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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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Mammas IN, Drysdale SB, Rath B, Theodoridou M, Papaioannou G, Papatheodoropoulou A, Koutsounaki E, Koutsaftiki C, Kozanidou E, Achtsidis V, Korovessi P, Chrousos GP, Spandidos DA. Update on current views and advances on RSV infection (Review). Int J Mol Med 2020; 46:509-520. [PMID: 32626981 PMCID: PMC7307844 DOI: 10.3892/ijmm.2020.4641] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood.
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Affiliation(s)
- Ioannis N Mammas
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | | | - Barbara Rath
- Vienna Vaccine Safety Initiative, D‑10437 Berlin, Germany
| | - Maria Theodoridou
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 15123 Athens, Greece
| | | | - Eirini Koutsounaki
- Neonatal Department, 'Alexandra' Maternity Hospital, 15123 Athens, Greece
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 15236 Penteli, Greece
| | - Eleftheria Kozanidou
- 2nd Department of Internal Medicine, 'St Panteleimon' General Hospital of Nikaia, 18454 Piraeus, Greece
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals, Cornwall TR1 3LQ, UK
| | - Paraskevi Korovessi
- Department of Paediatrics, 'Penteli' Children's Hospital, 15236 Penteli, Greece
| | - George P Chrousos
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment. World J Pediatr 2018; 14:498-503. [PMID: 30269305 DOI: 10.1007/s12519-018-0193-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Limited data are available in relation to the clinical features of PIBO undergoing prolonged nebulization treatment with budesonide, terbutaline and ipratropium bromide. This retrospective study aimed to outline the features of clinical, high-resolution computed tomography (HRCT) and pulmonary function test (PFT) of PIBO, undergoing maintenance therapy utilizing a triple nebulization treatment and to determine the factors associated with prognosis. METHODS Children diagnosed with PIBO were followed up between April 2014 and March 2017. The clinical features after maintenance nebulization treatment for 12 months were thereafter summarized. RESULTS Thirty patients, 21 boys and 9 girls, were enrolled in the study. The median age of patients was 17.4 months, with a range between 3.0 and 33 months. Persistent coughing and wheezing were detected whilst wheezing and crackles were the common manifestations presented. HRCT scans revealed patchy ground and glass opacity, while PFT showed fixed airway obstruction in all patients. Four patients were lost during follow-up. After treatment, the clinical symptoms were improved greatly in all patients (P < 0.01). The mean increase in the percentage of TPEF%TE and VPEF%VE were improved greatly (P < 0.01). Images of the HRCT scan indicated marked improvements in 18 patients (81.8%) in comparison with scans obtained pre-treatment. CONCLUSIONS Our data suggest a potential role of long-term nebulization treatment of budesonide, terbutaline, ipratropium bromide on PIBO, due to its efficacy as indicated in the improved clinical symptoms, pulmonary functions and CT manifestations identified in the children. New prospective and controlled studies are required to confirm this proposition.
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Tomikawa SO, Rodrigues JC. Current research on pediatric patients with bronchiolitis obliterans in Brazil. Intractable Rare Dis Res 2015; 4:7-11. [PMID: 25674382 PMCID: PMC4322598 DOI: 10.5582/irdr.2014.01020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/05/2022] Open
Abstract
Bronchiolitis obliterans (BO) is a rare but severe disease, characterized by inflammation and fibrosis of the terminal bronchioles. BO in children usually occurs after a severe lung viral infection. Diagnosis is based on clinical history of acute bronchiolitis followed by persistent obstruction of the airways and characteristic findings in HRCT. There is no consensus on treatment beyond supportive measures, but bronchodilators and corticosteroids are often used. This review describes the clinical and radiological characteristics and outcomes of BO in pediatric patients, with an emphasis on current research in Brazil.
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Affiliation(s)
- Silvia Onoda Tomikawa
- Pediatric Pulmonology Division, Children's Institute, Clinical Hospital, University of São Paulo, Brazil
- Address correspondence to: Dr. Silvia Onoda Tomikawa, Pediatric Pulmonology Division, Children's Institute, Clinical Hospital, University of São Paulo, Rua Bianchi Bertoldi, 166 apt101, CEP 05422-070 São Paulo, SP, Brazil. E-mail:
| | - Joaquim Carlos Rodrigues
- Pediatric Pulmonology Division, Children's Institute, Clinical Hospital, University of São Paulo, Brazil
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Li Y, Cheng H, Wang H, Wang Y, Liu L. Composite factors, including mycoplasmal pneumonia, hypersensitivity syndrome, and medicine, leading to bronchiolitis obliterans in a school-age child. Clin Pediatr (Phila) 2014; 53:1409-12. [PMID: 25022946 DOI: 10.1177/0009922814541808] [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: 11/17/2022]
Affiliation(s)
- Yanchun Li
- First Hospital of Jilin University, Changchun, China
| | - Huanji Cheng
- First Hospital of Jilin University, Changchun, China
| | - Hongbo Wang
- First Hospital of Jilin University, Changchun, China
| | | | - Li Liu
- First Hospital of Jilin University, Changchun, China
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Li YN, Liu L, Qiao HM, Cheng H, Cheng HJ. Post-infectious bronchiolitis obliterans in children: a review of 42 cases. BMC Pediatr 2014; 14:238. [PMID: 25252824 PMCID: PMC4181416 DOI: 10.1186/1471-2431-14-238] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to describe the clinical characteristics, radiological features and outcomes of 42 children with post-infectious bronchiolitis obliterans (PIBO). Methods Forty-two children diagnosed with PIBO were prospectively studied at the First Hospital of Jilin University in northern China between January, 2008 and January, 2013. Their clinical characteristics, lung high resolution computed tomography (HRCT) findings and pulmonary function tests were reported. Results In children with PIBO, adenovirus was the most common etiologic agent (21/42), followed by Mycoplasma pneumoniae (M. pneumoniae). All of the patients presented with repeated wheezing and tachypnea. In addition, 22 patients required intensive management, while six patients required home oxygen therapy. HRCT findings were consistent with the PIBO diagnosis in all of the patients. Pulmonary function testing was useful in evaluating therapeutic responses. Systemic steroids combined with azithromycin were effective for PIBO treatment. Conclusions Severe adenovirus bronchiolitis and M. pneumoniae infections have a higher risk of development for PIBO. HRCT and pulmonary function testing are useful in the diagnosis of PIBO. The degree of airway obstruction did not differ significantly between adenovirus and M. pneumoniae. A combination of steroids and azithromycin offers some benefit in treating these patients.
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Affiliation(s)
| | | | | | | | - Huan-Ji Cheng
- Department of Pediatrics, The First Hospital of Jilin University, Changchun 130021, PR China.
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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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Paludo J, Mocelin HT, Benedetti FJ, Mattiello R, Sarria EE, Mello EDD, Fischer GB. Balanço energético em crianças e adolescentes com bronquiolite obliterante pós-infecciosa. REV NUTR 2012. [DOI: 10.1590/s1415-52732012000200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: Quantificar o gasto e estimar a ingestão energética de crianças e adolescentes com bronquiolite obliterante pós-infecciosa e comparar com crianças e adolescentes hígidos. MÉTODOS: Estudo transversal com 72 crianças e adolescentes de 8 a 18 anos. Compararam-se dois grupos de 36 indivíduos - um com diagnóstico de bronquiolite obliterante e outro hígido -, os quais foram pareados pelo sexo, idade e classificação do índice de massa corporal. Para avaliação nutricional, utilizaram-se a antropometria e a composição corporal. O gasto energético foi medido pela calorimetria indireta; o fator atividade, pelo recordatório 24h de atividades físicas, e a ingestão energética, pelos inquéritos alimentares. RESULTADOS: O grupo com bronquiolite obliterante e o grupo-controle apresentaram respectivamente: índice de massa corporal de M=18,9, DP=4,0kg/m² e M=18,8, DP=3,4kg/m²; gasto energético de repouso de M=1717,6, DP=781,5 e M=2019,9, DP=819; gasto energético total de M=2677,5, DP=1514,0kcal/dia e M=3396,1, DP=1557,9kcal/dia; estimativa da ingestão energética de M=2294,1, DP=746,7kcal/dia e M=2116,5, DP=612,1kcal/dia. O gasto energético de repouso (p=0,102) e o gasto energético total (p=0,051) não foram diferentes entre os grupos, mesmo quando ajustados pela massa magra. Não houve diferenças estatisticamente significativas entre o o gasto energético total e o consumo energético no grupo com bronquiolite obliterante (p=0,202). O grupo-controle consumiu menos calorias do que o previsto pelo gasto energético total (p<0,001). CONCLUSÃO: O gasto energético de repouso e o gasto energético total foram semelhantes entre os grupos. A estimativa da ingestão energética dos hígidos foi menor que o gasto energético total. O grupo com bronquiolite obliterante apresentava um balanço energético adequado.
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Affiliation(s)
| | | | | | - Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | | | - Elza Daniel de Mello
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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Fischer GB, Sarria EE, Mattiello R, Mocelin HT, Castro-Rodriguez JA. Post infectious bronchiolitis obliterans in children. Paediatr Respir Rev 2010; 11:233-9. [PMID: 21109182 DOI: 10.1016/j.prrv.2010.07.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bronchiolitis Obliterans (BO) is an infrequent chronic and obstructive lung disease secondary to an insult to the terminal airway and its surroundings. In children, the most common presentation is the post-infectious variant, closely related to a severe viral infection in the first three years of life. However, the increase in the number of lung and bone-marrow transplants has also been followed by an increase in post-transplant BO. Post-transplant BO is progressive while post-infectious BO does not seem to be, but both forms share some common pathways that result in a characteristic histopathology of bronchiolar obliteration. This review covers up-to-date evidence on epidemiology, diagnosis, treatment and prognosis of post-infectious bronchiolitis obliterans, including areas of controversy that need to be addressed in future studies.
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Affiliation(s)
- Gilberto B Fischer
- Department of Paediatrics, Universidade Federal de Ciencias da Saude, Porto Alegre, Brazil.
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Abstract
PURPOSE OF REVIEW In this review, we discuss recent advances in our understanding of the etiology, pathology and pathogenesis, clinical presentation, diagnosis, treatment, and outcome of bronchiolitis obliterans in the nontransplant, pediatric population. RECENT FINDINGS The diagnosis of bronchiolitis obliterans in children can be made with confidence based on clinical presentation, particularly with a history of adenovirus bronchiolitis or pneumonia, fixed obstructive lung disease on pulmonary function testing, and characteristic changes of mosaic perfusion, vascular attenuation, and central bronchiectasis on chest high-resolution computed tomography, thus avoiding the need for lung biopsy in most patients. Patients with postinfectious bronchiolitis obliterans generally have chronic, nonprogressive disease; in contrast, patients with bronchiolitis obliterans from Stevens-Johnson syndrome often have progressive disease that may require lung transplantation. SUMMARY Bronchiolitis obliterans is a rare form of chronic obstructive lung disease that follows a severe insult to the lower respiratory tract, resulting in fibrosis of the small airways. In the nontransplant pediatric population, adenovirus infection is the most common cause. Treatment is largely supportive and prognosis is mainly related to the underlying cause and to the severity of the initial insult.
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