Understanding recurrent wheezing: A parent’s guide

Objective To investigate the clinical diagnostic value and safety of low dose computerized tomography (CT) in elderly patients with suspected acute lower respiratory tract infection. Methods From September 2016 to August 2018, a total of 92 elderly patients with suspected acute lower respiratory tract infection in Shenzhen Hospital, Guangzhou University of Chinese Medicine (Futian) were randomly divided into observation group and control group groups (46 cases in each group). Among whom, patients in control group were diagnosed by routine dose CT scanning, and patients in observation group were with low dose CT scanning. The diagnostic efficacy and radiation dose were compared between the two groups, and the diagnostic value of low-dose CT in acute lower respiratory tract infection was analyzed. Results The positive rates of CT in patients with suspected acute lower respiratory tract infection were 86.96% and 82.61% of patients in control group and observation group, respectively, with significant difference (χ2 = 0.733, P = 0.392). There was no significant difference in sensitivity, specificity, positive predictive value and negative predictive value of CT in the diagnosis of suspected acute lower respiratory tract infection between the two groups (all P > 0 05). The average radiation dose in the observation group was (1.28 ± 0.26) mSv, which was significantly lower than that of the control group [(3.12 ± 0.36) mSv], with significant difference (t = 28.102, P < 0.001). Conclusion The diagnostic value of low-dose CT in elderly patients with suspected acute lower respiratory tract infection is similar to that of routine-dose CT, and the radiation dose is small and safe. Key words: Acute lower respiratory tract infection; Low-dose computed tomography; Diagnosis; Suspected case

Study on the children of Kaohsiung with acute viral infection of lower respiratory tract by direct immunofluorescence assay.

Objective To investigate the occurrence of recent cardiovascular events (CVEs) for elderly patients with stable coronary artery disease (sCAD) after acute lower respiratory tract infection (ALRTI) and to analyze the related clinical risk factors. Methods Total of 210 stable elderly patients with coronary heart disease hospitalized in Wuji County Hospital of Hebei Province from June 2013 to June 2015 were selected. Patients were divided into infection group (110 cases) and control group (100 cases) according to whether associated with acute lower respiratory tract infection. The basic conditions of patents in the two groups were compared and routine examinations (indicators of blood, inflammation and nutrient intake) were performed, respectively. Follow-up was performed in both groups and cardiovascular events (acute heart failure, ST-elevation myocardial infarction, non-ST-elevation acute coronary syndrome, venous thromboembolism and acute ischemic stroke) were recorded. All the causes of death were compared and the risk factors were investigated. Results Compared with the control group, the follow-up results at the 10th day, 30th day and 60th day showed that the incidence of CVEs of patients in the infection group was 10.00%, 20.00% and 37.27%, respectively, with significant differences (χ2 = 2.34, 3.22, 4.18; P = 0.02, 0.01, 0.04). The all-cause mortality rates of patients in the infection group were 1.82%, 4.55% and 13.64%, which were significantly different compared with the control group (χ2 = 1.86, 2.07, 2.55; P = 0.03, 0.00, 0.03). The RDW of patients in the infection group had a unit of (15.76 ± 1.58)%, which was significantly higher than that of the control group [(13.35 ± 0.96)%], with significant difference (t = 0.25, P = 0.03). The RDW of patients with cardiovascular event was (14.18 ± 1.96)%, which was significantly higher than that of the patients without cardiovascular event [ (13.48 ± 1.02)% ], with significant difference (t = 1.36, P = 0.02). Conclusions Acute respiratory infections in elderly patients with stable coronary heart disease could increase the incidence of CVEs and the incidence of all-cause mortality. Increased RDW, acute lower respiratory tract infection, rapid heart rate and chronic kidney disease were independent predictors of CVEs and all-cause mortality in elderly patients with stable coronary heart disease. Key words: Coronary heart disease; Acute lower respiratory tract infection; Vascular events; Erythrocyte distribution width

Objective To explore the clinical characteristics of acute lower respiratory tract infection in children after influenza, and to provide evidence-based basis for timely diagnosis and accurate treatment of acute lower respiratory tract infection in children after influenza. Methods Eighty- two patients with acute lower respiratory tract infection admitted to Shanghai Children′s Medical Center from October 2016 to November 2017 were enrolled in our study.The clinical data of these patients were analyzed and influenza A or influenza B were confirmed by Filmarray platform.The clinical characteristics of patients with influenza A and influenza B, severe pneumonia and non-severe pneumonia, mechanical ventilation and non-mechanical ventilation were compared. Results The age distribution of the children ranged from 0.13 to 15 years old, with 73 cases (89.0%) being younger than 5 years old.There were 47 cases of influenza A (57.3%) and 35 cases of influenza B (42.7%). The proportions of cases in spring, summer, autumn and winter were 35.3%, 15.9%, 15.9% and 32.9%, respectively.Congenital heart disease was the most common underlying disease (28 cases, 34.1%). Twenty-five(30.5%) patients were diagnosed as severe pneumonia.Oseltamivir was added on the first to eighth days of the course with median time(IQR)2.0(3.0) days.Thirteen (15.9%) patients needed ventilator-assisted ventilation.There were significant differences in the incidence of influenza A and influenza B in summer (12/47 vs. 1/35, χ2=7.7, P<0.01). Compared to non-severe pneumonia, severe pneumonia was positively correlated with underlying diseases(17/25 vs.18/57, χ2=9.4, P<0.01), digestive tract symptoms(10/25 vs.6/57, χ2=9.6, P<0.01) and high PCT level(8/23 vs.8/56, χ2=3.1, P<0.01), but negatively correlated with oseltamivir application[M(IQR)][5.0(2.5)d vs.2.0(1.5)d, Z=-6.1, P<0.01]. There was significant difference in the proportion of influenza A/B between ventilator group and non-ventilator group (11/2 vs.36/33, χ2=4.7, P<0.01). Conclusion Filmarray respiratory tract detection system can detect influenza virus infection quickly and accurately, providing a good basis for early diagnosis and treatment.Children under 5 years old are susceptible to influenza.Influenza in children mainly occurs in winter and spring.Influenza A mainly occurs in summer.Patients with influenza A infection, underlying diseases, digestive tract symptoms during the course of illness and elevated PCT are more likely to progress to severe illness or even use ventilator treatment.Early use of oseltamivir can improve the prognosis of the disease. Key words: Acute lower respiratory tract infection; Influenza; Clinical features; Molecular diagnostic techniques; Treatment

Introduction: Respiratory syncytial virus (RSV) is the main cause of acute lower respiratory tract infection (LRTI) in children under two years of age. Several factors, intrinsic and extrinsic to the patient, determine the severity of the disease. Objectives: 1.- To evaluate the association of meteorological conditions and air pollution with hospital admissions for acute viral LRTI in children under two years of age. 2.- To analyze whether the expression of inflammatory and antiviral genes in the peripheral blood of children under two years of age with RSV bronchiolitis is associated with severe hypoxemia and disease progression. Material and methods: Three studies were designed: 1.- Environmental factors and pollutants: A bidirectional case-crossover study was conducted on 30,445 children with acute LRTI under two years of age, using data from the Minimum Basic Data Set (CMBD) between 2013 and 2015. Environmental data were obtained from the State Meteorological Agency (AEMET). The association was evaluated using conditional logistic regression. 2.- Expression of inflammatory and antiviral genes and hypoxemia: A cross-sectional study was conducted on 121 RSV-infected children requiring hospital admission between 2015 and 2023. Total RNA was extracted from blood samples, and gene expression (IL-6, TNFα, CXCL8, ISG15, IFIT1, RIGI, IFNβ, CCL5, and CXCL10) was evaluated by quantitative polymerase chain reaction (qPCR). The outcome variable was severe hypoxemia (SpO2 ≤90%) at the time of hospital admission. Association analysis was performed using a volcano plot, logistic regression adjusted for relevant clinical variables, and orthogonal partial least squares discriminant analysis (OPLS-DA). 3.- Expression of inflammatory and antiviral genes and progression of bronchiolitis: A prospective study was conducted on 117 infants between 2015 and 2023. The expression levels of nine inflammatory and antiviral genes were quantified by PCR. The infants were classified according to their evolution during admission into two groups: (i) no progression (n=74) and (ii) unfavorable progression (n=43). The association analysis was performed using logistic regression, adjusted for age, sex, prematurity, and severity. Results: Study 1: Lower temperatures one week before hospitalization (q=0.012) and higher relative humidity one and two weeks before the event (q=0.003 and q&lt;0.001, respectively) were associated with a higher probability of hospital admission. In addition, higher levels of NO2 two weeks before the event were also associated with increased hospital admissions (q&lt;0.001). Finally, on the event day, higher concentrations of SO2 (compared with 1-week (q=0.026) and 2-week (q&lt;0.001) lags), O3 (compared with 3-day (q&lt;0.001), 1-week (q&lt;0.001), and 2-week (q&lt;0.001) lags), and PM10 (compared with 2-week (q&lt;0.001) lag) were associated with increased odds of viral LRTI hospital admissions. Study 2: We found that CXCL8 was overexpressed (&gt;2-fold; q&lt;0.05) in children with severe hypoxemia, whereas ISG15, IFIT1, RIGI, IFNβ, CCL5, and CXCL10 were underexpressed (&lt;-2-fold; q&lt;0.05). These associations were confirmed by adjusted logistic regression. OPLS-DA analysis showed that gene expressions of CXCL8, ISG15, IFIT1, RIGI, and CXCL10 had variable importance in projection values (VIP) ≥1, being the most relevant features. Study 3: Univariate logistic models showed that low TNFα and CCL5 expression levels at baseline were associated with unfavorable RSV bronchiolitis progression. This was confirmed by multivariate analysis: TNFα (aOR=0.8; 95% CI=0.64 - 0.99; p=0.038) and CCL5 (aOR=0.76; 95% CI=0.62 - 0.93; p=0.007). Conclusions: 1.- Short-term exposure to environmental factors, such as weather conditions and pollutants, is related to increased hospitalizations in children with acute LRTI under two years of age. 2.- An imbalance in the innate response that favors inflammation over antiviral defense could contribute to severe hypoxemia in RSV-infected children. 3.- An inadequate immune response against RSV, characterized by low levels of CCL5 and TNFα gene expression in peripheral blood, was associated with an unfavorable evolution of RSV bronchiolitis.

Background and Aim: Acute lower respiratory infection (ALRI) is one of the leading causes of illness and death in children below 5 years of age. Anemia is one of the most widespread public health problems, especially in developing countries[2]. We aim to study the relationship between anemia as a risk factor and acute lower respiratory tract infections in Egyptian preschool children aged 6 months to 6 years. Subjects and methods: A case-control study was conducted on a total number of 172 infants and children aged 6 months to 6 years; in the period from January 2013 to December 2013, we recruited 86 cases hospitalized for lower respiratory tract infections in Children Hospital, Zagazig University comprising all newly diagnosed cases during the defined time period of the study (incident cases) to ascertain the temporal sequence of exposure and disease. 86 healthy controls without any respiratory problems, age and sex matched were selected by simple random sampling from the general population that gave rise to the cases . All patients were subjected to detailed history taking ( including past medical or pharmacy records), full clinical examination, and investigations including CBC, Iron profile: serum ferritin, total iron binding capacity and serum iron for all children. CRP and Chest X ray are done for cases only. Results: The percentage of anemia was higher among case than control, with 81.4 % of hospitalized cases and 32.5%of healthy controls and the percent of iron deficiency anemia was higher in cases than controls 69.8% and 23.2% respectively with a significant P-value of 0.001.There were significant lower medians of serum iron, ferritin and transferrin saturation in cases than controls with highly and significant higher total iron binding capacity (TIBC) in cases than controls , also There’s significant lower serum iron and transferrin saturation in anemic cases than anemic controls with no significant difference as a regard TIBC and serum ferritinApproval of ethical committee in college, and written consent from patients′ parents were obtained. Conclusion: we can conclude that anemia especially IDA is a risk factor for acute lower respiratory tract infections among Egyptian preschool children.

BackgroundThere are limited data on incidence, risk factors and etiology of acute lower respiratory tract infection (LRTI) among older adults in low- and middle-income countries.MethodsWe established a cohort of community dwelling older adults ≥60 years and conducted weekly follow-up for acute respiratory infections (ARI) during 2015-2017. Nurses assessed ARI cases for LRTI, collecting combined nasal/throat swabs from all LRTI cases and an equal number of age- and sex-matched asymptomatic neighbourhood controls. Swabs were tested for influenza viruses, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and parainfluenza viruses (PIV) using polymerase chain reaction. LRTI and virus-specific LRTI incidence was calculated per 1000 person-years. We estimated adjusted incidence rate ratios (IRR) for risk factors using Poisson regression and calculated etiologic fractions (EF) using adjusted odds ratios for detection of viral pathogens in LRTI cases vs controls.ResultsWe followed 1403 older adults for 2441 person-years. LRTI and LRTI-associated hospitalization incidences were 248.3 (95% confidence interval (CI) = 229.3-268.8) and 12.7 (95% CI = 8.9-18.1) per 1000 person-years. Persons with pre-existing chronic bronchitis as compared to those without (incidence rate ratio (IRR) = 4.7, 95% CI = 3.9-5.6); aged 65-74 years (IRR = 1.6, 95% CI = 1.3-2.0) and ≥75 years (IRR = 1.8, 95% CI = 1.4-2.4) as compared to 60-64 years; and persons in poorest wealth quintile (IRR = 1.4, 95% CI = 1.1-1.8); as compared to those in wealthiest quintile were at higher risk for LRTI. Virus was detected in 10.1% of LRTI cases, most commonly influenza (3.8%) and RSV (3.0%). EF for RSV and influenza virus was 83.9% and 83.6%, respectively.ConclusionIn this rural cohort of older adults, the incidence of LRTI was substantial. Chronic bronchitis was an important risk factor; influenza virus and RSV were major viral pathogens.

Introduction: Acute lower respiratory tract infection (ALRTI) is a major public health problem that causes significant morbidity and mortality and is the main reason for utilization of health services among children. Obectives: The study aimed to evaluate the clinical profile, severity pattern, and sociodemographic risk factors of ALRTI in hospitalized children under the age of five years in two tertiary hospitals in South East Nigeria. Materials and Methods: This is a cross-sectional study of children aged two months to five years in two teaching hospitals in the country. They were evaluated for ALRTI, focusing on their clinical profile and socio-demographic risk factors. Results: Two hundred children presented with features of ALRTI, mostly pneumonias and bronchiolitis. ALRTI occurred throughout the year with a peak in October. The majority had severe disease and risk factors for severity were infancy, type of ALRTI, presence of comorbidity and lack of measles vaccination or vitamin A supplementation, and exposure to wood smoke. Fast breathing was the most sensitive symptom, while breathlessness was the most specific for ALRTI. Conclusion: Bronchopneumonia and bronchiolitis are the most common ALRTI in under-five age children with bronchopneumonia occurring in severe forms. Poor breastfeeding, infancy, poor rate of immunization and exposure to biomass smoke are all risk factors for severity.

Background: Indoor air pollution is an important risk factor for acute lower respiratory tract infections (ALRTI) in developing countries.Aim: To determine the relationship of indoor air pollution with ALRTI in children under 5 years of age.Methods: A prospective, case-control study of risk factors, particularly indoor air pollution, for developing ALRTI in children under 5 years of age was conducted in Udupi District Hospital. The WHO definition of ALRTI was used. Healthy children attending immunisation services were enrolled as controls. Data pertaining to important factors causing indoor air pollution such as cooking fuel other than liquid petroleum gas (LPG) and passive smoking were collected along with potential socio-demographic factors and nutrition in both groups and analysed.Results: A total of 202 children including 101 cases and 101 controls were studied. The proportions of infants (1–12 months) among cases and controls were 62·4% and 71·3%, respectively. Of those with ALRTI, 24·8% had pneumonia, 45·5% had severe pneumonia and 29·7% had very severe disease. Exposure to passive smoking was not associated with ALRTI. Cooking fuel other than LPG was significantly associated with ALRTI (OR 26·3, 95% CI 10·5–65·7). On logistic regression analysis of multiple risk factors, cooking fuel other than LPG emerged as a significant risk factor for developing ALRTI (adjusted OR 4·73, 95% CI 1·67–13·45) along with poor socio-economic status (adjusted OR 3·38, 95% CI 1·63–7·03). Other than LPG, the main fuels used were wood (95%), kerosene and dung and crop residues.Conclusion: Indoor air pollution caused by using cooking fuel other than LPG and socio-economic factors are significantly associated with ALRTI.

Objective To investigate the clinical, etiological and epidemiological characteristics of acute lower respiratory tract infection (ALRI) in Kunming region. The etiological agents, including bacteria, virus and atypical pathogens were studied in order to determine different characteristics of age distribution of respiratory infectious agents. Methods From October 2005 to October 2007, a total of 1402 hospitalized children with ALRI were included into this study (study group). Meanwhile, another 50 healthy children who underwent regular physical examination were recruited into control group. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Children's Hospital of Kunming. Informed consent was obtained from each participate. There had no significant difference between two groups on ages and so on. The nasal secretion samples were collected from study group for the bacterial agents culture and identification; viral antigens were detected by direct and indirect immunofluorescent analysis. Results The etiological agents were detected in 402 of 1402 patients (28.79%), of which 9.1%(127/1402) were mixed infections. The bacterial-, viral-, and non-typical etiological agents were identified in 402 (28.79%), 365 (26.0%) and 259 (18.5%) of 1402 patients with ALRI, respectively. Total positive rate of respiratory pathogens was 82.2% (1153/1402). The bacterial agents identified from the 402 positive samples mainly consisted of the Gram-negative(G-) bacteria(73.1%) [E.coli (41.3%), Klebsiella pneumoniae (15.4%), Haemophilus inflenzae (6.0%)], and the G+ bacteria (mainly Streptococcus pneumoniae) was detected as causative agents responsible for ALRI, for incidences of 14.4%. Of 365 virus positive samples, 312 samples (85.5%) were tested as positive for the respiratory syncytial virus (RSV) antigen, 12 samples testing positive for influenza A virus(IVA), 7 samples for parainfluenza virus type (PIV)Ⅱ, 24 samples for PIVⅢ and 7 samples for adenovirus (ADV). No samples testing positive for influenza B virus (IVB). Non-typical pathogens identified were Mycoplasma pneumoniae(MP), Legionella pneumoniae type 1(LP1), and Chlamydia pneumoniae(CPn), accounting for 11.6%, 6.3%, and 0.6% of the total samples, respectively. Bacteria, virus were two main causative agents responsible for ALRI in younger children, whereas non-typical pathogens were frequently observed in elderly children. Bacteria and atypical pathogens infection incidences showed seasonal differences during a year, but the RSV was the main causative agent during a year, especially in autumn. Conclusions G- bacteria and respiratory syncytial virus are the two main local causative agents which were responsible for ALRI in children; the younger the children are, the higher incidence there is. The etiological agents' patterns vary from place to place. Key words: pathogen; non-typical pathogen; pediatrics; epidemiology; acute lower respiratory tract infection; virus

Inhaled antibiotics for acute lower respiratory tract infections in primary care: a hypothesis

Human parainfluenza virus type 4 infection in Chinese children with lower respiratory tract infections: A comparison study

ObjectiveTo estimate the association between household tenure and the odds of hospital admission for acute lower respiratory tract infections (LRTI) in children under age 2 years.&#x0D; MethodsWe developed a birth cohort of all singleton children born in Scotland 2010-2012, using linked birth registration records and maternal Census 2011 data. Further linkage to hospital admission records provided information on acute LRTI (pneumonia, bronchitis, bronchiolitis, influenza, unspecified LRTI) admissions in children aged less than 2 years. Using logistic regression models, we estimated the association between housing tenure at birth (owned, social rented, private rented/lives rent free) with odds of hospital admission for LRTI before and after adjustment for parental occupational class (household reference), family type and highest qualification level.&#x0D; ResultsFrom the cohort of all 174,279 births in 2010-2012, 84.1% linked to a maternal census record. Children whose parents were married or had a UK-born mother were more likely to link to a Census record. In the final linked cohort of 141,336 children, 7,486 (5.3%) were admitted to hospital for one or more LRTI during the 2 years of follow up. We found an association between housing tenure and LRTI admissions, with children residing in social rented, compared to owned housing having higher odds of an LRTI admission, OR: 1.40 (1.32-1.47); and children living in private rented/rent free housing, compared to owned, OR: 1.18 (1.11-1.26). After adjustment for household socioeconomic circumstances, these estimates attenuated to OR: 1.18 (1.11-1.27) and OR: 1.10 (1.03-1.18) respectively.&#x0D; ConclusionAfter accounting for household socioeconomic circumstances, children living in social and private tenured accommodation, compared to children living in owned accommodation were more likely to be hospitalised for an acute LRTI during the first 2 years of life. Further research to understand the contribution specific housing circumstances make to inequalities in LRTI hospitalisations early in life is needed.

Intraday effects of outdoor air pollution on acute upper and lower respiratory infections in Australian children.

Objective To investigate the distribution,transition and changes of drug resistance of bacteria in children with acute lower respiratory tract infection (ALRI) of Kunming by conducting a consecutive clinical study of 9 years.Methods Sputum specimens for bacterial cultures were collected from children with ALRI who had been admitted to ICU and general wards of Kunming Children's Hospital from Jan 2002 to Dec 2010.Antibiotic susceptibility tests were performed after bacteria had been identified.Results Pathogenic bacteria distribution:(1) total positive rate of pathogenic bacteria was 18.52％ (3006/16 229) ;gramnegative bacteria accounted for 75.35％ ; gram-positive bacilli accounted for 20.23％ ; fungi accounted for 4.42％ ;Escherichia coli was the most common pathogenic bacteria in children with ALRI,followed by Klebsiella pneumonia,Streptococcus pneumoniae,Hemophilus,Enterobacter cloacae,Pseudomonas aeruginosa.(2) Gram-negative bacteria such as Escherichia coli and Klebsiella pneumonia were the two most common bacteria in ICU,Staphylococcus aureus was the most common gram-positive bacteria in ICU;while Hemophilus took the palace of Klebsiella pneumonia as the second most common gram-negative bacteria in general wards;Streptococcus pneumoniae was the most common gram-positive bacteria in general wards.Drug resistance:compared with the years of 2002 ～ 2006,the rate of drug resistance between 2007 and 2010 had increased,and multiple drug resistance status was present.Resistant strains to imipenem and vancomycin were not found.Constituent ratio and proportion of Escherichia coli and Klebsiella pneumoniae producing extended spectrum β-lactamases showed the trend of increase by years.Conclusion Gram-negative bacilli were the main bacteria pathogens in children with ALRI in Kunming between 2002 and 2010,among which escherichia coli was the most common pathogen.Bacteria distribution and transition were different in different wards.The drug resistance of bacteria showed the trend of increase in the recent years. Key words: Acute low respiratory infection; Pathogenic bacteria; Antibiotics; Drug resistance