Mycoplasma pneumoniae strains can be classified into two major genetic groups, P1 type 1 (P1-1) and P1 type 2 (P1-2). It remains unknown if clinical manifestations of lower respiratory tract ...infections (LRTI) in children differ between the two genotypes. We aimed to determine if the M. pneumoniae P1 genotype is associated with severity of LRTI in children. Medical charts of 420 children (≤15 years old) with signs of acute LRTI who were PCR positive for M. pneumoniae from pharyngeal swabs in a recent M. pneumoniae epidemic were analyzed. We used a culture and pyrosequencing approach for genotyping PCR-positive samples. We compared epidemiological and clinical data of children with either P1-1 or P1-2 LRTI. P1-2-infected children presented with a significantly higher median baseline C-reactive protein level and were admitted to the hospital more often. The P1 genotype had a significant predictive value in a multiple linear regression model predicting C-reactive protein levels in our study sample. Moreover, the P1 genotype significantly affected the likelihood of hospital admission in a logistic regression model. Our modeling results were also confirmed on an additional independent sample of children with M. pneumoniae LRTI. Results from our large patient group indicate that the two M. pneumoniae P1 genotypes may have different pathogenic potential and that LRTI with P1-2 strains may have a more severe disease course than those with P1-1 strains in children. P1 genotyping is not routinely performed but could be used as a predictor of M. pneumoniae LRTI severity, enabling patient-tailored treatments.
Human bocavirus is a recently described respiratory pathogen. A case of a life-threatening human bocavirus infection of a previously healthy pediatric patient is described. An initial clinical ...presentation of acute bronchiolitis developed into an extremely severe course of disease characterized by pneumothorax, pneumomediastinum, and acute respiratory failure with pronounced air-leak syndrome.
Mycoplasma pneumoniae
(
M
.
pneumoniae
) isolates can be classified into two major genetic groups, P1 type 1 (MP1) and P1 type 2 (MP2), based on the DNA sequence of the P1 adhesion protein gene. The ...aim of our study was to determine if
M
.
pneumoniae
P1 genotype is associated with disease manifestation and severity of acute
M
.
pneumoniae
infection. We compared epidemiological and clinical data of children infected with either MP1 or MP2. In addition, we separately analysed data of patients presenting with individual manifestations of
M
.
pneumoniae
infection. Data of 356 patients infected with MP1 were compared with those of 126 patients infected with MP2. MP2-infected children presented with higher median baseline C-reactive protein levels and were admitted to the hospital more often. The distribution of P1 genotype varied among groups of patients with different manifestations of
M
.
pneumoniae
infection. MP2 was more common than MP1 among patients with neurological and cardiovascular manifestations, whereas MP1 was more prevalent in other manifestations. The results from our large cohort indicate that the two P1 subtypes may have different pathogenic potential and that infections with MP2 strains could be more virulent than those with MP1 strains.
is a common cause of lower respiratory tract infection (LRTI) in children that is difficult to distinguish from LRTI of other etiologies. We aimed to determine if a combination of clinical, ...laboratory, and chest radiographic features can help identify patients at higher risk of
LRTI. We reviewed medical charts of children referred to our tertiary hospital with suspected acute mycoplasmal LRTI. Pharyngeal swabs obtained from patients were tested by
PCR. We compared epidemiological and clinical data of children with positive and negative
PCR results. In addition, a multivariable logistic regression analysis was performed to predict
LRTI based on the patient's age, duration of symptoms, presence of extrapulmonary manifestations, laboratory findings, and chest radiographic findings. We included 65 children with
PCR-negative and 49 with
PCR-positive LRTI and no viral co-detection. Children with
LRTI were older (median age 5.8 vs. 2.2 years,
< 0.001), had a longer duration of symptoms on referral (median 7 vs. 4 days,
< 0.001), and lower median WBC (9.9 vs. 12.7 × 10
/L,
< 0.001). On chest radiograph, unilateral infiltrates were more frequently observed in the
PCR-positive group (57.5% vs. 24.1%,
= 0.001). Age, duration of symptoms, and chest radiographic findings had the highest predictive value for
LRTI in a multivariable logistic regression model. Our analysis suggests that a combination of clinical, laboratory, and chest radiographic features can be used to assess the likelihood of
LRTI and assist in decision-making for which children need further tests or macrolide antibiotic treatment.
A fatal case of human bocavirus 1 pulmonary infection in an 18-month-old prematurely born child is described. Despite conventional and oscillatory ventilatory support, intractable hyperinflation ...developed with bilateral pneumothorax and acute cardiac failure 3 days after the onset of respiratory symptoms.
Pierre Robinova sekvenca je triada, ki jo sestavljajo mikro- in/ali retrognatija, glosoptoza in zapora zgornjih dihal, ki se ji v 90 % pridruži palatoshiza. Pri otrocih s Pierre Robinovo sekvenco sta ...glavni funkcionalni težavi obstrukcija zgornjih dihal in oteženo hranjenje, ki se kažeta z raznolikimi dihalnimi težavami in slabim pridobivanjem telesne mase. Pri večini bolnikov zadoščajo konzervativni ukrepi, v redkih primerih pa je potrebno kirurško zdravljenje, v najtežjih primerih pa traheotomija. Klinični oddelek za neonatologijo Pediatrične klinike UKC Ljubljana je za zdravljenje novorojenčkov s Pierre Robinovo sekvenco uvedel v slovenski prostor novo metodo, tj. vstavitev nosno-žrelnega tubusa. Ta premosti zaporo zgornjih dihal v višini korena jezika in je ob izmenični zamenjavi strani vstavitve skozi nosnici lahko nameščen daljše obdobje tudi v domačem okolju. Obravnava otrok s Pierre Robinovo sekvenco je multidisciplinarna. Pri obravnavi sodelujejo neonatolog, otorinolaringolog, maksilofacialni kirurg in pulmolog. Gastroenterolog, dietetik in genetik pa so vključeni po potrebi. Članek predstavi klinično sliko otrok s Pierre Robinovo sekvenco, metode zdravljenja in uradno klinično pot obravnave v Sloveniji.
There are over 70.000 patients with cystic fibrosis (CF) in the world and numerous sequence variations in the CFTR gene have been reported but the clinical significance of all of them is still not ...known. There are currently 195 patients with the c.3140-26A>G (legacy name 3272-26A>G) variant in the CFTR gene listed in the European Cystic Fibrosis Society Patient Registry (ECFSPR) and only 4 are homozygous. We present longitudinal clinical data of one of these patients who is managed in our CF Center at the University Children's Hospital in Ljubljana and compare it with the patient data from the ECFSPR and the CFTR2 database in which additional 3 homozygous patients are described. Moreover, the effect of the detected variant in the described patient was evaluated on the RNA level in nasal epithelial cells. The variant was shown to result in aberrant splicing introducing a frameshift and a premature termination codon while normal transcript was not detected. Alternative spliced mutant transcripts in other tissues or the presence of spliceosome-mediated RNA trans-splicing could explain the mild clinical presentation of patients with this variant in homozygous state.
Factors associated with COVID-19 presentation in children with asthma are poorly defined. Our study aimed to assess the clinical course of COVID-19 in children with asthma, with particular attention ...to possible risk factors for severe disease and long-term sequelae in this group of patients. We assessed the occurrence of SARS-CoV-2 infection in children with asthma six months before their regular outpatient visit to the asthma clinic. Characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI) were compared. We focused on factors previously associated with COVID-19 severity. Twenty-seven percent of patients (57/210) reported exposure to SARS-CoV-2 infection. In the symptomatic group, 36% (15/42) reported symptoms of LRTI and 64% (27/42) of URTI. Poorer asthma control was observed in patients with LRTI compared to URTI (80% vs. 7%, p < 0.001). In addition, children with poorer asthma control had a higher risk of presenting with SARS-CoV-2 LRTI in a multiple logistic regression analysis. COVID-19 disease course was not associated with regular ICS use and asthma severity. However, patients on regular ICS had better asthma control (p = 0.026). We found no PFT deterioration post-COVID-19 in either group of patients. Our results suggest good asthma control and treatment adherence prior to infection are associated with better COVID-19 outcomes in children with asthma.
Summary
We report the isolation of the emerging fungal pathogen Rasamsonia aegroticola, which belongs Rasamsonia argillacea species complex, from a respiratory sample of a patient with cystic ...fibrosis. This filamentous fungus, resembling members of a Penicillium and Paecilomyces spp., was identified by morphology and confirmed by DNA sequence analysis. Susceptibility pattern showed high minimal inhibitory concentration of voriconazole and amphotericin B but low minimal inhibitory concentration of caspofungin, micafungin and itraconazole.
Transplantacija pri otrocih in mladostnikih je izjemno zahteven način zdravljenja. Aktivno vključevanje medicinske sestre v delo multidisciplinarnega tima prispeva k bolj kakovostni obravnavi ...bolnika. Dobro multidisciplinarno sodelovanje lahko zmanjša pogostnost možnih zapletov in skrajša dobo hospitalizacije. Bolniki se pogosto soočajo s strahom in socialno osamitvijo. Zaradi osnovne bolezni se pojavljajo še dodatne težave, ki zdravstveno stanje otežijo ali poslabšajo. Medicinska sestra igra pomembno vlogo tudi na področju zdravstvene vzgoje. Ta se praviloma začne že med samo pripravo bolnika na transplantacijo oz. takrat, ko je bolnik uvrščen na čakalni seznam. Bolniku in njegovim staršem se morajo ponuditi izčrpne in resnične informacije, pomembne za ugoden izid zdravljenja.
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