Aetiology of chronic suppurative lung disease.

Forty one (1%) of 4000 children referred for respiratory disease had chronic suppurative lung disease not due to cystic fibrosis. Further investigations showed congenital malformations in six (15%), primary ciliary dyskinesia syndrome in seven (17%), 11 had immunological abnormalities (27%), and two bronchiectasis due to aspiration (5%). Therefore the underlying cause for the disease was found in 63%. Identification of predisposing causes may facilitate prevention of further bronchial damage.     

Diagnosing and preventing chronic suppurative lung disease (CSLD) and bronchiectasis

Current diagnostic labelling of childhood bronchiectasis by radiology has substantial limitations. These include the requirement for two high resolution computerised tomography [HRCT] scans (with associated adversity of radiation) if criteria is adhered to, adoption of radiological criteria for children from adult data, relatively high occurrence of false negative, and to a smaller extent false positive, in conventional HRCT scans when compared to multi-detector CT scans, determination of irreversible airway dilatation, and absence of normative data on broncho-arterial ratio in children. A paradigm presenting a spectrum related to airway bacteria, with associated degradation and inflammation products causing airway damage if untreated, entails protracted bacterial bronchitis (at the mild end) to irreversible airway dilatation with cystic formation as determined by HRCT (at the severe end of the spectrum). Increasing evidence suggests that progression of airway damage can be limited by intensive treatment, even in those predestined to have bronchiectasis (eg immune deficiency). Treatment is aimed at achieving a cure in those at the milder end of the spectrum to limiting further deterioration in those with severe 'irreversible' radiological bronchiectasis.     

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??The term pediatric chronic suppurative lung disease has a history of one hundred years, but with the progress of diagnosis and treatment technology and changes of disease spectrum, the concept of chronic suppurative lung disease has changed greatly in recent years. The concept has been redefined and a series of researches have been conducted. Chronic suppurative lung disease is a clinical syndrome and mainly manifest as repeated attacks of chronic wet cough. There are varied causes, and the diagnosis and etiology are particularly important. The updates on this concept complete a disease spectrum, and can help to early find out children who may develop into bronchiectasis. Early treatments and interventions can improve outcomes and reduce mortality.     

儿童慢性化脓性肺疾病临床特征及细菌药敏分析#br#

目的分析儿童慢性化脓性肺疾病的临床特点及细菌药敏结果。方法回顾分析2013年1月—2016年12月住院治疗的26例慢性化脓性肺疾病患儿的临床资料及支气管肺泡灌洗液(BALF)细菌培养药敏结果。结果 26例慢性化脓性肺疾病患儿的平均年龄(18.3±18.4)月,咳嗽病程(11.1±9.5)周。25例(96.2%)肺部可闻及中/粗湿啰音,22例(84.6%)肺部可闻及哮鸣音。17例(65.4%)临床拟诊迁延性肺炎,19例(73.1%)拟诊气道发育异常,7例(26.9%)拟诊支气管哮喘。支气管镜下均提示化脓性内膜炎,13例(50.0%)合并气道发育异常,BALF分类中性粒细胞显著升高。BALF中检出前三位的细菌依次为肺炎链球菌7株、大肠埃希菌6株、流感嗜血杆菌5株。检出的肺炎链球菌对阿莫西林耐药率较低(28.6%),对万古霉素、利奈唑胺、左氧氟沙星均敏感;检出的大肠埃希菌、流感嗜血杆菌对氨苄西林完全耐药,对哌拉西林耐药较严重,对亚胺培南、美洛培南、哌拉西林他唑巴坦、阿米卡星敏感性较好。结论儿童慢性化脓性肺疾病以婴幼儿多见,临床易误诊为迁延性肺炎、气道发育异常、支气管哮喘、肺炎链球菌为最常见病原体,对阿莫西林耐药率较低;大肠埃希菌、流感嗜血杆对抗生素的耐药问题严峻。     

Microbiological diagnostic procedures in respiratory infections: suppurative lung disease

Pursuing a microbiological diagnosis in suppurative lung disease can enable focused antibiotic therapy, identify pathogens of potential concern for infection control, and in some cases delineate a specific pathological process. Suppurative lung disease can be categorized as acute or chronic. Acute disease most commonly consists of lung abscess or parapneumonic empyema. The vast majority of chronic suppurative lung disease in childhood is due to cystic fibrosis. Samples from the respiratory tract offer the most useful information for diagnosis and management, but adjunctive information can also be obtained from serological methods, blood cultures and molecular techniques. The quality of respiratory tract samples is vital to aid accurate interpretation of results, and this varies according to the technique of collection. Antibiotic sensitivity testing is of particular importance in an era of evolving antibiotic resistance and can be problematical in cystic fibrosis.     

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慢性肺疾病(CLD),过去曾被称作支气管肺发育不良,是一组由多种原因引起的肺部疾患。CLD的发病机制极为复杂,其病因包括早产、极低出生体重、氧中毒、气压伤、容量伤、肺出血及肺部感染等。有关CLD的定义尚不统一,美国胸科学会2003年将婴儿慢性肺疾病(CLDI)的要点描述为:婴儿CLD是起始于新生儿期多种不同肺部疾患的最终结局;支气管肺发育不良(BPD)是其常见刺激因素,但许多其他因素也可引起气道和肺实质炎症而导致慢性气流阻塞、呼吸费力和气道反应性增高;病因除肺部潜在性疾病外,还包括机械通气、气压性损伤和氧中毒等支持治疗;这些…     

Aetiology of Kawasaki disease.

Thirteen serum samples from nine children with Kawasaki disease and 23 control samples gave negative results on screening for antibodies to hog cholera virus, border disease of sheep, bovine diarrhoea virus, and equine arteritis virus. The sera from two children with Kawasaki disease were cytotoxic; a possible link with cytotoxin from Propionibacterium acnes is considered.     

Dexamethasone therapy in chronic lung disease

Steroids have been used in the treatment of infants with chronic lung disease (CLD) for over a decade. Some studies have reported beneficial effects from long, tapering 42-day course of dexamethasone. Short term regimens have also shown beneficial effects on ventilator dependent infants with CLD. Although steroid therapy has been successful in infants with established CLD, more recently, dexamethasone therapy is being initiated in infants with RDS considered to be at risk for developing CLD. Some of the initial studies reported higher rates of infection, but more recent prospective data have not shown an increased incidence of sepsis in patients treated with steroids. Presently, early steroid therapy appears to be beneficial to minimize lung injury in infants treated with surfactant     

Ureaplasma urealyticum and chronic lung disease

Neonatal lower respiratory tract colonisation with mycoplasma organisms was examined for an association with chronic lung disease.Ureaplasma urealyticum colonised 9/70 (13%) infants less than 1500 g. Seven (78%) colonised and 33 (54%) non-colonised infants developed chronic lung disease. Logistic regression analyses revealed early gestation, but not mycoplasma colonisation, was independently associated with chronic lung disease.     

Strategies to prevent chronic neonatal lung disease

ABSTRACT The pathogenesis of chronic neonatal lung disease involves the combined iatrogenic insults of oxygen toxicity and barotrauma in addition to lung inflammation. Newer ventilator strategies using smaller tidal volumes (3–7 mL/kg) in order to avoid overdistension, higher positive end-respiratory pressure and lower peak inspiratory pressures decrease barotrauma. Earlier reduction of F _iO₂ through the use of surfactant, high frequency ventilation and nitric oxide reduce oxygen toxicity. Other measures include careful fluid balance, avoidance of prolonged paralysis and early steroids to decrease inflammation.     

新生儿慢性肺疾病与肾上腺皮质功能

新生儿皮质醇分泌缺乏正常生理节奏,且肾上腺皮质功能与胎龄相关。肾上腺皮质功能低下与新生儿慢性肺疾病（CLD）及其预后有一定关系,并可能对新生儿死亡率有影响。其机制尚不明确,可能是由于促炎症反应和抗炎症反应机制的不平衡引起,促炎症细胞因子大量增加使HPA轴调节受到抑制。目前肾上腺皮质功能不全没有统一的诊断标准。糖皮质激素作为抗炎剂,其应用有较好疗效,但是应小剂量、短疗程,并且应注意糖皮质激素的不良反应。     

Pulmonary vein stenosis mimicking chronic lung disease

The presence of recurrent respiratory symptoms and right heart enlargement in an ex-premature infant is suggestive of chronic lung disease. Pulmonary vein stenosis is a rare, progressive disorder that produces similar symptoms and signs. A case is reported in which pulmonary vein stenosis was revealed by Doppler echocardiography, and this application is recommended in similar cases. Pulmonary vein stenosis is an extremely rare and progressive disorder, which, if left untreated, is usually fatal. The possibility of this diagnosis may not be considered during clinical examination and may be overlooked during routine echocardiography.

Conclusion: This report describes a patient with pulmonary vein stenosis in whom the diagnosis was delayed as she had symptoms and signs more commonly associated with chronic lung disease.     

Acute deteriorations in neonatal chronic lung disease

Preterm infants with chronic lung disease (CLD) have frequent respiratory relapses. The aim of this study was to assess the aetiology of such deteriorations and in particular the proportion due to viral infections. During the study period 118 preterm infants with birth weight <1500g were consecutively admitted to the neonatal intensive care unit; 22 (18.6%) developed CLD. At the onset of all respiratory deteriorations, infants were examined for the presence of patent ductus arteriosus, apnoea or aspiration; they were also carefully screened for both viral and bacterial infection. The 22 infants had a total of 74 episodes of respiratory deterioration; median 3 per baby (range 1–8). Two episodes were associated with patent ductus arteriosus, 18 with apnoea and 5 with aspiration. Infection was suspected or proven in association with all other episodes. On ten occasions the infants had positive blood cultures and on a further eight, bacteria were isolated only from the endotracheal or nasopharyngeal secretions. On the remaining 31 occasions, 27 associated with chest X-ray film abnormalities, infection was suspected, but no bacteria isolated. Viral infections were identified in association with 8 (11%) of these episodes. We conclude viral infection should be considered as a cause of otherwise unexplained respiratory deteriorations in infants with neonatal CLD.