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Chang AB, Dharmage SC, Marchant JM, McCallum GB, Morris PS, Schultz A, Toombs M, Wurzel DF, Yerkovich ST, Grimwood K. Improving the Diagnosis and Treatment of Paediatric Bronchiectasis Through Research and Translation. Arch Bronconeumol 2024; 60:364-373. [PMID: 38548577 DOI: 10.1016/j.arbres.2024.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/02/2024] [Accepted: 03/04/2024] [Indexed: 06/05/2024]
Abstract
Bronchiectasis, particularly in children, is an increasingly recognised yet neglected chronic lung disorder affecting individuals in both low-to-middle and high-income countries. It has a high disease burden and there is substantial inequity within and between settings. Furthermore, compared with other chronic lung diseases, considerably fewer resources are available for children with bronchiectasis. The need to prevent bronchiectasis and to reduce its burden also synchronously aligns with its high prevalence and economic costs to health services and society. Like many chronic lung diseases, bronchiectasis often originates early in childhood, highlighting the importance of reducing the disease burden in children. Concerted efforts are therefore needed to improve disease detection, clinical management and equity of care. Modifiable factors in the causal pathways of bronchiectasis, such as preventing severe and recurrent lower respiratory infections should be addressed, whilst also acknowledging the role played by social determinants of health. Here, we highlight the importance of early recognition/detection and optimal management of bronchiectasis in children, and outline our research, which is attempting to address important clinical knowledge gaps discussed in a recent workshop. The research is grouped under three themes focussing upon primary prevention, improving diagnosis and disease characterisation, and providing better management. Our hope is that others in multiple settings will undertake additional studies in this neglected field to further improve the lives of people with bronchiectasis. We also provide a resource list with links to help inform consumers and healthcare professionals about bronchiectasis and its recognition and management.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gabrielle B McCallum
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Peter S Morris
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - Andre Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute and Division of Paediatrics, Faculty of Medicine, University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Maree Toombs
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle F Wurzel
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
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O’Farrell HE, Kok HC, Goel S, Chang AB, Yerkovich ST. Endotypes of Paediatric Cough-Do They Exist and Finding New Techniques to Improve Clinical Outcomes. J Clin Med 2024; 13:756. [PMID: 38337450 PMCID: PMC10856076 DOI: 10.3390/jcm13030756] [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: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic cough is a common symptom of many childhood lung conditions. Given the phenotypic heterogeneity of chronic cough, better characterization through endotyping is required to provide diagnostic certainty, precision therapies and to identify pathobiological mechanisms. This review summarizes recent endotype discoveries in airway diseases, particularly in relation to children, and describes the multi-omic approaches that are required to define endotypes. Potential biospecimens that may contribute to endotype and biomarker discoveries are also discussed. Identifying endotypes of chronic cough can likely provide personalized medicine and contribute to improved clinical outcomes for children.
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Affiliation(s)
- Hannah E. O’Farrell
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Hing Cheong Kok
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Department of Paediatrics, Sabah Women and Children’s Hospital, Kota Kinabalu 88996, Sabah, Malaysia
| | - Suhani Goel
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Anne B. Chang
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Stephanie T. Yerkovich
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
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Guo J, Liang J, Guo Z, Bai X, Zhang H, Zhang N, Wang H, Chen Q, Li W, Dong R, Ge D, Yu X, Cui X. Network pharmacology and transcriptomics to determine Danggui Yifei Decoction mechanism of action for the treatment of chronic lung injury. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116873. [PMID: 37419225 DOI: 10.1016/j.jep.2023.116873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Several children with pneumonia (especially severe cases) have symptoms of cough and expectoration during the recovery stage after standard symptomatic treatment, which eventually results in chronic lung injury. Danggui yifei Decoction (DGYFD), a traditional Chinese formula, has shown clinical promise for the treatment of chronic lung injury during the recovery stage of pneumonia, however, its mechanism of action is yet to be deciphered. AIM OF THIS STUDY To investigate the therapeutic mechanism of DGYFD for the treatment of chronic lung injury by integrating network pharmacology and transcriptomics. MATERIALS AND METHODS BALB/c mice were used to establish the chronic lung injury mouse model by intratracheal instillation of lipopolysaccharide (LPS). Pathological analysis of lung tissue, lung injury histological score, lung index, protein levels in bronchoalveolar lavage fluid (BALF), immunohistochemical staining, blood rheology, inflammatory cytokines, and oxidative stress levels were used to evaluate the pharmacological effects of DGYFD. Chemical components of DGYFD were identified using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Integrated network pharmacology together with transcriptomics was used to predict potential biological targets. Western blot analysis was used to verify the results. RESULTS In this study, we demonstrated that DGYFD could improve lung injury pathological changes, decreases lung index, down-regulate NO and IL-6 levels, and regulate blood rheology. In addition, DGYFD was able to reduce the protein levels in BALF, up-regulate the expression levels of occludin and ZO-1, improve the ultrastructure of lung tissues, and reverse the imbalance of AT I and AT II cells to repair the alveolar-capillary permeability barrier. Twenty-nine active ingredients of DGYFD and 389 potential targets were identified by UPLC-MS/MS and network pharmacology, and 64 differentially expressed genes (DEGs) were identified using transcriptomics. GO and KEGG analysis revealed that the MAPK pathway may be the molecular target. Further, we found that DGYFD inhibits phosphorylation levels of p38 MAPK and JNK in chronic lung injury mouse models. CONCLUSIONS DGYFD could regulate the imbalance between the excessive release of inflammatory cytokines and oxidative stress, repair the alveolar-capillary permeability barrier and improve the pathological changes during chronic lung injury by regulating the MAPK signaling pathway.
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Affiliation(s)
- Jianning Guo
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Junming Liang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ziyi Guo
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xue Bai
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Hongxian Zhang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ning Zhang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Handong Wang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Qian Chen
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Wei Li
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China; School of Graduates, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ruijuan Dong
- Scientific Research and Experiment Center, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Dongyu Ge
- Scientific Research and Experiment Center, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xue Yu
- Scientific Research and Experiment Center, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xia Cui
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China.
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Zhang R, Wang L, Gong C, Gao H, Li W, Bian C, Zhao J, Ding S, Zhu Y. Associated Risk Factors and Diagnostic Value of Fiberoptic Bronchoscopy for Protracted Bacterial Bronchitis in Children. Int J Clin Pract 2023; 2023:8116651. [PMID: 37449299 PMCID: PMC10338127 DOI: 10.1155/2023/8116651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Untreated protracted bacterial bronchitis (PBB), a chronic wet cough prevalent in children, may lead to chronic suppurative lung disease. However, clinical diagnostic criteria are currently nonspecific; thus, PBB may be misdiagnosed. Thus, we assessed the diagnostic value of fiberoptic bronchoscopy (FOB) and the risk factors associated with PBB. Methods Children with chronic cough at The First Affiliated Hospital of Anhui Medical University from January 2015 to May 2020 were enrolled and allocated to a suspected PBB (n = 141) or a non-PBB (n = 206) group. All children underwent extensive laboratory, chest imaging, and allergen tests. Children with suspected PBB underwent FOB with bronchoalveolar lavage; lavage and sputum samples were cultured. Results All 347 children had a chronic wet cough for approximately 2 months. Of 141 children with suspected PBB, 140 received FOB with bronchoalveolar lavage. Visible tracheal changes included pale mucosa, mucosal congestion, edema, swelling, and increased secretions attached to the wall. Sputum was visible primarily in the left main bronchus (78.7%), left lower lobe (59.6%), right upper lobe (62.4%), and right lower lobe (64.5%). Sputum properties and amounts significantly differed between children with vs. without PBB (P < 0.05). Dermatophagoides (odds ratio (OR), 2.642; 95% CI, 1.283-5.369), milk protein (OR, 2.452; 95% CI, 1.243-4.836) allergies, and eczema (OR, 1.763; 95% CI, 1.011-3.075) were risk factors significantly associated with PBB. Conclusion Dermatophagoides, milk protein, and eczema were associated with an increased risk of PBB. Sputum distribution and tracheal wall changes observed through FOB may distinguish PBB and assist in its diagnosis.
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Affiliation(s)
- Rong Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Li Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Chen Gong
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Hui Gao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Wenhong Li
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Chenrong Bian
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Jiaying Zhao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Shenggang Ding
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
| | - Yulin Zhu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Anhui 230000, China
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Geerts N, De Vooght L, Passaris I, Delputte P, Van den Bergh B, Cos P. Antibiotic Tolerance Indicative of Persistence Is Pervasive among Clinical Streptococcus pneumoniae Isolates and Shows Strong Condition Dependence. Microbiol Spectr 2022; 10:e0270122. [PMID: 36374111 PMCID: PMC9769776 DOI: 10.1128/spectrum.02701-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022] Open
Abstract
Streptococcus pneumoniae is an important human pathogen, being one of the most common causes of community-acquired pneumonia and otitis media. Antibiotic resistance in S. pneumoniae is an emerging problem, as it depletes our arsenal of effective drugs. In addition, persistence also contributes to the antibiotic crisis in many other pathogens, yet for S. pneumoniae, little is known about antibiotic-tolerant persisters and robust experimental means are lacking. Persister cells are phenotypic variants that exist as a subpopulation within a clonal culture. Being tolerant to lethal antibiotics, they underly the chronic nature of a variety of infections and even help in acquiring genetic resistance. In this study, we set out to identify and characterize persistence in S. pneumoniae. Specifically, we followed different strategies to overcome the self-limiting nature of S. pneumoniae as a confounding factor in the prolonged monitoring of antibiotic survival needed to study persistence. Under optimized conditions, we identified genuine persisters in various growth phases and for four relevant antibiotics through biphasic survival dynamics and heritability assays. Finally, we detected a high variety in antibiotic survival levels across a diverse collection of S. pneumoniae clinical isolates, which assumes that a high natural diversity in persistence is widely present in S. pneumoniae. Collectively, this proof of concept significantly progresses the understanding of the importance of antibiotic persistence in S. pneumoniae infections, which will set the stage for characterizing its relevance to clinical outcomes and advocates for increased attention to the phenotype in both fundamental and clinical research. IMPORTANCE S. pneumoniae is considered a serious threat by the Centers for Disease Control and Prevention because of rising antibiotic resistance. In addition to resistance, bacteria can also survive lethal antibiotic treatment by developing antibiotic tolerance, more specifically, antibiotic tolerance through persistence. This phenotypic variation seems omnipresent among bacterial life, is linked to therapy failure, and acts as a catalyst for resistance development. This study gives the first proof of the presence of persister cells in S. pneumoniae and shows a high variety in persistence levels among diverse strains, suggesting that persistence is a general trait in S. pneumoniae cultures. Our work advocates for higher interest for persistence in S. pneumoniae as a contributing factor for therapy failure and resistance development.
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Affiliation(s)
- Nele Geerts
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Linda De Vooght
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | | | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Bram Van den Bergh
- Centre of Microbial and Plant Genetics, Department of Molecular and Microbial Systems, KU Leuven, Leuven, Belgium
- Center for Microbiology, Flanders Institute for Biotechnology, VIB, Leuven, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
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Huang L, Lai K, Zhan C, Long L, Yi F, Zhou J, Zhan W, Lu H, Jiang Z, Chen Y, Jiang M, Chen R, Xie J, Luo W. Clinical characteristics of protracted bacterial bronchitis in adults. Heliyon 2022; 9:e12299. [PMID: 36755583 PMCID: PMC9900482 DOI: 10.1016/j.heliyon.2022.e12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/23/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
There are few data regarding adult protracted bacterial bronchitis (PBB). This study aimed to delineate the clinical features of PBB and evaluate their potential diagnostic value in adults. We recruited 55 adult patients with PBB and selected randomly 220 patients with non-PBB as control. A diagnosis of PBB was considered if patients had a cough lasting ≥3 weeks, no abnormalities of chest computed tomography, positive bacterial culture in sputum and/or response well to oral moxifloxacin for 1-4 weeks. The clinical manifestations and laboratory investigations were compared between PBB patients and non-PBB patients. Of the 55 patients with PBB, approximately three-fifths (34, 61.8%) were females with a median age of 46.0 years, which were similar to that of patients with non-PBB. We observed a shorter cough duration in PBB than non-PBB (median 3.0 versus 24.0 months, p < 0.001). Compared to non-PBB patients, PBB patients had higher incidences of productive cough, yellow phlegm and a sensation of mucus in the throat (SMIT) (all p < 0.001). Sputum neutrophils and lymphocytes were markedly elevated in PBB patients than non-PBB patients (both p = 0.004). Bacterial pathogens were detected in eight (28.6%) of 28 cases with PBB. The multivariate analyses showed yellow phlegm, productive cough, SMIT, increased sputum lymphocytes (≥2.3%) and cough duration ≤8.5 months with moderate sensitivity (50.9-81.8%) and moderate-high specificity (60.5-94.4%) for determining PBB. In summary, adults with PBB are characterized by productive cough, yellow phlegm, SMIT and neutrophilic airway inflammation. These cough features and increased sputum lymphocytes may be useful to indicate PBB.
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Imbalance of alveolar epithelial type I and type Ⅱ cells in lipopolysaccharide-induced chronic lung injury young mouse model. Biochem Biophys Res Commun 2022; 618:107-112. [PMID: 35716594 DOI: 10.1016/j.bbrc.2022.05.081] [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: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
Abstract
Children are susceptible to pneumonia, which affects their growth and development. Immune disorders and unrepaired alveolar mucosal epithelium following pneumonia cause chronic lung injury. The mechanism of chronic lung injury is unknown and lacks animal models for reference. Therefore, we developed a chronic lung injury young mouse model to simulate the pathological process of children. 3-week-old mice were intratracheal instillation of lipopolysaccharide (LPS) every other day for six weeks. Consequently, the histopathology showed damaged integrity of lung tissue, fibrosis, and abnormally distributed alveolar epithelial cells. The total protein concentration in bronchoalveolar lavage fluid (BALF) was increased, alveolar epithelial type (AT) I cells were abnormal distribution, and AT II cells were reduced. The phosphorylation levels of IKBα and the expression levels of NF-κB p65 in lung tissue were up-regulated. In serum and BALF, the IL-6 was oversecretion, nitric oxide (NO) and superoxide dismutase (SOD) were perturbed secretion, oxidative stress imbalance. In addition, blood viscosity, plasma viscosity, and erythrocyte sedimentation rate (ESR) indexes in hemorheology were increased. In conclusion, it is feasible to construct the mouse model of chronic lung injury, and AT I and AT Ⅱ cells were imbalanced, which paves the way for further investigations on the pathogenesis of chronic lung injury and the efficacy of novel treatments.
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Capizzi A, Salvati P, Gallizia A, Rossi GA, Sacco O. Is secondary tracheomalacia associated with airway inflammation and infection? Pediatr Int 2022; 64:e15034. [PMID: 34674343 DOI: 10.1111/ped.15034] [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: 04/29/2021] [Revised: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recurrent lower respiratory tract infections are among the most prevalent symptoms in secondary tracheomalacia due to mediastinal vascular anomalies (MVAs). It is not known whether this condition could result in persistent lower respiratory tract inflammation and subclinical infection. METHODS A retrospective study was performed on records of children with tracheomalacia due to MVAs and recurrent respiratory infections who underwent computed tomography scan, bronchoscopy, and bronchoalveolar lavage (BAL) as part of their clinical evaluation. RESULTS Thirty-one children were included in the study: 21 with aberrant innominate artery, four with right aortic arch, one with double aortic arch, and five with aberrant innominate artery associated with right aortic arch. Cytological evaluation of bronchoalveolar lavage fluid showed increased neutrophil percentages and normal lymphocyte and eosinophil proportions. Microorganism growth was detected in 13 BAL samples, with a bacterial load ≥104 colony-forming units/mL in eight (25.8%) of them. Most isolates were positive for Haemophilus influenzae. Bronchiectasis was detected in four children, all with BAL culture positive for H. influenzae. Four patients underwent MVA surgical correction and 27 conservative management, i.e., respiratory physiotherapy in all and high-dose amoxicillin/clavulanic acid (40 mg/kg/day) for 2-4 weeks in those with significant bacterial growth. There was an excellent outcome in most of them. CONCLUSIONS Neutrophilic alveolitis is detectable in secondary tracheomalacia but is associated with a clinically significant bacterial load only in a quarter of the patients. Caution should be used regarding inappropriate antibiotic prescriptions to avoid the emergence of resistance, whilst airway clearance maneuvers and infection preventive measures should be promoted.
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Affiliation(s)
- Antonino Capizzi
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Pietro Salvati
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Annalisa Gallizia
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Giovanni A Rossi
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Oliviero Sacco
- Pulmonary Disease Unit, Department of Pediatrics, G. Gaslini Research Institute and University Hospital, Genoa, Italy
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Diagnostic Accuracy of Nasopharyngeal Swab Cultures in Children Less Than Five Years with Chronic Wet Cough. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121161. [PMID: 34943357 PMCID: PMC8700365 DOI: 10.3390/children8121161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022]
Abstract
Background: It is necessary to find a non-invasive and accurate procedure to predict persistent bacterial bronchitis (PBB) causative organisms and guide antibiotic therapy. The study objective was to compare the diagnostic accuracy of nasopharyngeal swab cultures with bronchoalveolar lavage (BAL) cultures in children with PBB. Methods: Nasopharyngeal swab and BAL fluid specimens were collected and cultured for bacterial pathogens prospectively from less than five-year-old children undergoing flexible bronchoscopy for chronic wet cough. Results: Of the 59 children included in the study, 26 (44.1%) patients had a positive BAL bacterial culture with neutrophilic inflammation. Prevalence of positive cultures for any of the four common respiratory pathogens implicated in PBB (Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae) was significantly higher (p = 0.001) in NP swabs compared to BAL fluids (86.4% and 44.1% of PBB cases, respectively). NP swab cultures for any of the four main bacterial pathogens had 85% (95% CI: 65–96%) and 48% (95% CI: 31–66%) sensitivity and specificity of detecting PBB, respectively. Positive and negative predictive values were 56% (95% CI: 47–65%) and 80% (95% CI: 60–91%), respectively. In conclusion, in children less than 5 years of age with chronic wet cough (PBB-clinical), a negative NP swab result reduces the likelihood of lower airway infection; however, a positive NP swab does not accurately predict the presence of lower airway pathogens. Flexible bronchoscopy should be considered in those with recurrent PBB-clinical or with clinical pointers of central airway anomalies.
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Li X, Li Q, Wang X, Lu M, Shen J, Meng Q. Pidotimod in the treatment of pediatric recurrent respiratory tract infection. Pak J Med Sci 2019; 35:981-986. [PMID: 31372128 PMCID: PMC6659081 DOI: 10.12669/pjms.35.4.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To observe the clinical efficacy of pidotimod in the treatment of recurrent respiratory tract infection in children. Methods: One hundred thirty-two patients with recurrent respiratory tract infection who received treatment in Tianan City Central Hospital were selected and divided into an observation group and a control group using random number table, 66 in each group. Patients in the control group were given conventional treatment, while patients in the observation group were given conventional treatment and pidotimod treatment; the clinical efficacy of the two therapies was compared. The levels of IgG and IgM were measured after treatment. Results: The vital signs and the content of inflammatory mediator and Th1/Th2 in serum before and after treatment were compared, and the clinical efficacy of the two groups was evaluated. The fever, pulmonary rale, cough and antiadoncus of patients in the observation group disappeared earlier than those in the control group (P<0.05). The onset duration of respiratory tract infection and days of antibiotic application of the observation group were shorter than those of the control group after treatment (P<0.05). The times of infection of the observation group were less than that of the control group (P<0.05). Before treatment, the two groups had no significant difference in the content of inflammatory mediators and Th1/Th2 in the serum (P>0.05). The serum content of tumor necrosis factor (TNF)-α and interleukin (IL)-4 of the two groups one week after treatment was lower than that before treatment, and the content of interferon (IFN)-γ and IFN-γ/IL-4 were higher than that before treatment; moreover the observation group had lower serum content of TFN-α and IL-4 and lower content of IFN-γ and IFN-γ/IL-4 compared to the control group (P<0.05). The overall response rate of the observation group was 92.4%, much higher than 81.8% in the control group (P<0.05). Conclusion: Pidotimod has a remarkable efficacy in the treatment of pediatric recurrent respiratory tract infection because it can effectively inhibit the infection and optimize Th1/Th2 immune function.
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Affiliation(s)
- Xia Li
- Xia Li, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Qingfang Li
- Qingfang Li, Department of Pediatric Orthopedics, Taian City Central Hospital, Shandong, 271000, China
| | - Xudong Wang
- Xudong Wang, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Man Lu
- Man Lu, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Jingjing Shen
- Jingjing Shen, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
| | - Qingmei Meng
- Qingmei Meng, Department of Pediatric, Taian City Central Hospital, Shandong, 271000, China
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11
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Hamilos DL. Biofilm Formations in Pediatric Respiratory Tract Infection : Part 1: Biofilm Structure, Role of Innate Immunity in Protection Against and Response to Biofilm, Methods of Biofilm Detection, Pediatric Respiratory Tract Diseases Associated with Mucosal Biofilm Formation. Curr Infect Dis Rep 2019; 21:6. [PMID: 30820766 DOI: 10.1007/s11908-019-0658-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Biofilm represents an organized structure of microorganisms within an extracellular matrix attached to a surface. While the importance of biofilm in prosthetic heart valve and catheter-related infections has been known since the 1980s, the role of mucosal biofilm in human disease pathogenesis has only recently been elucidated. It is now clear that mucosal biofilm is present in both healthy and pathologic states. The purpose of this review is to examine the role of mucosal biofilm in pediatric respiratory infections. RECENT FINDINGS Mucosal biofilm has been implicated in relationship to several pediatric respiratory infections, including tonsillitis, adenoiditis, otitis media with effusion, chronic rhinosinusitis, persistent endobronchial infection, and bronchiectasis. In these conditions, core pathogens are detected in the biofilm, biofilm organisms are often detected by molecular techniques when conventional cultures are negative, and biofilm presence is more extensive in relation to disease than in healthy tissues. In chronic rhinosinusitis, the presence of polymicrobial biofilm is also a predictor of poorer outcome following sinus surgery. Biofilm in the tonsillar and adenoidal compartments plays a distinct role in contributing to disease in the middle ear and sinuses. Key observations regarding the relevance of biofilm to pediatric respiratory infections include (1) the association between the presence of biofilm and persistent/recurrent and more severe disease in these tissues despite antibiotic treatment, (2) linkage between biofilm core pathogens and acute infections, and (3) interrelationship between biofilm presence in one tissue and persistent or recurrent infection in an adjacent tissue. A greater understanding of the significance of mucosal biofilm will undoubtedly emerge with the development of effective means of eradicating mucosal biofilm.
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Affiliation(s)
- Daniel L Hamilos
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, 55 Fruit Street, Bulfinch-422, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
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12
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Lovie-Toon YG, McPhail SM, Au-Yeung YT, Hall KK, Chang AB, Vagenas D, Otim ME, O'Grady KAF. The Cost of Acute Respiratory Infections With Cough Among Urban Aboriginal and Torres Strait Islander Children. Front Pediatr 2018; 6:379. [PMID: 30560110 PMCID: PMC6287573 DOI: 10.3389/fped.2018.00379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction: Acute respiratory infections with cough (ARIwC) contribute considerably to childhood morbidity, yet few studies have examined the cost of these illnesses among Australian children. Moreover, of the few studies that have, none are inclusive of Aboriginal and/or Torres Strait Islander children, despite this population experiencing a greater burden of respiratory illnesses. This study aimed to determine the costs of ARIwC among urban Aboriginal and/or Torres Strait Islander children from the perspective of caretakers, the public healthcare system, and employers. Methods: This cost of illness study used data collected from Aboriginal and/or Torres Strait Islander children aged <5 years enrolled in a 12 month prospective cohort study conducted through an urban primary healthcare clinic in Queensland, Australia. Illness-related resource use was collected for each episode of ARIwC reported, and costed at market rates. Linear regression was used to (a) examine cost per episode by season of illness onset and cough duration and (b) examine cost per month of observation by baseline child and family characteristics. Results: During the study period, a total of 264 episodes of ARIwC were reported among 138 children. The total mean cost was estimated to be $AU252 per non-hospitalized episode (95%CI 169-334). Caretakers, the public healthcare system and employers incurred 44, 39, and 17% of costs per episode, respectively. After accounting for months of completed follow-ups, the total mean cost per child per year was estimated to be $991 (95%CI 514-1468). Winter episodes and episodes resulting in chronic cough were associated with significantly higher costs per episode. A prior history of wheezing, connections to traditional lands and parent/guardian belief that antibiotics should be given until symptoms resolved were associated with significantly higher cost per child month of observation. Conclusion: The cost of ARIwC in this predominantly disadvantaged population is substantial, particularly for caretakers and this needs to be considered in both clinical management and public health initiatives. The importance of cultural factors on health and burden of illness should not be overlooked. Further research into the prevention of chronic cough may play an important role in reducing the economic burden of pediatric respiratory infections.
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Affiliation(s)
- Yolanda G Lovie-Toon
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia.,Centre for Functioning and Health Research, Metro South Health, Woolloongabba, QLD, Australia
| | - Yin To Au-Yeung
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Kerry K Hall
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Anne B Chang
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia.,Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Lady Cilento Children's Hospital, Queensland Children's Hospital and Health Services, South Brisbane, QLD, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Michael E Otim
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Public Health, Virtual University Uganda, Kampala, Uganda
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
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13
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[Chronic cough and protracted bacterial bronchitis in children and adolescents]. PNEUMOLOGE 2018; 15:272-278. [PMID: 32214960 PMCID: PMC7088285 DOI: 10.1007/s10405-018-0191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hartnäckiger Husten ist einer der häufigsten Vorstellungsgründe in der ambulanten Praxis. Insbesondere bei Kindern bedeutet chronischer Husten (>4 Wochen) eine erhebliche Belastung für Kind und Familie. Während in der Vergangenheit die unteren Atemwege als steril betrachtet wurden, hat sich mittlerweile zunehmend das Konzept eines physiologischen Mikrobioms der unteren Atemwege herauskristallisiert. Von den Differenzialdiagnosen des chronischen Hustens ist v. a. bei ansonsten (lungen)gesunden Kindern unter 6 Jahren die protrahierte bakterielle Bronchitis (PBB) eine häufigere Form. Eine Tracheomalazie kann primär bestehen oder Folge des mechanisch belastenden Hustens sein, während bis auf eine verminderte alveoläre Phagozytose meist keine systemische oder lokale Abwehrschwäche besteht. Vielmehr lässt sich immunologisch eine aktivierte angeborene Immunität mit vermehrter Genexpression des Interleukin-1β-Signalwegs nachweisen. Auch hier ist es schwierig, zwischen Ursache und Auswirkung des chronisch entzündlichen Geschehens zu differenzieren. Nach heutiger Vorstellung sind die PBB und Nicht-CF-Bronchiektasie, also die nicht durch zystische Fibrose (CF) bedingte Bronchiektasie, 2 Seiten eines Krankheitsspektrums eitriger Lungenerkrankungen, sodass eine konsequente Therapie und langfristige kinderpneumologische Begleitung von Kindern mit chronisch feuchtem Husten notwendig erscheint.
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14
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15
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Hare KM, Leach AJ, Smith-Vaughan HC, Chang AB, Grimwood K. Streptococcus pneumoniae and chronic endobronchial infections in childhood. Pediatr Pulmonol 2017; 52:1532-1545. [PMID: 28922566 DOI: 10.1002/ppul.23828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/06/2017] [Indexed: 01/03/2023]
Abstract
Streptococcus pneumoniae (pneumococcus) is the main cause of bacterial pneumonia worldwide and has been studied extensively in this context. However, its role in chronic endobronchial infections and accompanying lower airway neutrophilic infiltration has received little attention. Severe and recurrent pneumonia are risk factors for chronic suppurative lung disease (CSLD) and bronchiectasis; the latter causes considerable morbidity and, in some populations, premature death in children and adults. Protracted bacterial bronchitis (PBB) is another chronic endobronchial infection associated with substantial morbidity. In some children, PBB may progress to bronchiectasis. Although nontypeable Haemophilus influenzae is the main pathogen in PBB, CSLD and bronchiectasis, pneumococci are isolated commonly from the lower airways of children with these diagnoses. Here we review what is known currently about pneumococci in PBB, CSLD and bronchiectasis, including the importance of pneumococcal nasopharyngeal colonization and how persistence in the lower airways may contribute to the pathogenesis of these chronic pulmonary disorders. Antibiotic treatments, particularly long-term azithromycin therapy, are discussed together with antibiotic resistance and the impact of pneumococcal conjugate vaccines. Important areas requiring further investigation are identified, including immune responses associated with pneumococcal lower airway infection, alone and in combination with other respiratory pathogens, and microarray serotyping to improve detection of carriage and infection by multiple serotypes. Genome wide association studies of pneumococci from the upper and lower airways will help identify virulence and resistance determinants, including potential therapeutic targets and vaccine antigens to treat and prevent endobronchial infections. Much work is needed, but the benefits will be substantial.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Gold Coast Health, Gold Coast, Queensland, Australia
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16
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Slack MPE. The evidence for non-typeable Haemophilus influenzae as a causative agent of childhood pneumonia. Pneumonia (Nathan) 2017; 9:9. [PMID: 28702311 PMCID: PMC5483294 DOI: 10.1186/s41479-017-0033-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/31/2017] [Indexed: 11/21/2022] Open
Abstract
Haemophilus influenzae type b (Hib) was a major cause of bacterial pneumonia in children prior to the introduction of Hib-conjugate vaccines. The widespread use of Hib-conjugate vaccines has resulted in a significant decline in the number of cases of invasive Hib disease, including bacteraemic pneumonia, in areas where the vaccine has been implemented. In many countries, non-typeable H. influenzae (NTHI) is now the most common cause of invasive haemophilus infection in all ages. NTHI are a recognized cause of bacteraemic and non-bacteraemic pneumonia in children and in adults. Less than 10% of cases of pediatric pneumonia are bacteraemic, and children generally do not expectorate lower respiratory tract secretions, so determining the microbial cause of a non-bacteraemic pneumonia is challenging. In this commentary the evidence that NTHI is a cause of pneumonia in children is briefly reviewed.
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Affiliation(s)
- Mary P E Slack
- School of Medicine, Gold Coast Campus, Griffith University, Southport, Queensland 4222 Australia
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17
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Pifferi M, Bush A, Caramella D, Metelli MR, Di Cicco M, Piras M, Gherarducci G, Capristo C, Maggi F, Peroni D, Boner AL. Matrix metalloproteinases and airway remodeling and function in primary ciliary dyskinesia. Respir Med 2017; 124:49-56. [PMID: 28284321 DOI: 10.1016/j.rmed.2017.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/16/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The balance between matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) is important in the regulation of airway damage. OBJECTIVE To evaluate whether they are important in the pathophysiology of primary and secondary ciliary dyskinesia (PCD, SCD). METHODS We measured sputum bacteriology, lung CT changes, MMPs, TIMPs and lung function in 86 patients (51 PCD, 35 SCD) in a cross-sectional study; the 10 controls studied did not have HRCT or sputum cultures. MMPs, TIMPs and lung function were evaluated longitudinally for up to one year in 38 PCD patients. RESULTS At baseline, there were no differences in MMPs, TIMPs and MMPs/TIMPs, between PCD and SCD but lower levels were found in controls. There was an association between poorer lung function with increasing levels of MMPs in PCD, while in SCD only MMP-9/TIMP-1 values correlated with FRC z-scores. Levels of MMPs and TIMPs significantly correlated with severity HRCT changes. Longitudinally, there were significant correlations between slope of changes in spirometric parameters and slope of change in sputum MMPs in PCD patients. CONCLUSIONS In conclusion, we report for the first time that increased MMPs are associated with worse airway damage in PCD and SCD, and thus are potential therapeutic targets.
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Affiliation(s)
- Massimo Pifferi
- Department of Paediatrics, University Hospital of Pisa, Italy.
| | - Andrew Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | - Davide Caramella
- Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Italy
| | - Maria Rita Metelli
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Maria Di Cicco
- Department of Paediatrics, University Hospital of Pisa, Italy
| | - Martina Piras
- Department of Paediatrics, University Hospital of Pisa, Italy
| | - Giulia Gherarducci
- Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Italy
| | - Carlo Capristo
- Visiting Professor at Department of Paediatrics, University of Verona, Italy
| | - Fabrizio Maggi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Diego Peroni
- Department of Paediatrics, University Hospital of Pisa, Italy
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18
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Paediatric chronic suppurative lung disease: clinical characteristics and outcomes. Eur J Pediatr 2016; 175:1077-84. [PMID: 27287408 DOI: 10.1007/s00431-016-2743-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/26/2016] [Accepted: 06/07/2016] [Indexed: 01/09/2023]
Abstract
UNLABELLED We describe the clinical, bronchoscopic, bronchoalveolar lavage (BAL) and radiographic characteristics of children whose chronic wet cough did not resolve with oral antibiotics and which led to their hospitalisation for intravenous antibiotics and airway clearance therapy. Between 2010 and 2014, medical chart review identified 22 such children. Their median cough duration was 26 weeks (interquartile range (IQR) 13-52). All received oral antibiotics immediately before their hospitalisation (median 4 weeks; IQR 4-6.5). On chest examination, seven (31 %) children had auscultatory crackles. At bronchoscopy, 9 (41 %) had tracheomalacia, 18 (86 %) demonstrated airway neutrophilia (>15 %) and 12 (57 %) grew Haemophilus influenzae from their BAL fluid. They received intravenous antibiotics (mostly cefotaxime or ceftriaxone) and airway clearance therapy as inpatients (median 12.5 days (IQR 10.8-14). All were cough-free at follow-up. CONCLUSION The children's BAL characteristics are similar to those with protracted bacterial bronchitis and bronchiectasis, but their poor clinical response to oral antibiotics and non-specific chest CT findings differentiated them from these other two disorders. The findings are consistent with chronic suppurative lung disease. Intravenous antibiotics and airway clearance therapy should therefore be considered in children whose wet cough persists despite 4 weeks of oral antibiotics and where other causes of chronic wet cough are absent. What is known on this topic? • Chronic wet cough not resolving with appropriate antibiotics increases the likelihood of bronchiectasis. • Children with chronic suppurative lung disease (CSLD) have clinical features of bronchiectasis, but lack the radiographic evidence for this diagnosis. WHAT THIS STUDY ADDS • Children with CSLD have airway neutrophilia and predominantly Haemophilus influenzae in lower airway cultures, similar to children with protracted bacterial bronchitis and bronchiectasis. • Chronic wet cough in CSLD, unresponsive to oral antibiotics, resolves with intravenous antibiotics and airway clearance therapy.
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19
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Fitzgerald DA, Shapiro AJ. When to suspect primary ciliary dyskinesia in children. Paediatr Respir Rev 2016; 18:3-7. [PMID: 26822945 DOI: 10.1016/j.prrv.2015.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
Primary ciliary dyskinesia [PCD] is an uncommon, autosomal recessively inherited condition that is often overlooked and undertreated in childhood. Amidst the myriad of children with coloured nasal secretions, otitis media and a wet cough, there exists a subset with PCD as the underlying unifying diagnosis. In this paper we have highlighted the varying clinical manifestations of PCD, emphasising different presentations between neonates, toddlers, school aged children and adults.
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Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, NSW, Australia.
| | - Adam J Shapiro
- Pediatric Respiratory Medicine, Montreal Children's Hospital, McGill University, 1001 Decarie Blvd - BRC.5016, Montreal, Quebec, Canada, H4A 3J1
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20
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Gupta AK, Lodha R, Kabra SK. Non Cystic Fibrosis Bronchiectasis. Indian J Pediatr 2015; 82:938-44. [PMID: 26307756 DOI: 10.1007/s12098-015-1866-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
Bronchiectasis is a pathological abnormality of the airways in which there is permanent dilatation and thickening of the airways. Precise incidence/prevalence in India is not known. Recent data suggests that about 1 % young children admitted in a hospital with pneumonia may develop bronchiectasis. Due to significant burden of pneumonia in young children in developing countries including India, it may be a significant problem that is possibly under recognized. Causes of bronchiectasis depend on the burden of respiratory infections and availability of the investigations for identification of the underlying cause. Post infectious causes are common in countries where infections are more common; however, since these countries are usually resource constrained and therefore, are not able to appropriately diagnose the other causes, leading to more than real overrepresentation of infections as a cause. In countries with less of infectious illnesses and good diagnostic facilities, malformations of airways, immune deficiency disorders and primary ciliary dyskinesia are common causes of bronchiectasis. High resolution CT scan of chest confirms the diagnosis. Treatment is supportive care and consists of maintenance of nutrition, airway clearance and antibiotics for exacerbations. Medical treatment is successful in the majority.
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Affiliation(s)
- Anand K Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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21
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Paul SP, Sanapala S, Bhatt JM. Recognition and management of children with protracted bacterial bronchitis. Br J Hosp Med (Lond) 2015; 76:398-404. [DOI: 10.12968/hmed.2015.76.7.398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Siba P Paul
- Specialty Trainee Year 8 in Paediatrics, Bristol Royal Hospital for Children, Bristol BS2 8BJ
| | - Swathi Sanapala
- Specialty Trainee Year 2 in Paediatrics, Southmead Hospital, Bristol
| | - Jayesh M Bhatt
- Consultant Respiratory Paediatrician, Nottingham Children's Hospital, Nottingham
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