ABSTRACT
Mucoid impaction and plastic bronchitis are relatively rare disorders affecting patients of any age. Here we report the case of mucoid impaction developing in a four-year-old child as a complication of pneumonic infection treated four weeks prior. p.a. chest X-ray and fiberoptic bronchoscopy showed atelectasis and the location of a mucus cast in the left upper lobe. After extraction of the cast via the suction channel of the bronchoscope had failed, we administered 2.5 mg of undiluted recombinant human deoxyribonuclease (rhDNase) instilled directly over the affected area of occlusion for 15 minutes. This mucolytic agent mobilized the cast by reducing viscoelasticity and adherence of mucus. Subsequent extraction of the mucus cast was easy, resulting in immediate reduction of atelectasis and discharge of the child the following day. Treatment of severe mucus plugging by direct instillation of rhDNase has been a safe and efficacious procedure for mobilising adherent mucus plugs and for facilitating bronchoscopic extraction.
Subject(s)
Bronchitis/drug therapy , Bronchoscopes , Deoxyribonuclease I/administration & dosage , Expectorants/administration & dosage , Mucus/metabolism , Pulmonary Atelectasis/drug therapy , Recombinant Proteins/administration & dosage , Child, Preschool , Follow-Up Studies , Humans , Male , Radiography, Thoracic , Time Factors , Treatment OutcomeABSTRACT
Most allergic reactions after vaccination occur in patients sensitive to egg protein. Therefore this subject is well investigated, and the majority of common vaccines today contain only traces of egg protein. In contrast, there is little knowledge of hypersensitivities to other substances frequently contained in vaccines, e. g. antibiotics, phenol, gelatin and different preservatives. Here we report the case of a boy who had an anaphylactic reaction after being vaccinated against measles, mumps, rubella (MMR), and tick-born encephalitis (TBE) simultaneously. Different tests finally revealed a hypersensitivity to gelatin. This should be kept in mind especially during emergency care, since gelatin containing products like Haemaccel, Gelifundol or Gelofusin are widely used as colloid for resuscitation. If type 1 reactions after vaccination occur, gelatin should be taken into account as the causative agent. A medical alert card is recommended for such patients.
Subject(s)
Anaphylaxis/chemically induced , Gelatin/adverse effects , Measles-Mumps-Rubella Vaccine/adverse effects , Viral Vaccines/adverse effects , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Anti-Inflammatory Agents/therapeutic use , Bronchodilator Agents/therapeutic use , Follow-Up Studies , Humans , Male , Prednisolone/therapeutic use , Prednisone/therapeutic use , Theophylline/therapeutic use , Time Factors , Treatment OutcomeABSTRACT
Acute dyspnea is one of the most frequent pediatric emergencies in the medical practice. The severity of the condition ranges from mild and self-limiting to severe and life threatening. The primary care physician must recognize the clinical symptoms of impending respiratory distress in a child and, especially, in an infant or very young child who is not yet able to communicate verbally, so that the appropriate therapy can be initiated as quickly as possible and, therefore, to fundamentally influence the development of the condition. The most important clinical causes of dyspnea are croup, epiglottitis, foreign body aspiration, and bronchial obstruction.
