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Shah SN, Monuteaux MC, Neuman MI. Prevalence and predictors of radiographic pneumonia in children with wheeze: A systematic review and meta-analysis. Acad Emerg Med 2024. [PMID: 39189186 DOI: 10.1111/acem.15006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Diagnostic uncertainty exists surrounding the identification of radiographic pneumonia in children with wheeze. It is important to determine the prevalence and clinical predictors of pneumonia in this population to limit chest radiography (CXR) and promote judicious antibiotic use. OBJECTIVES The objectives were to (1) estimate the prevalence of radiographic pneumonia in children with wheeze and (2) systematically review the diagnostic accuracy of clinical findings for the identification of radiographic pneumonia. METHODS Data sources were MEDLINE, PubMed Central, Cochrane Library, CINAHL, and Web of Science (January 1995 to September 2023). For study selection, two reviewers identified high-quality studies reporting on clinical characteristics associated with radiographic pneumonia in wheezing children (age 0-21 years). Using Covidence software, data regarding study characteristics, methodologic quality, and results were extracted. Data were pooled using random-effects meta-analysis. RESULTS A total of 8333 unique titles and abstracts were reviewed. Twelve studies, representing 7398 patients, were included. Fifteen percent of children with wheeze undergoing CXR had pneumonia. Findings associated with radiographic pneumonia included temperature ≥ 38.4°C (positive likelihood ratio [LR+] 2.1, 95% CI 1.2-3.6, specificity 85%), oxygen saturation < 92% (LR+ 3.6, 95% CI 1.4-8.9, specificity 89%), and grunting (LR+ 2.7, 95% CI 1.6-4.4, pooled specificity 91%). Factors associated with the absence of radiographic pneumonia included lack of fever (negative likelihood ratio [LR-] 0.67, 95% CI 0.52-0.85) and oxygen saturation ≥ 95% (LR- 0.64, 95% CI 0.42-0.98). Tachypnea and auscultatory findings were not associated with radiographic pneumonia. DISCUSSION Heterogeneity across studies limits generalizability. Additionally, all included studies overestimate the rate of radiographic pneumonia given the fact that all subjects had a CXR performed due to clinical suspicion of pneumonia. CONCLUSIONS Radiographic pneumonia occurs in 15% of wheezing children undergoing CXR for pneumonia. Auscultatory findings and tachypnea do not differentiate children with and without pneumonia, and the rate of radiographic pneumonia is very low in the absence of fever and hypoxemia.
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Affiliation(s)
- Sonal N Shah
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Anderson J, Oeum M, Verkolf E, Licciardi PV, Mulholland K, Nguyen C, Chow K, Waller G, Costa AM, Daley A, Crawford NW, Babl FE, Duke T, Do LAH, Wurzel D. Factors associated with severe respiratory syncytial virus disease in hospitalised children: a retrospective analysis. Arch Dis Child 2022; 107:359-364. [PMID: 34526293 DOI: 10.1136/archdischild-2021-322435] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Early recognition of children at risk of severe respiratory syncytial virus (RSV) lower respiratory tract infection is important as it informs management decisions. We aimed to evaluate factors associated with severe disease among young children hospitalised with RSV infection. METHODS We conducted a retrospective cohort study of all children <2 years of age hospitalised for RSV lower respiratory tract infection at a single tertiary paediatric hospital over three RSV seasons (January 2017-December 2019). We classified children as having 'moderate' or 'severe' disease based on the level of respiratory intervention and used univariable and multivariable regression models to determine factors associated with severe disease. RESULTS Of 970 hospitalised children, 386 (40%) were classified as having 'severe' and 584 (60%) as having 'moderate' RSV disease. On multivariable analyses, age <2 months (OR: 2.3, 95% CI 1.6 to 3.3, p<0.0001), prematurity (OR: 1.6, 95% CI 1.1 to 2.4, p=0.02) and RSV-parainfluenza virus type 3 (PIV3) codetection (OR: 2.6, 95% CI 1.05 to 6.5, p=0.04) were independently associated with severe disease. CONCLUSION Younger age, prematurity and PIV3 codetection were associated with severe RSV disease in children <2 years of age hospitalised with RSV infection. The association between PIV3 and severe RSV disease is a novel finding and warrants further investigation.
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Affiliation(s)
- Jeremy Anderson
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Michelle Oeum
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Eva Verkolf
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,London School of Hygiene & Tropical Medicine, London, UK
| | - Cattram Nguyen
- The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Kim Chow
- Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Gregory Waller
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Anna-Maria Costa
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Andrew Daley
- Microbiology and Infection Control, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nigel W Crawford
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Trevor Duke
- Intensive Care Unit and Department of Paediatrics, The Royal Children's Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - Lien Anh Ha Do
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Danielle Wurzel
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Elkhunovich MA, Wang VJ, Pham P, Arpilleda JC, Clingenpeel JM, Mansour K, Riech T, Yen K, Liu DR. Assessing the Utility of Urine Testing in Febrile Infants 2 to 12 Months of Age With Bronchiolitis. Pediatr Emerg Care 2021; 37:e1104-e1109. [PMID: 31804430 DOI: 10.1097/pec.0000000000001912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The utility of testing for urinary tract infection (UTI) in febrile infants with bronchiolitis is indeterminate. OBJECTIVE The objective of this study was to investigate if the incidence of UTIs in febrile infants 2 to 12 months of age with bronchiolitis is higher than the presumed incidence of asymptomatic bacteriuria and determine risk factors associated with UTIs in this population. METHODS This prospective multicenter cross-sectional study was conducted in the emergency departments of 6 children's hospitals between November 2011 and June 2015. We obtained a convenience sample of febrile infants with bronchiolitis 2 to 12 months of age who were tested for UTI. Patient characteristics analyzed included age, maximum temperature, duration of fever, ethnicity, sex, and circumcision status. RESULTS A total of 442 patients (including 86 from a previously published pilot study) were enrolled. Mean age was 5.5 months, 65.2% were Latino, 50.9% were male, and 27.6% of male infants were circumcised. Urinary tract infections were found in 33 patients (7.69%, binomial; 95% confidence interval [CI], 5.19%-10.33%). Urinary tract infections were not related to age, height of temperature, duration of fever, or ethnicity. Uncircumcised males were significantly more likely to have UTIs than circumcised males (7.64% vs 0%, P = 0.03). Odds ratios (ORs) were lower for circumcised males but not uncircumcised males when compared with females (OR, 0.12; CI, 0.0-0.71; P = 0.01 vs OR, 0.77; CI, 0.33-1.74; P = 0.64). CONCLUSIONS Febrile infants 2 to 12 months of age with bronchiolitis have a clinically significant incidence of UTI, suggesting that UTI evaluation should be considered in these patients.
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Affiliation(s)
- Marsha A Elkhunovich
- From the Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Vincent J Wang
- Division of Pediatric Emergency Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Phung Pham
- From the Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Joyce C Arpilleda
- Department of Emergency Medicine, Napa-Solano Permanente Medical Group, Napa, CA
| | - Joel M Clingenpeel
- Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
| | - Karim Mansour
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Teresa Riech
- Division of Emergency Medicine, OSF Children's Hospital of Illinois, Peoria, IL
| | - Ken Yen
- Division of Pediatric Emergency Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Deborah R Liu
- From the Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA
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Juliana AE, Tang MJ, Kemps L, Noort AC, Hermelijn S, Plötz FB, Zonneveld R, Wilschut JC. Viral causes of severe acute respiratory infection in hospitalized children and association with outcomes: A two-year prospective surveillance study in Suriname. PLoS One 2021; 16:e0247000. [PMID: 33606795 PMCID: PMC7894877 DOI: 10.1371/journal.pone.0247000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/29/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Viruses are the most frequent cause of severe acute respiratory infection (SARI) in children. It is currently unknown whether presence of a virus, the number of viruses, or type of virus, are associated with clinical outcomes of pediatric SARI in developing countries. METHODS Between 2012 and 2014 nasopharyngeal swabs and demographic and clinical variables were prospectively collected for surveillance of viral causes of SARI in Surinamese children within 48 hours after hospitalization. These swabs were tested for 18 respiratory viruses using a multiplex polymerase chain reaction (PCR) panel to identify the specific viral causes of SARI, unknown to the treating physicians. In post hoc analyses we evaluated if the PCR results, and demographic and clinical characteristics, were associated with course of disease, duration of respiratory support, and length of stay (LOS). RESULTS Of a total of 316 analyzed children, 290 (92%) had one or more viruses. Rhinovirus/enterovirus (43%) and respiratory syncytial virus (34%) were most prevalent. Course of disease was mild in 234 (74%), moderate in 68 (22%), and severe in 14 (4%) children. Neither presence of a single virus, multiple viruses, or the type of virus, were different between groups. Prematurity and lower weight-for-age-z-score were independent predictors of a severe course of disease, longer duration of respiratory support, and longer LOS. CONCLUSIONS Viruses are common causes of pediatric SARI in Suriname, yet not necessarily associated with clinical outcomes. In developing countries, demographic and clinical variables can help to identify children at-risk for worse outcome, while PCR testing may be reserved to identify specific viruses, such as influenza, in specific patient groups or during outbreaks.
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Affiliation(s)
- Amadu E. Juliana
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
- * E-mail:
| | - Ming-Jan Tang
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Lex Kemps
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Albert C. Noort
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Sandra Hermelijn
- Department of Medical Microbiology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Frans B. Plötz
- Department of Pediatrics, Tergooi Hospitals, Blaricum, The Netherlands
- Department of Pediatrics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rens Zonneveld
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Jan C. Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Matera MG, Rogliani P, Ora J, Cazzola M. Current pharmacotherapeutic options for pediatric lower respiratory tract infections with a focus on antimicrobial agents. Expert Opin Pharmacother 2018; 19:2043-2053. [PMID: 30359143 DOI: 10.1080/14656566.2018.1534957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Antibiotics are frequently prescribed to children in the community and in nosocomial settings, mainly because of lower respiratory tract infections(LRTIs), which include influenza, bronchitis, bronchiolitis, pneumonia, and tuberculosis, in addition to bronchiectasis and cystic fibrosis lung disease. It is important to note, however, that more than 50% of these prescriptions are unnecessary or inappropriate. Areas covered: The current choice of antimicrobial therapy for etiological agents of LRTIs is examined and discussed considering each type of LRTI. Expert opinion: There is a clear need for the appropriate utilization of antibiotics in children. Therefore, accurate drug selection and choice of best dosage and duration of the antibacterial treatment are important to optimize the treatment of LRTIs. It's fundamental to bear in mind that children differ from adults in how LRTIs manifest and evolve not only because of the diversity in the immunological profiles but also the fundamental age-related differences in absorption, distribution, metabolism, and elimination of drugs. Since comprehensive antibiotic guideline recommendations for the treatment of pediatric LRTIs are generally lacking, there is an undeniable need for the introduction of pediatric antimicrobial stewardship programmes in both community and hospital settings.
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Affiliation(s)
- Maria Gabriella Matera
- a Department of Experimental Medicine , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Paola Rogliani
- b Department of Experimental Medicine and Surgery , University of Rome Tor Vergata , Rome , Italy
| | - Josuel Ora
- b Department of Experimental Medicine and Surgery , University of Rome Tor Vergata , Rome , Italy
| | - Mario Cazzola
- b Department of Experimental Medicine and Surgery , University of Rome Tor Vergata , Rome , Italy
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Abstract
Infection of the upper airways is very common and is the most common acute illness evaluated in the outpatient setting. The infection is usually caused by viruses including rhinoviruses, influenza viruses, parainfluenza and respiratory syncytial viruses. Influenza is the only viral infection preventable by vaccination and occurs predominately during annual winter epidemics. Bacterial infection such as acute rhinopharyngitis is uncommon and usually presents with either persistent symptoms of an URTI lasting over a week or worsening course after initial improvement or acute onset with high fever and inflammatory changes confined to the pharynx. Fever is common in both bacterial and viral gastroenteritis. High fever is commonly present in many bacterial causes (e.g. Shigella, Salmonella, Shiga toxin-producing E. coli). Fever is often absent or low-grade in other diseases (e.g. enteropathogenic E. coli, cholera). Other febrile conditions cause diarrhoea and need to be differentiated. Fever in CNS infection is the most common presenting symptom in children beyond the neonatal age owing to the presence of inflammatory mediators, particularly IL-1 and TNF in the blood or within the CNS. In MCD, fever was the first symptom in children younger than 5 years and 94% developed fever at some point. Viral exanthems are common causes of febrile illness in children. More than 50 viral agents are known to cause a rash. Historically, exanthems were numbered in the order in which they were differentiated from other exanthems. Thus the first was measles; second, scarlet fever; third, rubella; forth, so-called Filatov-Dukes disease (no longer recognized as an entity); fifth, erythema infectiosum; and sixth, exanthema subitum. As more exanthems were described, numerical assignment became impractical.
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Fretzayas A, Moustaki M. Etiology and clinical features of viral bronchiolitis in infancy. World J Pediatr 2017; 13:293-299. [PMID: 28470580 PMCID: PMC7090852 DOI: 10.1007/s12519-017-0031-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bronchiolitis is a common lower respiratory tract infection in infancy. The aim of this review is to present the clinical profile of viral bronchiolitis, the different culprit viruses and the disease severity in relation to the viral etiology. DATA SOURCES Databases including PubMed and Google Scholar were searched for articles about the clinical features of bronchiolitis and its viral etiology. The most relevant articles to the scope of this review were analyzed. RESULTS Currently there are two main definitions for bronchiolitis which are not identical, the European definition and the American one. The most common viral pathogen that causes bronchiolitis is respiratory syncytial virus which was identified in 1955; now many other viruses have been implicated in the etiology of bronchiolitis such as rhinovirus, adenovirus, metapneumovirus, and bocavirus. Several studies have attempted to investigate the correlation of bronchiolitis severity with the type of detected virus or viruses. However, the results were not consitent. CONCLUSIONS For the time being, the diagnosis of bronchiolitis remains clinical. The isolation of the responsible respiratory pathogens does not seem to confer to the prognosis of the disease severity.
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Affiliation(s)
- Andrew Fretzayas
- 3rd Department of Pediatrics, "Attikon" University Hospital, Athens University, School of Medicine, 1 Rimini str, Haidari, 12462, Athens, Greece.
| | - Maria Moustaki
- 0000 0001 2155 0800grid.5216.03rd Department of Pediatrics, “Attikon” University Hospital, Athens University, School of Medicine, 1 Rimini str, Haidari, 12462 Athens, Greece
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Abstract
OBJECTIVES The aims of the study were to investigate whether the prevalence of urinary tract infections (UTIs) in febrile infants aged 2 to 12 months with bronchiolitis is higher than the presumed prevalence of asymptomatic bacteriuria (1%) in similarly aged patients and thus to determine whether UTI testing is necessary for these patients. METHODS This was a prospective cohort study in which we enrolled a convenience sample of febrile infants aged 2 to 12 months with a clinical diagnosis of bronchiolitis. All patients were seen in the emergency department at a large children's hospital between November 1, 2011 and April 15, 2012, had reported or documented fever higher than 38°C, and had urine collected for determination of the presence of UTI. After the conclusion of enrollment, a chart review was conducted to assess missed cases. RESULTS Positive urine cultures were found in 6/90 (6.7%) patients (confidence interval, 2.5%-13.9%). The positive urine cultures and urinalysis results were found in 4/90 (4.5%) patients (confidence interval, 1.2%-11%). CONCLUSIONS In our patient population, a significant proportion of infants aged 2 to 12 months who present with bronchiolitis and fever have a concurrent UTI. Obtaining a urine specimen for UTI testing should be considered in infants aged 2 to 12 months with bronchiolitis and fever. A larger multicenter study is needed to further assess the risk factors for UTIs in this patient population.
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Cha MA, Woo YR, Kim HJ, Kim MS, Ahn YH. Factors associated with obesity of acute bronchiolitis in infants: association of obesity with disease severity. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.4.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min Ah Cha
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeol Ryoon Woo
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Min Sub Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeon Hwa Ahn
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
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Affiliation(s)
- Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI and Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia School of Medicine & Health Science, University of Papua New Guinea, Papua New Guinea
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McCracken JP, Arvelo W, Ortíz J, Reyes L, Gray J, Estevez A, Castañeda O, Langley G, Lindblade KA. Comparative epidemiology of human metapneumovirus- and respiratory syncytial virus-associated hospitalizations in Guatemala. Influenza Other Respir Viruses 2014; 8:414-21. [PMID: 24761765 PMCID: PMC4181800 DOI: 10.1111/irv.12251] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/23/2022] Open
Abstract
Background Human metapneumovirus (HMPV) is an important cause of acute respiratory infections (ARI), but little is known about how it compares with respiratory syncytial virus (RSV) in Central America. Objectives In this study, we describe hospitalized cases of HMPV- and RSV-ARI in Guatemala. Methods We conducted surveillance at three hospitals (November 2007–December 2012) and tested nasopharyngeal and oropharyngeal swab specimens for HMPV and RSV using real-time reverse transcription-polymerase chain reaction. We calculated incidence rates, and compared the epidemiology and outcomes of HMPV-positive versus RSV-positive and RSV-HMPV-negative cases. Results We enrolled and tested specimens from 6288 ARI cases; 596 (9%) were HMPV-positive and 1485 (24%) were RSV-positive. We observed a seasonal pattern of RSV but not HMPV. The proportion HMPV-positive was low (3%) and RSV-positive high (41%) for age <1 month, whereas these proportions were similar (∼20%) by age 2 years. The annual incidence of hospitalized HMPV-ARI was 102/100 000 children aged <5 years [95% confidence interval (CI): 75–178], 2·6/100 000 persons aged 5–17 years (95%CI: 1·2–5·0), and 2·6/100 000 persons aged ≥18 years (95%CI: 1·5–4·9). Among children aged <5 years, HMPV-positive cases were less severe than HMPV-RSV-negative cases after adjustment for confounders [odds ratio (OR) for intensive care = 0·63, 95% CI 0·47–0·84]; OR for death = 0·46, 95% CI 0·23–0·92). Conclusions Human metapneumovirus is a substantial contributor to ARI hospitalization in Guatemala, but HMPV hospitalizations are less frequent than RSV and, in young children, less severe than other etiologies. Preventive interventions should take into account the wide variation in incidence by age and unpredictable timing of incidence peaks.
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Affiliation(s)
- John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
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Ahmad SA, Mujawar Q, Al Othman M, Salleh HB, Alsarfandi MA. Clinical profile of bronchiolitis in infants younger than 90 days in Saudi Arabia. J Emerg Trauma Shock 2014; 7:49-52. [PMID: 24550632 PMCID: PMC3912653 DOI: 10.4103/0974-2700.125641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 11/11/2022] Open
Abstract
Background: Bronchiolitis is a self-limiting disease of children caused by viral infections of the small airways with a wide spectrum of illness severity. Search of the literature reveals a need for refinement of criteria for testing for concomitant severe bacterial infections as well as appropriate therapeutic interventions for patients <90-day-old diagnosed with clinical bronchiolitis. We believe that a better understanding of the disease spectrum will help optimize health-care delivery to these patients. Aims: The aim of this study was to determine the clinical profile at presentation, disease course and outcome of bronchiolitis in <3-month-old infants who presented to our Pediatric Emergency Department (PED) during one disease season. Settings: Retrospective chart review during one bronchiolitis season, from November 1, 2011 to April 20, 2012. Subjects: All <90-day-old infants presenting with clinical bronchiolitis presenting to Urban PED of a tertiary care university hospital during one bronchiolitis season. Materials and Methods: A retrospective chart review based on computer records of all emergency department visits of infants less than 90 days with a clinical diagnosis of bronchiolitis, covering the period between November 1, 2011 and April 30, 2012. Results: Out of the total of 1895 infants <90 days of age, 141 had a clinical diagnosis of bronchiolitis and 35 needed admission to hospital. Blood for culture was obtained from 47 infants, urine for culture was obtained from 46 infants and cerebrospinal fluid for culture was obtained from eight infants. One case of bacteremia was documented, but this was found to be a contaminant. No cases of meningitis occurred among these infants. However, one infant had a positive urine culture consistent with infection (Escherichia coli). Conclusion: Based on the results, it can be conclude that the risk of bacteremia or meningitis among infants <90 days of age with fever and bronchiolitis is low. The risk of urinary tract infection in this age group is also low, but it is higher than the risk for meningitis or bacteremia. Our data for admission and treatment guidelines are similar to those published from other countries.
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Affiliation(s)
- Syed Amir Ahmad
- Department of Emergency Medicine, Pediatric Emergency, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Quais Mujawar
- Department of Emergency Medicine, Pediatric Emergency, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al Othman
- Department of Emergency Medicine, Pediatric Emergency, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Hashim Bin Salleh
- Department of Emergency Medicine, Pediatric Emergency, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Abdelhadi Alsarfandi
- Department of Emergency Medicine, Pediatric Emergency, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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McCracken JP, Prill MM, Arvelo W, Lindblade KA, López MR, Estevez A, Müller ML, Muñoz F, Bernart C, Cortez M, Moir JC, Ortíz J, Paredes A, Iwane MK. Respiratory syncytial virus infection in Guatemala, 2007-2012. J Infect Dis 2014; 208 Suppl 3:S197-206. [PMID: 24265479 DOI: 10.1093/infdis/jit517] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute respiratory illness (ARI). Little is known about RSV disease among older children and adults in Central America. METHODS Prospective surveillance for ARI among hospital patients and clinic patients was conducted in Guatemala during 2007-2012. Nasopharyngeal and oropharyngeal swab specimens were tested for RSV, using real-time reverse-transcription polymerase chain reaction. RESULTS Of 6287 hospitalizations and 2565 clinic visits for ARI, 24% and 12%, respectively, yielded RSV-positive test results. The incidence of RSV-positive hospitalization for ARI was 5.8 cases/10 000 persons per year and was highest among infants aged <6 months (208 cases/10 000 persons per year); among adults, the greatest incidence was observed among those aged ≥ 65 years (2.9 cases/10 000 persons per year). The incidence of RSV-positive clinic visitation for ARI was 32 cases/10 000 persons per year and was highest among infants aged 6-23 months (186 cases/10 000 persons per year). Among RSV-positive hospital patients with ARI, underlying cardiovascular disease was associated with death, moribund discharge, intensive care unit admission, or mechanical ventilation (odds ratio, 4.1; 95% confidence interval, 1.9-8.8). The case-fatality proportion among RSV-positive hospital patients with ARI was higher for those aged ≥ 5 years than for those aged <5 years (13% vs 3%; P < .001). CONCLUSIONS The incidences of RSV-associated hospitalization and clinic visitation for ARI were highest among young children, but a substantial burden of ARI due to RSV was observed among older children and adults.
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Rowlinson E, Dueger E, Taylor T, Mansour A, Van Beneden C, Abukela M, Zhang X, Refaey S, Bastawy H, Kandeel A. Incidence and clinical features of respiratory syncytial virus infections in a population-based surveillance site in the Nile Delta Region. J Infect Dis 2014; 208 Suppl 3:S189-96. [PMID: 24265478 DOI: 10.1093/infdis/jit457] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most reports about respiratory syncytial virus (RSV) in developing countries rely on sentinel surveillance, from which population incidence is difficult to infer. We used the proportion of RSV infections from population-based surveillance with data from a healthcare utilization survey to produce estimates of RSV incidence in Damanhour district, Egypt. METHODS We conducted population-based surveillance in 3 hospitals (2009-2012) and 3 outpatient clinics (2011-2012) in Damanhour district. Nasopharyngeal and oropharyngeal specimens from hospitalized patients with acute respiratory illness and outpatients with influenza-like illness were tested by real-time reverse transcriptase polymerase chain reaction for RSV. We also conducted a healthcare utilization survey in 2011-2012 to determine the proportion of individuals who sought care for respiratory illness. RESULTS Among 5342 hospitalized patients and 771 outpatients, 12% and 5% tested positive for RSV, respectively. The incidence of RSV-associated hospitalization and outpatient visits was estimated at 24 and 608 (per 100 000 person-years), respectively. Children aged <1 year experienced the highest incidence of RSV-associated hospitalizations (1745/100 000 person-years). CONCLUSIONS This study demonstrates the utility of combining a healthcare utilization survey and population-based surveillance data to estimate disease incidence. Estimating incidence and outcomes of RSV disease is critical to establish the burden of RSV in Egypt.
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Affiliation(s)
- Emily Rowlinson
- Global Disease, Detection, and Response Program, US Naval Medical Research Unit 3, Cairo, Egypt
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15
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Naorat S, Chittaganpitch M, Thamthitiwat S, Henchaichon S, Sawatwong P, Srisaengchai P, Lu Y, Chuananon S, Amornintapichet T, Chantra S, Erdman DD, Maloney SA, Akarasewi P, Baggett HC. Hospitalizations for Acute Lower Respiratory Tract Infection Due to Respiratory Syncytial Virus in Thailand, 2008-2011. J Infect Dis 2013; 208 Suppl 3:S238-45. [DOI: 10.1093/infdis/jit456] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Zappia T, Peter S, Hall G, Vine J, Martin A, Munns A, Shields L, Verheggenn M. Home oxygen therapy for infants and young children with acute bronchiolitis and other lower respiratory tract infections: the HiTHOx program. ISSUES IN COMPREHENSIVE PEDIATRIC NURSING 2013; 36:309-18. [PMID: 24083944 DOI: 10.3109/01460862.2013.834397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute lower respiratory tract infection (LRTI) including bronchiolitis, is one of the leading causes of pediatric hospital admissions worldwide. Recent studies have demonstrated that some children with acute bronchiolitis can be successfully managed using home oxygen therapy. AIM To report the impact of a Hospital in The Home Oxygen therapy program (HiTHOx) for selected infants and young children with acute bronchiolitis and other LRTI. FINDINGS The HiTHOx program appears to be a safe model of care for carefully selected infants and young children with acute bronchiolitis and LRTI that reduces the hospital length of stay. CONCLUSIONS The HiTHOx program provides an alternative model of care for infants and young children with acute LRTI. Implementation of models of care similar to that of the HiTHOx program in other pediatric health services may have the potential to create additional bed capacity, at the time of year when it is most needed.
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Kim KH, Hwang J, Song JH, Lee YS, Kwon JW, Suh DI, Park JD, Koh YY. Association between the clinical index and disease severity in infants with acute bronchiolitis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.4.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyung Hoon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jinsol Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Hyuk Song
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Sik Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Yull Koh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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El-Radhi ASM. Fever management: Evidence vs current practice. World J Clin Pediatr 2012; 1:29-33. [PMID: 25254165 PMCID: PMC4145646 DOI: 10.5409/wjcp.v1.i4.29] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 09/15/2012] [Accepted: 12/05/2012] [Indexed: 02/06/2023] Open
Abstract
Fever is a very common complaint in children and is the single most common non-trauma-related reason for a visit to the emergency department. Parents are concerned about fever and it’s potential complications. The biological value of fever (i.e., whether it is beneficial or harmful) is disputed and it is being vigorously treated with the belief of preventing complications such as brain injury and febrile seizures. The practice of alternating antipyretics has become widespread at home and on paediatric wards without supporting scientific evidence. There is still a significant contrast between the current concept and practice, and the scientific evidence. Why is that the case in such a common complaint like fever The article will discuss the significant contrast between the current concepts and practice of fever management on one hand, and the scientific evidence against such concepts and practice.
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Affiliation(s)
- A Sahib Mehdi El-Radhi
- A Sahib Mehdi El-Radhi, Department of Children, Chelsfield Park Hospital, Chelsfield, Orpington, Kent BR6 0SB, United Kingdom
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Piñero Fernández JA, Alfayate Migueléz S, Menasalvas Ruiz A, Salvador García C, Moreno Docón A, Sánchez-Solís de Querol M. [Epidemiology, clinical features and medical interventions in children hospitalized for bronchiolitis]. An Pediatr (Barc) 2012; 77:391-6. [PMID: 22726299 PMCID: PMC7105076 DOI: 10.1016/j.anpedi.2012.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/07/2011] [Accepted: 05/09/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To describe the epidemiology, clinical characteristics and treatments prescribed in children with bronchiolitis admitted to our hospital. MATERIAL AND METHODS Observational, descriptive and prospective study of children younger than 18 months, admitted to Hospital Virgen de la Arrixaca of Murcia (Spain), with the diagnosis of bronchiolitis, during the season of maximum incidence (December 2008-April 2009). RESULTS A total of 235 infants were admitted, of whom 78.7% of them were aged 5 months or less. We found a positive correlation between the number of cigarettes smoked by their mothers during pregnancy and the number of hospitalization and oxygen therapy days. Children whose mothers were smokers at the time of their admission needed a greater number of oxygen therapy days. Also infants who were not breastfed needed oxygen therapy during more days. Just under one quarter (23.8%) of them had underlying diseases, with prematurity being the most frequent and a risk factor for the ongoing of oxygen therapy and hospital stay. The use of diagnostic tests, bronchodilators, corticosteroids and antibiotics was high. The onset of high temperature was associated with an increased use of antibiotics in outside and inside the hospital setting. An abnormal chest X-ray or a raised C-reactive protein was associated with a higher use of antibiotics. Respiratory Syncytial virus (RSV) was the main aetiological agent, followed by Rhinovirus, Bocavirus, Adenovirus and Metapneumovirus CONCLUSIONS The majority of hospital admissions due to bronchiolitis took place during the first months of life. Infants whose mothers smoked during pregnancy had a worse clinical outcome. Despite the availability of clinical practice guidelines in our area, the use of diagnostic tests and pharmacological treatment was high.
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Affiliation(s)
- J A Piñero Fernández
- Sección de Enfermedades Infecciosas Pediátricas, Hospital Virgen de la Arrixaca, Murcia, España.
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Renukaradhya GJ, Manickam C, Khatri M, Rauf A, Li X, Tsuji M, Rajashekara G, Dwivedi V. Functional invariant NKT cells in pig lungs regulate the airway hyperreactivity: a potential animal model. J Clin Immunol 2010; 31:228-39. [PMID: 21042929 DOI: 10.1007/s10875-010-9476-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 10/10/2010] [Indexed: 01/12/2023]
Abstract
Important roles played by invariant natural killer T (iNKT) cells in asthma pathogenesis have been demonstrated. We identified functional iNKT cells and CD1d molecules in pig lungs. Pig iNKT cells cultured in the presence of α-GalCer proliferated and secreted Th1 and Th2 cytokines. Like in other animal models, direct activation of pig lung iNKT cells using α-GalCer resulted in acute airway hyperreactivity (AHR). Clinically, acute AHR-induced pigs had increased respiratory rate, enhanced mucus secretion in the airways, fever, etc. In addition, we observed petechial hemorrhages, infiltration of CD4(+) cells, and increased Th2 cytokines in AHR-induced pig lungs. Ex vivo proliferated iNKT cells of asthma induced pigs in the presence of C-glycoside analogs of α-GalCer had predominant Th2 phenotype and secreted more of Th2 cytokine, IL-4. Thus, baby pigs may serve as a useful animal model to study iNKT cell-mediated AHR caused by various environmental and microbial CD1d-specific glycolipid antigens.
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Affiliation(s)
- Gourapura J Renukaradhya
- Food Animal Health Research Program, Ohio Agricultural Research and Development Center, Department of Veterinary Preventive Medicine, The Ohio State University, 1680 Madison Ave., Wooster, OH 44691, USA.
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Kaur C, Chohan S, Khare S, Puliyel JM, Gupta P, Faridi MMA, Dev G. Respiratory viruses in acute bronchiolitis in Delhi. Indian Pediatr 2010. [DOI: 10.1007/s13312-010-0058-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The polymorphism of IL-17 G-152A was associated with childhood asthma and bacterial colonization of the hypopharynx in bronchiolitis. J Clin Immunol 2010; 30:539-45. [PMID: 20437253 DOI: 10.1007/s10875-010-9391-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 03/16/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Interleukin (IL)-17 plays an important role in the pathogenesis of asthma. We investigated the association between single-nucleotide polymorphism (SNP) of IL-17 (rs2275913, IL-17 G-152A) and asthma-related traits. Its effect on IL-17 production was also attractive. METHODS One hundred and sixty eight childhood asthmatic patients, 144 bronchiolitis patients, and 205 healthy controls were recruited in this study. SNP rs2275913 was genotyped by polymerase chain reaction-restriction fragment length polymorphism. Peripheral blood mononuclear cells (PBMCs) from parts of healthy controls with different genotype were isolated and cultured with phytohaemagglutinin (PHA) for detection of IL-17 in the supernatants. RESULTS SNP rs2275913 was associated with asthma (P = 0.03) in genotype frequency test. Children with homozygous A were 2.29 times more likely to have asthma than others (95% confidence interval 1.39-3.78, P = 0.001). The strength of associations was moderately higher by allergy comorbidity. Furthermore, SNP rs2275913 A allele was associated with abnormal lung function and serum total IgE in asthmatics, although the production of IL-17 by PHA-induced PBMC seemed to be not different among individuals with different genotypes. The distribution of SNP rs2275913 in bronchiolitis was marginally statistically different with controls and demonstrated a tendency close to that in asthma. Higher Streptococcus pneumoniae and Moraxella catarrhalis detection rates were shown in bronchiolitis patients with homozygous A allele than those with other genotypes (20.8% vs. 3.7%, P < 0.01 and 20.8% vs. 6.2%, P = 0.03). CONCLUSION The preliminary results demonstrate that IL-17 SNP rs2275913 was associated with several asthma-related traits and confers genetic susceptibility to childhood asthma. It may be used to develop markers to assess the risk of asthma, especially in the bronchiolitis population. It may be a potential bridge to connect the bacterial colonization and the onset of asthma.
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Ochoa Sangrador C, González de Dios J. [Consensus conference on acute bronchiolitis (VI): prognosis of acute bronchiolitis. Review of scientific evidence]. An Pediatr (Barc) 2010; 72:354.e1-354.e34. [PMID: 20409766 DOI: 10.1016/j.anpedi.2009.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
We present a review of the evidence on prognosis of acute bronchiolitis, risk factors for severe forms, symptom or severity scores and risk of post-bronchiolitis asthma. Documented risk factors of long stay or PICU admission in hospitalized patients are: bronchopulmonary dysplasia and/or chronic lung disease, prematurity, congenital heart disease and age less than 3 months. Other less well documented risk factors are: tobacco exposure, history of neonatal mechanical ventilation, breastfeeding for less than 4 months, viral co-infection and other chronic diseases. There are several markers of severity: toxic appearance, tachypnea, hypoxia, atelectasis or infiltrate on chest radiograph, increased breathing effort, signs of dehydration, tachycardia and fever. Although we have some predictive models of severity, none has shown sufficient predictive validity to recommend its use in clinical practice. While there are different symptom or severity scores, none has proven to be valid or accurate enough to recommend their preferable application in clinical practice. There seems to be a consistent and strong association between admission due to bronchiolitis and recurrent episodes of wheezing in the first five years of life. However it is unclear whether this association continues in subsequent years, as there are discordant data on the association between bronchiolitis and asthma.
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Affiliation(s)
- C Ochoa Sangrador
- Servicio de Pediatría, Hospital Virgen de la Concha, Zamora, España.
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24
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Conferencia de Consenso sobre Bronquiolitis Aguda (III): diagnóstico en la bronquiolitis aguda. Revisión de la evidencia científica. An Pediatr (Barc) 2010; 72:284.e1-284.e23. [DOI: 10.1016/j.anpedi.2009.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 12/14/2009] [Indexed: 11/22/2022] Open
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Abstract
Little attention has been given to the relationship between fever and the severity of asthma. The authors studied 202 successive admissions of children with asthma over a period of 16 months to investigate the relationship between fever and the clinical course of asthma. There were 38 febrile children (18.8%), who were mostly younger than 5 years. Febrile children had a shorter mean hospital stay than afebrile children (1.7 vs 2.0 days). There were 25 episodes of acute severe asthma (13%): 2 among the 38 febrile children (5.2%), compared with 23 episodes among the remaining 164 afebrile children (14%). Three children, who had very severe asthma requiring transfer to an intensive care unit, were afebrile. Radiological abnormalities (collapse/consolidation) occurred in 13 cases: 3 from the febrile and 10 from the afebrile group. Monitoring body temperature is important in cases of asthma. Febrile children tend to be younger and are more likely to have a less severe clinical course of asthma.
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Affiliation(s)
- A Sahib El-Radhi
- Queen Mary's Hospital, Sidcup, Kent; Department of Computing and Mathematical Sciences, University of Greenwich, Woolwich, London, United Kingdom. sahib.el-radhi@ hotmail.co.uk
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Abstract
#x203A; Infection of the respiratory tract is the most common reason for seeking medical advice and hospital admission in children. A viral upper respiratory tract infection (URTI) is the most common infection of the respiratory tract. › In developing countries, acute respiratory infection remains a leading cause of childhood mortality, causing an estimated 1.5–2 million deaths annually in children younger than 5 years of age. › In developed countries, viruses are responsible for most upper and lower respiratory tract infections, including pharyngitis and pneumonia. › Although the degree of fever cannot differentiate between viral and bacterial diseases, high fever is associated with a greater incidence of serious bacterial diseases such as pneumonia or meningitis. › Worldwide, diarrheal disease is the leading cause of childhood deaths under 5 years of age. › If the fever does not have an evident source, urinary tract infection (UTI) should be considered, particularly if the fever is greater than 39.0°C and persists for longer than 24–48 h. › Widespread vaccinations against bacteria causing meningitis, such as Hib, and vaccines against meningococci and pneumococci have dramatically reduced the incidence of meningitis. › A child with fever and nonblanching rash should be promptly evaluated to exclude meningococcal diseases. › Young children with malaria may present with irregular fever and not with typical paroxysms of fever, occurring particularly in early falciparum infection or as a consequence of previous chemoprophylaxis, which modifies the typical pattern of fever.
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Affiliation(s)
- Natalie Redshaw
- Malaghan Institute of Medical Research, Wellington, New Zealand
- University of Otago, Wellington, New Zealand
| | - Catherine Wood
- Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Fenella Rich
- Malaghan Institute of Medical Research, Wellington, New Zealand
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Hazir T, Nisar YB, Qazi SA, Khan SF, Raza M, Zameer S, Masood SA. Chest radiography in children aged 2-59 months diagnosed with non-severe pneumonia as defined by World Health Organization: descriptive multicentre study in Pakistan. BMJ 2006; 333:629. [PMID: 16923771 PMCID: PMC1570841 DOI: 10.1136/bmj.38915.673322.80] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the chest radiographs of children diagnosed with non-severe pneumonia on the basis of the current World Health Organization guidelines (fast breathing alone) for radiological evidence of pneumonia. DESIGN Descriptive analysis. SETTING Outpatient departments of six hospitals in four cities in Pakistan. PARTICIPANTS 2000 children with non-severe pneumonia were enrolled; 1932 children were selected for chest radiography. INTERVENTIONS Two consultant radiologists used standardised WHO definitions to evaluate chest radiographs; no clinical information was made available to them. If they disagreed, the radiographs were read by a third radiologist; the final classification was based on agreement between two of the three radiologists. MAIN OUTCOME MEASURES Presence or absence of pneumonia on radiographs. RESULTS Chest radiographs were reported normal in 1519 children (82%). Radiological evidence of pneumonia was reported in only 263 (14%) children, most of whom had interstitial pneumonitis. Lobar consolidation was present in only 26 children. The duration of illness did not correlate significantly with the presence of radiological changes (relative risk 1.17, 95% confidence interval 0.91 to 1.49). CONCLUSION Most children diagnosed with non-severe pneumonia on the basis of the current WHO definition had normal chest radiographs.
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Affiliation(s)
- Tabish Hazir
- ARI Research Cell, Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
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Walsh P, Rothenberg SJ, O'Doherty S, Hoey H, Healy R. A validated clinical model to predict the need for admission and length of stay in children with acute bronchiolitis. Eur J Emerg Med 2005; 11:265-72. [PMID: 15359199 DOI: 10.1097/00063110-200410000-00005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To develop and validate a logistic regression model to predict need for admission and length of hospital stay in children presenting to the Emergency Department with bronchiolitis. SETTING Two children's hospitals in Dublin, Ireland. METHODS We reviewed 118 episodes of bronchiolitis in 99 children admitted from the Emergency Department. Those discharged within 24 h by a consultant/attending paediatrician were retrospectively categorized as suitable for discharge. We then validated the model using a cohort of 182 affected infants from another paediatric Emergency Department in a bronchiolitis season 2 years later. In the validation phase actual admission, failed discharge, and age less than 2 months defined the need for admission. RESULTS The model predicted admission with 91% sensitivity and 83% specificity in the validation cohort. Age [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.76-0.97], dehydration (OR 2.54, 95% CI 1.34-4.82), increased work of breathing (OR 3.39, 95% CI 1.29-8.92) and initial heart rate above the 97th centile (OR 3.78, 95% CI 1.05-13.57) predicted the need for admission and a longer hospital stay. CONCLUSION We derived and validated a severity of illness model for bronchiolitis. This can be used for outcome prediction in decision support tools or severity of illness stratification in research/audit.
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Affiliation(s)
- Paul Walsh
- Department of Emergency Medicine, Kern Medical Centre, Bakersfield, CA, USA.
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Melendez E, Harper MB. Utility of sepsis evaluation in infants 90 days of age or younger with fever and clinical bronchiolitis. Pediatr Infect Dis J 2003; 22:1053-6. [PMID: 14688564 DOI: 10.1097/01.inf.0000101296.68993.4d] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the clinical utility of obtaining blood, urine and cerebrospinal fluid for bacterial culture among febrile infants <90 days of age with clinical bronchiolitis. DESIGN Retrospective chart review from 1995 to 2000. SETTING Urban emergency department of a tertiary children's hospital. PARTICIPANTS All infants <90 days of age presenting with fever and clinical bronchiolitis. MAIN OUTCOME MEASURES Result of the cultures of blood, urine and cerebrospinal fluid. RESULTS Of 3051 (11%) febrile infants, 329 met criteria for clinical bronchiolitis. Blood for culture was obtained from 309 (94%), urine for culture was obtained from 273 (83%) and cerebrospinal fluid for culture was obtained from 200 (61%). One hundred eighty-seven (57%) infants had all 3 specimens sent for culture. No cases of bacteremia [0%; 95% confidence interval (CI), 0, 1.1%] or meningitis (0%; 95% CI 0, 1.8%) occurred among these infants. However, 6 infants (2%; 95% CI 0.8, 5.7%), all male, had a culture of urine consistent with infection (4 Escherichia coli, 1 Staphylococcus aureus, 1 viridans streptococci). CONCLUSION The risk of bacteremia or meningitis among infants <90 days with fever and bronchiolitis is low in this age group. The risk of urinary tract infection in this age group is also low, but not negligible, at 2%.
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Affiliation(s)
- Elliot Melendez
- Department of Medicine, Children's Hospital Boston, MA 02115, USA
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Abstract
Meningococcal disease is the leading infective cause of mortality in children. Bronchiolitis and meningococcal disease share some common features. Both are seasonal diseases with epidemics in winter. A preceding history of upper respiratory tract infection is commonly present in both. We report two cases of meningococcal disease in infants whose initial presentation was suggestive of bronchiolitis. We draw attention to tachypnoea as an important but overlooked early sign of meningococcal septicaemia.
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Affiliation(s)
- R Hameed
- Birmingham Heartlands Hospital, Bordesley Green, Birmingham, UK.
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32
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Surcin L, Bloch J, Vitout-Brot C. [Reduction of complimentary prescription examinations in a pediatric emergency department]. Arch Pediatr 2001; 8:481-8. [PMID: 11396107 DOI: 10.1016/s0929-693x(00)00249-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
UNLABELLED Numerous biological tests and X-rays are prescribed though the patient's clinical status does not warrant them. They are a source of extra work, extra costs, and painful and potential measurement errors. OBJECTIVES To reduce unnecessary tests in four frequent situations (bronchiolitis, gastroenteritis, unexplained fever in children more than three months of age, asthma attack) at the pediatric emergency department of the Robert-Debré hospital (Paris). METHODS Using a 'before/after' intervention survey, the intervention consisted of a modification of the request forms by adding prescription recommendations. All the children presenting with any one of the four targeted pathologies were included during the two 2-week periods. RESULTS Test requests were reduced from 0.98 test per child to 0.77 (p = 0.02). The percentage of necessary tests increased from 33 to 50% (p < 0.0001); the percentage of children who underwent unnecessary blood samples decreased from 30 to 15% (p = 0.01). At the same time, the percentage of tests which were appropriate but not prescribed did not increase during the intervention period. CONCLUSION It is possible to reduce unnecessary tests in an emergency pediatric department by adding recommendations to the request form. Unfortunately, the effects of such intervention do not last if the recommendations are not regularly recalled.
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Affiliation(s)
- L Surcin
- Service de santé publique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019, Paris, France
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Affiliation(s)
- G Dutau
- Service d'allergologie et de pneumologie, hôpital des Enfants, 330, avenue de Grande-Bretagne, BP 3110, Toulouse, France
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Neves Barreira J, Fonseca C, Cardoso M, Azevedo A, Bonito Vítor A. Relación entre el subtipo del virus respiratorio sincitial y la gravedad clínica en la bronquiolitis. An Pediatr (Barc) 2001. [DOI: 10.1016/s1695-4033(01)77594-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Le Roux P. [Bronchiolitis in infants. Are there severity criteria for hospitalization?]. Arch Pediatr 2001; 8 Suppl 1:102S-108S. [PMID: 11232425 DOI: 10.1016/s0929-693x(01)80167-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- P Le Roux
- Unité de pneumologie, département de pédiatrie, groupe hospitalier, 55 bis, rue Gustave-Flaubert, 76033 Le Havre, France
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García García M, Ordobás Gabin M, Calvo Rey C, González Álvarez M, Aguilar Ruiz J, Arregui Sierra A, Pérez Breña P. Infecciones virales de vías respiratorias inferiores en lactantes hospitalizados: etiología, características clínicas y factores de riesgo. An Pediatr (Barc) 2001. [DOI: 10.1016/s1695-4033(01)77644-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chevallier B. [Bronchiolitis in infants. Clinical criteria of severity for hospital admission]. Arch Pediatr 2001; 8 Suppl 1:39S-45S. [PMID: 11232441 DOI: 10.1016/s0929-693x(01)80154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- B Chevallier
- Hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Hau-Rainsard I. [Criteria for hospitalization, for severity and for the role of oxymetry in infant bronchiolitis]. Arch Pediatr 2001; 8 Suppl 1:157S-173S. [PMID: 11232435 DOI: 10.1016/s0929-693x(01)80176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I Hau-Rainsard
- Service de pédiatrie, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France
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