Chlamydia trachomatis and lower respiratory tract infection during infancy in Assiut

The study included 330 cases with lower acute respiratory tract infection [LARI] as well as 100 controls. Their ages ranged from 0 to 12 months [median 5 -months]. The cases were subjected to full clinical and radiological examination. The cases and controls were subjected to laboratory investigations which included determination of antichlamydial antibodies of IgG fraction in the serum, as well as gastric aspirate direct smear for determination of polymorphonuclear leucocytic proportion in relation to other cells and for bacterial and fungal detection. Cultures from gastric aspirate were done for bacterial and fungal isolation. The frequency of chlamydia trachomatis LARI was present in 15.2% of our cases. 29% of our cases with LARI between 1-6 months of age were due to chlamydia infection. The commonest presenting clinical picture of chlamydia LARI was that of bronchiolitis. The frequency of chlamydia bronchiolitis in our cases with LARI was significantly higher in low socio-economic state than the rest of the cases, in rural than urban cases, among artificially fed infants than breast fed ones and during spring and summer than autumn and winter. The frequencies of both acute otitis media and gastroenteritis were significantly higher among chlamydia LARI than other causes of LARI. The prognosis of chlamydia bronchiolitis was good except when associated with other bacterial infection. Gastric aspirate study proved to be as the sensitivity for direct gastric aspirate smear in detecting pathogenic micro-organisms In relation to culture was 84.6% for Candida, 81.3% for single bacterial infection and 69.7% for mixed bacterial infection useful tool in the diagnosis bacterial and fungal LARI in infancy, Chlamydial LARI should be considered in infants below 6 months of age with bronchiolitis

Gastric fluid fibronectin, transferring and prealbumin in children with bacterial pneumonia

The study included 103 patients with bacterial pneumonia as well as 20 controls. Their ages ranged from 2-36 months. Patients with any disease that could affect plasma proteins were excluded from the patients and controls. Patients were classified according to Downe's score for respiratory distress into mild, moderate and severe. The patients were subjected to full clinical examination chest x-ray, full blood picture, tuberculin test and early morning fasting gastric aspirate for bacteriological studies as well as for determination of fibronectin [Fn] transferrin [Tn] and prealbumin [PA] initial and on follow up after 10 days. Similarly gastric aspirate to plasma ratio [G/P] of Fn, Tn and PA were done initially and on follow up. Controls were subjected to the same gastric aspirate studies. Patients with bacterial pneumonia showed significantly higher values of gastric fluid as well as G/P ratio of Fn and Tn and significantly lower gastric aspirate and G/P ratio of PA than controls. Cases with both severe and moderate bacterial pneumonia showed significantly lower values of gastric fluid and G/P ratio of Fn and PA and significantly higher values of gastric fluid and G/P ratio of Tn than mild ones. Mild cases that became worse showed significantly lower values of gastric fluid and G/P ratio of Fn and PA and significantly higher values of gastric fluid and G/P ratio of Tn than mild cases that became better, cases who died from bacterial pneumonia showed significantly lower values of gastric fluid Fn initially than cases that improved either within or after 10 days treatment. There was a marked and significant decline of gastric fluid Fn in cases that died at deterioration of their state than cases that improved. These data suggest that gastric fluid Fn, Tn and PA may have a prognostic value during the management of bacterial pneumonia. The addition of I.V. fibronectin during the treatment of bacterial pneumonia in the cases that show either significant initial low or significant decline in gastric fluid Fn during the course of the disease may be worthy trial