Paediatric hospitalisations for lower respiratory tract infections in Mount Isa.

OBJECTIVE: To compare the rates of acute lower respiratory tract infection (ALRI) among children in north-west Queensland, according to age, sex and Indigenous status. DESIGN, SETTING AND PATIENTS: Retrospective chart review of hospitalisations at Mt Isa Base Hospital, Queensland, from 1 January 2007 to 31 December 2011 among children < 15 years of age. MAIN OUTCOME MEASURES: Rates of admission for bronchiolitis, pneumonia and bronchiectasis, calculated using population data from the Australian Bureau of Statistics. RESULTS: There were 356 admissions for ALRI, involving 276 children. Of the 162 children aged < 12 months old, 125 (77.2%) were Indigenous. Hospitalisations increased over the study period, and rates were significantly higher among Indigenous children compared with non-indigenous children (24.1 v 4.5 per 1000 population per year). There were 195 admissions of 164 children with pneumonia, 126 (76.8%) of whom were Indigenous. Annual rates for Indigenous children were higher than for non-Indigenous children (13.7 v 2.3 per 1000 population). Multiple admissions were common. One-third presented with gastrointestinal symptoms and signs. Pneumococcal disease persisted despite vaccination. There were 160 hospitalisations for bronchiolitis; 114 occasions (71.3%) involved Indigenous children. Seven children had bronchiectasis; all were Indigenous. CONCLUSION: Rates of ALRI in Mt Isa are comparable to those in the Northern Territory, which is reported to have rates of pneumonia among the highest in the world for children < 12 months of age. Multiple admissions are common, suggesting an even higher rate of bronchiectasis. Pneumonia may present as gastrointestinal disease, and invasive pneumococcal infection must be suspected despite vaccination.

Transbronchial lung cryobiopsy: a novel confirmatory tool to diagnose asbestos-related pulmonary fibrosis.

Asbestosis is diagnosed with a combination of historical, clinical and radiological findings in the absence of another cause. Histology is required when uncertainty exists, with lung biopsy via VATs being gold standard. Transbronchial cryobiopsy is becoming increasingly popular for diagnosing interstitial lung disease and may provide sufficient lung sample to demonstrate asbestosis. A 73 year old man presented with dyspnoea on a background of rheumatoid arthritis, previous methotrexate use and asbestos exposure. Examination revealed fine crackles in the mid and lower zones bilaterally without signs of pulmonary hypertension. The presence of pleural plaques and basal interstitial reticulation on HRCT was suggestive of asbestosis but histology was required to differentiate this from rheumatoid or methotrexate associated ILD. Samples of lung tissue were obtained via transbronchial cryobiopsy, demonstrating fibrosis and asbestos fibres consistent with asbestosis. Transbronchial cryobiopsy appears effective in obtaining sufficient parenchymal lung samples to diagnose asbestosis when clinical uncertainty exists.