ABSTRACT
Spinal muscular atrophy (SMA) causes a predominantly bilateral proximal muscle weakness and atrophy. The respiratory muscles are also involved with a weakness of the intercostal muscles and a relatively spared diaphragm. This respiratory muscle weakness translates into a cough impairment, resulting in poor clearance of airway secretions and recurrent pulmonary infections, restrictive lung disease due to a poor or insufficient chest wall and lung growth, nocturnal hypoventilation and, finally, respiratory failure. Systematic and regular monitoring of respiratory muscle performance is necessary in children with SMA in order to anticipate respiratory complications, such as acute and chronic respiratory failure, and guide clinical care. This monitoring is based in clinical practice on volitional and noninvasive tests, such as vital capacity, sniff nasal inspiratory pressure, maximal static pressures, peak expiratory flow and peak cough flow because of their simplicity, availability and ease. In young children, those with poor cooperation or severe respiratory muscle weakness, other, mostly invasive, tests may be required to evaluate respiratory muscle performance. A sleep study, or at least overnight monitoring of nocturnal gas exchange is mandatory for detecting nocturnal alveolar hypoventilation. Training for patients and caregivers in cough-assisted techniques is recommended when respiratory muscle strength falls below 50% of predicted or in case of recurrent or severe respiratory infections. Noninvasive ventilation (NIV) should be initiated in case of isolated nocturnal hypoventilation and followed by a pediatric respiratory team with expertise in NIV. Multidisciplinary (neurology and respiratory) pediatric management is crucial for optimal care of children with SMA. © 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
Subject(s)
Respiratory Muscles/physiopathology , Respiratory Therapy/methods , Spinal Muscular Atrophies of Childhood/therapy , Child , Humans , Muscle Strength , Spinal Muscular Atrophies of Childhood/diagnosis , Spinal Muscular Atrophies of Childhood/physiopathologyABSTRACT
We report the case of an 18-month-old infant with severe serotype 3 adenovirus pneumonia, exceptionally associated with hemophagocytic syndrome. Treatment included cidofovir and mechanical ventilation for 13 days. The child developed chronic respiratory insufficiency due to bronchiectasis and bronchiolitis obliterans.
Subject(s)
Adenovirus Infections, Human/diagnosis , Bronchiectasis/virology , Bronchiolitis Obliterans/virology , Lymphohistiocytosis, Hemophagocytic/virology , Pneumonia, Viral/diagnosis , Respiratory Insufficiency/virology , Adenovirus Infections, Human/complications , Adenovirus Infections, Human/therapy , Antiviral Agents/therapeutic use , Bronchiectasis/diagnosis , Bronchiectasis/therapy , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/therapy , Chronic Disease , Cidofovir/therapeutic use , Combined Modality Therapy , Humans , Infant , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/therapy , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Respiration, Artificial , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Severity of Illness IndexABSTRACT
Aspergillus fumigatus is the causative agent of allergic broncho-pulmonary aspergillosis. Prompt and accurate diagnosis may be difficult to achieve with current clinical and laboratory scores, which do not include immune responses to recombinant A. fumigatus allergens. We measured specific immunoglobulin E and G4 directed to recombinant A. fumigatus allergens in 55 cystic fibrosis patients without allergic broncho-pulmonary aspergillosis but sensitized to A. fumigatus and in nine patients with allergic broncho-pulmonary aspergillosis (two with cystic fibrosis and seven with asthma). IgG4 responses to recombinant A. fumigatus allergens were detected in all patients, but neither prevalence nor levels were different between the two patient groups. On the other hand, both prevalence and levels of IgE responses to Asp f 3, Asp f 4, and Asp f 6 helped distinguish allergic broncho-pulmonary aspergillosis from A. fumigatus sensitization with good negative and positive predictive values.
Subject(s)
Antigens, Fungal/immunology , Aspergillosis, Allergic Bronchopulmonary/immunology , Aspergillus fumigatus/immunology , Immunoglobulin E/immunology , Immunoglobulin G/immunology , Adolescent , Adult , Antibodies, Bacterial/blood , Antibodies, Bacterial/immunology , Aspergillosis, Allergic Bronchopulmonary/epidemiology , Aspergillosis, Allergic Bronchopulmonary/microbiology , Child , Cystic Fibrosis/complications , Humans , Immunization , Male , Middle Aged , ROC Curve , Seroepidemiologic Studies , Young AdultABSTRACT
We report the case of a 21-month-old child suffering from pulmonary fibrosis, who presented with acute respiratory distress and liver damage, due to an accidental overdose of intravenous lipid emulsion. This poisoning is a rare entity, whose potential severity and almost exclusive iatrogenic effect deserve to be remembered.