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Cai LM, Yao Y, Jiao AX, Zhang FZ, Qin Q, Duan XM. Circumferential subglottic hemangioma misdiagnosed twice in an infant with life-threatening dyspnea. Pediatr Pulmonol 2023; 58:606-608. [PMID: 36349997 DOI: 10.1002/ppul.26228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/29/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Liang-Ming Cai
- Pediatric Intensive Care Unit, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yao Yao
- Department of Respiratory, China National Clinical Research Center of Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - An-Xia Jiao
- Department of Interventional Pulmonology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Feng-Zhen Zhang
- Department of Otolaryngology, Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Qiang Qin
- Department of Respiratory, China National Clinical Research Center of Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiao-Min Duan
- Imaging Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Jiao AX, Sun L, Liu F, Rao XC, Ma YY, Liu XC, Shen C, Xu BP, Shen AD, Shen KL. Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis. World J Pediatr 2017. [PMID: 28623556 DOI: 10.1007/s12519-017-0046-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children. The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB. METHODS A retrospective, descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014. RESULTS The median age of the enrolled patients was 3.4 years, with 73.2% of patients under five years old. The most common subtype was tumorous type (145/157, 92.4%). If only involved bronchus were considered, the common affected sites were right middle lobe bronchus (49/228, 21.5%), left upper lobe bronchus (41/228, 18.0%), right upper lobe bronchus (41/228, 18.0%), right main bronchus (35/228, 15.4%), respectively. Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044), with an odds ratio of 2.313 (95% confidence interval: 1.009-5.299). Before the bronchoscopy, only 16 (10.2%) patients were highly suspected of EBTB, while the others were diagnosed as PTB without EBTB (69.4%), or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission. CONCLUSIONS The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions. The most frequent subtype of EBTB in children is tumorous type. The lesions are seen in the right bronchial system more frequently. FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.
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Affiliation(s)
- An-Xia Jiao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Department of Interventional Pulmonology, Beijing, China
| | - Lin Sun
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children'ss Health, Beijing, China
| | - Fang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Department of Interventional Pulmonology, Beijing, China
| | - Xiao-Chun Rao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Department of Interventional Pulmonology, Beijing, China
| | - Yu-Yan Ma
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Department of Interventional Pulmonology, Beijing, China
| | - Xi-Cheng Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Department of Interventional Pulmonology, Beijing, China
| | - Chen Shen
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children'ss Health, Beijing, China
| | - Bao-Ping Xu
- Department of Respiratory Diseases, Beijing Children'ss Hospital, Capital Medical University, National Center for Children'ss Health, Beijing, China
| | - A-Dong Shen
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children'ss Health, Beijing, China
| | - Kun-Ling Shen
- Department of Respiratory Diseases, Beijing Children'ss Hospital, Capital Medical University, National Center for Children'ss Health, Beijing, China. .,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Beijing, 100045, China.
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Gao LW, Jiao AX, Wu XR, Zhao SY, Ma Y, Liu G, Yin J, Xu BP, Shen KL. Clinical characteristics of disseminated cryptococcosis in previously healthy children in China. BMC Infect Dis 2017; 17:359. [PMID: 28532447 PMCID: PMC5440943 DOI: 10.1186/s12879-017-2450-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background Disseminated cryptococcosis is a rare and fatal disease, and limited data exist regarding it in children. This study aimed to investigate the clinical characteristics of disseminated cryptococcosis in previously healthy children in China. Methods Hospitalized patients with disseminated cryptococcosis were enrolled during January 1996 to December 2015 in Beijing Children’s Hospital, Capital Medical University, China. Data on clinical manifestations, laboratory tests, treatment, and prognosis were evaluated. Results A total of 52 pediatric patients with no underlying disease were enrolled, including 38 boys and 14 girls. Only 10 cases had a history of exposure to pigeon droppings. Fever, cough, and hepatomegaly were 3 main manifestations of disseminated cryptococcosis. However, headache was more common in patients with central nervous system (CNS) invasion than in patients with non-CNS invasion (P < 0.05). Lung (96.2%, 50/52) was the most commonly invaded organ, but only 9.6% (5/52) of patients had respiratory signs. The most common findings on chest imaging were hilar or mediastinal lymphadenopathy (46.8%, 22/47), and nodules (44.7%, 21/47), including small nodules in a scattered distribution (57.1%, 12/21) or miliary distribution (42.9%, 9/25), especially localized in subpleural area. Subsequent invasion occurred in the CNS, abdomen lymph nodes, liver, spleen, peripheral lymph nodes, and skin. In all patients, 42.3% (22/52) and 51.9% (27/52) had elevated eosinophils or IgE, respectively. The positive rate of serum cryptococcal antigen was higher, especially in patients with CNS invasion (approximately 83.3%), than with other primary methods used for pathogen detection, including cerebrospinal fluid (CSF) cryptococcal antigen, cultures of blood, bone marrow, or CSF, and CSF ink staining. The overall mortality rate of pediatric patients in our study was 11.5% (6/52). Some cases had long-term sequela, including hydrocephalus, cirrhosis, or blindness. Conclusions Disseminated cryptococcosis can occur in previously healthy or immunocompetent children in China. Lung and CNS were most commonly invaded by this disease. Furthermore, most cases usually showed no obvious or specific symptoms or signs, and therefore pediatricians should pay more careful attention to identify this disease.
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Affiliation(s)
- Li-Wei Gao
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - An-Xia Jiao
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Xi-Rong Wu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Shun-Ying Zhao
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yun Ma
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ju Yin
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Bao-Ping Xu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Respiratory Diseases, Beijing, China.
| | - Kun-Ling Shen
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
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Wu XR, Yin QQ, Jiao AX, Xu BP, Sun L, Jiao WW, Xiao J, Miao Q, Shen C, Liu F, Shen D, Shen A. Pediatric tuberculosis at Beijing Children's Hospital: 2002-2010. Pediatrics 2012. [PMID: 23184116 DOI: 10.1542/peds.2011-3742] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our aim was to describe the patient characteristics, clinical-epidemiological profile, and treatment outcome of childhood tuberculosis (TB). METHODS A retrospective, descriptive study was undertaken of 1212 children aged 0 to 18 years admitted to Beijing Children's Hospital for the treatment of TB from January 2002 to December 2010. Statistical significance of category variables was evaluated by using Fisher's exact test. RESULTS Fifty-four percent of patients had extrapulmonary tuberculosis (EPTB), 38.8% had tuberculous meningitis, and 31.3% had disseminated TB. The last 2 types were defined as severe TB. Most patients with TB (81.6%) were cured or completed treatment. There were more patients aged <5 years and from rural areas with EPTB than with pulmonary tuberculosis. More severe cases of TB were found in patients aged <1 year than other less severe types of TB. Patients with no bacille Calmette-Guérin vaccination and a contact history at home had a significantly risk of contracting severe TB. Children aged <1 year and those with severe TB were more likely to have poor treatment outcomes (failed to improve or died). Among those with EPTB, only 61.3% and 61.1% had positive results on the purified protein derivative tuberculin skin test and chest radiograph, respectively. CONCLUSIONS In this referral hospital setting, more pediatric EPTB and severe TB patients were found among children aged <1 year. Age <1 year and having severe TB were risk factors for treatment failure. Thus, prevention and health care in pediatric TB should focus on both EPTB and severe TB.
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Affiliation(s)
- Xi-Rong Wu
- Beijing Pediatric Research Institute, Beijing Children's Hospital (affiliated with Capital Medical University), Beijing, 56 Nanlishi Rd, Xicheng District, Beijing 100045, China
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Hu YH, Jiao AX. [Clinical features of endogenous bronchial foreign bodies and application of bronchoscopy in children]. Zhongguo Dang Dai Er Ke Za Zhi 2010; 12:712-714. [PMID: 20849720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To study the clinical features of endogenous bronchial foreign bodies and the value of bronchoscopy in children. METHODS One hundred and six children who presented lobe or lung segment atelectasis by the chest X-ray and bronchial foreign body inhalation was excluded by bronchoscopy were enrolled. The original diseases included Mycoplasma pneumonia (n=62), endobronchial tuberculosis (n=24), bronchial pneumonia (n=16), nephrotic syndrome (n=2), laryngotracheal bronchitis (n=1) and bronchiolitis (n=1). On the basis of conventional treatment of the original diseases, bronchoscopy was performed in the children. Eighty children with bronchial foreign body inhalation severed as the control group. RESULTS Bronchoscopy showed the properties of endogenous foreign bodies: mucus emboli in 77 cases, cheese substances in 24 cases, dendritic white membrane in 4 cases, thrombosis in 1 case, and flaky pseudomembrane in 1 case. Hyperplasia of granulation tissue was seen in 25 cases. Of the 25 cases, endobronchial tuberculosis as the original disease was found in 22 cases. Mediastinal emphysema and pneumothorax occurred in 4 cases in the control group, but none in the endogenous foreign bodies group. The number of bronchoalveolar lavage by bronchoscopy in the endogenous foreign bodies group was significantly higher than that in the control group. CONCLUSIONS Bronchoscopy is valuable in the diagnosis and treatment of endogenous bronchial foreign bodies.
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Affiliation(s)
- Ying-Hui Hu
- Department of Internal Medicine, Capital Medical University, Beijing 100045, China.
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Jin J, Sun L, Jiao WW, Zhao SY, Li HM, Guan XL, Jiao AX, Chi W, Jiang ZF, Shen AD. [Association of NRAMP1 gene polymorphisms with the susceptibility to tuberculosis in ethnic Han Chinese children]. Zhongguo Dang Dai Er Ke Za Zhi 2009; 11:283-287. [PMID: 19374813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Tuberculosis is still a public health problem. Host genetic factors, such as polymorphisms in NRAMP1 gene, may play a role in the development of tuberculosis. To clarify the effect of NRAMP1 gene polymorphisms on the development of childhood tuberculosis, the association of NRAMP1 gene polymorphisms with susceptibility to tuberculosis in the ethnic Han Chinese children was investigated. METHODS From January 2005 to March 2008, 130 ethnic Han children with tuberculosis (TB group) were enrolled. Three hundred and ninety hospitalized ethnic Han children for physical examination in the surgery department were used as the control group. The controls were matched with tuberculosis children by age, sex and area. PCR-RFLP analysis was performed on DNA samples to identify allele genotypes of INT4 and D543N in NRAMP1 gene. Genotype frequency differences between tuberculosis patients and controls were analyzed using x2 test. RESULTS No statistical difference was found in the genotype frequency of variants G/C and C/C at the INT4 locus between the TB and the control groups. At the D543N locus, the frequency of genotype variants (G/A and A/A) was significantly higher in the TB group (34/130) than that in the control group (66/390) (x2=5.349, P<0.05; OR=1.74, 95%CI=1.08-2.79). When stratified by sex, differences in the genotype distribution were observed only in females at the D543N locus, which the variant genotypes were higher in the TB group (16/52) than in the control group (21/155) (x2=7.866, P<0.05; OR=2.84, 95%CI=1.34-5.99). For males, there was no difference between the TB and the control groups. At the INT4 locus, no difference was observed between the two groups in boys and girls. CONCLUSIONS Genotypic variation at the D543N locus in NRAMP1 gene may be associated with susceptibility to tuberculosis in ethnic Han Chinese children. Variant genotypes in NRAMP1 gene (G/A and A/A) may be susceptible genotypes to tuberculosis in ethnic Han Chinese children. Girls with variant genotypes were more susceptible to tuberculosis.
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Affiliation(s)
- Jing Jin
- Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
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