[Acute viral respiratory tract infections and childhood asthma].

Respiratory viral infections are very important triggers of asthma exacerbation. Recent epidemiologic studies support the hypothesis that they are associated with 80 to 85 % of acute attacks of asthma in children, both in mild exacerbations, and in more severe exacerbations leading to hospital admission. The respiratory syncytial and parainfluenza viruses are predominantly detected in infants, while rhinovirus and mycoplasma are the commonest viruses in children.

[Acute viral respiratory infections and asthma].

Respiratory viral infections are very important triggers of asthma exacerbation. Recent epidemiologic studies support the hypothesis that they are associated with 80 to 85% of acute attacks of asthma in children. The respiratory syncytial and parainfluenza viruses are predominantly detected in infants, while rhinovirus and mycoplasma are the commonest in children.

Efficacy of nebulized budesonide in treatment of severe infantile asthma: a double-blind study.

Background And Objective: Treatments with inhaled corticosteroids yielded conflicting results in infants with severe asthma. The purpose of this study was to assess the efficacy of nebulized budesonide on the control of asthma in this age group.

Methods: In a double-blind, placebo-controlled study, 40 infants with severe asthma received either nebulized budesonide (1 mg) or placebo twice daily for 12 weeks, followed by a follow-up period of up to 12 weeks.

[Allergic children].

Epidemiologic data have shown an increased prevalence (and severity) of atopy related diseases (asthma, eczema and allergic rhinitis) during the post 15-20 years. Atopic respiratory diseases such as allergic rhinitis and asthma represent the effects of an immunological response to allergens, mediated through immunoglobulins E. Development of a clinically significant atopic reaction depends on environmental exposure.

Short-term clinical measurement: acute severe episodes.

Clinical measurements are widely used to evaluate both the severity and outcome of acute and severe episodes of wheeze. A large number of clinical scores have been produced, rating the severity from 0 to 3 or 4. The heterogenicity of these clinical scores, their subjective nature, shown by the poor interobserver agreement and the poor correlation with oximetry, make comparison between trials very difficult.

Unapparent systemic dissemination of Mycobacterium tuberculosis.

A healthy 6-week-old girl exposed to tuberculosis presented a positive DNA amplification for Mycobacterium tuberculosis complex in gastric aspirates and cerebrospinal fluid whereas she had no other clinical or biological symptoms. Cultures were negative. This report underlines the interest of polymerase chain reaction for early diagnosis of tuberculosis and suggests the importance of treating exposed neonates and young infants just as active tuberculosis.

Pulmonary alveolar proteinosis: experience with eight pediatric cases and a review.

We report eight pediatric cases of pulmonary alveolar proteinosis (PAP) that illustrate the polymorphic nature of this disease: two cases with severe neonatal onset, three cases with progressive respiratory distress in patients under 1 year old, and three cases in older children with mild symptoms. Consanguineous parents or affected siblings were identified or suspected in four families. Three patients suffered from associated immune or blood disorders (severe combined immune deficiency, myelodysplasia).

[Inhalation therapy for asthma in children. Questions about effectiveness].

A better understanding of childhood asthma, a disease affecting 6 to 10% of the paediatric population, has led to the development inhalation systems which can provide undeniably effective therapy but also raise a certain number of questions as to the quantity of drug actually reaching the pulmonary airways. When aerosols, the reference system, are used with a good inhalation technique, as much as 80% of the active product goes no further than the oral cavity, only 10% reaching the intrapulmonary airways. In addition, the system requires a co-ordination between hand movements and inspiration which is beyond the capacity of children under 7 or 8 years of age.

Enhanced arachidonic acid metabolism in alveolar macrophages from wheezy infants. Modulation by dexamethasone.

To test the hypothesis that alveolar macrophages (AM) from wheezy infants release increased amounts of eicosanoids, as do AM from adults with asthma, we compared eicosanoid release by unstimulated- and ionophore-A23187-stimulated AM from 13 wheezy and six nonwheezy infants and analyzed its regulation by dexamethasone in vitro. Alveolar macrophages from wheezy infants released greater amounts of thromboxane A2 (TxA2) and leukotriene B4 (LTB4) under resting conditions and of TxA2 upon stimulation than did those from control subjects. Dexamethasone induced a dose-dependent inhibition of the spontaneous and A23187-stimulated release of TxA2, but not of the A23187-stimulated release of lipoxygenase products.

[Chronic septic granulomatosis revealed by neonatal pulmonary aspergillosis].

Background: Pulmonary aspergillosis is now the main cause of death in chronic granulomatous disease (CGD); it may occur before the age of one year and then often reveals CGD.

Case Report: A male newborn was referred to hospital at 27 days of age for fever (39 degrees C), hemodynamic failure and biological inflammation syndrome caused by pulmonary infection. Chest CT scan revealed multiple and bilateral intraparenchymatous nodules.

Azathioprine-induced pulmonary haemorrhage in a child after renal transplantation.

We report a case of azathioprine-induced haemorrhagic alveolitis, in a 14-year-old boy, after renal transplantation. On day 25 the patient developed haemoptysis, fever and hypoxaemia. Chest X-ray showed diffuse reticulo-nodular shadows in both lung fields.

Use of polymerase chain reaction for improved diagnosis of tuberculosis in children.

Objective: To study the value of a rapid diagnostic method based on the amplification by polymerase chain reaction (PCR) of a fragment of the IS6110 insertion element for the detection of Mycobacterium tuberculosis in children.

Design: We tested 199 specimens obtained from 68 children referred for evaluation of suspected tuberculosis.

Results: In 83.

Correlation between activity of beta-lactam agents in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis.

A study was conducted to determine whether a direct relationship exists between beta-lactam and/or aminoglycoside activity measured in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis. Twenty-seven patients, aged between 6 months and 24 years (mean age 10 1/2 years), were included in the study and received 41 i.v.

Sensitization to inhalant allergens in wheezing infants is predictive of the development of infantile asthma.

Early recognition of infantile asthma in wheezing infants is a major problem for physicians. We investigated whether detection of early sensitization to inhalant allergens would be useful to identify those wheezing infants who are likely to develop asthma. A total of 67 infants (aged 1-25 months) hospitalized for a wheezing episode were initially tested for reactivity to inhalant allergens by both skin prick test and in vitro measurement of specific IgE antibodies (Phadiatop).

Insulin responses to intravenous glucose and the hyperglycemic clamp in cystic fibrosis patients with different degrees of glucose tolerance.

The relationship between altered insulin secretion and impaired glucose tolerance was studied in 32 cystic fibrosis patients, 16 men and 16 women, aged 8-26 y, using oral and i.v. glucose tolerance tests and a hyperglycemic glucose clamp (10 mmol/L).

Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae.

Objective: Pulmonary dysfunction is common in children who survive bronchopulmonary dysplasia. Chest radiographs are not satisfactory for the identification of the sequelae of bronchopulmonary dysplasia because, although they often show abnormalities, the abnormalities are usually minor and sometimes absent. We therefore assessed the value of CT for identifying the sequelae of bronchopulmonary dysplasia.

Nonspecific refractoriness to adenylyl cyclase stimulation in alveolar macrophages from infants with recurrent bronchiolitis.

Epidemiologic studies suggest an association between recurrent bronchiolitis in children younger than 3 years of age and diagnosis of asthma later in life. Bronchoalveolar lavages from 20 infants with recurrent wheezing and 18 nonwheezy control subjects were analyzed to determine whether alveolar macrophages of wheezy infants present abnormalities similar to those described in adults with asthma. Alveolar macrophages from both groups responded in vitro, in a concentration-dependent manner, to prostaglandin E2, salbutamol, and forskolin, drugs that increase cyclic adenosine monophosphate levels.

[Value of ipratropium bromide in asthma crisis in children].

Ipratropium bromide is a synthetic derivative of atropine with little absorption when used in inhalation, and therefore little secondary effects. The authors review its pharmacological properties and therapeutic efficacy in the treatment of asthma in children. Combined nebulized inhalation of ipratropium bromide and beta 2 sympathomimetic results in a more efficient and more sustained bronchodilatation than beta 2 sympathicomimetic alone in the treatment of acute asthma in children.

Bronchiectasis in a child after acrolein inhalation.

Acrolein is an unsaturated aldehyde produced by combustion of many organic compounds. Massive exposure may lead to severe pulmonary disease and possibly death. We report a case of intoxication in a 2-year-old boy; an 18-month follow-up showed development of obstructive bronchiolar disease with diffuse bronchiectasis.

Computed tomography with normal chest radiograph in tuberculous infection.

Children with primary tuberculosis infection without disease must be identified and treated preventively to avoid an increase in the incidence of tuberculosis in children. However, the recognition of infected cases without disease is often difficult. In particular, minimal active disease may be present in many cases but unrecognised on chest radiography.