Chlamydophila pneumoniae respiratory tract infection aggravates therapy refractory bronchitis or pneumonia in childhood.

BACKGROUND: Chlamydophila pneumoniae was frequently found in bronchial secretions of children with therapy-refractory bronchitis or pneumonia. It was studied, how the agent modifies the course of disease and what findings are associated with the infection. PATIENTS AND METHODS: Bronchial secretions obtained at bronchoscopy of 428 children were studied for C. pneumoniae infection using polymerase chain reaction with enzyme immunoassay detection. Children tested negative and positive were compared for their clinical findings. RESULTS: C. pneumoniae was found in 143 children (33 %). A C. pneumoniae infection has been found to be associated with a purulent bronchial inflammation (90/143 vs. 144/285, p = 0.02), a Streptococcus pneumoniae co-infection (13/143 vs. 6/285, p = 0.002) and a restrictive disturbance (11/51 vs. 8/93, p = 0.04). Purulent inflammation (Odds ratio 7.9; 95 % confidence interval [CI] 1.6-39.3), 2 co-infections (Odds ratio 14.3; 95 % CI 1.4-144.4) and co-infection with M. pneumoniae (4/4 versus 9/26, p = 0.03; Mantel Haentzel 3.0; 95 % CI 1.1-8.0) were identified as factors more often associated with a restrictive disturbance in children with bronchial C. pneumoniae infection. An adequate antibiotic therapy improved pulmonary function. No association was found for wheezing, eosinophil inflammation of the nasal mucosa, alpha-1 antitrypsin or immunoglobulin deficiency in serum, level of secretory IgA in bronchial mucus, pathological lung scintigram, gastro-esophageal reflux disease, sweat test and other co-infections. CONCLUSIONS: In children with therapy-refractory bronchitis or pneumonia bronchial C. pneumoniae infection was associated with a more severe disease in case of several, mostly bacterial co-infections. Adequate antibiotic therapy for C. pneumoniae infection has been demonstrated to improve pulmonary function.

Intensive chemotherapeutic regimens against acute leukemia transiently suppress asthma symptoms but do not lead to long-term relief.

In some very rare cases children suffer from a combination of asthma and a malignant disease. This study investigated whether intensive chemotherapy might have a positive effect on asthma in these special cases and whether asthma generally relapses after completion of chemotherapy. The authors monitored clinical outcome and lung function of 43 children with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received chemotherapy at the University Children's Hospital of Greifswald between 1993 and 1998. Cytostatic chemotherapy was administered according to the German treatment protocols. Two of the 43 patients had asthma before leukemia was diagnosed. During the course of chemotherapy, asthma symptoms diminished promptly after beginning of chemotherapy but asthma was rediagnosed after completion of chemotherapy in both cases. The third patient developed asthmatic symptoms shortly after completion of chemotherapy for the first time. It can be stated that chemotherapy does not essentially cure asthma. Therefore, it seems mandatory to perform follow-up lung testings after chemotherapy, especially in patients with asthma.

[Effect of ambulatory sports therapy on bronchial asthma in children]. / Der Einfluss einer ambulanten Sporttherapie auf das Asthma bronchiale bei Kindem.

Exercise-induced asthma (EIA) is very common in children with asthma. For this reason they avoid every strenuous exercise because they fear a new asthma attack. Working capacity and maturation of motor performance can be insufficient as a consequence. We investigated whether a special training programme in an asthma sports group has positive effects not only on asthma, but also on working capacity and motor performance. 11 children with extrinsic asthma (4 girls, 7 boys), 8 to 14 years old, were studied before and after a 6-month out-patient rehabilitative sports therapy (sports group) with regard to their degree of bronchial hyperreactivity (BHR), frequency of EIA, cardiopulmonary capacity for exercise; knowledge about their asthma, level of coordination and condition, and their movement-related anxiety. There were 9 children with extrinsic asthma (2 girls, 7 boys), 8 to 15 years old, in a control group. They did not take part in any special training programme. After the sports therapy we found in 3 children of the sports group a decrease in BHR, EIA was now present in only 2 of formerly 4 children. Physical working capacity (PWC) at the aerobic/anaerobic threshold improved in the sports group by about 1 W/kg body weight (p = 0.008), efficiency of work from 23.7% to 27.9% (p = 0.009). We also found a remarkable improvement of motor abilities. Movement-related anxiety decreased in the sports group both in Indoor sports (p = 0.0089) and aquatics (p = 0.026). In the control group there was no significant change. Physical training in children with asthma has many positive effects on lung function and motor performance. We believe that the limit for an EIA release is shifted to a higher PWC. The reduction of the anxiety over sports at a higher level of PWC contributes to an improved quality of life for children with asthma.

Acute obstructive respiratory diseases (ARD) and bacterial complications of ARD (pneumonia, sinusitis) in infants and children associated with human herpesvirus-6 infection.

The existence of catharreal respiratory symptoms (such as pharyngitis, tracheitis, bronchitis etc.) is established as the usual manifestation of "exanthema subitum" due to acute human herpesvirus-6 (HHV-6) infection. But so far pneumonia, purulent sinusitis, purulent otitis media and/or acute obstructive bronchitis (bronchiolitis) in infants and children have not been described. Here we report the results of observations of 2 children with bronchopneumonia/sinusitis maxillaris and severe bronchiolitis associated with an acute HHV-6 infection. Other respiratory viruses were excluded as agents causing the ARD.

[Complications of acute respiratory tract infection (pneumonia, sinusitis) in young children associated with acute HHV 6 infection]. / Komplikationen einer ARE (Pneumonie, Sinusitis) bei Kleinkindern assoziiert mit akuter HHV-6-Infektion.

The human herpesvirus-6 (HHV-6) causes exanthema subitum ("e.s."). "E.s." is characterized by fever, exanthem (rash), in many cases gastroenteritis, occasionally cerebral convulsions (but more frequently general cerebral irritability) and enlargement of all lymph nodes; usually there are mild catarrhal respiratory symptoms of the upper airways (ARD). So-called "complications" of an ARD (pneumonia, acute purulent otitis media, acute sinusitis) due to bacterial infections are very unusual as sequelae of a HHV-6 infection. Here we report the case of 2 small children (toddlers) suffering from bronchopneumonia or pneumonia and acute sinusitis maxillaris associated with an acute HHV-6 infection. It seems that HHV-6 (like other respiratory tract viral pathogens) also can lead to secondary bacterial infections of the lower respiratory tract. So far it is not known, why such complications are so rare, although the extreme granulocytopenia accompanying "e.s." suggests a transient disturbance of the antibacterial defence mechanisms.

Transepithelial potential difference in the bronchial system of children with chronic bronchitis and bronchial asthma.

In 45 children with chronic non-specific respiratory diseases (CNSRD), 18 with bronchial asthma and 27 with relapsing or chronic bronchitis, the transepithelial potential difference (tpd) was measured in the tracheobronchial system (bronchoscopy under general anaesthesia). The statistical variation in the tpds was highly significant. In asthmatics with significant eosinophilia in the bronchial secretions of the main bronchus we found a tpd of 26.5 (+/- 8.5) mV and in bronchitics a tpd of 18.2 (+/- 6.3) mV. This suggests that the presence or absence of eosinophils in the secretions, the products of intermediate cell metabolism or different pathogenetic processes, could be responsible for the variety of change in the tpd measured in the respiratory tract.

The effect of N-acetyl-cysteine (Mucosolvin) on the transmural potential difference of the mucosa in children.

The mucosa of the respiratory and gastrointestinal tract produces an active transepithelial (or transmural) electric potential difference (tpd), which can be measured (in millivolts, mV). In CF-children receiving oral N-acetyl-cysteine treatment, the tpd of the buccal mucosa is largely the same as that in non-CF-children; the tpd of the nasal mucosa is significantly higher in CF-children. Given orally, N-acetyl-cysteine also provokes a significant decrease in the rectal mucosa tpd in CF-children. We suggest the effect is caused either by an osmotic effect of N-acetyl-cysteine (local), and/or by alteration of the factors regulating basal electrolyte transport/conductance of epithelia (chloride secretion? leaky junction?).

[Obstructive respiratory tract diseases in children and Parvovirus B19 infections]. / Obstruktive Respirationstrakterkrankungen bei Kindern und Parvovirus B19-Infektion.

Acute respiratory diseases (ARD) due to parvovirus B 19 infection can be observed relative frequently in children. In 21 children (infants, toddlers and school children) we have seen acute or prolonged obstructive bronchitis/bronchiolitis (15 infants), acute subglottic laryngitis (3 toddlers) and acute asthmatic attacks (3 children of school age) in connection with parvovirus B 19 infection. Other respiratory viruses (adeno-, influenza, parainfluenza and RS-virus) could be excluded as agents causing the ARD. We suggest that parvovirus B 19 can provoke ARD with obstructive ventilatory disturbances of the upper or lower airways in children with a specific endogenous predisposition (small or unstable bronchial walls, or bronchial or tracheal mucosal hyperreactivity).

[Diagnostic value of skin tests in children with bronchial asthma and/or atopic eczema]. / Zum diagnostischen Wert von Hauttestungen bei Kindern mit Asthma bronchiale und/oder atopischem Ekzem.

Positive test results with relevance to the patients' history resp. illness' development were seen in all age groups of patients suffering from asthma. In cases with atopic dermatitis, but without asthma or bronchitis, positive test reactions were not relevant; in these cases hyperreagibility of the skin is supposed. The results confirmed that cutaneous testing is indicated in children suffering from asthma, even in those cases with associated atopic dermatitis provided that testing is carried out in lesion-free skin-area and beyond exacerbation of eczema. Test-results should be interpreted only with regard to the patients' history, clinical picture and its development.

The eosinophilic granulocyte count in the respiratory secretions of children with chronic nonspecific respiratory diseases.

We performed cytologic evaluations of 6116 nasal and/or bronchial smears from 4510 patients (average age: 7.6 years; 3 months--17 years) suffering from different kinds of chronic nonspecific respiratory diseases (CNSRD); in 137 children (average age: 4.8 years) undergoing bronchologic examinations under general anesthesia we compared the findings with those for bronchoalveolar lavage (BAL). Nasal smears of 77 healthy children at a day care center (control group) were analysed four times per year for "significant secretory eosinophilia" (SEE; i.e. more than 13% eosinophils). We found: 1. Healthy children do not have such "SSE" in contrast to children with CNSRD who show different frequencies of "SSE" depending on the age of the child and the specific kind (diagnosis) of CNSRD. 2. 4.6% of infants (first year of life) were found to have SSE with a statistically significant correlation to increase in the following 10 years up to 50% of all children (p less than 0.001). 3. We found SSE in 4.41% of cases with relapsing bronchitis, in 7.14% (8.3% resp.) with chronic bronchitis, in 6.49% (9.2% resp.) with relapsing or chronic obstructive bronchitis and in 46.05% (55.3% resp.) with bronchial asthma (p less than 0.001). 4. The intensity of obstructive symptoms (nose: rhinitis; bronchus: dyspnoea) did not correlate with the number of eosinophils in the secretions. 5. Only the smear cytograms (nose/bronchus) enabled us to detect "SSE" whereas BAL cytograms were too insensitive (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Serum prolactin concentration and hypothalamic-pituitary hormone release in CF-children.

Some experimental data from animals suggest that prolactin (PROL) is involved in sweat production and modulates the chloride concentration of sweat. We determined the serum PROL level by RIA in 38 CF-patients (age: 3-24 years) and 48 patients with bronchial asthma (age: 2-18 years) and found no concentration differences between the two groups each taken as a whole; the TSH level was increased in CF (p less than 0.05). Separate analysis showed a significantly higher PROL level in CF-females and in CF-children (male and female) under 12 years old (p less than 0.05). To assess the hypothalamic-pituitary system we performed the metoclopramide test (by Cerucal) on 30 children suffering from CF (n = 10), bronchial asthma (n = 10) or pyelonephritis (n = 10) for PROL, LH, FSH, TSH and HGH. The hormone release was normal for all kinds checked in all groups of patients. Hence it follows that the neurohormonal system of prolactin is normal in CF-patients and the increased serum PROL and TSH concentrations in CF should be seen as a regulatory phenomenon but not as a mechanism associated with the basic defect of the CF-disease.

[High-grade tracheomalacia and tracheal stenosis in congenital esophageal atresia with lower esophagotracheal fistula (Type III b)]. / Hochgradige Tracheomalazie und Trachealstenose bei konnataler Osophagusatresie mit unterer ösophagotrachealer Fistel (Typ III b).

Stenosis and malacia of the trachea wall can provoke chronic stridor and/or chronic bronchitis, but usually stenosis and malacia only exist separately. The finding of an infant born with atresia of the oesophagus and a lower tracheoesophageal fistula which was cured by surgery on the 1st day of life are discussed. During the following 8 months we observed persistent stridor, chronic cough and (4-times) relapsing episodes of respiratory insufficiency ("nearly-sudden-infant-death-syndrome"/NSIDS) due to gastrooesophageal reflux (GER with aspiration) and severe tracheomalacia combined with tracheostenosis and bacterial infections (Pseudomonas aeruginosa). The strategy of therapy for GER and for the tracheal abnormality are discussed.

[Some new treatment strategies for lung involvement in patients with mucoviscidosis]. / Einige neue Behandlungsstrategien der Lungenmanifestation bei Mukoviszidosepatienten.

Autogenic drainage, PEP mask breathing as well as physical exercise are now well established in the treatment of pulmonary disease in cystic fibrosis, but there are different opinions about oxygen therapy over a long period as well as corticosteroid treatment. First reports on amiloride inhalations seem to be hopeful, but there is no experience with cystic fibrosis children till now, therefore clinical use can not be recommended. Heart lung transplants are not to consider as an alternative treatment for all cystic fibrosis patients, in special cases it may be successful.

[The saccharin test in the pediatric broncho-pneumonologic outpatient clinic. A noninvasive screening method for the assessment of ciliary function of the respiratory tract in children]. / Der Saccharin-Test im pädiatrisch-bronchopneumologischen Dispensaire. Eine nichtinvasive Screeningmethode zur Beurteilung der Zilienfunktion des Respirationstraktes bei Kindern.

The Saccharin test is a non-dangerous, inexpensive, suitable and repeatable method for assessing the mucociliary function of the respiratory epithelium. A small quantity of Saccharin (R) is deposited on the inferior nasal concha; the chemical agent will be transported by the respiratory epithelium (kinocilia) from the nasopharynx to the oropharynx and can be tasted here as "sweet". The time interval between the deposition of Saccharin and the "sweet" taste is the "nasal mucociliary transport time (nmctt)"; data in minutes. In 381 children (age: 3-17 years) we found an average nmctt of 6.6 (+/- 4.8) min (healthy controls) and 8.8 (+/- 5.2) min resp. (CNSRD children). A nmctt longer than 30 min leads one to suspect disturbances of the mucociliary function, the aetiology of which can be analysed by mucosa biopsy and subsequent examination under the electron microscope. We hold the view that Saccharin test is an essential part of the diagnostic program for children suffering from CNSRD; after 3 tests the mucociliary function can be evaluated correctly. The test can be used both for diagnosing the aetiology of respiratory diseases and for the assessment of the efficiency of therapeutic and prophylactic measures.

The pediatric bronchopneumonologic consultation centres (dispensaries) for children and adolescents suffering from chronic nonspecific respiratory diseases (CNSRD) in the G.D.R.

A survey is given of the three-level health service for young patient with chronic nonspecific respiratory diseases (CNSRD) in the GDR. The expected prevalence of the diseases in the young population (0-18 years) is 2-3% and still higher in regions with heavy air pollution. The pediatric working group of bronchopneumonology (in the Pediatric Society of the GDR) has organized a country-wide system of pediatric bronchopneumonologic consultation centres in the form of district (2nd level) and county dispensaries (3rd level) helping the local primary care pediatricians and general practitioners (1st level) in diagnostics, therapy and surveillance of such patients. The bronchopneumonologic county centres with all modern diagnostic and therapeutic facilities have a capacity which is sufficient for our country. However the function of the primary care doctors (to spot such children and refer them to the dispensaries), that of the district dispensaries (so far only 50-65% of expected patients in control!), and the availability of lung function test equipment and special bronchoscopic aids for infants and small children (in the county centres) needs to be improved.