Normal gastrointestinal tract inflammatory cells and review of select benign hematolymphoid proliferations

The luminal gastrointestinal tract can be a site of robust immune response in which reactive lymphoproliferative processes can sometimes be difficult to distinguish from lymphoma. In this article, we review gastrointestinal tract normal resident inflammatory cells and common nonneoplastic lymphoproliferative responses with emphasis on their differential and links to lymphoma. Topics that are covered include lymphocytic esophagitis, gastric chronic inflammation, mucosa-associated lymphoid tissue, and ulceration, small intestinal lymphoid hyperplasia, celiac disease, microscopic colitis, inflammatory bowel disease, primary immunodeficiency, graft-versus-host disease, and anti-programmed cell death protein-1 effect. We additionally present the less common differential of histiocytic processes within the gastrointestinal tract. The aim of this paper is to serve as a reference for practicing pathologists facing lymphoid, lymphoplasmacytic, or histiocytic processes in the luminal gastrointestinal tract. We hope to help the practicing pathologist distinguish benign from malignant entities and identify features requiring further workup.     

Multivariate analyses of molecular genetic associations between childhood psychopathology and adult mood disorders and related traits

Ubiquitous associations have been detected between different types of childhood psychopathology and polygenic risk scores based on adult psychiatric disorders and related adult outcomes, indicating that genetic factors partly explain the association between childhood psychopathology and adult outcomes. However, these analyses in general do not take into account the correlations between the adult trait and disorder polygenic risk scores. This study aimed to further clarify the influence of genetic factors on associations between childhood psychopathology and adult outcomes by accounting for these correlations. Using a multivariate multivariable regression, we analyzed associations of childhood attention-deficit/hyperactivity disorder (ADHD), internalizing, and social problems, with polygenic scores (PGS) of adult disorders and traits including major depression, bipolar disorder, subjective well-being, neuroticism, insomnia, educational attainment, and body mass index (BMI), derived for 20,539 children aged 8.5–10.5 years. After correcting for correlations between the adult phenotypes, major depression PGS were associated with all three childhood traits, that is, ADHD, internalizing, and social problems. In addition, BMI PGS were associated with ADHD symptoms and social problems, while neuroticism PGS were only associated with internalizing problems and educational attainment PGS were only associated with ADHD symptoms. PGS of bipolar disorder, subjective well-being, and insomnia were not associated with any childhood traits. Our findings suggest that associations between childhood psychopathology and adult traits like insomnia and subjective well-being may be primarily driven by genetic factors that influence adult major depression. Additionally, specific childhood phenotypes are genetically associated with educational attainment, BMI and neuroticism.     

Childhood trauma and depression in alcoholics: relationship to hostility

OBJECTIVE: To examine for a relationship between childhood trauma and depression in alcoholics. METHODS: Euthymic depressed alcoholics (N = 23) were compared with never depressed alcoholics (N = 20) for their scores on the Childhood Trauma Questionnaire (CTQ). Subjects also completed the Hostility and Direction of Hostility Questionnaire (HDHQ). RESULTS: Euthymic depressed alcoholics had significantly higher scores on the CTQ for childhood emotional abuse, physical abuse, sexual abuse, and emotional neglect. They also had significantly higher hostility scores on the HDHQ. There were significant correlations between adult hostility scores and CTQ scores for childhood emotional neglect, physical neglect, sexual abuse and total childhood trauma. CONCLUSION: A history of childhood trauma was correlated with adult depression in male alcoholics: a hostile personality dimension might be a mediating variable. LIMITATION: Subjects were queried on their memories of childhood traumas. Prospective studies are needed.     

Drug-induced injury in the gastrointestinal tract

Abnormalities of the gastrointestinal tract due to drug-induced injuries are common and often have important clinical consequences. Medications may cause damage by direct corrosive effects on mucosae or by alter processes, mucosal immunity, and local environmental conditions. The aim of this review is to guide practicing pathologists in the identification of drug-related injuries in gastrointestinal mucosal biopsies and resection specimens. Common causes of injury and their gross, endoscopic, and microscopic features are presented.     

Clinical aspects of infantile asthma.

Infantile asthma presents a major therapeutic challenge to the practicing physician. The typical infant with asthma is a 14-month-old boy with recurrent episodes of wheezing since the age of seven months. Nasal eosinophilia is found less often than in older allergic children; however, 47 percent of infants with asthma will have either peripheral blood or nasal secretion eosinophilia to aid in the recognition of their atopic diathesis. The younger the infant (both at age of onset and at age of evaluation) the more likely are foods to be important factors in his allergic respiratory disease. His disease is unlikely to interfere with growth during infancy but may do so later in life. Hyposensitization is more likely to be required later in childhood if he does not respond to dietary manipulation. Despite appropriate therapy, wheezing may continue to be a problem during childhood and this is significantly correlated with the presence of a positive nasal smear at the time of initial allergy evaluation.     

The BeWo cell line derived from a human placental choriocarcinoma is permissive for respiratory syncytial virus infection

Virus Genes - The respiratory syncytial virus (RSV) is the main pathogen associated with upper respiratory tract infections during early childhood. Vertical transmission of this virus has been...     

Clinical features of influenza A and B in children and association with myositis.

Influenza virus is among the most common causes of respiratory illness, which may manifest as a range of conditions, from mild upper respiratory tract infection to bronchiolitis and pneumonia. Acute childhood myositis associated with influenza occurs mostly in influenza B infection. In this retrospective study, we analyzed the characteristics of 197 children with influenza virus treated from January 2000 to December 2001. Among them, 73 children had influenza A infection and 124 had influenza B infection. Influenza A virus outbreaks occurred in January 2000, July 2001, and December 2001, while influenza B virus outbreaks occurred from March 2000 to May 2000 and from December 2000 to February 2001. The most common clinical manifestations of influenza A and influenza B virus infection included fever, cough, and rhinorrhea. These infections also frequently manifested as laryngo-tracheobronchitis, pneumonia, and unexplained fever, which led to hospitalization. The most common clinical diagnosis was upper respiratory tract infection. The rates of benign acute childhood myositis in influenza A and influenza B were 5.5% and 33.9%, respectively. Creatine kinase levels were elevated in most myositis cases and boys were more commonly affected. Acute childhood myositis was more commonly seen in influenza B infection.     

Preeclampsia: Is it because of the asymptomatic,unrecognized renal scars caused by urinary tract infections in childhood that become symptomatic with pregnancy?

Preeclampsia is an important disease of pregnancy whose exact etiology is still unknown despite continuing developments in medicine. Although most commonly it is believed to be caused by a defective placentation, in this paper, we hypothesize that the primary underlying problem in the development of preeclampsia can be in kidneys in a greater proportion of cases than it is believed today. The increased intravascular volume and the increased work load of kidneys together with the resulting glomerular hypertrophy may precipitate nephrotic syndrome, which in this case is called “preeclampsia” in a previously affected kidney. Urinary tract infections in childhood leaving silent, unrecognized small scars in the kidneys may be the underlying renal cause which disrupts its silence with an increased work load of kidneys prominently occurring after the midtrimester. The histopathologic finding in kidneys with renal scars after childhood urinary tract infections and in preeclampsia is focal segmental glomerulosclerosis in the majority of cases and this similarity strengthens our hypothesis.     

Childhood trauma, borderline personality symptomatology, and psychophysiological and pain disorders in adulthood

In the empirical literature, there is support for the idea of a relationship between childhood trauma and various psychophysiological as well as pain disorders, and between borderline personality symptomatology and somatic preoccupation, as well as chronic pain. However, to date, no single study has examined the relationships between childhood trauma and borderline personality symptomatology, and the number of psychophysiological and pain disorders in adulthood. In this study, the authors examined these relationships and found no significant correlation between borderline personality symptomatology and the number of psychophysiological and pain disorders. However, there were positive and significant correlations between childhood physical abuse, emotional abuse, and witnessing violence and the number of psychophysiological and pain disorders in adulthood. Using hierarchical-regression analyses to determine which specific childhood traumas significantly predicted the number of psychophysiological and pain disorders, only witnessing violence emerged, accounting for 12% of the variance. These data suggest that a general factor associated with various forms of trauma predicts number of psychophysiological and pain disorders and that a specific predictor may be witnessing violence in childhood.     

A retrospective study of the relationship between childhood asthma and respiratory infection during gestation

BACKGROUND: Wheeze in children has been found to be associated with prior antepartum haemorrhage and raised levels of IgE in cord blood, and acute wheezing episodes are intimately linked with respiratory viral infections. OBJECTIVE: To assess the relationship between maternal presentation with respiratory tract infections in pregnancy and childhood asthma, taking into account factors which could affect presentation. METHODS: This was a case-control study of 200 asthmatic children, 5-16-year-old, age-matched with one control, having no recorded history of wheeze. Data on respiratory tract infections, maternal wheeze, atopy and smoking was collected from primary care records. Deprivation score was assessed according to small residential areas and subjects were equally distributed between four general practices in Plymouth, UK. RESULTS: Presentation with respiratory tract infections during pregnancy was significantly associated with childhood asthma (OR 1.69, 95% confidence interval 1.05-2.77, P = 0.03). The association was marginally stronger for infections in the first trimester (OR 2.30, 95% CI 1.05-5.41, P = 0.04) and for those with cough during pregnancy (OR 2.24, 95% CI 1.23-4.22, P = 0.007). The associations remained significant after allowing for the effect of the independent variables (gender, maternal smoking, maternal wheeze, allergic rhinitis, eczema, asthma treatment in pregnancy and deprivation [Townsend] score), using multiple logistic regression analysis (ORs and 95% CIs 1.91, 1.14-3.22; 2.32, 1.01-5.34 and 2.29, 1.17-4.48, respectively). There was also an association between numbers of presentations with respiratory infections and childhood asthma (test for trend, P = 0.02). CONCLUSIONS: This study has shown an association between presentation with respiratory infection during gestation and childhood asthma. The results were not affected by the other independent variable factors studied and therefore provide some evidence to support the theory that respiratory viruses may be implicated in the aetiology of asthma.     

A comparison of homeless women and their intimate partners

In this study, we examine differences among 448 homeless women and their male partners in terms of sociodemographic and psychological characteristics, risky sexual and drug-use behaviors, and childhood abuse and adult victimization. Findings reveal women scored significantly lower on mental health and self-esteem, and significantly higher on depression, anxiety, and hostility measures, than their intimate partners. Scores for the dyad were nevertheless indicative of poor mental health functioning. Homeless women and their intimate partners both reported low levels of injection drug-use (5% and 6%); higher percentages of both groups reported practicing unprotected sex (70% vs. 72%) and sex with multiple partners (26% vs. 23%). Homeless women were less likely to report non-injection drug use, but more likely to report childhood and adult sexual abuse, than their intimate partners. Implications for Acquired Immune Deficiency Syndrome (AIDS) risk reduction and safety enhancement programs for the dyad are discussed. © 1999 John Wiley & Sons, Inc.     

Relationship between childhood atopy and wheeze: what mediates wheezing in atopic phenotypes?

BACKGROUND: The nature of the relationship between childhood wheeze and atopy remains uncertain. OBJECTIVE: To characterize childhood wheeze among atopic phenotypes in a longitudinal birth cohort study. METHODS: A whole population birth cohort (N = 1,456) was recruited in 1989. Children were seen at birth and at 1, 2, 4, and 10 years of age to obtain information on asthma and allergic disease development and relevant risk factors for these states. Skin prick testing at ages 4 (n = 980) and 10 (n = 1,036) years was used to define atopic phenotypes. Wheezing in these states was characterized, and logistic regression was used to identify independent risk factors for wheeze onset in different atopic phenotypes. RESULTS: Wheeze ever occurred in 37% of never atopics, 38% of early childhood atopics, 65% of chronic childhood atopics, and 52% of delayed childhood atopics. Chronic childhood atopics had significant wheezing morbidity and bronchial hyperresponsiveness. Their wheezing was associated with male sex, early eczema, family history of eczema, and early tobacco exposure. Never atopic wheeze was related to maternal asthma, parental smoking, and respiratory tract infections. Exclusive breastfeeding protected against early childhood atopic wheeze. Maternal asthma, family history of urticaria, and dog ownership increased delayed childhood atopic wheeze. CONCLUSIONS: In many respects, chronic childhood atopy is the atopic phenotype associated with the most significant forms of childhood wheezing. In such children, heritable drive, allergens, and synergy with other environmental triggers seem to be crucial determinants of wheeze onset. Where such sensitization is absent, numerous environmental factors plus genetic predisposition may assume importance for wheezing.     

Papillary carcinoma of the thyroid gland and atresia of the common bile ducts of a five year old boy

Summary We present a case of papillary carcinoma of the thyroid gland with pulmonary metastases in a 5 year old boy. The child also suffered from atresia of the gallbladder and the common bile ducts with biliary cirrhosis of the liver and died from hepatic insufficiency. Possible correlations between childhood thyroid carcinoma and congenital malformations are discussed.     

Viral respiratory tract infections and asthma in early life: cause and effect?

Interactions between viral respiratory tract infections in infancy and childhood, and asthma development and exacerbation, are complex and intriguing. This review aims to unravel some of these complexities. Does severe respiratory viral infection early in life predispose to later asthma development, or is it indicative of a predisposition to allergic respiratory disease? How could variables such as age and severity of viral infection affect the interaction between respiratory viral infections and asthma? How could respiratory viral infection drive allergic sensitization? Here, we review the evidence surrounding these questions, and discuss current and future research and therapeutic approaches targeting the interplay between viral respiratory tract infection and asthma.     

The impact of respiratory viral infection on wheezing illnesses and asthma exacerbations

The etiology and morbidity associated with asthma are thought to stem from both genetic factors and potentially modifiable environmental factors, such as viral infections. Although it is unclear whether respiratory viral infections cause asthma, observational studies have demonstrated a high rate of asthma in children with a history of severe viral lower respiratory tract infections during infancy, and viruses are associated with the majority of asthma exacerbations among both children and adults. This article discusses the pathogens associated with virus-induced wheezing illnesses during infancy and early childhood, the association of bronchiolitis during infancy with an increased risk of childhood asthma, and the association of respiratory viruses with asthma exacerbations in older children and adults.     

Viral infections and asthma inception

Respiratory tract infections caused by viruses have been implicated in the pathogenesis of asthma. Of these respiratory pathogens, viruses have been demonstrated to be associated with asthma epidemiologically in at least 3 ways ( Fig 1 ). First, during infancy, certain viruses have been implicated in the inception of the asthmatic phenotype. Genetic susceptibility, particularly genes coding for atopic phenotypic characteristics, might differentiate, at least in part, those children who are destined to have persistent wheezing, asthma, or both later in childhood. Second, repeated exposure to infectious viruses in daycare centers or in households with multiple older siblings increases the number of respiratory infections, but in doing so, it might paradoxically reduce the long-term risk of allergies and asthma through either pre-existing or newly formed alterations in cytokine response profiles. Third, in patients with established asthma, particularly children, viral upper respiratory tract infections play a significant role in producing acute exacerbations of airway obstruction that might result in frequent outpatient visits or in hospitalizations. This review will highlight available data on respiratory syncytial virus infections and their relationship to asthma inception in childhood.     

Tucson Children's Respiratory Study: 1980 to present

The Tucson Children's Respiratory Study (TCRS), begun in 1980, has followed 1246 subjects from birth together with their family members to delineate the complex interrelationships between a large number of potential risk factors, acute lower respiratory tract illnesses, and chronic lung disorders later in childhood and early adult life, especially asthma. Nine hundred seventy-four (78%) of the original subjects are still being followed. Among its numerous findings, the TCRS has (1) described various wheezing disorders (transient, nonatopic, atopic) and their characteristics; (2) developed an Asthma Predictive Index; (3) delineated the respiratory and atopic outcomes for children who had respiratory syncytial virus-related wheezing illnesses in infancy; and (4) evaluated a large number of risk factors for acute respiratory tract illnesses during the first 3 years of life. Future TCRS studies will focus on (1) factors in infancy and early childhood that relate to persistent asthma and atopy; (2) role of genetic factors in persistent asthma; and (3) determinants of lung function decline in early adult life.     

Analysis of possible causes of recurrent respiratory tract infections in children from Lodz, Poland

Recurrent respiratory tract infections are responsible for about 85% of all diseases in childhood. Early diagnosis helps to prevent infections and start the appropriate treatment, what in turn prevents lungs from irreversible damage. The aim of this study was the analysis of possible causes of recurrent respiratory tract infections in children in Lodz region. We analyzed cases of 6335 children with recurrent respiratory tract infections, age 3 months to 17 years, referred to the clinic in our hospital by family doctors from 2000 to 2002. Among all children, 41.5% were diagnosed with allergy, 26.9% of patients had persistent Mycoplasma pneumoniae and 1.4% Bordetella pertussis infection. Very disturbing was the fact of very late cystic fibrosis diagnose at the age of 7,11 and 16. Congenital immune disorders were diagnosed late in five children at the age of 6,7,8,9,11, what delayed appropriate therapy and early prevention of infections.     

Diverse genotypes of Kaposi's sarcoma associated herpesvirus (KSHV) identified in infant blood infections in African childhood-KS and HIV/AIDS endemic region

Kaposi's sarcoma-associated herpesvirus (KSHV or HHV-8) has been associated with several neoplasias, including childhood endemic Kaposi's sarcoma (KS). It is possible that strain genotypes could contribute to the differences in regional presentation (mainly sub-Saharan Africa), childhood infection, lack of male sex bias, distinct disseminated forms and rapid fatality observed for childhood endemic KS. Early studies, at the advent of the HIV/AIDS epidemic, identified only the K1-A5 genotype in childhood KS biopsies as well as blood of a few HIV positive and negative febrile infants in Zambia, a highly endemic region. This current enlarged study analyses blood infections of 200 hospitalized infants (6-34 months age) with symptoms of fever as well as upper respiratory tract infection, diarrhoea, rash or rhinitis. KSHV and HIV viraemia and were prevalent in this group, 22% and 39%, respectively. Multiple markers at both variable ends of the genome (K1, K12, and K14.1/K15) were examined, showing diverse previously adult-linked genotypes (K1 A2, A5, B, C3, D, with K12 B1 and B2 plus K14.1/K15 P or M) detected in both HIV positive and negative infants, demonstrating little restriction on KSHV genotypes for infant/childhood transmission in a childhood endemic KS endemic region. This supports the interpretation that the acquisition of childhood KSHV infections and subsequent development of KS are due to additional co-factors.     

The diagnostic value of detecting eosinophilia of nasal secretions in allergic rhinitis

Nasal mucus eosinophilia was found in 92 per cent of adults with active hay fever. After an initial period of gaining experience in the method of collecting mucus, this was found to be a simple cheap method of demonstating an allergic component in the genesis of rhinitis. This test could be employed for detecting the relationship of allergic factors to chronic respiratory tract disease in childhood and in adults.