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Lee KJ, Ko JS, Park KY, Kang KS, Lee K, Hong J, Kim SC, Lee Y, Kang B, Kim YB, Kim HJ, Eun BW, Cho HK, Kim YJ, Kim MJ, Lee J, Lee TJ, Oh SH, Park S, Hwang EH, Sohn S, Lim JG, Kim Y, Lee YJ. A Report on a Nationwide Surveillance System for Pediatric Acute Hepatitis of Unknown Etiology in Korea. J Korean Med Sci 2023; 38:e401. [PMID: 38050913 PMCID: PMC10695753 DOI: 10.3346/jkms.2023.38.e401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Several cases of pediatric acute hepatitis of unknown etiology related to adenoviral infections have been reported in Europe since January 2022. The aim of this study was to compare the incidence, severity, possible etiology, and prognosis of the disease with those in the past in Korea. METHODS The surveillance group collected data between May and November 2022 using a surveillance system. Acute hepatitis of unknown etiology was defined in patients aged < 16 years with a serum transaminase level > 500 IU/L, not due to hepatitis A-E or other underlying causes. For comparison, data from 18 university hospitals were retrospectively collected as a control group between January 2021 and April 2022. RESULTS We enrolled 270 patients (mean age, 5 years). The most common symptom was fever. However, the incidence was similar between 2021 and 2022. Liver function test results, number of patients with acute liver failure (ALF), liver transplantation (LT), death, and adenovirus detection rates did not differ between the two groups. None of the adenovirus-positive patients in either group experienced ALF, LT, or death. In the surveillance group, adenovirus-associated virus-2 was detected in four patients, one of whom underwent LT. Patients with an unknown etiology showed significantly higher bilirubin levels, a lower platelet count, and a higher LT rate than patients with a possible etiology. CONCLUSION The incidence of pediatric acute hepatitis of unknown etiology and adenovirus detection rate have not increased in Korea.
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Affiliation(s)
- Kyung Jae Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kie Young Park
- Department of Pediatrics, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Ki Soo Kang
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Kunsong Lee
- Department of Pediatrics, Dankook University Hospital, Cheonan, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Yoon Lee
- Department of Pediatrics, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Children's Hospital, Daegu, Korea
| | - Yu Bin Kim
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Eulji University Eulji General Hospital, Seoul, Korea
| | - Hye-Kyung Cho
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Lee
- Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Taek-Jin Lee
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Sowon Park
- Department of Pediatrics, Severance Children's Hospital, Severance Pediatric Liver Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ha Hwang
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sangjun Sohn
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jin Gyu Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - YooJin Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea.
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Ritter E, Shusterman E, Prozan L, Kehat O, Weiss Meilik A, Shibolet O, Ablin JN. The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections. J Clin Med 2023; 12:jcm12093335. [PMID: 37176775 PMCID: PMC10179215 DOI: 10.3390/jcm12093335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. AIMS we aimed to compare patterns of abnormal liver function tests in patients suffering from COVID-19 infection and seasonal respiratory viruses: respiratory syncytial virus (RSV) and influenza (A and B). METHODS a retrospective cohort study was performed including 4140 patients admitted to a tertiary medical center between 2010-2020. Liver test abnormalities were classified as hepatocellular, cholestatic or mixed type. Clinical outcomes were defined as 30-day mortality and mechanical ventilation. RESULTS liver function abnormalities were mild to moderate in most patients, and mainly cholestatic. Hepatocellular injury was far less frequent but had a strong association with adverse clinical outcome in RSV, COVID-19 and influenza (odds ratio 5.29 (CI 1.2-22), 3.45 (CI 1.7-7), 3.1 (CI 1.7-6), respectively) COVID-19 and influenza patients whose liver functions did not improve or alternatively worsened after 48 h had a significantly higher risk of death or ventilation. CONCLUSION liver function test abnormalities are frequent among patients with COVID-19 and seasonal respiratory viruses, and are associated with poor clinical outcome. The late liver tests' peak had a twofold risk for adverse outcome. Though cholestatic injury was more common, hepatocellular injury had the greatest prognostic significance 48 h after admission. Our study may provide a viral specific auxiliary prognostic tool for clinicians facing patients with a respiratory virus.
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Affiliation(s)
- Einat Ritter
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Eden Shusterman
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Lior Prozan
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Orli Kehat
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Ahuva Weiss Meilik
- I-Medata AI Center, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
| | - Oren Shibolet
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Jacob Nadav Ablin
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
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Isa HM, Hasan AZ, Khalifa SI, Alhewaizem SS, Mahroofi AD, Alkhan FN, Al-Beltagi M. Hepatic involvement in children with acute bronchiolitis. World J Hepatol 2022; 14:1907-1919. [PMID: 36340752 PMCID: PMC9627436 DOI: 10.4254/wjh.v14.i10.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a prevalent cause of lower respiratory tract infections. It may be associated with hepatocellular involvement, as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase (ALT). AIM To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical, laboratory, and radiological variables. METHODS The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department, Salmaniya Medical Complex, the Kingdom of Bahrain, between 2019 and 2020. We collected the demographic data, the clinical presentation, the laboratory and radiological findings, and the clinical outcomes. We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up. RESULTS We included 166 (57.8%) of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria. Ninety-three (56%) patients were males. The median age at presentation was 3.4 (interquartile range 1.1 to 12.4) mo. Fifty-four (28%) patients tested positive for RSV, which was confirmed in 15 of them (28%) by PCR. Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14 (8.7%) patients and normal ALT in 147 (91.3%). Coagulation profiles were measured in 46 (27.7%) of 166 patients. High prothrombin time was present in 15 (32.6%), a high international normalized ratio was present in 13 (28.3%), and high activated partial thromboplastin time was present in three (6.5%). Thrombin time was elevated in nine (27.3%) of 33 patients. Five (21.7%) of 23 patients with available radiological data had hepatomegaly; one of them had findings suggestive of fatty infiltration. High ALT had a significant association with lengthy hospital stays (P < 0.05) and positive urine culture (P < 0.05). Seventy (42.2%) patients had documented follow-up with liver function tests over a median follow-up period of 10.2 (IQR, 2.4-23.3) mo. Total serum protein and serum globulin levels were normalized at the follow-up time, with a significant P value of < 0.05. CONCLUSION This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course. However, there was a rising trend in ALT during follow-up. Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.
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Affiliation(s)
- Hasan M Isa
- Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain
- Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
| | - Asma Z Hasan
- Department of Pediatrics, Sulwan Psychiatric Hospital, Manama 973, Bu Quwah, Bahrain
| | - Sara I Khalifa
- Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain
| | - Sana S Alhewaizem
- Department of Pediatrics, Dream Reem Medical Center, Muharraq 50573, Bahrain
| | | | - Fatema N Alkhan
- Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
- Department of Pediatrics, University Medical Center, Dr. Sulaiman Al-Habib Medical Group, Bahrain, Manama 26671, Bahrain.
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Lee Y, Yi DY, Lee YM, Choi SY, Choi YJ, Lee KJ. A Multicenter Study of Real-world Practice for Management of Abnormal Liver Function Tests in Children with Acute Infectious Diseases. J Korean Med Sci 2021; 36:e310. [PMID: 34873882 PMCID: PMC8648609 DOI: 10.3346/jkms.2021.36.e310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/14/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Abnormal liver function tests (LFTs) are commonly seen in pediatric patients with acute infectious diseases. Few studies and no definite clinical guidelines for these conditions are available. The present study aimed to elucidate the causes and factors associated with prolongation of liver enzyme elevation. We also investigated actual real-world practices in Korea. METHODS A retrospective study was performed on all patients younger than 18 years, who visited six tertiary teaching hospitals around Korea in 2018 for acute infectious diseases and showed alanine aminotransferase (ALT) levels above 60 IU/L without other specific conditions that could cause ALT elevation. We categorized the infections that cause LFT elevation into six groups: respiratory infection, gastrointestinal infection, urinary tract infection, other febrile disease, Epstein-Barr virus infection, and cytomegalovirus infection. We collected data on the medical specialty of the attending physician who followed up the subject, follow-up duration, percentage of follow-up loss, and their investigation. RESULTS A total of 613 patients were enrolled in this study, half of whom (50.7%) were younger than 12 months. The mean initial aspartate aminotransferase and ALT values were 171.2 ± 274.1 and 194.9 ± 316.1 IU/L (range 23-2,881, 60-2,949 IU/L), respectively; however, other LFTs were within the normal range. Respiratory infection was the most common diagnosis (45.0%), and rhinovirus was the most commonly identified pathogen (9.8%). The follow-up rate was higher with pediatric gastroenterologists (90.5%) and non-gastroenterology pediatricians (76.4%) than with pediatric residents and emergency doctors. Older age was related to better ALT recovery (odds ratio [OR] of age for month = 1.003; 95% confidence interval [CI], 1.001-1.004; P = 0.004), while the number of infection episodes (OR = 0.626; 95% CI, 0.505-0.777; P < 0.001) was associated with poor ALT recovery. Abdominal sonography was the most commonly used diagnostic tool (36.9%), followed by the hepatotropic virus workup. The modalities of hepatitis workup were significantly differently applied by physicians based on their specialties and institutions. CONCLUSION Abnormal liver function test after a systemic infection was common in respiratory infection and under the age of 1 year. Age, number of infections, and initial results of LFTs were related to ALT recovery time. Inter-physician, inter-institution, and inter-specialty variances were observed in real-world practice.
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Affiliation(s)
- Yoon Lee
- Department of Pediatrics, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of medicine, Bucheon, Korea
| | - So Yoon Choi
- Department of Pediatrics, Kosin Gospel Hospital, Kosin University College of Medicine, Busan, Korea
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - You Jin Choi
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Jae Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
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Vargas-Mendoza N, García-Machorro J, Angeles-Valencia M, Martínez-Archundia M, Madrigal-Santillán EO, Morales-González Á, Anguiano-Robledo L, Morales-González JA. Liver disorders in COVID-19, nutritional approaches and the use of phytochemicals. World J Gastroenterol 2021; 27:5630-5665. [PMID: 34629792 PMCID: PMC8473593 DOI: 10.3748/wjg.v27.i34.5630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has affected millions of people globally. It was declared a pandemic by the World Health Organization in March 2020. The hyperinflammatory response to the entry of SARS-CoV-2 into the host through angiotensin-converting enzyme 2 is the result of a "cytokine storm" and the high oxidative stress responsible for the associated symptomatology. Not only respiratory symptoms are reported, but gastrointestinal symptoms (diarrhea, vomiting, and nausea) and liver abnormalities (high levels of aspartate aminotransferase, alanine aminotransferase transaminases, and bilirubin) are observed in at least 30% of patients. Reduced food intake and a delay in medical services may lead to malnutrition, which increases mortality and poor outcomes. This review provides some strategies to identify malnutrition and establishes nutritional approaches for the management of COVID-19 and liver injury, taking energy and nutrient requirements and their impact on the immune response into account. The roles of certain phytochemicals in the prevention of the disease or as promising target drugs in the treatment of this disease are also considered.
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Affiliation(s)
- Nancy Vargas-Mendoza
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | - Jazmín García-Machorro
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | | | - Marlet Martínez-Archundia
- Laboratorio de Diseño y Desarrollo de Nuevos Fármacos e Innovación Biotécnológica, Instituto Politécnico Nacional, México 11340, Mexico
| | | | | | | | - José A Morales-González
- Laboratorio Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México 11340, Mexico
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Singh C, Angurana SK, Bora I, Jain N, Kaur K, Sarkar S. Clinico demographic profiling of the Respiratory syncytial virus (RSV) infected children admitted in tertiary care hospital in North India. J Family Med Prim Care 2021; 10:1975-1980. [PMID: 34195134 PMCID: PMC8208215 DOI: 10.4103/jfmpc.jfmpc_2406_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Acute bronchiolitis is fatal disease involving lower respiratory tract of infants and children of paediatric age group. Respiratory Syncytial Virus (RSV) is responsible for causing more than 70% hospital admissions of children aged less than 2 years thus making a necessity for accurate and timely diagnosis. Aims: The main aim of study was clinicodemographic correlation of RSV positive children presenting to our tertiary care hospital. Setting and Design: It is a retrospective study done between December to January 2018. Materials and Methods: Detection of RSV antigen from nasophyrangeal aspirates using Mouse Monoclonal anti RSV Antibody (by Novatetra) and Goat Anti Mouse Antibody conjugated with FITC as secondary antibody. Results: A total of 147 samples were received in the laboratory and 20 were tested as positive for RSV Antigen. Totally, 19/20 children were aged less than 1 year and with a male predominance. The most common symptom was cough and respiratory distress. Eight percent of the children showed wheezing and 18/20 required assisted ventilation. The clinical course in one child deteriorated leading to death of that patient. Conclusions: The timely diagnosis and management of RSV infected children is utmost needed to prevent morbidity and mortality. The premorbid conditions can assist to differentiate the viral from bacterial pneumonia and thus enable speedy recovery of the child.
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Affiliation(s)
- Charu Singh
- Department of Microbiology, IMS- BHU, Varanasi, Uttar Pradesh, India
| | - Suresh Kumar Angurana
- Department of Paediatrics, APC, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Ishani Bora
- Department of Virology, Research Block A, Sixth Floor, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Neha Jain
- Department of Virology, Research Block A, Sixth Floor, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Kanwalpreet Kaur
- Department of Virology, Research Block A, Sixth Floor, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
| | - Subhabrata Sarkar
- Department of Virology, Research Block A, Sixth Floor, Post Graduate Institute of Medical Sciences and Research, Chandigarh, India
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Soto JA, Gálvez NMS, Pacheco GA, Bueno SM, Kalergis AM. Antibody development for preventing the human respiratory syncytial virus pathology. Mol Med 2020; 26:35. [PMID: 32303184 PMCID: PMC7164255 DOI: 10.1186/s10020-020-00162-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
Human respiratory syncytial virus (hRSV) is the most important etiological agent causing hospitalizations associated with respiratory diseases in children under 5 years of age as well as the elderly, newborns and premature children are the most affected populations. This viral infection can be associated with various symptoms, such as fever, coughing, wheezing, and even pneumonia and bronchiolitis. Due to its severe symptoms, the need for mechanical ventilation is not uncommon in clinical practice. Additionally, alterations in the central nervous system -such as seizures, encephalopathy and encephalitis- have been associated with cases of hRSV-infections. Furthermore, the absence of effective vaccines or therapies against hRSV leads to elevated expenditures by the public health system and increased mortality rates for the high-risk population. Along these lines, vaccines and therapies can elicit different responses to this virus. While hRSV vaccine candidates seek to promote an active immune response associated with the achievement of immunological memory, other therapies -such as the administration of antibodies- provide a protective environment, although they do not trigger the activation of the immune system and therefore do not promote an immunological memory. An interesting approach to vaccination is the use of virus-neutralizing antibodies, which inhibit the entry of the pathogen into the host cells, therefore impairing the capacity of the virus to replicate. Currently, the most common molecule targeted for antibody design against hRSV is the F protein of this virus. However, other molecular components of the virus -such as the G or the N hRSV proteins- have also been explored as potential targets for the control of this disease. Currently, palivizumab is the only monoclonal antibody approved for human use. However, studies in humans have shown a protective effect only after the administration of at least 3 to 5 doses, due to the stability of this vaccine. Furthermore, other studies suggest that palivizumab only has an effectiveness close to 50% in high-risk infants. In this work, we will review different strategies addressed for the use of antibodies in a prophylactic or therapeutic context and their ability to prevent the symptoms caused by hRSV infection of the airways, as well as in other tissues such as the CNS.
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Affiliation(s)
- Jorge A Soto
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins #340, 8331010, Santiago, Chile
| | - Nicolás M S Gálvez
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins #340, 8331010, Santiago, Chile
| | - Gaspar A Pacheco
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins #340, 8331010, Santiago, Chile
| | - Susan M Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins #340, 8331010, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins #340, 8331010, Santiago, Chile.
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Wi PH, Kim HS, Jung JA. Analysis of factors affecting clinical feature and disease severity according to the subtypes of respiratory syncytial virus. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.4.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Pan-Hyeok Wi
- Department of Pediatrics, Donga-A University College of Medicine, Busan, Korea
| | - Han-Sol Kim
- Department of Pediatrics, Donga-A University College of Medicine, Busan, Korea
| | - Jin-A Jung
- Department of Pediatrics, Donga-A University College of Medicine, Busan, Korea
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10
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Zhang S, Hu B, Xu J, Ren Q, Wang L, Wang S. Influenza A virus infection induces liver injury in mice. Microb Pathog 2019; 137:103736. [PMID: 31505263 PMCID: PMC7125922 DOI: 10.1016/j.micpath.2019.103736] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 12/20/2022]
Abstract
Respiratory infections such as SARS-CoV in humans are often accompanied by mild and self-limiting hepatitis. As a respiratory disease, influenza A virus (IAV) infection can lead to hepatitis, but the mechanism remains unclear. This study aimed to investigate the occurrence of hepatitis by establishing a model for infected mice for three different subtypes of respiratory IAVs (H1N1, H5N1, and H7N2). Histological analysis was performed, and results showed increase serum aminotransferase (ALT and AST) levels and evident liver injury on days 3 and 7, especially on day 5 post infection. Immunohistochemistry (IHC) results indicated a wide distribution of IAV's positive signals in the liver of infected mice. Real-time PCR results further revealed a similar viral titer to IHC that presented a remarkedly positive correlation with histology injury. All these data showed that the mouse model suitably contributed valuable information about the mechanism underlying the occurrence of hepatitis induced by respiratory influenza virus.
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Affiliation(s)
- Shouping Zhang
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, 453003, China; Key Laboratory of Animal Epidemiology and Zoonosis of Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, 100193, China
| | - Bin Hu
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, 453003, China
| | - Jingfei Xu
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, 453003, China
| | - Qiuxuan Ren
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, 453003, China
| | - Lirong Wang
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, 453003, China
| | - Sanhu Wang
- College of Animal Science and Veterinary Medicine, Henan Institute of Science and Technology, Xinxiang, 453003, China.
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Bakalli I. Liver Dysfunction in Severe Sepsis from Respiratory Syncytial Virus. J Pediatr Intensive Care 2018; 7:110-114. [PMID: 31073482 PMCID: PMC6260355 DOI: 10.1055/s-0037-1612609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/08/2017] [Indexed: 12/16/2022] Open
Abstract
A 1-month-old child was admitted at our pediatric intensive care unit (PICU) in a very critical state with generalized cyanosis, grunting, high fever, tachypnea, tachycardia, severe hypotension with capillary refill time > 5 seconds, and no palpable pulse. The child was apparently doing well until a few hours before admission. On admission to PICU, his clinical diagnosis was consistent with severe sepsis with his sequential organ failure assessment scores of 7 to 8 points. We started rapid restoration of circulation with aggressive volume replacement and empiric antimicrobial therapy. Despite optimal supportive therapy, the patient showed severe liver injury leading to liver failure, making the treatment more challenging. His simplex real-time reverse transcriptase polymerase chain reaction assay and enzyme linked immune sorbent assay documented respiratory syncytial virus (RSV) infection. Through our case report we would like to highlight the extrapulmonary manifestations of RSV infections and the importance of liver dysfunction during sepsis.
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Affiliation(s)
- Ilirjana Bakalli
- Department of Pediatrics, Pediatric Intensive Care Unit, UHC “Mother Theresa,” Tirana, Albania
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Thorburn K, Fulton C, King C, Ramaneswaran D, Alammar A, McNamara PS. Transaminase levels reflect disease severity in children ventilated for respiratory syncytial virus (RSV) bronchiolitis. Sci Rep 2018; 8:1803. [PMID: 29379110 PMCID: PMC5789039 DOI: 10.1038/s41598-018-20292-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/15/2018] [Indexed: 12/16/2022] Open
Abstract
Bronchiolitis, often caused by respiratory syncytial virus (RSV), is the commonest cause of hospitalisation in infancy. Serum transaminases are sometimes raised in children with bronchiolitis. We tested the hypothesis that raised transaminases are associated with increased disease severity in children ventilated for bronchiolitis. Prospective observational cohort study of mechanically ventilated children with community-acquired RSV bronchiolitis. Alanine transaminase (ALT) and aspartate transaminase (AST) levels were measured daily. Children with normal transaminases were compared with those with elevated levels. Over 11 consecutive winters, 556 children with RSV bronchiolitis were mechanically ventilated – 226 had comorbidities and therefore excluded; 313 of remaining 330 were under 2 years age; 305 had early transaminase measurements. 57/305 (19%) had elevated transaminase (AST and/or ALT) levels. For the first time we show that duration of ventilation and length of admission were both significantly longer, and paediatric index of mortality and C-reactive protein higher, in those with elevated AST levels on admission (but not those with elevated ALT levels). Furthermore, transaminase elevations were transient, generally having normalised by seven days following admission. RSV bronchiolitis was more severe in children with early elevated AST levels and could be used early in the illness as a predictor for disease severity.
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Affiliation(s)
- Kentigern Thorburn
- Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK. .,Department of Clinical Infection, Microbiology & Immunology, The University of Liverpool, Liverpool, L69 7BE, UK.
| | - Crawford Fulton
- Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Charlotte King
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Difijah Ramaneswaran
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Abdulaziz Alammar
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Paul S McNamara
- Department of Child Health, Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, L12 2AP, UK.,Paediatric Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
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New Insights Contributing to the Development of Effective Vaccines and Therapies to Reduce the Pathology Caused by hRSV. Int J Mol Sci 2017; 18:ijms18081753. [PMID: 28800119 PMCID: PMC5578143 DOI: 10.3390/ijms18081753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022] Open
Abstract
Human Respiratory Syncytial Virus (hRSV) is one of the major causes of acute lower respiratory tract infections (ALRTI) worldwide, leading to significant levels of immunocompromisation as well as morbidity and mortality in infants. Its main target of infection is the ciliated epithelium of the lungs and the host immune responses elicited is ineffective at achieving viral clearance. It is thought that the lack of effective immunity against hRSV is due in part to the activity of several viral proteins that modulate the host immune response, enhancing a Th2-like pro-inflammatory state, with the secretion of cytokines that promote the infiltration of immune cells to the lungs, with consequent damage. Furthermore, the adaptive immunity triggered by hRSV infection is characterized by weak cytotoxic T cell responses and secretion of low affinity antibodies by B cells. These features of hRSV infection have meant that, to date, no effective and safe vaccines have been licensed. In this article, we will review in detail the information regarding hRSV characteristics, pathology, and host immune response, along with several prophylactic treatments and vaccine prototypes. We will also expose significant data regarding the newly developed BCG-based vaccine that promotes protective cellular and humoral response against hRSV infection, which is currently undergoing clinical evaluation.
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Oh JS, Choi JS, Lee YH, Ko KO, Lim JW, Cheon EJ, Lee GM, Yoon JM. The Relationships between Respiratory Virus Infection and Aminotransferase in Children. Pediatr Gastroenterol Hepatol Nutr 2016; 19:243-250. [PMID: 28090469 PMCID: PMC5234413 DOI: 10.5223/pghn.2016.19.4.243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/02/2016] [Accepted: 09/24/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We sought to examine the relationship between the clinical manifestations of nonspecific reactive hepatitis and respiratory virus infection in pediatric patients. METHODS Patients admitted to the pediatric unit of Konyang University Hospital for lower respiratory tract disease between January 1, 2014 and December 31, 2014 and who underwent reverse transcriptase polymerase chain reaction tests were examined. The patients were divided into those with increased levels of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) and those with normal ALT or AST levels. Further, patients with increased ALT and AST levels were individually compared with patients in the normal group, and the blood test results were compared according to the type of respiratory virus. RESULTS Patients with increased ALT or AST levels had one more day of hospital stay, on average, compared with patients in the normal group (5.3±3.1 days vs. 4.4±3.0 days, p=0.019). Patients in the increased ALT level group were younger and had a longer mean hospital stay, compared with patients in the normal group (p=0.022 and 0.003, respectively). The incidences of increased ALT or AST were the highest in adenovirus infections (6/24, 25.0%), followed by enterovirus (2/11, 18.2%) and respiratory syncytial virus A (21/131, 16.0%) infections. CONCLUSION Nonspecific reactive hepatitis is more common among patients with adenovirus, enterovirus and respiratory syncytial virus infection, as well as among those infected at a younger age. Compared with AST levels, ALT levels are better indicators of the severity of nonspecific reactive hepatitis.
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Affiliation(s)
- Jun Suk Oh
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jun Sik Choi
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hyuk Lee
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Og Ko
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Gyung Min Lee
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
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Bohmwald K, Espinoza JA, Rey-Jurado E, Gómez RS, González PA, Bueno SM, Riedel CA, Kalergis AM. Human Respiratory Syncytial Virus: Infection and Pathology. Semin Respir Crit Care Med 2016; 37:522-37. [PMID: 27486734 PMCID: PMC7171722 DOI: 10.1055/s-0036-1584799] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The human respiratory syncytial virus (hRSV) is by far the major cause of acute lower respiratory tract infections (ALRTIs) worldwide in infants and children younger than 2 years. The overwhelming number of hospitalizations due to hRSV-induced ALRTI each year is due, at least in part, to the lack of licensed vaccines against this virus. Thus, hRSV infection is considered a major public health problem and economic burden in most countries. The lung pathology developed in hRSV-infected individuals is characterized by an exacerbated proinflammatory and unbalanced Th2-type immune response. In addition to the adverse effects in airway tissues, hRSV infection can also cause neurologic manifestations in the host, such as seizures and encephalopathy. Although the origins of these extrapulmonary symptoms remain unclear, studies with patients suffering from neurological alterations suggest an involvement of the inflammatory response against hRSV. Furthermore, hRSV has evolved numerous mechanisms to modulate and evade the immune response in the host. Several studies have focused on elucidating the interactions between hRSV virulence factors and the host immune system, to rationally design new vaccines and therapies against this virus. Here, we discuss about the infection, pathology, and immune response triggered by hRSV in the host.
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Affiliation(s)
- Karen Bohmwald
- Departamento de Genética Molecular y Microbiología, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Janyra A Espinoza
- Departamento de Genética Molecular y Microbiología, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Emma Rey-Jurado
- Departamento de Genética Molecular y Microbiología, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roberto S Gómez
- Departamento de Genética Molecular y Microbiología, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo A González
- Departamento de Genética Molecular y Microbiología, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M Bueno
- Departamento de Genética Molecular y Microbiología, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia A Riedel
- Departamento de Ciencias Biológicas y Facultad de Medicina, Millennium Institute on Immunology and Immunotherapy, Universidad Andrés Bello, Santiago, Chile
| | - Alexis M Kalergis
- Departamento de Genética Molecular y Microbiología, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lesage-Horton H, Ney G, Stojan J. Case 2: Respiratory distress and abdominal tenderness in 21-month-old girl. Pediatr Rev 2015; 36:76-8. [PMID: 25646312 DOI: 10.1542/pir.36-2-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Gina Ney
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Jennifer Stojan
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
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Del Vecchio A, Ferrara T, Maglione M, Capasso L, Raimondi F. New perspectives in Respiratory Syncitial Virus infection. J Matern Fetal Neonatal Med 2013; 26 Suppl 2:55-9. [DOI: 10.3109/14767058.2013.831282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kirin BK, Topić RZ, Dodig S. Hepatitis during respiratory syncytial virus infection--a case report. Biochem Med (Zagreb) 2013; 23:112-6. [PMID: 23457772 PMCID: PMC3900097 DOI: 10.11613/bm.2013.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Respiratory syncytial virus (RSV) infection is the most common cause of hospitalization in infants and small children. The aim was to present a 13-months old boy diagnosed with acute airway infection, acute otitis media (AOM) and hepatitis during the RSV-infection. Material and methods: Serum catalytic activities of alkaline phosphatase (ALP), aspartate aminotranspherase (AST), alanine aminotranspherase (ALT), gamma glutamyl transpherase (GGT), lactate dehydrogenase (LD), and concentrations of bilirubin were monitored during hospitalization and at control examination. Results: The child had clinical signs and symptoms of respiratory failure, AOM, and laboratory findings of virus infection and liver disease. On admission, catalytic activities of enzymes were markedly increased, especially the activity of ALP (10333 U/L, i.e. 24-fold increase in comparison with the upper reference limit). The highest increased in AST (339 U/L, 4.5-fold), ALT (475 U/L, 10.3-fold) and LD (545 U/L, 1.5-fold) were registered on the 3rd day, and the highest increase in GGT (68 U/L, 3.1-fold) occurred on the 11th day. Seven weeks after discharge AST, ALT, GGT and LD decreased into reference range, and ALP remain mildly increased (478 U/L, 1.1 fold increase). RSV was confirmed in nasal lavage fluid. Conclusion: Laboratory results in patient with RSV infection needs to be interpreted in the light of both, respiratory and extrapulmonary manifestations of the infection, respectively.
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Fleming PF, Richards S, Waterman K, Davis PG, Kamlin COF, Stewart M, Sokol J. Medical retrieval and needs of infants with bronchiolitis: an analysis by gestational age. J Paediatr Child Health 2013; 49:E227-31. [PMID: 23227930 PMCID: PMC7166545 DOI: 10.1111/jpc.12025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2011] [Indexed: 11/29/2022]
Abstract
AIM Viral bronchiolitis is the most common lower respiratory tract infection in children less than 12 months of age. Prematurity is an independent risk factor for disease severity. Many infected infants require hospitalisation and those living in regional centres frequently require transfer to metropolitan hospitals capable of providing assisted ventilation. METHOD We reviewed infants with bronchiolitis transported by the Victorian Newborn Emergency Transport Service between January 2003 and June 2007. We compared the clinical presentation and treatment required by infants born preterm with those of their term counterparts. RESULTS Of the 192 infants transported, 92 were born preterm. Preterm infants were younger at time of transport (mean post-menstrual age 41 weeks vs. 45 weeks) and were more likely to require invasive ventilation (60% vs. 32%, P < 0.001) and to receive a fluid bolus (47% vs. 34%, P = 0.04) when compared with infants who had been born at term. Apnoea, either as a presenting symptom or in combination with respiratory distress, was more common in the preterm group (70% vs. 36%, P < 0.001). CONCLUSION Higher illness severity should be anticipated in ex-preterm infants who present with bronchiolitis. Preterm infants with bronchiolitis are more likely to require invasive ventilation and fluid resuscitation than term infants, suggesting the need for a lower threshold for referral and medical retrieval.
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Affiliation(s)
- Paul F Fleming
- Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia.
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Spengler U, Fischer HP, Caselmann WH. Liver Disease Associated with Viral Infections. ZAKIM AND BOYER'S HEPATOLOGY 2012. [PMCID: PMC7152320 DOI: 10.1016/b978-1-4377-0881-3.00034-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Fares M, Mourad S, Rajab M, Rifai N. The use of C-reactive protein in predicting bacterial co-Infection in children with bronchiolitis. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2011; 3:152-6. [PMID: 22540082 PMCID: PMC3336903 DOI: 10.4297/najms.2011.3152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bronchiolitis is a potentially life-threatening respiratory illness commonly affecting children who are less than two years of age. Patients with viral lower respiratory tract infection are at risk for co-bacterial infection. AIM The aim of our study was to evaluate the use of C-reactive protein (CRP) in predicting bacterial co-infection in patients hospitalized for bronchiolitis and to correlate the results with the use of antibiotics. PATIENTS AND METHODS This is a prospective study that included patients diagnosed with bronchiolitis admitted to Makassed General Hospital in Beirut from October 2008 to April 2009. A tracheal aspirate culture was taken from all patients with bronchiolitis on admission to the hospital. Blood was drawn to test C-reactive protein level, white cell count, transaminases level, and blood sugar level. RESULTS Forty-nine patients were enrolled in the study and were divided into two groups. Group 1 included patients with positive tracheal aspirate culture and Group 2 included those with negative culture. All patients with a CRP level ≥2 mg/dL have had bacterial co-infection. White cell count, transaminases and blood sugar levels were not predictive for bacterial co-infection. The presence of bacterial co-infection increased the length of hospital stay in the first group by 2 days compared to those in the second group. CONCLUSION Bacterial co-infection is frequent in infants with moderate to severe bronchiolitis and requires admission. Our data showed that a CRP level greater than 1.1 mg/dL raised suspicion for bacterial co-infection. Thus, a tracheal aspirate should be investigated microbiologically in all hospitalized patients in order to avoid unnecessary antimicrobial therapy and to shorten the duration of the hospital stay.
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Affiliation(s)
- Mohamad Fares
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Sawsan Mourad
- Centre Hospitalier Régional Universitaire de Lille Hopital Jeanne de Flandre Lille, France
| | - Mariam Rajab
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Nahida Rifai
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
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Ochoa Sangrador C, González de Dios J. [Consensus conference on acute bronchiolitis (VI): prognosis of acute bronchiolitis. Review of scientific evidence]. An Pediatr (Barc) 2010; 72:354.e1-354.e34. [PMID: 20409766 DOI: 10.1016/j.anpedi.2009.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
We present a review of the evidence on prognosis of acute bronchiolitis, risk factors for severe forms, symptom or severity scores and risk of post-bronchiolitis asthma. Documented risk factors of long stay or PICU admission in hospitalized patients are: bronchopulmonary dysplasia and/or chronic lung disease, prematurity, congenital heart disease and age less than 3 months. Other less well documented risk factors are: tobacco exposure, history of neonatal mechanical ventilation, breastfeeding for less than 4 months, viral co-infection and other chronic diseases. There are several markers of severity: toxic appearance, tachypnea, hypoxia, atelectasis or infiltrate on chest radiograph, increased breathing effort, signs of dehydration, tachycardia and fever. Although we have some predictive models of severity, none has shown sufficient predictive validity to recommend its use in clinical practice. While there are different symptom or severity scores, none has proven to be valid or accurate enough to recommend their preferable application in clinical practice. There seems to be a consistent and strong association between admission due to bronchiolitis and recurrent episodes of wheezing in the first five years of life. However it is unclear whether this association continues in subsequent years, as there are discordant data on the association between bronchiolitis and asthma.
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Affiliation(s)
- C Ochoa Sangrador
- Servicio de Pediatría, Hospital Virgen de la Concha, Zamora, España.
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Prodhan P, Westra SJ, Lin J, Karni-Sharoor S, Regan S, Noviski N. Chest radiological patterns predict the duration of mechanical ventilation in children with RSV infection. Pediatr Radiol 2009; 39:117-23. [PMID: 19005648 DOI: 10.1007/s00247-008-1042-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/19/2008] [Accepted: 10/03/2008] [Indexed: 01/30/2023]
Abstract
BACKGROUND RSV-infected children demonstrate various radiographic features, some of which are associated with worse clinical outcomes. OBJECTIVE To investigate whether specific chest radiological patterns in RSV-infected children with acute respiratory failure (ARF) in the peri-intubation period are associated with prolonged duration of mechanical ventilation. MATERIALS AND METHODS We included RSV-infected children <1 year of age admitted with ARF from 1996 through 2002 to the pediatric intensive care unit at Massachusetts General Hospital. Their chest radiographs were evaluated at three time-points: preintubation (day -1) and days 1 and 2 after intubation. Univariate and multiple logistic regressions models were utilized to investigate our objective. RESULTS The study included 46 children. Using day 1 chest radiograph findings to predict duration of mechanical ventilation of >8 days, a backward stepwise regression arrived at a model that included age and right and left lung atelectasis. Using day 2 chest radiograph results, the best model included age and left lung atelectasis. A model combining the two days' findings yielded an area under the ROC curve of 0.92 with a satisfactory fit (P = 0.95). CONCLUSION Chest radiological patterns around the time of intubation can identify children with RSV-associated ARF who would require prolonged mechanical ventilation.
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Affiliation(s)
- Parthak Prodhan
- Division of Pediatric Critical Care and Cardiology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
OBJECTIVE To evaluate in children with bronchiolitis requiring mechanical ventilation the association between blood glucose level and duration of mechanical ventilation and pediatric intensive care unit (PICU) stay. DESIGN Retrospective cohort study. SETTING University hospital PICU. PATIENTS Children admitted to a university hospital PICU over a period of 3 yrs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic data, infection with respiratory syncytial virus, history of prematurity, mechanical ventilator settings, and use of inotrope during illness were noted. In addition, C-reactive protein, alanine transaminase, and glucose levels were recorded. Data from 50 children with median (interquartile range) age of 2.2 (1.3-4.7) months were analyzed. There were 37 boys, 21 children had been premature babies, and 30 children were positive for respiratory syncytial virus. Hyperglycemia at any time was frequent (peak glucose > or =6.1 mmol/L [110 mg/dL] in 98% and >8.3 mmol/L [150 mg/dL] in 72%). Children with sustained hyperglycemia were more likely to be boys with higher alanine transaminase and C-reactive protein, requiring inotrope (p < .05). These children are more likely to have required high-frequency oscillation ventilation, required higher airway pressures, and had longer duration of mechanical ventilation and PICU stay (p < .05). Peak glucose and sustained peak glucose were not independently associated with duration of mechanical ventilation or PICU stay. Multiple regression showed that age, C-reactive protein, the need for inotrope, and respiratory syncytial virus infection were independent factors associated with duration of PICU stay. Glucose level was not a factor. CONCLUSIONS Our findings show that hyperglycemia is frequent in children with bronchiolitis requiring mechanical ventilation, but we failed to show that this phenomenon was independently associated with prolonged duration of mechanical ventilation or PICU stay. Our observations raise the question whether tight glycemic control should be used in children with bronchiolitis.
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Affiliation(s)
- Ricardo G Branco
- Department of Paediatrics, University of Cambridge School of Medicine, Addenbrookes Hospital, Cambridge, UK.
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Eisenhut M. Myocardial injury associated with hyperinflation of the lung. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 11:412; author reply 412. [PMID: 17466084 PMCID: PMC2206471 DOI: 10.1186/cc5738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Thorburn K, Hart CA. Think outside the box: extrapulmonary manifestations of severe respiratory syncytial virus infection. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:159. [PMID: 16934132 PMCID: PMC1750979 DOI: 10.1186/cc5012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extrapulmonary effects of severe respiratory syncytial virus (RSV) infection are not uncommon. Dr Eisenhut's systematic review of extrapulmonary manifestations of severe RSV infection clearly demonstrates clinical consequences peripheral to the lung parenchyma. The extrapulmonary impact of RSV infection raises questions as to whether these are direct RSV effects (i.e., RSV infection of site-specific tissue), secondary to parenchymal lung disease and its causative respiratory failure, or the result of inflammatory mediators dispersed from the provoked respiratory epithelium.
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Affiliation(s)
- Kentigern Thorburn
- Department of Paediatric Intensive Care, Royal Liverpool Children's Hospital, Liverpool, UK
| | - C Anthony Hart
- Department of Medical Microbiology and Genito-urinary Medicine, University of Liverpool, UK
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Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R107. [PMID: 16859512 PMCID: PMC1751022 DOI: 10.1186/cc4984] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 06/22/2006] [Accepted: 07/06/2006] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) bronchiolitis is the most important cause for admission to the paediatric intensive care unit in infants with lower respiratory tract infection. In recent years the importance of extrapulmonary manifestations of RSV infection has become evident. This systematic review aimed at summarizing the available evidence on manifestations of RSV infection outside the respiratory tract, their causes and the changes in clinical management required. METHODS Databases searched were Medline (1950 to present), EMBASE (1974 to present), PubMed and reference lists of relevant articles. Summarized were the findings of articles reporting on manifestations of RSV infection outside the respiratory tract in patients of all age groups. RESULTS Extrapulmonary manifestations reported in previous observational studies included cardiovascular failure with hypotension and inotrope requirements associated with myocardial damage as evident from elevated cardiac troponin levels (35-54% of ventilated infants), cardiac arrhythmias like supraventricular tachycardias and ventricular tachycardias, central apnoeas (16-21% of admissions), focal and generalized seizures, focal neurological abnormalities, hyponatraemia (33%) associated with increased antidiuretic hormone secretion, and hepatitis (46-49% of ventilated infants). RSV or its genetic material have been isolated from cerebrospinal fluid, myocardium, liver and peripheral blood. CONCLUSION The data summarized indicate a systemic dissemination of RSV during severe disease. Cerebral and myocardial involvement may explain the association of RSV with some cases of sudden infant death. In infants with severe RSV infection cardiac rhythm, blood pressure and serum sodium need to be monitored and supportive treatment including fluid management adjusted accordingly.
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Affiliation(s)
- Michael Eisenhut
- Luton & Dunstable Hospital, Lewsey Road, Luton, Bedfordshire, LU4 ODZ, UK.
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Eisenhut M. Ischemic hepatitis and collateral damage to the liver in severe viral respiratory tract infections. THE AMERICAN JOURNAL OF PATHOLOGY 2006; 169:1100; author reply 1100. [PMID: 16936282 PMCID: PMC1698836 DOI: 10.2353/ajpath.2006.060514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Adams DH, Hubscher SG. Systemic viral infections and collateral damage in the liver. THE AMERICAN JOURNAL OF PATHOLOGY 2006; 168:1057-9. [PMID: 16565481 PMCID: PMC1606546 DOI: 10.2353/ajpath.2006.051296] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- David H Adams
- Liver Research Laboratories, Institute for Biomedical Research, University of Birmingham Medical School, Wolfson Dr., Birmingham, B15 2TT, UK.
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Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R, Vallet B. Year in review in intensive care medicine, 2004. III. Outcome, ICU organisation, scoring, quality of life, ethics, psychological problems and communication in the ICU, immunity and hemodynamics during sepsis, pediatric and neonatal critical care, experimental studies. Intensive Care Med 2005; 31:356-72. [PMID: 15719149 DOI: 10.1007/s00134-005-2573-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 01/24/2005] [Indexed: 11/24/2022]
Affiliation(s)
- Peter Andrews
- Intensive Care Medicine Unit, Western General Hospital, Edinburgh, UK
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