Clinical features and pathogens of plastic bronchitis in children: an analysis of 9 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features and pathogens of plastic bronchitis in children.</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 9 children who were diagnosed with plastic bronchitis between January 2011 and December 2012.</p><p><b>RESULTS</b>Plastic bronchitis began with a fever and cough in all cases, followed by progressive dyspnea on days 1-3 of onset; unilateral or bilateral decreased breath sounds and hepatosplenomegaly were found; complications included respiratory failure (6 cases), toxic encephalopathy (6 cases), toxic hepatitis (7 cases), shock (3 cases), heart failure (3 cases), and renal failure (2 cases). Chest X-ray or chest CT showed single and multiple lobar or segmental consolidation and atelectasis, as well as pleural effusion (4 cases). The bronchofibroscopy revealed some grey-white mucus plugs that blocked bronchial openings and aspirates of bronchial shape. Influenza viruses (IFVs) were detected in all cases, including IFV-A (6 cases, 67%) and IFV-B (3 cases, 33%). Mixed infection with IFV-A and Mycoplasma pneumoniae (MP)/bacteria was found in 50% of all cases. In the three cases of IFV-B infection, one was complicated by MP infection. Nine patients were given treatment of antibiotics, hormones, gamma globulin and necessary respiratory support, and also were given removal of endogenous foreign body by bronchoscopy. Five patients were given antiviral therapy of oseltamivir. Seven cases cured, and 2 died.</p><p><b>CONCLUSIONS</b>Plastic bronchitis and severe pneumonia are similar in clinical manifestations. IFVs are the main pathogen. In addition to anti-infection treatment, hormone, gamma globulin, respiratory support, and other conventional treatments, endogenous foreign body removal by bronchofibroscopy and early antiviral therapy with oseltamivir have good efficacy.</p>

Value of fluorescence quantitative PCR assay of bronchoalveolar lavage fluid samples in the diagnosis of Mycoplasma pneumoniae pneumonia in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the value of fluorescence quantitative polymerase chain reaction (FQ-PCR) for detecting Mycoplasma pneumoniae (MP)-DNA in bronchoalveolar lavage fluid (BALF) in the early diagnosis of Mycoplasma pneumoniae pneumonia (MPP).</p><p><b>METHODS</b>FQ-PCR was used to detect MP-DNA in BALF obtained by fiberoptic bronchoscopy from 61 children with MPP, and the sensitivity and the specificity of FQ-PCR were compared with the traditional serological test.</p><p><b>RESULTS</b>The sensitivity and the specificity of BALF FQ-PCR for detecting MP-DNA were 94% and 100% respectively. The accuracy of BALF FQ-PCR assay for detecting MP-DNA was higher than that of the serological test at the early stage of the disease (1-7 days) (P<0.01). In the children with refractory MPP, BALF FQ-PCR assay also showed higher accuracy for detecting MP-DNA than the serological test (P<0.01). The copies of MP-DNA in children with refractory MPP were significant higher than those in children with common MPP (P<0.05). The copies of MP-DNA were positively correlated with CRP values (r=0.845, P<0.01).</p><p><b>CONCLUSIONS</b>FQ-PCR assay of BALF for detecting MP-DNA in BALF is superior to the serological test. It is a reliable method for the early diagnosis of MPP, especially refractory MPP. The copies of MP-DNA can be used as an index for evaluation of the treatment outcome of refractory MPP.</p>

The influence of glucocorticoid inhalation on serum IgE of asthmatic children / 中国综合临床

Objective To discuss the significance of serum IgE before and after inhale glucocorticoid treat-ment of children's asthma. Methods 520 children with asthma were seleceted from the outpatient. Different type of fluticasone propionate were given to different age groups: Aerosol type by a spacer in less than 5 years old,and in-halant (Seretide) 5 years and the above. The dosage was between 200 μg/day to 375 μg/day. IgE was tested before and 3 months after the treatment. Results Serum IgE decreased significantly in 3 months treatment [ from (496.12±24.75) kU/L to (390.71±18.71) kU/L] (t=7.337,P<0.01). The change of IgE was related to clinical effect and age. The level increased in those less than 3 years [(307.05±34.71)kU/L vs (483.09±41.78) kU/L] (t=2.963,P=0.004),but decreased between 4 to 5 years old group [(543.46±51.03) kU/L vs (316.93±29.30) kU/L] (t=3.368,P=0.000) ,and decreased between 6 to 14 years old group[ (586.30±37.19)kU/L vs (387.61±27.60) kU/L] (t=4.827,P=0.000). In fluticasone group IgE level changed from (468.91±32.81) kU/L to (359.03±22.79) kU/L after treatment (t=5.988,P<0.01),which decreased from (586.30±37.19) kU/L to (387.6±27.60) kU/L in Salmeterol group (t=4.827,P<0.01). In 260 cases of IgE below 300 kU/L 109 cases (41.92%,109/260) increased while in 260 cases of IgE above 300 kU/L,total IgE lev-el increased in 45 cases (16.15% ,45/260) after treatment,with statistical significance(χ<'2>=37.789,P=0.000). Conclusion Inhale glucocorticoid can make the level of IgE decreased.