1
|
McCallum GB, Oguoma VM, Versteegh LA, Wilson CA, Bauert P, Spain B, Chang AB. Comparison of Profiles of First Nations and Non-First Nations Children With Bronchiectasis Over Two 5-Year Periods in the Northern Territory, Australia. Chest 2021; 160:1200-1210. [PMID: 33964302 DOI: 10.1016/j.chest.2021.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the burden of bronchiectasis is recognized globally, pediatric data are limited, particularly on trends over the years. Also, no published data exists regarding whether vitamin D deficiency or insufficiency and human T-cell lymphotropic virus type 1 (HTLV-1) infection, both found to be related to severe bronchiectasis in First Nations adults, also are important in children with bronchiectasis. RESEARCH QUESTION Among children with bronchiectasis, (1) have the clinical and BAL profiles changed between two 5-year periods (period 1, 2007-2011; period 2, 2012-2016) and (b) are vitamin D deficiency or insufficiency, HTLV-1 infection, or both associated with radiologic severity of bronchiectasis? STUDY DESIGN AND METHODS We analyzed the data from children with bronchiectasis prospectively enrolled at Royal Darwin Hospital, Australia, at the first diagnosis; that is, no child was included in both periods. Data collected include demographics, BAL, bloods, and high-resolution CT scan of the chest evaluated using the Bhalla and modified Bhalla scores. RESULTS The median age of the 299 children was 2.2 years (interquartile range, 1.5-3.7 years). One hundred sixty-eight (56%) were male and most were First Nations (92%). Overall, bronchiectasis was high over time, particularly among First Nations children. In the later period, numbers of non-First Nations children more than tripled, but did not reach statistical significance. In period 2 compared with period 1, fewer First Nations children demonstrated chronic cough (period 1, 61%; period 2, 47%; P = .03), were younger, First Nations children were less likely to have received azithromycin (period 1, 42%; period 2, 21%; P < .001), and the BAL fluid of First Nations children showed lower Haemophilus influenzae and Moraxella catarrhalis infection. HTLV-1 infection was not detected, and vitamin D deficiency or insufficiency did not correlate with severity of bronchiectasis. INTERPRETATION Bronchiectasis remains high particularly among First Nations children. Important changes in their profiles that arguably reflect improvements were present, but overall, the profiles remained similar. Although vitamin D deficiency was uncommon, its role in children with bronchiectasis requires further evaluation. HTLV-1 infection was nonexistent and is unlikely to play any role in First Nations children with bronchiectasis.
Collapse
Affiliation(s)
- Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT.
| | - Victor M Oguoma
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Health Research Institute, University of Canberra, Canberra, ACT
| | - Lesley A Versteegh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Cate A Wilson
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Paul Bauert
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT
| | - Brian Spain
- Department of Anaesthetics, Royal Darwin Hospital, Darwin, NT
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| |
Collapse
|
2
|
Vitamin D Modulation of the Innate Immune Response to Paediatric Respiratory Pathogens Associated with Acute Lower Respiratory Infections. Nutrients 2021; 13:nu13010276. [PMID: 33478006 PMCID: PMC7835957 DOI: 10.3390/nu13010276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is an essential component of immune function and childhood deficiency is associated with an increased risk of acute lower respiratory infections (ALRIs). Globally, the leading childhood respiratory pathogens are Streptococcus pneumoniae, respiratory syncytial virus and the influenza virus. There is a growing body of evidence describing the innate immunomodulatory properties of vitamin D during challenge with respiratory pathogens, but recent systematic and unbiased synthesis of data is lacking, and future research directions are unclear. We therefore conducted a systematic PubMed literature search using the terms “vitamin D” and “Streptococcus pneumoniae” or “Respiratory Syncytial Virus” or “Influenza”. A priori inclusion criteria restricted the review to in vitro studies investigating the effect of vitamin D metabolites on human innate immune cells (primary, differentiated or immortalised) in response to stimulation with the specified respiratory pathogens. Eleven studies met our criteria. Despite some heterogeneity across pathogens and innate cell types, vitamin D modulated pathogen recognition receptor (PRRs: Toll-like receptor 2 (TLR2), TLR4, TLR7 and nucleotide-binding oligomerisation domain-containing protein 2 (NOD2)) expression; increased antimicrobial peptide expression (LL-37, human neutrophil peptide (HNP) 1-3 and β-defensin); modulated autophagosome production reducing apoptosis; and modulated production of inflammatory cytokines (Interleukin (IL) -1β, tumour necrosis factor-α (TNF-α), interferon-ɣ (IFN-ɣ), IL-12p70, IFN-β, Regulated on Activation, Normal T cell Expressed (RANTES), IL-10) and chemokines (IL-8 and C-X-C motif chemokine ligand 10 (CXCL10)). Differential modulation of PRRs and IL-1β was reported across immune cell types; however, this may be due to the experimental design. None of the studies specifically focused on immune responses in cells derived from children. In summary, vitamin D promotes a balanced immune response, potentially enhancing pathogen sensing and clearance and restricting pathogen induced inflammatory dysregulation. This is likely to be important in controlling both ALRIs and the immunopathology associated with poorer outcomes and progression to chronic lung diseases. Many unknowns remain and further investigation is required to clarify the nuances in vitamin D mediated immune responses by pathogen and immune cell type and to determine whether these in vitro findings translate into enhanced immunity and reduced ALRI in the paediatric clinical setting.
Collapse
|
3
|
Chang AB, Toombs M, Chatfield MD, Mitchell R, Fong SM, Binks MJ, Smith-Vaughan H, Pizzutto SJ, Lust K, Morris PS, Marchant JM, Yerkovich ST, O'Farrell H, Torzillo PJ, Maclennan C, Simon D, Unger HW, Ellepola H, Odendahl J, Marshall HS, Swamy GK, Grimwood K. Study Protocol for Preventing Early-Onset Pneumonia in Young Children Through Maternal Immunisation: A Multi-Centre Randomised Controlled Trial (PneuMatters). Front Pediatr 2021; 9:781168. [PMID: 35111703 PMCID: PMC8802227 DOI: 10.3389/fped.2021.781168] [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: 09/22/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Preventing and/or reducing acute lower respiratory infections (ALRIs) in young children will lead to substantial short and long-term clinical benefits. While immunisation with pneumococcal conjugate vaccines (PCV) reduces paediatric ALRIs, its efficacy for reducing infant ALRIs following maternal immunisation has not been studied. Compared to other PCVs, the 10-valent pneumococcal-Haemophilus influenzae Protein D conjugate vaccine (PHiD-CV) is unique as it includes target antigens from two common lower airway pathogens, pneumococcal capsular polysaccharides and protein D, which is a conserved H. influenzae outer membrane lipoprotein. Aims: The primary aim of this randomised controlled trial (RCT) is to determine whether vaccinating pregnant women with PHiD-CV (compared to controls) reduces ALRIs in their infants' first year of life. Our secondary aims are to evaluate the impact of maternal PHiD-CV vaccination on different ALRI definitions and, in a subgroup, the infants' nasopharyngeal carriage of pneumococci and H. influenzae, and their immune responses to pneumococcal vaccine type serotypes and protein D. Methods: We are undertaking a parallel, multicentre, superiority RCT (1:1 allocation) at four sites across two countries (Australia, Malaysia). Healthy pregnant Australian First Nation or Malaysian women aged 17-40 years with singleton pregnancies between 27+6 and 34+6 weeks gestation are randomly assigned to receive either a single dose of PHiD-CV or usual care. Treatment allocation is concealed. Study outcome assessors are blinded to treatment arms. Our primary outcome is the rate of medically attended ALRIs by 12-months of age. Blood and nasopharyngeal swabs are collected from infants at birth, and at ages 6- and 12-months (in a subset). Our planned sample size (n = 292) provides 88% power (includes 10% anticipated loss to follow-up). Discussion: Results from this RCT potentially leads to prevention of early and recurrent ALRIs and thus preservation of lung health during the infant's vulnerable period when lung growth is maximum. The multicentre nature of our study increases the generalisability of its future findings and is complemented by assessing the microbiological and immunological outcomes in a subset of infants. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374381, identifier: ACTRN12618000150246.
Collapse
Affiliation(s)
- Anne B Chang
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Maree Toombs
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
| | - Mark D Chatfield
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Siew M Fong
- Division of Paediatric Infectious Diseases, Hospital Likas, Kota Kinabalu, Malaysia
| | - Michael J Binks
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Heidi Smith-Vaughan
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Susan J Pizzutto
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Karin Lust
- Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Peter S Morris
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Stephanie T Yerkovich
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Hannah O'Farrell
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paul J Torzillo
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,Prince Alfred Hospital, Sydney, NSW, Australia
| | - Carolyn Maclennan
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Simon
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Holger W Unger
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Hasthika Ellepola
- Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, QLD, Australia
| | - Jens Odendahl
- Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, QLD, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Geeta K Swamy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, NC, United States
| | - Keith Grimwood
- Department of Infectious Disease and Paediatrics, Gold Coast Health, Southport, QLD, Australia.,School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| |
Collapse
|
4
|
Response to "Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain" Eur J Pediatr (2018) 177:181-192. Eur J Pediatr 2018; 177:1409-1410. [PMID: 29948257 DOI: 10.1007/s00431-018-3176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
|
5
|
O'Grady KAF, Chang AB, Cripps A, Mulholland EK, Smith-Vaughan H, Wood N, Danchin M, Thornton R, Wilson A, Torzillo PJ, Morris PM, Richmond P, Rablin S, Arnold D, Connor A, Goyal V, Stoney T, Perrett K, Grimwood K. The clinical, immunological and microbiological impact of the 10-valent pneumococcal-Protein D conjugate vaccine in children with recurrent protracted bacterial bronchitis, chronic suppurative lung disease and bronchiectasis: A multi-centre, double-blind, randomised controlled trial. Hum Vaccin Immunother 2018; 14:2768-2779. [PMID: 29944440 DOI: 10.1080/21645515.2018.1488562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We aimed to determine the efficacy of the 10-valent pneumococcal-Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in children aged 18-months to <18-years with recurrent protracted bacterial bronchitis (rPBB), chronic suppurative lung disease (CSLD) or bronchiectasis. In a multi-centre, double-blind randomised controlled trial, children received two doses, 2-months apart of the 10vPHiD-CV or quadrivalent meningococcal-ACYW135 conjugate vaccine. Active surveillance for acute exacerbations, respiratory symptoms and antibiotic use was undertaken through to 12-months after the second vaccine dose (clinical cohort only). Serum, saliva and nasopharyngeal swabs were collected to measure immunological and microbiological effects (immunology cohort). Between December 2012 and August 2015, 62 children were enrolled onto the clinical protocol (1 excluded from clinical analyses due to unblinding), while 74 contributed to the immunology cohort (overall mean age = 6.8-years (standard deviation = 3.7), 42 (56.8%) male). The absolute risk difference comparing the 10vPHiD-CV group (n = 31 children) to the MenACYW135 group (n = 30 children) for acute exacerbations was -0.5 exacerbations/100-weeks at risk (95% confidence interval (CI) -2.0, 0.9). Compared to the MenACYW135 group, children who received the 10vPHiD-CV were less likely to have respiratory symptoms in each fortnight of surveillance (incidence density ratio (IDR) 0.82, 95%CI 0.61, 1.10) and required fewer short-course (<14-days duration) antibiotics (IDR 0.81, 95% CI 0.61, 1.09). The vaccine was immunogenic and no serious adverse events related to the vaccine were reported. In conclusion, 10vPHiD-CV might have a future role in managing children with rPBB, CSLD and bronchiectasis, but larger multicentre trials are needed to confirm or refute findings from this preliminary study.
Collapse
Affiliation(s)
- Kerry-Ann F O'Grady
- a Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology , South Brisbane , Queensland , Australia
| | - Anne B Chang
- a Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology , South Brisbane , Queensland , Australia.,b Child Health Division, Menzies School of Health Research, Charles Darwin University , Tiwi , Northern Territory , Australia.,c Department of Respiratory Medicine , Lady Cilento Children's Hospital , South Brisbane , Queensland , Australia
| | - Allan Cripps
- d School of Medicine and Menzies Health Institute Queensland, Griffith University , Southport , Queensland , Australia
| | - Edward K Mulholland
- e Murdoch Children's Research Institute, The University of Melbourne , Parkville , Victoria , Australia.,f London School of Hygiene and Tropical Medicine , Bloomsbury , London , UK
| | - Heidi Smith-Vaughan
- b Child Health Division, Menzies School of Health Research, Charles Darwin University , Tiwi , Northern Territory , Australia.,d School of Medicine and Menzies Health Institute Queensland, Griffith University , Southport , Queensland , Australia
| | - Nicholas Wood
- g National Centre for Immunisation Surveillance and Research, The University of Sydney , Westmead , New South Wales , Australia
| | - Margaret Danchin
- e Murdoch Children's Research Institute, The University of Melbourne , Parkville , Victoria , Australia
| | - Ruth Thornton
- h Telethon Kids Institute, University of Western Australia , Subiaco , Western Australia , Australia
| | - Andrew Wilson
- i Department of Respiratory Medicine , Princess Margaret Hospital for Children , Perth , Western Australia , Australia
| | - Paul J Torzillo
- j School of Medicine, University of Sydney , Camperdown , New South Wales , Australia
| | - Peter M Morris
- b Child Health Division, Menzies School of Health Research, Charles Darwin University , Tiwi , Northern Territory , Australia
| | - Peter Richmond
- h Telethon Kids Institute, University of Western Australia , Subiaco , Western Australia , Australia
| | - Sheree Rablin
- a Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology , South Brisbane , Queensland , Australia
| | - Daniel Arnold
- a Centre for Children's Health Research, Institute of Health & Biomedical Innovation, Queensland University of Technology , South Brisbane , Queensland , Australia
| | - Ann Connor
- k UQ Child Health Research Centre, The University of Queensland , South Brisbane , Queensland , Australia
| | - Vikas Goyal
- c Department of Respiratory Medicine , Lady Cilento Children's Hospital , South Brisbane , Queensland , Australia.,k UQ Child Health Research Centre, The University of Queensland , South Brisbane , Queensland , Australia
| | - Tanya Stoney
- h Telethon Kids Institute, University of Western Australia , Subiaco , Western Australia , Australia
| | - Kirsten Perrett
- e Murdoch Children's Research Institute, The University of Melbourne , Parkville , Victoria , Australia
| | - Keith Grimwood
- d School of Medicine and Menzies Health Institute Queensland, Griffith University , Southport , Queensland , Australia.,l Departments of Infectious Diseases and Paediatrics , Gold Coast Health , Southport , Queensland , Australia
| |
Collapse
|
6
|
Reduced nontypeable Haemophilus influenzae lower airway infection in children with chronic endobronchial suppuration vaccinated with the 10-valent pneumococcal H. influenzae protein D conjugate vaccine. Vaccine 2018; 36:1736-1742. [DOI: 10.1016/j.vaccine.2018.02.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 11/22/2022]
|
7
|
Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain. Eur J Pediatr 2018; 177:181-192. [PMID: 29285648 PMCID: PMC5758651 DOI: 10.1007/s00431-017-3044-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
Abstract
UNLABELLED This cross-sectional study assessed the prevalence of bacteria isolated from Spanish children with suspected chronic lower respiratory tract infection (LRTI) for whom bronchoalveolar lavage (BAL) was indicated. BAL fluid (BALF) was collected from 191 children (aged ≥ 6 months to < 6 years, with persistent or recurrent respiratory symptoms, non-responders to usual treatment) and cultured. Nasopharyngeal swabs (NPSs) were also obtained and cultured to assess concordance of BALF and NPS findings in the same patient. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis were identified from BALF with a bacterial load indicative of infection (> 104 colony-forming units/mL) in 10.5, 8.9, and 6.3% of children, respectively. Clinical characteristics were similar among participants, regardless of positivity status for any of the bacteria. Approximately 26% of pneumococcal isolates were PCV13 serotypes, and 96% of H. influenzae isolates were non-typeable (NTHi). Concordance between BALF and NPS isolates was 51.0% for S. pneumoniae, 52.1% for H. influenzae, and 22.0% for M. catarrhalis. CONCLUSION S. pneumoniae, NTHi, and M. catarrhalis were the main bacteria detected in BALF and NPS. Children with suspected chronic LRTI may benefit from a vaccine protecting against NTHi. What is Known: • Chronic lower respiratory tract infection (LRTI) in children can cause high morbidity and is a major use of healthcare resources worldwide. Despite this, their etiology or potential preventive measures are poorly assessed. • Bronchoalveolar lavage can be used to determine bacterial etiology of chronic LRTI. What is New: • We used conventional and molecular techniques to show that Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis were present in the LRT of Spanish children with suspected chronic LRTI • Concordance between isolates from bronchoalveolar lavage fluid and nasopharyngeal swabs was low, suggesting that samples from the upper respiratory tract could not reliably predict the bacterial etiology of suspected chronic LRTI.
Collapse
|
8
|
Montaner AE, de Lomas JG, Asensi JRV, de la Cruz OA, de la Serna Blázquez O, Burruchaga MS, López PM, Vernetta AT, Feng Y, Van Dyke MK, Reyes J, Garcia-Corbeira P, Talarico CA. Authors' response to correspondence for EPI-STREP-064 publication. Eur J Pediatr 2018; 177:1411-1412. [PMID: 29948258 PMCID: PMC6096774 DOI: 10.1007/s00431-018-3180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/18/2018] [Indexed: 12/04/2022]
Affiliation(s)
- Amparo Escribano Montaner
- 0000 0001 2173 938Xgrid.5338.dPediatric Pneumology and Cystic Fibrosis Unit, University Clinic Hospital of Valencia, University of Valencia, Av. de Blasco Ibáñez, 13, 46010 Valencia, Spain
| | - Juan García de Lomas
- 0000 0001 2173 938Xgrid.5338.dDepartment of Microbiology, School of Medicine and University Hospital, University of Valencia, Av. de Blasco Ibañez 17, 46010 Valencia, Spain
| | - José Ramón Villa Asensi
- Pediatric Department, Niño Jesús University Hospital for Children, Calle Menéndez Pelayo, 65, 28009 Madrid, Spain
| | - Oscar Asensio de la Cruz
- Pediatric Pulmonology Unit, University Hospital Parc Tauli de Sabadell, Parc Taulí, 1, 08208 Sabadell, Barcelona Spain
| | - Olga de la Serna Blázquez
- 0000 0000 8970 9163grid.81821.32Pediatric Department, Hospital La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Mikel Santiago Burruchaga
- 0000 0004 1767 5135grid.411232.7Pediatric Pneumology and Cystic Fibrosis Unit, Cruces University Hospital, Plaza de Cruces, S/N, 48903 Barakaldo, Vizcaya Spain
| | - Pedro Mondéjar López
- 0000 0001 0534 3000grid.411372.2Pediatric Pulmonology and Cystic Fibrosis UnitVirgen of Arrixaca University Hospital, Murcia, Spain
| | - Alba Torrent Vernetta
- Paediatric Pulmonology and Cystic Fibrosis UnitVall d’Hebron University Hospital, Barcelona, Spain
| | - Yang Feng
- grid.425090.aNingyang Group Co., Limited, C/O GSK, Wavre, Belgium
| | | | - Janet Reyes
- 0000 0004 1768 1287grid.419327.aGSK, Parque Tecnológico de Madrid, Tres Cantos, Spain
| | - Pilar Garcia-Corbeira
- 0000 0004 1768 1287grid.419327.aGSK, Parque Tecnológico de Madrid, Tres Cantos, Spain
| | | | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Pizzutto SJ, Hare KM, Upham JW. Bronchiectasis in Children: Current Concepts in Immunology and Microbiology. Front Pediatr 2017; 5:123. [PMID: 28611970 PMCID: PMC5447051 DOI: 10.3389/fped.2017.00123] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 12/26/2022] Open
Abstract
Bronchiectasis is a complex chronic respiratory condition traditionally characterized by chronic infection, airway inflammation, and progressive decline in lung function. Early diagnosis and intensive treatment protocols can stabilize or even improve the clinical prognosis of children with bronchiectasis. However, understanding the host immunologic mechanisms that contribute to recurrent infection and prolonged inflammation has been identified as an important area of research that would contribute substantially to effective prevention strategies for children at risk of bronchiectasis. This review will focus on the current understanding of the role of the host immune response and important pathogens in the pathogenesis of bronchiectasis (not associated with cystic fibrosis) in children.
Collapse
Affiliation(s)
- Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|