Post-infectious bronchiolitis obliterans.

Bronchiolitis obliterans is a rare and severe chronic lung disease resulting from a lower respiratory tract lesion. It may occur after a bone marrow or lung transplantation, infectious diseases, or less frequently after inhaling toxic substances or after connective tissue diseases. Pathology, pathogenesis, and molecular biology, as well as the best treatment of bronchiolitis obliterans, remain the subject of ongoing research. This review discusses our current knowledge of different areas of bronchiolitis obliterans associated with infectious lesions.

Asma de difícil control en niños y adolescentes: Estrategias diagnóstico-terapéuticas / Poorly controlled asthma: diagnosis and therapeutics in children and adolescents

El asma es una de las enfermedades crónicas más frecuentes en los niños. Si bien la mayoría de los niños con asma responden a bajas dosis de corticoides inhalados y/o antagonistas del receptor de leucotrienos, algunos de ellos permanecen sintomáticos independientemente de cualquier esfuerzo terapéutico, presentando una elevada morbilidad e inclusive mortalidad. Aunque la mayoría de los pacientes controlan los síntomas de forma adecuada, existe un grupo importante que presenta síntomas graves de la enfermedad difíciles de controlar (ADC). El objetivo de la presente revisión es discutir los aspectos clínicos, diagnósticos y terapéuticos del ACD en los menores de 18 años y su implicancia en la práctica clínica diaria.

Asthma is one of the most common chronic diseases in children. While most children with asthma respond to low doses of inhaled corticosteroids and /or leukotriene receptor antagonists, some of them remain symptomatic regardless of any therapeutic effort, showing a high morbidity and even mortality. While most of the patients control symptoms adequately, there is a large group with severe symptoms of the disease and difficult to control. The aim of this review is to discuss the clinical aspects, diagnosis and treatment of poorly controlled asthma in children and adolescents and its implications in daily clinical practice.

Clinical prediction rule to diagnose post-infectious bronchiolitis obliterans in children.

RATIONALE: Infant pulmonary function testing has a great value in the diagnosis of post-infectious bronchiolitis obliterans (BOs), because of characteristic patterns of severe and fixed airway obstruction. Unfortunately, infant pulmonary function testing is not available in most pediatric pulmonary centers. OBJECTIVE: To develop and validate a clinical prediction rule (BO-Score) to diagnose children under 2 years of age with BOs, using multiple objectively measured parameters readily available in most medical centers. METHODS: Study subjects, children under 2 years old with a chronic pulmonary disease assisted at R. Gutierrez Children's Hospital of Buenos Aires. Patients were randomly divided into a derivation (66%) and a validation (34%) set. ROC analyses and multivariable logistic regression included significant clinical, radiological, and laboratory predictors. The main outcome measure was a diagnosis of BOs. The performance of the BO-Score was tested on the validation set. RESULTS: Hundred twenty-five patients were included, 83 in the derivation set and 42 in the validation set. The BO-Score (area under ROC curve = 0.96; 95% CI, 0.9-1.0%) was developed by assigning points to the following variables: typical clinical history (four points), adenovirus infection (three points), and high-resolution computed tomography with mosaic perfusion (four points). A Score > or =7 predicted the diagnosis of BOs with a specificity of 100% (95% CI, 79-100%) and a sensitivity of 67% (95% CI, 47-80%). CONCLUSIONS: The BO-Score is a simple-to-use clinical prediction rule, based on variables that are readily available. A BO-Score of 7 or more predicts a diagnosis of post-infectious BOs with high accuracy.

Bronquiolitis obliterante posinfecciosa / Postinfectious bronchiolitis obliterans

La bronquiolitis obliterante es una enfermedad pulmonar crónica infrecuente y grave producto de una lesión del tracto respiratorio inferior.Puede ocurrir luego de un trasplante de médula ósea o de pulmón, de enfermedades infecciosas o, menos frecuentemente, luego de inhalaciones tóxicas o enfermedades del tejido conectivo. La patología, patogenia y biología molecular, como así también el mejor tratamiento para la bronquiolitisobliterante son áreas aún en investigación. Esta revisión discute el estado actual del conocimiento en las diferentes áreas de la bronquiolitis obliterante secundaria a una lesión infecciosa.

Bronchiolitis obliterans is an uncommon and severe form of chronic obstructive lung disease that results from an insult tothe lower respiratory tract. The bronchiolitis obliterans was described as a complication of graft versus host disease in bone marrow or lung transplant recipients. Bronchiolitis obliterans is most commonly seen in children after severe viral lower respiratory tract infections. The understanding of pathology, pathogenesis and molecular pathology, as well as the best treatment in bronchiolitis obliterans remain the subject of ongoing investigations. This review discusses our current knowledge on the different areas of bronchiolitisobliterans associated to infectious disease.

[New respiratory viruses in children 2 months to 3 years old with recurrent wheeze]. / Nuevos virus respiratorios en niños de 2 meses a 3 años con sibilancias recurrentes.

INTRODUCTION: Respiratory viruses are associated with respiratory exacerbations, more frequently Respiratory Syncytial Virus in infants and Rhinovirus in children. OBJECTIVE: To evaluate the prevalence and epidemiological features of newer and traditional respiratory viruses in infants and young children with recurrent wheeze. MATERIAL AND METHODS: Cross sectional, prospective and descriptive study. Patients with recurrent wheeze and risk factors for asthma, age 2 months to 3 years, hospitalized with bronchial obstruction were included. On admission a respiratory sample was obtained through a nasopharyngeal aspirate. Immunofluorescence was performed to detect Respiratory Syncytial Virus, Adenovirus, Parainfluenza 1, 2, 3 and Influenza A and B. Polymerase Chain Reaction was used to detect Rhinovirus, Enterovirus, Metapneumovirus, Bocavirus, Adenovirus and Coronavirus. RESULTS: 119 patients (61 female), age (x E DS) 1.5 E 0.9 years were included. Days on admission and on oxygen requirement were, respectively (x E DS): 6.3 E 2.9 y 4.4 E 2.7. One hundred and two (86%) positive cases were diagnosed. Fifty five percent of the viruses were detected by Immunofluorescence and 45% by Polymerase Chain Reaction. A single virus was present in 75% of the samples, 22% had a double co-infection and 3% a triple virus co-infection. Overall, the prevalence of detected respiratory viruses was: Respiratory Syncytial Virus 55 (43%); Rhinovirus 30 (23%); Metapneumovirus 13 (10%); Influenza A 8 (6%); Enterovirus 6 (5%); Bocavirus 6 (5%); Adenovirus 4 (3%); Coronavirus 3 (2%); Parainfluenza 1: 2 (1%); Influenza B, 1 (1%) and Parainfluenza 3: 1 (1%). CONCLUSIONS: Infants and young children with recurrent wheeze and risk factors for asthma hospitalized for bronchial obstruction present a high prevalence of respiratory viruses. Hospital admissions were more frequent during months of higher respiratory circulation.

Nuevos virus respiratorios en niños de 2 meses a 3 años con sibilancias recurrentes / New respiratory viruses in children 2 months to 3 years old with recurrent wheeze

Introducción. Los virus respiratorios son los agentes que con más frecuencia desencadenan sibilancias, especialmente, el virus sincicial respiratorio en los lactantes y los rinovirus en niños mayores.Objetivos. Conocer la prevalencia y la circulación estacional de los virus respiratorios nuevos y tradicionalesen lactantes y niños pequeños con sibilancias recurrentes.Material y métodos. Estudio de corte transversal, prospectivo y descriptivo. Se incluyeron pacientes de 2 meses a 3 años con sibilancias recurrentes yfactores de riesgo para desarrollar asma hospitalizados por obstrucción bronquial. Se obtuvo una muestra de secreciones respiratorias por aspiradonasofaríngeo y se utilizó la técnica de inmunofluorescencia para detectar Virus Sincicial Respiratorio, Adenovirus, Parainfluenza 1, 2 y 3 e Influenza A y B,y la Reacción en Cadena de la olimerasa para determinar Rinovirus, Enterovirus, Virus Sincicial Respiratorio, Bocavirus, Adenovirus y Coronavirus.Resultados. Se evaluaron 119 pacientes (61 femeninos), edad (x más menos DE) 1,5 más menos 0,9 años. Los días de internación y de requerimientos de oxígeno fueron(x más menos DE): 6,3 más menos 2,9 y 4,4 más menos 2,7 respectivamente. Se hallaron 102 (86 por ciento) casos positivos. El 55 por ciento de los virus se detectó por Inmunofluorescencia y el 45 por cientopor Reacción en Cadena de la polimerasa. El 75 por ciento delas muestras respiratorias presentó un solo agente viral, el 22 por ciento una coinfección doble y el 3 por ciento unacoinfección triple. Las prevalencias de los virus respiratorios detectados fueron: Virus Sincicial Respiratorio55 (43 por ciento); Rinovirus 30 (23 por ciento); Metapneumovirus13 (10 por ciento); Influenza A 8 (6 por ciento), Enterovirus 6 (5 por ciento); Bocavirus 6 (5 por ciento); Adenovirus 4 (3 por ciento); Coronavirus3 (2 por ciento); Parainfluenza 1: 2 (1 por ciento); Influenza B, 1(1 por ciento) y Parainfluenza 3: 1 (1 por ciento).

[Flexible bronchoscopy in a pediatric pulmonology service]. / Broncoscopia flexible en un servicio de neumonología infantil.

INTRODUCTION: Flexible bronchoscopy is a valuable diagnostic and therapeutic tool. The objective of the study is to describe the experience with flexible bronchoscopy in a Pulmonology Section of a Pediatric tertiary care hospital associated to the university. POPULATION AND METHODS: Studies performed between 01/2002 and 12/2005 were reviewed. Olympus(R) bronchoscopes (external diameters 2.8 and 4.8 mm) were used. Bronchoalveolar lavage was performed with 3 aliquots of 1 ml/kg of warmed sterile saline solution. RESULTS: One hundred and two fiberoptic bronchoscopies (49 males, 42 outpatients) and 77 bronchoalveolar lavage were performed. Patient's age ranged from 2 months to 18 years. Fifty one studies were done in an endoscopy suite, 47 in the operating room and 4 in the intensive care unit. Patient's diagnosis were: chronic lung disease (recurrent/ persistent pneumonia, bronchiectasis, primary ciliary dyskinesia) 65% (n: 66); immune deficiencies 18% (n: 18); cystic fibrosis 7% (n: 7), difficult airway 5% (n: 6) and noisy breathing 5% (n: 5). Ten patients developed mild complications (7 hypoxemia, 2 upper airway obstruction, 1 cardiac arrhythmia), and 1 patient a severe one (severe bronchial obstruction). Eighty five (65/77) bronchoalveolar lavage samples, 100% (12/12) bronchial brushing and 100% (6/6) endobronchial biopsies were representative. Procedures helped the decision-making process in 75% (76/102) of the patients studied. CONCLUSIONS: In this carefully selected population, flexible bronchoscopy and bronchoalveolar lavage were useful for their diagnosis and treatment.

Broncoscopia flexible en un servicio de neumonología infantil / Flexible bronchoscopy in a pediatric pulmonology service

La fibrobroncoscopia constituye una herramienta diagnóstico-terapéutica de gran valor.El objetivo del presente estudio es describir la experienciacon fibrobroncoscopia en un servicio deneumonología de un hospital de niños urbano asociadoa la Universidad.Material y métodos. Se revisaron todos los procedimientosde fibrobroncoscopia realizados entre01/2002 y 12/2005. Se utilizaron broncoscopiosOlympus® (diámetro externo 2,8 mm y 4,8 mm). El lavado broncoalveolar se realizó con 3 alícuotas de1 ml/kg de solución salina entibiada.Resultados. Se efectuaron 102 fibrobroncoscopias(49 varones, 42 pacientes ambulatorios), y en 77 casosse realizó lavado broncoalveolar. El intervalo deedad fue de 2 meses a 18 años. Cincuenta y unestudios se realizaron en la sala de procedimientosde la unidad, 47 en quirófano y 4 en la unidad decuidados intensivos. Los diagnósticos de los pacientesfueron: enfermedad pulmonar crónica (neumoníarecurrente/persistente, bronquiectasias, sospechade disquinesia ciliar) 65% (n: 66); huésped inmunocomprometido18% (n: 18); fibrosis quística 7% (n:7), intubación dificultosa 5% (n: 6) y respiraciónruidosa 5% (n: 5). Diez pacientes tuvieron complicacionesleves (7 hipoxemia, 2 obstrucción laríngea, 1arritmia cardíaca), y 1 paciente complicación grave(obstrucción bronquial graves). Ochenta y cinco porciento (65/77) de las muestras de lavado broncoalveolar,100% (12/12) de los cepillados bronquiales y100% (6/6) de las biopsias de mucosa fueron representativas.Los procedimientos fueron de utilidadclínica en 75% (76/102) de los pacientes estudiados.Conclusiones. En esta población cuidadosamenteseleccionada, los resultados de la fibrobroncoscopiay el lavado broncoalveolar fueron útiles para sudiagnóstico y tratamiento.

Introduction. Flexible bronchoscopy is a valuable diagnostic and therapeutic tool. The objective of the study is to describe the experience with flexible bronchoscopy in a Pulmonology Section of a Pediatric tertiary care hospital associated to the university. Population and methods. Studies performed between 01/2002 and 12/2005 were reviewed. Olympus® bronchoscopes (external diameters 2.8 and 4.8 mm) were used. Bronchoalveolar lavage was performed with 3 aliquots of 1 ml/kg of warmed sterile saline solution. Results. One hundred and two fiberoptic bronchoscopies (49 males, 42 outpatients) and 77 bronchoalveolar lavage were performed. Patient’s age ranged from 2 months to 18 years. Fifty one studies were done in an endoscopy suite, 47 in the operating room and 4 in the intensive care unit. Patient’s diagnosis were: chronic lung disease (recurrent/persistent pneumonia, bronchiectasis, primary ciliary dyskinesia) 65% (n: 66); immune deficiencies 18% (n: 18); cystic fibrosis 7% (n: 7), difficult airway 5% (n: 6) and noisy breathing 5% (n: 5). Ten patients developed mild complications (7 hypoxemia, 2 upper airway obstruction, 1 cardiac arrhythmia), and 1 patient a severe one (severe bronchial obstruction). Eighty five (65/77) bronchoalveolar lavage samples, 100% (12/12) bronchial brushing and 100% (6/6) endobronchial biopsies were representative. Procedures helped the decision-making process in 75% (76/102) of the patients studied. Conclusions. In this carefully selected population, flexible bronchoscopy and bronchoalveolar lavage were useful for their diagnosis and treatment.