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.
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.
Izhodišča: Cistična fibroza (CF) je najpogostejša kronična avtosomno recesivno dedna bolezen belcev. Kaže se s prizadetostjo številnih organov, zato se bolniki spremljajo v centrih CF s ...specializiranim multidisciplinarnim timom strokovnjakov. Eden takih je center CF Pediatrične klinike Ljubljana, kjer se vodijo vsi otroci in mladostniki s CF v Sloveniji. Od ustanovitve centra dalje vodimo zbirko podatkov o bolnikih, ki nam je v pomoč pri analizi razmer in pri primerjavi kakovosti obravnave naših bolnikov z drugimi evropskimi centri CF.
Metode: Izvedli smo retrospektivno raziskavo z namenom pregledati in oceniti kazalce bolezni otrok in mladostnikov s CF, vodenih na Pediatrični kliniki Ljubljana v letu 2020. Pri 78 vključenih bolnikih smo analizirali podatke o demografskih značilnostih, genetskih mutacijah, pljučni funkciji, prehranjenosti, kroničnih okužbah in zdravljenju s CFTR modulatornimi zdravili (angl. cystic fibrosis transmembrane conductance regulator, CFTR – regulator transmembranske prevodnosti pri cistični fibrozi). Za primerjavo z drugimi evropskimi centri smo uporabili podatke iz letnega poročila Evropskega registra CF za leto 2020.
Rezultati: Leta 2020 smo v našem centru obravnavali 78 bolnikov, izmed katerih je bilo 56 % (44/78) bolnikov moškega spola. Povprečna starost bolnikov je znašala 13,2 leta (SD 6,4 let), z razponom od 1,2 leta do 25,5 leta. Mutacija F508del je bila najpogosteje zastopana, saj je bilo kar 88,5 % nosilcev vsaj ene, pri 64,1 % obolelih pa je bila mutacija prisotna na obeh alelih. Povprečni forsirani izdihani volumen v 1 sekundi (FEV1) naših bolnikov je bil nad evropskim povprečjem, prevalenca kronične okužbe s povzročiteljem Pseudomonas aeruginosa pa nižja od evropskega povprečja. V letu 2020 smo 21 bolnikom uvedli CFTR modulatorno zdravilo, od tega 5 bolnikom lumakaftor/ivakaftor in 16 bolnikom eleksakaftor/tezakaftor/ivakaftor.
Zaključek: Kazalci kakovosti obravnave otrok in mladostnikov s CF v Sloveniji dosegajo in pogosto presegajo evropsko povprečje. Med prvimi državami v Evropi smo pričeli uvajati CFTR modulatorna zdravila, ki obetajo pomembno izboljšanje kliničnega stanja in kakovosti življenja bolnikov s CF.
Akutni bronhiolitis je najpogostejša okužba spodnjih dihal pri otrocih, mlajših od dveh let. Zdravljenje akutnega bronhiolitisa je podporno. Poleg skrbi za primerno hidracijo je dodatek kisika ...otrokom s hipoksemijo praktično edini način zdravljenja teh otrok. Vrednost, ki jo dobimo s pulznim oksimetrom, je le posredna meritev dejanske vrednosti kisika v krvi in ne odrazi resnosti bolezni. Z dodatkom kisika sicer povišamo zasičenost hemoglobina s kisikom in tako zmanjšamo hipoksemijo, ne zdravimo pa osnovnega vzroka za njen nastanek. Kljub vsemu pulzna oksimetrija ostaja odločilna preiskava pri odločitvi glede zdravljenja s kisikom, saj z nobenim kliničnim znakom ne moremo natančno oceniti, ali gre pri otroku za hipoksemijo. Študije so pokazale, da pediatri pri oceni resnosti bolezni vse bolj zaupajo vrednosti zasičenosti kisika v krvi (SpO2) kot pa klinični oceni. Odkar je pulzna oksimetrija v uporabi, se je odstotek hospitaliziranih zaradi akutnega bronhiolitisa zvišal za približno 250 %. Smernice za obravnavo otrok z akutnim bronhiolitisom niso enotne glede vrednosti SpO2, ki zahtevajo zdravljenje s kisikom. V prispevku smo jih kritično ovrednotili in predstavili lastne izkušnje glede zdravljenja akutnega bronhiolitisa s kisikom.
In this retrospective study we employed real-time polymerase chain reaction (PCR) to analyse the occurrence of Mycoplasma pneumoniae among upper and lower respiratory tract infections (RTI) in the ...Central Region of Slovenia between January 2006 and December 2014. We also used a culture and pyrosequencing approach to genotype strains and infer their potential macrolide resistance. Of a total 9,431 tested samples from in- and out-patient with RTI, 1,255 (13%) were found to be positive by M. pneumoniae PCR. The proportion of positive samples was 19% (947/5,092)among children (≤16 years-old) and 7% (308/4,339) among adults (>16 years-old). Overall, among those PCR tested, the highest proportions of M. pneumonia infections during the study period were observed in 2010 and 2014. In these two years, 18% (218/1,237) and 25% (721/2,844) of samples were positive respectively,indicating epidemic periods. From the 1,255 M. pneumoniae PCR-positive samples, 783 (614 from paediatric and 169 from adult patients) were successfully cultured. Of these, 40% (312/783) were constituted of strains belonging to the P1 type II genomic group, while 60% (469/783) contained strains of the P1 type I group. Two isolates comprised both P1 type Iand II strains. Results of a genotype analysis by year,showed that the dominant M. pneumoniae P1 type during the 2010 epidemic was P1 type II (82% of isolates;81/99), which was replaced by P1 type I in the 2014 epidemic (75%; 384/510). This observation could indicate that the two epidemics may have been driven by a type shift phenomenon, although both types remained present in the studied population during the assessed period of time. Only 1% of strains (7/783) were found to harbour an A2063G mutation in the 23S rRNA gene,which confers macrolide resistance, suggesting that the occurrence of M. pneumoniae macrolide resistance still seems to be sporadic in our geographic area.
Objective
Cohort studies on physical fitness (PF) in former extremely preterm children are scarce and yield conflicting results. Therefore, this study aimed to assess the effect of extremely preterm ...birth on PF in school‐age with a focus on bronchopulmonary dysplasia (BPD).
Methods
Eighty school‐aged children were enrolled in the longitudinal cohort study. Fifty were born extremely preterm (<completed 28 weeks of gestation): 19 had BPD, and 31 did not; 30 term‐born healthy children were included as controls. They were monitored annually throughout primary school (ages 7–14 years) with eight annual fitness testings within the Slovenian national surveillance system of children's somatic and motor development (SLOfit). The physical fitness index (PFI), calculated as the mean of percentiles of eight fitness tests, was used as an indicator of overall PF. Generalised estimating equations were used to compare changes in PFI between ages 7 and 14 in the three cohort groups: preterm children with BPD, preterm children without BPD and term controls.
Results
Preterm children with BPD had significantly and persistently lower PFI than preterm children without BPD and term‐born children throughout primary school age. Their PFI was less than half that of national median values (15.1st–19.7th percentile). Preterm children without BPD experienced progressive improvement in PFI during their school age (from 32.6th to 44.7th percentile of national median PFI values), while the ones with BPD did not.
Conclusion
Extreme prematurity per se is not a risk factor for lower PF at school age. However, if complicated by BPD, PF is significantly and sustainably reduced.
Acute bronchiolitis is the most common lower respiratory tract infection in children under two years of age. Treatment of acute bronchiolitis is supportive, i.e. application of oxygen to children ...with hypoxaemia and care for proper hydration. The value obtained by pulse oximetry is merely an indirect measurement of the actual oxygen level in the blood and does not reflect the severity of the disease. By the application of oxygen we only correct hypoxaemia, but do not treat the underlying cause. Nevertheless, as there is no clinical sign that would precisely define children with hypoxaemia, pulse oximetry remains the decisive investigation in decision-making about oxygen application. Studies have shown that when assessing the severity of the disease, pediatricians trust the values of oxygen saturation (SpO2) rather than the clinical assessment. Since pulse oximetry has been in use, the percentage of hospitalised patients due to acute bronchiolitis has increased by about 250 %. Guidelines for treating children with acute bronchiolitis are not consistent in terms of specifying a SpO2 cut-off value that requires oxygen therapy. In this review we have critically evaluated these guidelines and presented our own experience regarding oxygen treatment of acute bronchiolitis.
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.
COUGH IN CHILDREN Praprotnik, Marina; Županič, Melanija; Lozej, Tina ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
05/2017, Letnik:
86, Številka:
5-6
Journal Article
Recenzirano
Odprti dostop
Kašelj je zelo pogosta težava pri otroku. Glede na trajanje ga delimo na akutni kašelj (do tri tedne), subakutni (3–8 tednov) in kronični (več kot 8 tednov). Akutni kašelj je najpogosteje posledica ...virusnih okužb dihal, ki izzvenijo same po sebi. Potrebno pa je izključiti morebitne resne osnovne bolezni. Subakutni kašelj se najbolj pogosto pojavi po akutni okužbi dihal (postinfekcijski kašelj) in izzveni brez specifčnega zdravljenja. Če je otrok sicer zdrav, kašelj pa suh, se postopno izboljšuje in niso prisotni specifični kazalci, ki bi kazali na resno bolezen, je potrebno otroka le spremljati. Če pa obstaja možnost, da je subakutni kašelj posledica aspiracije tujka, kronične pljučne bolezni ali če se kašelj stopnjuje, je potrebno čimprej opraviti dodatne preiskave. Tudi kronični kašelj je najpogosteje posledica okužb dihal, lahko pa tudi težkih bolezni, ki ogrožajo življenje. Potrebno je ločiti med specifičnim kašljem (poleg kašlja so prisotni simptomi in znaki osnovne bolezni) in nespecifičnim kašljem (prisoten je le suh kašelj brez drugih simptomov in znakov bolezni). Da bi preprečili nepotrebne preiskave in neučinkovito zdravljenje otrok s kašljem, ob tem pa ne bi spregledali katere od težkih bolezni, je potrebno upoštevati priporočila za obravnavo otrok s kašljem, ki temeljijo na medicini, podprti z dokazi.
Chlamydia trachomatis is the most common bacterial pathogen causing sexually transmitted infections. As prenatal screening for C. trachomatis and treatment of pregnant women is not practice in ...Slovenia, perinatal transmission of C. trachomatis may therefore occur. We present a case of infant chlamydial pneumonia to illustrate that a high index of suspicion is necessary to make the diagnosis in an afebrile infant with cough and “bronchiolitis”. Unnecessary investigations can be avoided and treatment can be promptly instituted if a diagnosis is made on time.
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