Department of Pediatrics; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Hyun-Ju Cho
- Department of Pediatrics; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Soo-Jong Hong
- Department of Pediatrics; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jinho Yu
- Department of Pediatrics; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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Chen D, Xie N, Lin Y, Yang Z, Liu W, Wu S, Chen J, Pan X, Yang S, Cai Y. Diagnostic value of antineutrophil cytoplasmic antibodies in children with bronchiolitis obliterans. J Thorac Dis 2016; 8:1306-1315. [PMID: 27293851 PMCID: PMC4886013 DOI: 10.21037/jtd.2016.05.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/09/2016] [Indexed: 08/15/2023]
Abstract
BACKGROUND Diagnosis of childhood bronchiolitis obliterans (BO) is difficult owing to non-specific clinical presentations and limited investigational options. There is a lack in established serum biomarkers for BO. While the diagnostic value of antineutrophil cytoplasmic antibodies (ANCAs) has been discussed, little is known about this in BO. We aimed to investigate the serological profiles of ANCAs against myeloperoxidase (MPO-ANCA) and proteinase-3 (PR3-ANCA) in BO and acute pneumonia. METHODS In this study, 42 BO children (BO group) and 43 with mild acute pneumonia (pneumonia group) were included, based on rigorous diagnostic criteria and additional constraints for minimizing selection bias. Serum MPO-ANCA and PR3-ANCA levels were measured on the first (baseline) and the last day of hospitalization (on discharge) by enzyme linked immunosorbent assay. RESULTS Although the BO children had a longer hospital stay, the overall rate of positivity (≥180 AAU/mL) and median serum level of MPO-ANCA were higher in the BO group compared with the pneumonia group, either at baseline (69.1% vs. 9.3%, 292.00 vs. 104.75 AAU/mL, both P<0.001) or on discharge (61.9% vs. 9.3%, 310.50 vs. 95.42 AAU/mL). Similar was found for PR3-ANCA (38.1% vs. 4.7%, 106.66 vs. 54.56 AAU/mL at baseline; 35.7% vs. 2.3%, 97.98 vs. 57.23 AAU/mL on discharge, both P<0.001). There were a higher rate of dual-positivity and a lower rate of dual-negativity to both ANCAs in the BO group than those in the pneumonia group (all P<0.001). CONCLUSIONS Detection of MPO- and PR3-ANCA can help diagnosis of childhood BO.
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Borthwick LA, Suwara MI, Carnell SC, Green NJ, Mahida R, Dixon D, Gillespie CS, Cartwright TN, Horabin J, Walker A, Olin E, Rangar M, Gardner A, Mann J, Corris PA, Mann DA, Fisher AJ. Pseudomonas aeruginosa Induced Airway Epithelial Injury Drives Fibroblast Activation: A Mechanism in Chronic Lung Allograft Dysfunction. Am J Transplant 2016; 16:1751-65. [PMID: 26714197 PMCID: PMC4879508 DOI: 10.1111/ajt.13690] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 12/03/2015] [Accepted: 12/06/2015] [Indexed: 01/25/2023]
Abstract
Bacterial infections after lung transplantation cause airway epithelial injury and are associated with an increased risk of developing bronchiolitis obliterans syndrome. The damaged epithelium is a source of alarmins that activate the innate immune system, yet their ability to activate fibroblasts in the development of bronchiolitis obliterans syndrome has not been evaluated. Two epithelial alarmins were measured longitudinally in bronchoalveolar lavages from lung transplant recipients who developed bronchiolitis obliterans syndrome and were compared to stable controls. In addition, conditioned media from human airway epithelial cells infected with Pseudomonas aeruginosa was applied to lung fibroblasts and inflammatory responses were determined. Interleukin-1 alpha (IL-1α) was increased in bronchoalveolar lavage of lung transplant recipients growing P. aeruginosa (11.5 [5.4-21.8] vs. 2.8 [0.9-9.4] pg/mL, p < 0.01) and was significantly elevated within 3 months of developing bronchiolitis obliterans syndrome (8.3 [1.4-25.1] vs. 3.6 [0.6-17.1] pg/mL, p < 0.01), whereas high mobility group protein B1 remained unchanged. IL-1α positively correlated with elevated bronchoalveolar lavage IL-8 levels (r(2) = 0.6095, p < 0.0001) and neutrophil percentage (r(2) = 0.25, p = 0.01). Conditioned media from P. aeruginosa infected epithelial cells induced a potent pro-inflammatory phenotype in fibroblasts via an IL-1α/IL-1R-dependent signaling pathway. In conclusion, we propose that IL-1α may be a novel therapeutic target to limit Pseudomonas associated allograft injury after lung transplantation.
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Affiliation(s)
- L. A. Borthwick
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. I. Suwara
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - S. C. Carnell
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - N. J. Green
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - R. Mahida
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - D. Dixon
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - C. S. Gillespie
- School of Mathematics and StatisticsNewcastle UniversityNewcastle upon TyneUK
| | - T. N. Cartwright
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - J. Horabin
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - A. Walker
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - E. Olin
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - M. Rangar
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
| | - A. Gardner
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - J. Mann
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - P. A. Corris
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
| | - D. A. Mann
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
| | - A. J. Fisher
- Tissue Fibrosis and Repair GroupInstitute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK,Institute of TransplantationNewcastle Upon Tyne Hospitals NHS Foundation TrustFreeman HospitalNewcastle upon TyneUK
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Gassas A, Krueger J, Zaidman I, Schechter T, Craig-Barnes H, Ali M, Palaniyar N. Infections and neutrophils in the pathogenesis of bronchiolitis obliterans syndrome in children after allogeneic stem cell transplantation. Pediatr Transplant 2016; 20:303-6. [PMID: 26918734 DOI: 10.1111/petr.12657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/28/2022]
Abstract
It is plausible that infections post-hematopoietic SCT play a role in the pathogenesis of BOS. A prospective study for children with history, questionnaire, examination, PFTs, and blood counts at one, three, six, nine, 12, 18, and 24 months post-SCT was conducted. Between September 2009 and September 2011 (n = 39), six developed BOS at 200 days (range 94-282), three patients had probable clinical respiratory infection, and all six had higher neutrophil count compared to non-BOS patients (4.7 vs. 2.4 at three months and 6.3 vs. 2.9 at six months ×10(9) /L, p = 0.03). Contribution of clinical and subclinical infection needs to be considered in the pathogenesis of BOS.
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Affiliation(s)
- Adam Gassas
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joerg Krueger
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Irina Zaidman
- Division of Hematology/Oncology/BMT, Rambam Medical Center, Haifa, Israel
| | - Tal Schechter
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hayley Craig-Barnes
- Programs of Physiology & Experimental Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Muhammad Ali
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nades Palaniyar
- Programs of Physiology & Experimental Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Gassas A, Schechter T, Krueger J, Craig-Barnes H, Sung L, Ali M, Dell S, Egeler RM, Zaidman I, Palaniyar N. Serum Krebs Von Den Lungen-6 as a Biomarker for Early Detection of Bronchiolitis Obliterans Syndrome in Children Undergoing Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1524-8. [PMID: 25963919 DOI: 10.1016/j.bbmt.2015.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/16/2015] [Indexed: 11/25/2022]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a devastating complication after allogeneic stem cell transplantation (allo-SCT). Early identification of high-risk patients is pivotal for success. Lung proteins, KL-6, CCSP, SP-A, and SP-D, measured in the serum may identify high-risk patients for BOS earlier than pulmonary function tests (PFTs) can identify changes or clinical symptoms. Lung proteins were measured in patients' serum at baseline and at 1, 3, 6, 9, 12, 18, and 24 months after transplantation along with history, clinical examination, and PFTs. Serum levels of lung proteins were also measured in healthy control subjects. The primary endpoint was the development of BOS confirmed by pathological biopsy or National Institutes of Health criteria. Between September 2009 and September 2011, 39 patients were enrolled. Six children developed BOS at a median time of 200 days (range, 94 to 282). KL-6 levels were low in control subjects, at a median of .1 U/mL (range, .1 to 1.5). Pre-SCT and 1-month KL-6 levels were significantly higher in surviving patients who developed BOS (n = 6) versus those who did not (n = 18) (pre-SCT: mean, 32.6 U/mL [IQR, 9.7 to 89.3] versus 5.8 U/mL [IQR, 2.1 to 12.6], P = .03; at 1 month: mean, 52.5 U/mL [IQR, 20.2 to 121.3] versus 11.4 U/mL [IQR, 5.7 to 36.0], P = .04). Three- and 6-month KL-6 levels continued to be higher in BOS group but were not statistically significant. CCSP, SP-A, and SP-D were not predictive. KL-6 measured in the serum of children receiving allo-SCT may identify patients at high risk for the development of BOS. These patients will benefit from intensive surveillance protocol and early therapy before irreversible lung damage.
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Affiliation(s)
- Adam Gassas
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Tal Schechter
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joerg Krueger
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Hayley Craig-Barnes
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Programs of Physiology & Experimental Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Programs of Physiology & Experimental Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Ali
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Dell
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - R Maarten Egeler
- Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Irina Zaidman
- Division of Hematology/Oncology/BMT, Rambam Medical Center, Haifa, Israel
| | - Nades Palaniyar
- Programs of Physiology & Experimental Medicine, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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Quantitative computed tomography assessment of graft-versus-host disease-related bronchiolitis obliterans in children: A pilot feasibility study. Eur Radiol 2015; 25:2931-6. [DOI: 10.1007/s00330-015-3700-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/24/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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Rosewich M, Zissler UM, Kheiri T, Voss S, Eickmeier O, Schulze J, Herrmann E, Dücker RP, Schubert R, Zielen S. Airway inflammation in children and adolescents with bronchiolitis obliterans. Cytokine 2015; 73:156-62. [PMID: 25748838 DOI: 10.1016/j.cyto.2014.10.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/22/2014] [Accepted: 10/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Airway inflammation plays a major role in the progression of chronic lung diseases. The features of airway inflammation are not well defined among patients with cases of bronchiolitis obliterans (BO) that began in childhood. OBJECTIVES To investigate the sputum cell and cytokine profiles of stable cases of BO regarding lung function and the involvement of small airway disease (SAD). METHODS Twenty patients with BO (median age=14.5, range=7-23years) and 22 healthy controls (median age=16.5years, range=7-24years) were investigated. Lung function parameters and bronchial reversibility testing as well as sputum cell and cytokine profiles (IL-1β, IL-6, IL-8, TNF-α, IL-5, IFN-γ, and NFκB regulation) were analysed using quantitative RT-PCR and cytometric bead assay (CBA) in induced sputum. RESULTS Patients with BO had significantly lower lung function values, including FVC, forced expiratory volume (FEV1), the Tiffeneau index (FEV1/VC), and MEF25, but increased functional residual capacity (RV/TLC) values. Bronchial reversibility was found in five patients (25%). Moreover, airway inflammation (as indicated by total cells, neutrophils, IL-1β, IL-6, IL-8, TNF-α, and NFκB) was significantly increased among patients with BO compared with controls. CONCLUSIONS BO is predominantly a neutrophilic disease of the small bronchioles featuring elevated levels of pro-inflammatory cytokines leading to tissue remodelling and fibrosis of the small airways. Future therapies for patients with BO should more efficiently target the small airways.
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Affiliation(s)
- Martin Rosewich
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | - Ulrich M Zissler
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Germany
| | - Tanja Kheiri
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Sandra Voss
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Olaf Eickmeier
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Johannes Schulze
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Ruth Pia Dücker
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Ralf Schubert
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Stefan Zielen
- Department of Paediatric Pulmonology, Allergy and Cystic Fibrosis, Children's Hospital, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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Bronchiolitis obliterans complicating a pneumothorax after Stevens-Johnson syndrome induced by lamotrigine. J Formos Med Assoc 2015; 114:285-9. [DOI: 10.1016/j.jfma.2012.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/20/2012] [Accepted: 02/28/2012] [Indexed: 11/21/2022] Open
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Castro-Rodriguez JA, Giubergia V, Fischer GB, Castaños C, Sarria EE, Gonzalez R, Mattiello R, Vega-Briceño LE, Murtagh P. Postinfectious bronchiolitis obliterans in children: the South American contribution. Acta Paediatr 2014; 103:913-21. [PMID: 24832610 DOI: 10.1111/apa.12689] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/18/2014] [Accepted: 05/12/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED Postinfectious bronchiolitis obliterans (PIBO) is an infrequent chronic lung that causes irreversible obstruction and, or, obliteration of the smaller airways. This review particularly focuses on more than 30 studies from South America. CONCLUSION The initial PIBO event occurs in the early years of life and is strongly associated with adenovirus infection and the need for mechanical ventilator support. Treatment requires a multidisciplinary strategy. Multicentre studies are needed to determine progression, optimal management and long-term follow-up.
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Affiliation(s)
- Jose A. Castro-Rodriguez
- Pulmonology Unit; Departments of Pediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Veronica Giubergia
- Pulmonology Department; Hospital de Pediatria Dr Juan P. Garrahan; Buenos Aires Argentina
| | - Gilberto B. Fischer
- Department of Pediatrics; Universidade Federal de Ciencias da Saude; Porto Alegre Brazil
| | - Claudio Castaños
- Pulmonology Department; Hospital de Pediatria Dr Juan P. Garrahan; Buenos Aires Argentina
| | - Edgar E. Sarria
- Centro Infant- Instituto de Pesquisas Biomédicas; Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre Brasil
| | - Ramiro Gonzalez
- Department of Pediatrics; Clinica Las Condes; Santiago Chile
| | - Rita Mattiello
- Centro Infant- Instituto de Pesquisas Biomédicas; Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre Brasil
| | - Luis E. Vega-Briceño
- Department of Pediatrics; Clinica Alemana; Universidad del Desarrollo; Santiago Chile
| | - Patricia Murtagh
- Pulmonology Department; Hospital de Pediatria Dr Juan P. Garrahan; Buenos Aires Argentina
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Tomikawa SO, Adde FV, da Silva Filho LVRF, Leone C, Rodrigues JC. Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy. Orphanet J Rare Dis 2014; 9:128. [PMID: 25124141 PMCID: PMC4243923 DOI: 10.1186/s13023-014-0128-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background Bronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. Here we report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy. Methods Forty patients fulfilling the BO diagnosis criteria were treated with methylprednisolone pulse therapy in monthly cycles until clinical improvement. After the pulse therapy began, we analyzed the clinical and laboratory data at intervals. Statistical analyses were performed using non-parametric tests to compare repeated measures (Friedman, Wilcoxon) or paired nominal data (McNemar) (α = 5%). Results The frequency of wheezing exacerbations and hospitalizations was reduced (p = 0.0042 and p < 0.0001, respectively) and oxygen saturation improved (p = 0.0002) in the pulse therapy-treated patients. Prolonged oral corticosteroid therapy was discontinued in 83% of these patients. The mean Z-score length for age improved from -1.08 to -0.63, and the mean Z-score weight for age improved from -0.91 to -0.59. The adverse effects during the infusion were temporary and none were serious. Conclusions Our data suggest that pulse corticotherapy could be a safe alternative to prolonged systemic oral corticotherapy in children with BO, thus minimizing the adverse effects of the oral therapy. New prospective controlled studies are required to confirm this proposition.
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Affiliation(s)
- Silvia Onoda Tomikawa
- Pediatric Pulmonology Division, Instituto da Criança, Hospital das Clínicas, University of São Paulo, Avenida Dr Enéas de Carvalho Aguiar, 647, São Paulo, CEP 05403-000, SP, Brazil.
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Lino CA, Batista AKM, Soares MAD, de Freitas AEH, Gomes LC, M Filho JH, Gomes VCC. Bronchiolitis obliterans: clinical and radiological profile of children followed-up in a reference outpatient clinic. REVISTA PAULISTA DE PEDIATRIA 2014; 31:10-6. [PMID: 23703038 DOI: 10.1590/s0103-05822013000100003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 07/30/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe the clinical and radiological characteristics of patients with bronchiolitis obliterans. METHODS This is a retrospective and descriptive study. Data were collected from patients diagnosed with bronchiolitis obliterans between 2004 and 2008 in the Pediatric Pulmonology Clinic of Hospital Infantil Albert Sabin, in Ceará, Northeast Brazil. Such diagnosis was based on clinical and tomographic criteria. Previous history, clinical findings at the diagnosis, complementary exams, and follow-up data were evaluated. RESULTS 35 children diagnosed with bronchiolitis obliterans were identified. There was a predominance of male patients (3:1). The mean age at the onset of symptoms was 7.5 months, and bronchiolitis obliterans was diagnosed at a mean age of 21.8 months. The most common clinical findings were crackles/wheezing, tachypnea, dyspnea, and chest deformity. Post-infectious etiology was the main cause of bronchiolitis obliterans. Predominant findings at chest X-ray and high resolution computed tomography were peri-bronchial thickening and mosaic pattern, respectively. The treatment was variable and individualized. The majority of patients improved during follow-up, despite the persistence of respiratory symptoms. CONCLUSIONS In this study, the predominance of male patients and post-infectious etiology was noted, corroborating scientific literature. The most common tomographic findings were similar to those described in previous studies (mosaic pattern, peri-bronchial thickening, and bronchiectasis). Evidence about the treatment of this disease is still lacking. The diagnosis was delayed, which indicates that clinical suspicion of bronchiolitis obliterans is necessary in children with persistent and severe wheezing.
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Abstract
PURPOSE OF REVIEW Lung transplantation for infants and children is an accepted but rarely exercised option for the treatment of end-stage lung disease, with outcomes equivalent to those for adults. However, widespread misconceptions regarding pediatric outcomes often confound timely and appropriate referral to specialty centers. We present the updated information for primary pediatricians to utilize when counseling families with children confronted by progressive end-stage pulmonary or cardiovascular disease. RECENT FINDINGS We provide general guidelines to consider for referral, and discuss allocation of organs in children, information regarding standard treatment protocols, and survival outcomes. SUMMARY Lung transplantation is a worthwhile treatment option to consider in children with end-stage lung disease. The treatment is complex, but lung transplant provides substantial survival benefit and markedly improved quality of life for children and their families. This timely review provides comprehensive information for pediatricians who are considering options for treatment of children with end-stage lung disease.
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Affiliation(s)
- Carol Conrad
- aDivision of Pediatric Pulmonary Medicine bDivision of Critical Care, Department of Pediatrics, Center for Excellence in Pulmonary Biology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California, USA
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Xie BQ, Wang W, Zhang WQ, Guo XH, Yang MF, Wang L, He ZX, Tian YQ. Ventilation/perfusion scintigraphy in children with post-infectious bronchiolitis obliterans: a pilot study. PLoS One 2014; 9:e98381. [PMID: 24852165 PMCID: PMC4031120 DOI: 10.1371/journal.pone.0098381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/02/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Childhood post-infectious bronchiolitis obliterans (BO) is an infrequent lung disease leading to narrowing and/or complete obliteration of small airways. Ventilation and perfusion (V/Q) scan can provide both regional and global pulmonary information. However, only few retrospective researches investigating post-infectious BO involved V/Q scan, the clinical value of this method is unknown. This preliminary prospective study was aimed to evaluate the correlation of V/Q scan with disease severity, pulmonary function test results, and prognosis in children with post-infectious BO. METHODS Twenty-five post-infectious BO children (18 boys and 7 girls; mean age, 41 months) underwent V/Q scan and pulmonary function tests. Patients were followed after their inclusion. Ventilation index and perfusion index obtained from V/Q scan were used to measure pulmonary abnormalities. Spearman's rank correlation test of ventilation index and perfusion index on disease severity, lung function tests indices, and follow-up results were performed. RESULTS The median follow-up period was 4.6 years (range, 2.2 to 5.0 years). Ventilation index and perfusion index were both correlated with disease severity (r = 0.72, p<0.01 and r = 0.73, p<0.01), but only ventilation index was related to pulmonary function tests results (all p<0.05). In addition, Spearman test yielded significant correlations between perfusion index and prognosis (r = 0.77, p<0.01), and ventilation index and prognosis (r = 0.63, p = 0.01). CONCLUSIONS For children with post-infectious BO, the present study preliminarily indicated that the degree of ventilation and perfusion abnormalities evaluated by V/Q scan may be used to assess disease severity, and may be predictive of patient's outcome.
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Affiliation(s)
- Bo-Qia Xie
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wang
- Department of Respiration, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wen-Qian Zhang
- Department of Thoracic surgery, Institute of Respiratory Disease, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin-Hua Guo
- Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min-Fu Yang
- Department of Nuclear Medicine, Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zuo-Xiang He
- Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Qin Tian
- Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail:
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Sabri YY, Hamdy Ibrahim IM, Radman AF. Bronchiolitis Obliterans (BO): HRCT findings in 20 patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Teixeira MF, Rodrigues JC, Leone C, Adde FV. Acute Bronchodilator Responsiveness to Tiotropium in Postinfectious Bronchiolitis Obliterans in Children. Chest 2013; 144:974-980. [DOI: 10.1378/chest.12-2280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Recurrent pneumothorax, pneumomediastinum, and subcutaneous emphysema in late-onset noninfectious pulmonary complications (LONIPCs) after hematopoietic stem cell transplantation. J Pediatr Hematol Oncol 2013; 35:242-3. [PMID: 23242331 DOI: 10.1097/mph.0b013e318279f1ca] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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