scholarly journals Diagnostic and predictor role of some paraclinical markers in the differential diagnosis of acute infectious-inflammatory processes of the lower respiratory tract in children

2020 ◽  
pp. 14-21
Author(s):  
Ye.P. Ortemenka ◽  
◽  
S.I. Tarnavska ◽  
T.V. Krasnova ◽  
◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Epidemiology ◽  
Lung Parenchyma ◽  
Community Acquired Pneumonia ◽  
Chest Radiographs ◽  
Clinical Group ◽  
Different Ages

Diagnosis of acute infectious-inflammatory processes of the lower respiratory tract with a respect to justify etiotropic therapy is often based on evaluation of the activity of blood inflammatory markers and data of lungs' X-ray examination, but scientific evidence of their informativity in the differential diagnosis of community-acquired pneumonia and acute bronchitis is conflicting. Purpose — to study the predictor role of some paraclinical indices in the verification of infectious and inflammatory diseases of the lower respiratory tract (community-acquired pneumonia and acute obstructive bronchitis) in children of different ages in order to optimize the treatment. Materials and methods. To achieve the goal of the study, a cohort of patients with acute infectious-inflammatory pathology of children with different ages (75 patients) who received inpatient treatment at the pulmonology department of the Regional Children's Clinical Hospital in Chernivtsi has been formed by the method of simple random sampling. The first (I) clinical group was formed by 51 patients with a verified diagnosis of community-acquired pneumonia (CAP), acute course, and the second (II) clinical group included 24 children, in which the infiltrative acute process in the lungs was excluded, but who had broncho-obstructive syndrome. According to the main clinical characteristics, the comparison groups have been comparable. The results of the study have been analyzed by parametric («P», Student's criterion) and non-parametric («Рϕ», Fisher's angular transform method) calculation methods, and methods of clinical epidemiology with an evaluation of the diagnostic value of the tests has been performed taking into account their sensitivity (Se) and specificity (Sp), as well as attributive (AR) and relative (RR) risks, and the odd ratio (OR) of the event, taking into account their 95% confidence intervals (95% CI). Results. The analysis of the obtained dada has showed that in the patients with CAP such common inflammatory blood markers (leukocytosis, relative neutrophilosis, shift of leukocyte formula to the left, elevation of erythrocyte sedimentation rate (ESR) or high level of CRP — С-reactive protein) are characterized by low sensitivity (Se in range between 11% and 63%) indicating that they are inadvisable for use as the screening tests for the verification of pneumonia. At the same time, it has been shown that these inflammatory blood markers are characterized by sufficient specificity (in the range from 75% to 93%) in the verification of pneumonia only under their significant increase (total leukocyte count >15.0x109, ESR>10 mm/h and CRP level in blood >6 mg/ml), indicating that they are enough, but only for confirming inflammation of the lung parenchyma. From the standpoint of clinical epidemiology, it has been proved that the asymmetry of findings at lung radiographs (asymmetry of pulmonary enhancement, asymmetric changes of lung roots and, especially, the presence of infiltrative changes at lung parenchyma) are the most informative diagnostic tests in pneumonia verification (ST=90–95%) and have a statistically significant predictor role in the final diagnosis (OR=11.6–150). When assessing the hemogram in children of the II clinical group it has been found that only the relative number of band neutrophils <5%, as a diagnostic test, had an insignificant amount (16%) of false-positive results, which allows to use this marker in confirming the diagnosis of acute obstructive bronchitis, but not as its predictor (OR=2.21; 95% CI: 0.69–7.06) or screening test (Se=29%). At the same time, a significant diagnostic and predictor role of the chest X-ray examination in the differential diagnosis of acute BOS with pneumonia has been established. Namely, symmetrical alteration of the lung root architecture at chest radiographs in the absence of infiltrative changes in the pulmonary fields was characterized by few false-negative results (10%), which allow the use of this feature as a screening pattern in the diagnosis of acute obstructive bronchitis. The absence of changes of pulmonary at chest radiographs should be used to confirm the diagnosis of acute obstructive bronchitis (Sp=98%), but not as a screening sign due to the significant number of negative results in the presence of the disease (Se=48%). Conclusions. In general, the low diagnostic and predicting role of the common blood inflammatory markers for the diagnosis of acute inflammation of the lung parenchyma in children of different ages, as well as in the differential diagnosis of pneumonia and acute obstructive bronchitis have been confirmed. At the same time, it has been found that such radiological features as asymmetry of pulmonary pattern enhancement and the presence of asymmetric infiltrative changes of the lung parenchyma are the most informative diagnostic tests in the verification of pneumonia (Se=80–88% and Sp=90–95%), and have a statistically significant predictor role in the final diagnosis (OR=38.95–150). It has been shown that symmetrical changes of lung roots (their deformation, widening or infiltration) at chest radiographs in the absence of infiltrations in the pulmonary fields, as well as the absence of changes in the pulmonary pattern, have a statistically significant predictor role in the diagnosis of acute obstructive bronchitis (OR=20,78–55,0). The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution specified in the work. Informed consent was obtained from the parents of the children for the research. The authors declare no conflicts of interest. Key words: community-acquired pneumonia, obstructive bronchitis, children, diagnostic value, predictors.

scholarly journals Respiratory viral infections in the lower respiratory tract failure (Literature review)

2021 ◽  
Vol 13 (4) ◽  
pp. 5-13
Author(s):  
I. V. Babachenko ◽  
E. A. Kozyrev ◽  
E. V. Sharipova ◽  
E. D. Orlova ◽  
N. S. Tian
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Viral Infections ◽  
Community Acquired Pneumonia ◽  
Laboratory Diagnostics ◽  
Bacterial Strains ◽  
Lower Respiratory Tract Disease ◽  
Coronavirus Infection ◽  
Tract Disease

The sharp increase in viral pneumonia against the background of the pandemic of the new coronavirus infection SARS-CoV-2 requires more attention to the study of the role of viruses in damage to the lower respiratory tract, including their etiological significance in the development of community-acquired pneumonia. Modern possibilities of laboratory diagnostics make it possible not only to identify and study respiratory viruses, but also to help differentiate active viral infections as a cause of lower respiratory tract disease from virus carriers. The review describes the epidemiological and clinical features of the most relevant or less studied pneumotropic viral infections in children (respiratory syncytial, adenovirus, bocavirus, metapneumovirus), including their role in the etiology of pneumonia in children. Understanding the viral etiology of pneumonia in children will reduce the antibacterial load, which will help to reduce the side effects of chemotherapy and slow the emergence of antimicrobialresistant bacterial strains.

scholarly journals The Clinical Significance of the Primary Malignant Melanoma of the Lower Respiratory Tract and/or Lung Based on the Analysis of Published Case Reports and of Two Patients

1995 ◽  
Vol 1 (3) ◽  
pp. 169-175
Author(s):  
P. Barzó ◽  
K. Minik ◽  
P. Tuka ◽  
J. I. Kiss
Keyword(s):  
Malignant Melanoma ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Case Reports ◽  
Lung Parenchyma ◽  
Primary Malignant Melanoma ◽  
Biopsy Material ◽  
Diagnostic Endoscopy ◽  
Actual Size

Considering the data and including two patients of the authors, there exist only 18 authentic cases of primary malignant melanoma of the lower respiratory tract and/or the lung. The tumor was localized in the endobronchial space in 7 cases and only once in the trachea. Endobronchial localization, together with the involvement of the surrounding lung tissue, was found in two cases, whereas in 8 patients, the tumor was found exclusively in the lung parenchyma. Successful resection could be performed in 14 of the 18 cases. Survival was influenced primarily by operability, and on actual size and extension. The authors question the role of the obduction in the diagnostic criteria, because most of the survivors, even up to ten years postsurgery were considered primary. Apart from the various imaging methods, diagnostic endoscopy (i.e., bronchoscopy) and the histology of the biopsy material are major aides in the diagnosis of primary character, location, and operability, as well as in the elaboration of the surgical plans, than it is usual in cases of other tumors.

Respiratory tract damage with bocavirus infection in children

2020 ◽  
Vol 19 (2) ◽  
pp. 14-18
Author(s):  
E. V. Sharipova ◽  
I. V. Babachenko ◽  
M. A. Shcherbatyh
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Manifestations ◽  
Respiratory Viruses ◽  
Community Acquired Pneumonia ◽  
Human Bocavirus ◽  
Long Time ◽  
Clinically Significant ◽  
Tract Infections ◽  
Tract Damage

Long time the main pathogens associated with the development of community-acquired pneumonia were bacteria. However, in recent years in the Russian Federation, like all over the world, the view of the damage of lower respiratory tract changed, including a unique approach to community-acquired pneumonia as a bacterial infection, and respiratory viruses have become seen as a direct cause of lower respiratory tract damage, or as part of a viral-bacterial co-infection. These studies became possible since the widespread introduction of PCR techniques in the clinical setting, identification of respiratory viruses has increased and new microorganisms such, one as human bocavirus have been discovered. Objective: to study the features of respiratory tract damage in acute bocavirus infection in children of different ages. Materials and methods: A retrospective analysis of 97 medical hospital documentation of children with acute bocavirus infection, detected confirmed by PCR in nasopharyngeal aspirate. Results: In this work, it was shown that human bocavirus spread throughout the year with an increase in the incidence of clinically significant forms in the autumnwinter period, including during the period of an increase in the incidence of influenza. HBoV infection requiring hospitals is most significant in the first three years of life. In 74.2% of hospitalized children, bocavirus infection occurs with lower respiratory tract infections in the form of bronchitis — 77.8%, pneumonia — 28.9% and rarely bronchiolitis and is complicated by the development of respiratory failure in 28.9% of cases. Changes in the blood test are non-specific, and the level of C-reactive protein in children with various clinical manifestations of HBoV infection generally does not exceed 50 mg / l. An x-ray of the chest organs does not objectively reflect the existing volume and nature of the inflammatory process in the lungs.

scholarly journals Functional profiling of COVID-19 respiratory tract microbiomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Niina Haiminen ◽  
Filippo Utro ◽  
Ed Seabolt ◽  
Laxmi Parida
Keyword(s):  
Respiratory Tract ◽  
Carbohydrate Metabolism ◽  
Lower Respiratory Tract ◽  
Viral Infections ◽  
Lavage Fluid ◽  
Degradation Pathway ◽  
Community Acquired Pneumonia ◽  
The Body ◽  
Sequencing Data ◽  
Functional Profiling

AbstractIn response to the ongoing global pandemic, characterizing the molecular-level host interactions of the new coronavirus SARS-CoV-2 responsible for COVID-19 has been at the center of unprecedented scientific focus. However, when the virus enters the body it also interacts with the micro-organisms already inhabiting the host. Understanding the virus-host-microbiome interactions can yield additional insights into the biological processes perturbed by viral invasion. Alterations in the gut microbiome species and metabolites have been noted during respiratory viral infections, possibly impacting the lungs via gut-lung microbiome crosstalk. To better characterize microbial functions in the lower respiratory tract during COVID-19 infection, we carry out a functional analysis of previously published metatranscriptome sequencing data of bronchoalveolar lavage fluid from eight COVID-19 cases, twenty-five community-acquired pneumonia patients, and twenty healthy controls. The functional profiles resulting from comparing the sequences against annotated microbial protein domains clearly separate the cohorts. By examining the associated metabolic pathways, distinguishing functional signatures in COVID-19 respiratory tract microbiomes are identified, including decreased potential for lipid metabolism and glycan biosynthesis and metabolism pathways, and increased potential for carbohydrate metabolism pathways. The results include overlap between previous studies on COVID-19 microbiomes, including decrease in the glycosaminoglycan degradation pathway and increase in carbohydrate metabolism. The results also suggest novel connections to consider, possibly specific to the lower respiratory tract microbiome, calling for further research on microbial functions and host-microbiome interactions during SARS-CoV-2 infection.

scholarly journals The lung microbiota in Korean patients with non-tuberculous mycobacterial pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sung-Yoon Kang ◽  
Hyojung Kim ◽  
Sungwon Jung ◽  
Sang Min Lee ◽  
Sang Pyo Lee
Keyword(s):  
Principal Component Analysis ◽  
Respiratory Tract ◽  
Pulmonary Disease ◽  
Beta Diversity ◽  
Lower Respiratory Tract ◽  
Principal Component ◽  
Control Group ◽  
Flexible Bronchoscope ◽  
Bronchial Washing

Abstract Background The microbiota of the lower respiratory tract in patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD) has not been fully evaluated. We explored the role of the lung microbiota in NTM-PD by analyzing protected specimen brushing (PSB) and bronchial washing samples from patients with NTM-PD obtained using a flexible bronchoscope. Results Bronchial washing and PSB samples from the NTM-PD group tended to have fewer OTUs and lower Chao1 richness values compared with those from the control group. In both bronchial washing and PSB samples, beta diversity was significantly lower in the NTM-PD group than in the control group (P = 2.25E-6 and P = 4.13E-4, respectively). Principal component analysis showed that the PSBs and bronchial washings exhibited similar patterns within each group but differed between the two groups. The volcano plots indicated differences in several phyla and genera between the two groups. Conclusions The lower respiratory tract of patients with NTM-PD has a unique microbiota distribution that is low in richness/diversity.

scholarly journals Chest radiographs for acute lower respiratory tract infections

2013 ◽  
Author(s):  
Amy Millicent Y Cao ◽  
Joleen P Choy ◽  
Lakshmi Narayana Mohanakrishnan ◽  
Roger F Bain ◽  
Mieke L van Driel
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Chest Radiographs ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Role of diagnostic imaging in diagnosis by Covid-19

2020 ◽  
Author(s):  
Coda Marco ◽  
Sica Federica ◽  
Finelli Mirko ◽  
Ungaro Gaetano ◽  
Sica Alfonso Marco
Keyword(s):  
Differential Diagnosis ◽  
Lung Parenchyma ◽  
Chest Ct ◽  
Initial Assessment ◽  
X Rays ◽  
Radiological Imaging ◽  
Laboratory Examinations ◽  
Clinical Conditions

The diagnosis from Covid-19 provides the set of several examinations such as: clinical examinations, laboratory examinations, radiographic examinations. Using radiological imaging, RX and chest CT, it is possible to evaluate the impairment of lung function and thanks to this aspect it is possible to define the severity and clinical conditions of the patient. In this way, it allows timely therapeutic intervention especially if the patient shows a mild condition in such a way as to avoid the onset of further complications. Chest X-rays allow both an initial assessment of patients and the possibility to perform a differential diagnosis towards other possible causes of lung parenchyma involvement. The CT scan, which highlights the peculiar characteristics of COVID pneumonia, is performed both as diagnostic confirmation and in the patient’s follow-up.

Approach to the Patient with Cough

2018 ◽  
Author(s):  
Christopher H. Fanta
Keyword(s):  
Respiratory Tract ◽  
Chronic Cough ◽  
Lower Respiratory Tract ◽  
Airflow Obstruction ◽  
Sensory Nerve ◽  
Lung Parenchyma ◽  
Flow Volume ◽  
Respiratory Compromise ◽  
Cough Reflex ◽  
Persistent Cough

The cough reflex is critically important in the clearance of abnormal airway secretions and protection of the lower respiratory tract from aspirated foreign matter. A weak or ineffective cough can lead to respiratory compromise from even a relatively minor bronchial infection. Persistent cough is often one of a constellation of symptoms indicative of respiratory disease—a potential clue in the differential diagnosis of the patient’s illness. Given the widespread distribution of sensory nerve endings of the cough reflex throughout the upper and lower respiratory tract, it is not surprising that myriad respiratory diseases, involving lung parenchyma and airways, can manifest with cough. Sometimes cough is the sole or predominant symptom in a patient who is otherwise well. Evaluating and treating the patient with persistent cough who has few, if any, other respiratory symptoms is a common challenge for the practicing physician. This review covers the normal cough mechanism, impaired cough, pathologic cough, cough suppressant therapy, and new developments. Figures show a flow-volume loop during cough, a posteroanterior chest x-ray in a patient presenting with chronic cough, flow-volume curves and spirograms documenting expiratory airflow obstruction, and the approach to the patient with chronic cough. The table lists selected examples of extrapulmonary physical findings of potential importance in the assessment of cough. This review contains 4 highly rendered figures, 1 table, and 94 references.

scholarly journals Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010–2013

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Eric J Chow ◽  
Melissa A Rolfes ◽  
Ruth L Carrico ◽  
Stephen Furmanek ◽  
Julio A Ramirez ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Community Acquired Pneumonia ◽  
Vaccine Effectiveness ◽  
Self Report ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Radiographic Findings ◽  
History Of ◽  
Tract Infections

Abstract Background Preventing severe complications of influenza such as hospitalization is a public health priority; however, estimates of influenza vaccine effectiveness (VE) against influenza-associated acute lower respiratory tract infection (LRTI) hospitalizations are limited. We examined influenza VE against influenza-associated LRTIs in hospitalized adult patients. Methods We retrospectively analyzed data from a randomized trial of oseltamivir treatment in adults hospitalized with LRTI in Louisville, Kentucky, from 2010 to 2013. Patients were systematically tested for influenza at the time of enrollment. We estimated VE as 1 – the adjusted odds ratio (aOR) of antecedent vaccination in influenza-positives vs negatives × 100%. Vaccination status was obtained by patient self-report. Using logistic regression adjusting for age, sex, season, timing of illness, history of chronic lung disease, and activities of daily living, we estimated VE against hospitalized influenza-associated LRTIs and community-acquired pneumonia (CAP) with radiographic findings of infiltrate. Results Of 810 patients with LRTI (median age, 62 years), 184 (23%) were influenza-positive and 57% had radiographically confirmed CAP. Among influenza-positives and -negatives, respectively, 61% and 69% were vaccinated. Overall, 29% were hospitalized in the prior 90 days and &gt;80% had comorbidities. Influenza-negatives were more likely to have a history of chronic obstructive pulmonary disease than influenza-positives (59% vs 48%; P = .01), but baseline medical conditions were otherwise similar. Overall, VE was 35% (95% CI, 4% to 56%) against influenza-associated LRTI and 51% (95% CI, 13% to 72%) against influenza-associated radiographically confirmed CAP. Conclusions Vaccination reduced the risk of hospitalization for influenza-associated LRTI and radiographically confirmed CAP. Clinicians should maintain high rates of influenza vaccination to prevent severe influenza-associated complications.

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