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Nayır-Büyükşahin H, Emiralioğlu N, Kılınç AA, Girit S, Yalçın E, Şişmanlar Eyüboğlu T, Çobanoğlu N, Cinel G, Pekcan S, Gökdemir Y, Oğuz B, Orhan D, Doğru D, Özçelik U, Başkan AK, Arslan H, Çokuğraş H, Onay ZR, Oksay SC, Tortop DM, Aslan AT, Kekeç H, Zirek F, Tekin MN, Gülen F, Girgin Dindar B, Eryılmaz Polat S, Uytun S, Yılmaz Aİ, Ünal G, Eralp EE, Karadağ B, Hangül M, Köse M, Özsezen B, Çakır E, Bingöl A, Hızal M, Kartal Öztürk G, Uyan ZS, Ramaslı Gürsoy T, Serbes M, Kiper N. Childhood interstitial lung disease in Turkey: first data from the national registry. Eur J Pediatr 2024; 183:295-304. [PMID: 37875631 DOI: 10.1007/s00431-023-05290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
The childhood interstitial lung diseases (chILD) Turkey registry (chILD-TR) was established in November 2021 to increase awareness of disease, and in collaboration with the centers to improve the diagnostic and treatment standards. Here, the first results of the chILD registry system were presented. In this prospective cohort study, data were collected using a data-entry software system. The demographic characteristics, clinical, laboratory, radiologic findings, diagnoses, and treatment characteristics of the patients were evaluated. Clinical characteristics were compared between two main chILD groups ((A) diffuse parenchymal lung diseases (DPLD) disorders manifesting primarily in infancy [group1] and (B) DPLD disorders occurring at all ages [group 2]). There were 416 patients registered from 19 centers. Forty-six patients were excluded due to missing information. The median age of diagnosis of the patients was 6.05 (1.3-11.6) years. Across the study population (n = 370), 81 (21.8%) were in group 1, and 289 (78.1%) were in group 2. The median weight z-score was significantly lower in group 1 (- 2.0 [- 3.36 to - 0.81]) than in group 2 (- 0.80 [- 1.7 to 0.20]) (p < 0.001). When we compared the groups according to chest CT findings, ground-glass opacities were significantly more common in group 1, and nodular opacities, bronchiectasis, mosaic perfusion, and mediastinal lymphadenopathy were significantly more common in group 2. Out of the overall study population, 67.8% were undergoing some form of treatment. The use of oral steroids was significantly higher in group 2 than in group 1 (40.6% vs. 23.3%, respectively; p = 0.040). Conclusion: This study showed that national registry allowed to obtain information about the frequency, types, and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. What is Known: • Childhood interstitial lung diseases comprise many diverse entities which are challenging to diagnose and manage. What is New: • This study showed that national registry allowed to obtain information about the frequency, types and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. Also, our findings reveal that nutrition should be considered in all patients with chILD, especially in A-DPLD disorders manifesting primarily in infancy.
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Affiliation(s)
- Halime Nayır-Büyükşahin
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
| | - Nagehan Emiralioğlu
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayşe Ayzıt Kılınç
- Division of Pulmonology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Saniye Girit
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ebru Yalçın
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tuğba Şişmanlar Eyüboğlu
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Güzin Cinel
- Division of Pulmonology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Sevgi Pekcan
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Yasemin Gökdemir
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Berna Oğuz
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Doğru
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Uğur Özçelik
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Azer Kılıç Başkan
- Division of Pulmonology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Hüseyin Arslan
- Division of Pulmonology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Haluk Çokuğraş
- Division of Pulmonology, Department of Pediatrics, Cerrahpaşa Faculty of Medicine Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zeynep Reyhan Onay
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sinem Can Oksay
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Deniz Mavi Tortop
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayşe Tana Aslan
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Handan Kekeç
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fazılcan Zirek
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Nur Tekin
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Figen Gülen
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Bahar Girgin Dindar
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Sanem Eryılmaz Polat
- Division of Pulmonology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Salih Uytun
- Division of Pulmonology, Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Aslı İmran Yılmaz
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gökçen Ünal
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ela Erdem Eralp
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bülent Karadağ
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Melih Hangül
- Division of Pediatric Pulmonology, Gaziantep Cengiz Gökçek Maternity and Children Hospital, Gaziantep, Turkey
| | - Mehmet Köse
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Beste Özsezen
- Division of Pediatric Pulmonology, Şanlıurfa Children Hospital, Şanıurfa, Turkey
| | - Erkan Çakır
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, İstinye University, Istanbul, Turkey
| | - Ayşen Bingöl
- Department of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mina Hızal
- Department of Pediatric Pulmonology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Gökçen Kartal Öztürk
- Division of Pulmonology, Department of Pediatrics, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Tuğba Ramaslı Gürsoy
- Division of Pediatric Pulmonology, Dr Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Mahir Serbes
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Nural Kiper
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ozsezen B, Özcan HN, Emiralioglu N, Ocak E, Ademhan Tural D, Sunman B, Nayir Buyuksahin H, Guzelkas İ, Cinel G, Orhan D, Yalçın E, Doğru D, Özçelik U, Kiper N. Clinical radiological and pathological staging of children with hypersensitivity pneumonitis. Pediatr Pulmonol 2022; 57:2344-2355. [PMID: 35676765 DOI: 10.1002/ppul.26038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hypersensitivity pneumonitis (HP) is rare in the pediatric population. To date, there are no studies defining a correlation between clinical, radiological, and pathological findings in children with HP. The objective of this study is to define the clinical, and radiological characteristics and prognosis of childhood HP and to examine the clinical, radiological, and pathological correlation between HP stages. METHODS Patients with suspected HP and followed at two tertiary care hospitals between 2000 and 2020 were retrospectively evaluated. Computed tomography (CT) of the chest of patients was evaluated by a single radiologist. The interagreement between clinical and radiological severity of the patients was calculated with the κ test. RESULTS Fourteen children with suspected HP were identified. The results of 10 patients with the definitive diagnosis were as follows: one patient (10%) had acute, five patients (50%) had subacute, and four patients (40%) had chronic HP. The most prominent findings in chest CT were hilar, or hilar and subcarinal lymphadenopathy (80%), centrilobular nodules (60%), patchy or diffuse ground-glass opacities (50%), and cysts (50%). The interagreement between clinical and radiological severity of the patients was 100% (approximate significance: 0.003). The diagnosis of four patients with suspected HP who were unresponsive to standardized medical treatments or developed multisystem involvement was diagnosed with other diseases. One patient (10%) with definitive chronic HP died due to respiratory failure during follow up. CONCLUSION Similar to adult HP, the prognosis is worse in children with existing fibrotic equivalents in chest CT. Patients who are not responding to standard medical treatments or develop multisystem involvement should be evaluated for other lung diseases.
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Affiliation(s)
- Beste Ozsezen
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - H Nursun Özcan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ece Ocak
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İsmail Guzelkas
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güzin Cinel
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Uğur Özçelik
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ademhan Tural D, Emiralioglu N, Ozsezen B, Sunman B, Nayir Buyuksahin H, Guzelkas I, Oguz B, Bilginer Y, Orhan D, Yalcin E, Dogru D, Ozcelik U, Ozen S, Kiper N. Clinical spectrum of children with interstitial pneumonia with autoimmune features. Respir Med 2021; 187:106566. [PMID: 34416614 DOI: 10.1016/j.rmed.2021.106566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Interstitial pneumonia with autoimmune features (IPAF) is a term used to describe adult patients with interstitial lung disease (ILD) who display some clinical or serological features of autoimmune diseases and who do not meet the full criteria for a specific connective tissue disease (CTD). The aim of this study was to define the demographic, clinical, radiologic, serologic and histopathologic features and assess treatment in children with IPAF. METHODS This retrospective cohort study was conducted at a tertiary referral pediatric pulmonology center between January 2010 and August 2020. Children with proven interstitial pneumonia with no known etiologies were evaluated for IPAF according to European Respiratory Society/American Thoracic Society research statement of IPAF. RESULTS Among 132 children with ILD, 17 patients were evaluated in detail for IPAF criteria and six patients were further diagnosed as having IPAF. The incidence of IPAF in our patients with ILD was 4.5%. Four of these patients were female. The median age at the time of ILD diagnosis was 10.5 years. The most common initial symptom was shortness of breath, and the most common physical examination sign was crackles in both lungs. Steroid therapy was given to all patients and four patients received other immunosuppressive agents for steroid sparing. Two of those patients died because of respiratory insufficiency during the follow-up. CONCLUSION Children with interstitial pneumonia and certain clinical, serologic, and/or morphologic features should raise suspicion for the presence of an underlying systemic autoimmune disease. IPAF is also seen in children and should be categorized in chILD classifications.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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