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Leon-Astudillo C, Dy FJ, McCown MY, Perez IA, Chhabra D, Bansal M, Maloney MA, Bedoya M, Ezmigna D, Bush D, Okorie CUA, Gross JE. ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants. Pediatr Pulmonol 2024; 59:1552-1568. [PMID: 38545994 DOI: 10.1002/ppul.26961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 05/28/2024]
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2023 American Thoracic Society International Conference. The respiratory disorders of infancy discussed in this year's review include: the care of the patient with bronchopulmonary dysplasia in the neonatal intensive care unit, clinical phenotypes and comorbidities; diffuse lung disease; pulmonary hypertension; central and obstructive sleep apnea. The care of infants with respiratory disorders often poses significant challenges to the general pediatric pulmonologist, sleep clinician, and neonatologist. This review aims to highlight the most clinically relevant aspects of the evaluation, management, and outcomes of infants with these key respiratory disorders, while emphasizing the importance of multidisciplinary care. Furthermore, this document summarizes essential aspects of genetic testing, novel imaging and treatment modalities, and includes multiple resources for clinical practice.
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Affiliation(s)
- Carmen Leon-Astudillo
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Fei J Dy
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Michael Y McCown
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Virginia, USA
| | - Iris A Perez
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Divya Chhabra
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Manvi Bansal
- Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Melissa A Maloney
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mariana Bedoya
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Monroe Carrell Jr. Children's Hospital of Vanderbilt, Nashville, Tennessee, USA
| | - Dima Ezmigna
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Douglas Bush
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Caroline U A Okorie
- Department of Pediatrics, Stanford Children's Health, Stanford, California, USA
| | - Jane E Gross
- Departments of Pediatrics and Medicine, National Jewish Health, Denver, Colorado, USA
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Guliyeva V, Demirkan FG, Yiğit RE, Esen E, Bayındır Y, Torun R, Kılbas G, Gezgin Yıldırım D, Otar Yener G, Cakan M, Demir F, Özturk K, Baglan E, Yuksel S, Bakkaloglu SA, Bora Makay B, Paç Kısaarslan A, Oray M, Bilginer Y, Eker Ömeroğlu R, Ozen S, Sozeri B, Aktay Ayaz N. A clinical overview of paediatric sarcoidosis: Multicentre experience from Turkey. Mod Rheumatol 2024; 34:639-645. [PMID: 37243724 DOI: 10.1093/mr/road050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/29/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES We aimed to outline the demographic data, clinical spectrum, and treatment approach of sarcoidosis in a large group of patients and sought to figure out the variations of early-onset (EOS) and late-onset paediatric sarcoidosis (LOS). METHODS The study followed a retrospective-descriptive design, with the analysis of medical records of cases diagnosed as paediatric sarcoidosis. RESULTS Fifty-two patients were included in the study. The median age at disease onset and follow-up duration were 83 (28.2-119) and 24 (6-48) months, respectively. Ten (19.2%) cases had EOS (before 5th birthday) and 42 (80.7%) cases had LOS. The most common clinical findings at the time of the disease onset were ocular symptoms (40.4%) followed by joint manifestation (25%), dermatological symptoms (13.5%), and features related to multi-organ involvement (11.5%). Anterior uveitis was the most common (55%) one among ocular manifestations. Patients with EOS displayed joint, eye, and dermatological findings more commonly than patients with LOS. The recurrence rate of disease in patients with EOS (5.7%) and LOS (21.1%) were not statistically different (P = .7). CONCLUSIONS Patients with EOS and LOS may present with variable clinical features and studies addressing paediatric sarcoidosis cases in collaboration between disciplines will enhance the awareness of this rare disease among physicians and assist early diagnosis with lesser complications.
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Affiliation(s)
- Vafa Guliyeva
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Fatma Gul Demirkan
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ramazan Emre Yiğit
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Science, Istanbul, Türkiye
| | - Esra Esen
- Department of Pediatric Rheumatology, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Yagmur Bayındır
- Division of Pediatric Rheumatology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ruya Torun
- Division of Pediatric Rheumatology, Dokuz Eylül Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Gulsah Kılbas
- Department of Pediatric Rheumatology, Pamukkale Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Deniz Gezgin Yıldırım
- Department of Pediatric Rheumatology, Gazi Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Gulcin Otar Yener
- Department of Pediatric Rheumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Türkiye
| | - Mustafa Cakan
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Science, Istanbul, Türkiye
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acibadem Hospital, Istanbul,Türkiye
| | - Kübra Özturk
- Department of Pediatric Rheumatology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Esra Baglan
- Department of Pediatric Rheumatology, University of Health Sciences, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Türkiye
| | - Selcuk Yuksel
- Department of Pediatric Rheumatology, Pamukkale Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Sevcan A Bakkaloglu
- Department of Pediatric Rheumatology, Gazi Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Balahan Bora Makay
- Division of Pediatric Rheumatology, Dokuz Eylül Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Merih Oray
- Department of Ophthalmology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Rukiye Eker Ömeroğlu
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Seza Ozen
- Division of Pediatric Rheumatology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Betul Sozeri
- Department of Pediatric Rheumatology, Ümraniye Research and Training Hospital, University of Health Science, Istanbul, Türkiye
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
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Nguyen AT, Koné-Paut I, Dusser P. Diagnosis and Management of Non-Infectious Uveitis in Pediatric Patients. Paediatr Drugs 2024; 26:31-47. [PMID: 37792254 DOI: 10.1007/s40272-023-00596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
Uveitis in children accounts for 5-10% of all cases. The causes vary considerably. Classically, uveitis is distinguished according to its infectious or inflammatory origin and whether it is part of a systemic disease or represents an isolated ocular disease. It is important to highlight the specificity of certain etiologies among children such as juvenile idiopathic arthritis. The development of visual function can potentially be hindered by amblyopia (children aged < 7 years), in addition to the usual complications (synechiae, macular edema) seen in adult patients. Moreover, the presentation of uveitis in children is often "silent" with few warning signs and few functional complaints from young children, which frequently leads to a substantial diagnostic delay. The diagnostic approach is guided by the presentation of the uveitis, which can be characterized by its location, and corresponds to the initial and main site of intraocular inflammation; its presentation, whether acute or chronic, granulomatous or not; and the response to treatment. Pediatricians have an important role to play and must be aware of the various presentations and etiologies of uveitis in children. Juvenile idiopathic arthritis is the most common etiology of pediatric non-infectious uveitis, but other causes must be recognized. Promptly initiated treatment before complications arise requires early diagnosis, recognition, and treatment. Any dependence on prolonged local corticosteroid therapy justifies discussing the introduction of a corticosteroid-sparing treatment considering the risk to develop corticoid-induced glaucoma and cataracts. Systemic corticosteroid therapy can be required for urgent control of inflammation in the case of severe uveitis. Long-lasting immunosuppressive treatment and biotherapies are most often prescribed at the same time to reinforce treatment efficacy and to prevent relapse and corticosteroid dependency. We review the different causes of uveitis, excluding infection, and the diagnostic and therapeutic management aimed at limiting the risk of irreversible sequelae.
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Affiliation(s)
- Ai Tien Nguyen
- Department of Pediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Université de Paris Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France.
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Université de Paris Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - Perrine Dusser
- Department of Pediatric Rheumatology, CeReMAIA, CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Université de Paris Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
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Jeon MH, Kang T, Yoo SH, Swan HS, Kim HJ, Ahn HS. The incidence, comorbidity and mortality of sarcoidosis in Korea, 2008-2015: a nationwide population-based study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:24-26. [PMID: 33093766 PMCID: PMC7569540 DOI: 10.36141/svdld.v37i1.7660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/10/2020] [Indexed: 01/13/2023]
Abstract
Background: Few national level, population-based studies are present on the epidemiology of sarcoidosis and it is unclear whether these patients have higher mortality than the general population. The objective of this study was to investigate the nationwide epidemiology, comorbidity and mortality in sarcoidosis in Korea. Material and Methods: For the period between 2008 to 2015, we used the national population-based database operated by Rare Intractable Disease registration program in which patients’ diagnosis are based on uniform criteria. All sarcoidosis patients were identified and followed-up using the National Health Insurance database to determine their incidence, comorbidity, mortality, causes of death and standardised mortality ratio (SMR). Results: During the study period, we identified 3,259 new sarcoidosis patients. The average annual incidence was 0.81 per 100,000. The annual mortality rate was 9.26 per 1,000 person-years. The mortality rate were significantly higher than those of the general population (SMR 1.91, 95% confidence interval 1.62-2.25). The major comorbidities of sarcoidosis patients were the diseases of the respiratory system (17.64%), heart (5.43%), eyes (4.27%) and cancer (2.3%). Mortality was higher in patients with lung involvement. Of the 84 deaths identified in this study from 2008-2013, the most common cause of death was cancer (41.7%), followed by respiratory disease (13.1%), sarcoidosis (13.1%) and heart disease (8.3%). Conclusions: We reported a nationwide incidence of sarcoidosis as 0.81 per 100,000 in Korea. The mortality of sarcoidosis patients was higher compared to the general population and the major causes of death were cancer, respiratory disease and sarcoidosis. Sarcoidosis patients with comorbid diseases showed increased mortality. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 24-36)
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Affiliation(s)
- Mi Hye Jeon
- Department of Public Health, Graduate School, Korea University
| | - Taeuk Kang
- Department of Public Health, Graduate School, Korea University
| | - Sang Hoon Yoo
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Daejeon St.Mary's Hospital, The Catholic University of Korea
| | - Heather S Swan
- School of Sociology and Anthropology, University of Ottawa
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University
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Bush A, Cunningham S, de Blic J, Barbato A, Clement A, Epaud R, Hengst M, Kiper N, Nicholson AG, Wetzke M, Snijders D, Schwerk N, Griese M. European protocols for the diagnosis and initial treatment of interstitial lung disease in children. Thorax 2015; 70:1078-84. [DOI: 10.1136/thoraxjnl-2015-207349] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/14/2015] [Indexed: 11/04/2022]
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Nathan N, Marcelo P, Houdouin V, Epaud R, de Blic J, Valeyre D, Houzel A, Busson PF, Corvol H, Deschildre A, Clement A. Lung sarcoidosis in children: update on disease expression and management. Thorax 2015; 70:537-42. [PMID: 25855608 DOI: 10.1136/thoraxjnl-2015-206825] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/16/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sarcoidosis is a rare lung disease in children. The aim of the present study was to provide update information on disease presentation and progression, patient management and prognosis factors in a cohort of children with lung sarcoidosis. METHODS With the network of the French Reference Centre for Rare Lung Diseases (RespiRare), we collected information on a large cohort of paediatric thoracic sarcoidosis to provide information on disease presentation, management and outcome. RESULTS Forty-one patients were included with a median age at diagnosis of 11.8 years (1.1-15.8), mostly from Afro-Caribbean and Sub-Saharan origin. At diagnosis, 85% presented with a multi-organic disease, and no major differences were found regarding disease severity between the patients diagnosed before or after 10 years old. Corticosteroids were the most used treatment, with more intravenous pulses in the youngest patients. The 18-month outcome showed that patients diagnosed before 10 years old were more likely to recover (50% vs 29%), and presented fewer relapses (29% vs 58%). At 4-5 years of follow-up, relapses were mostly observed for patients diagnosed after 10 years old. DISCUSSION In the included children, mostly of Afro-Caribbean and Sub-Saharan origin, sarcoidosis seems severe, with multi-organic involvement and foreground general symptoms. Common prognosis factors are not suitable in paediatric patients, and a young age at diagnosis does not seem to be associated with a poorer prognosis. The study is ongoing to provide further information on the very-long-term follow-up of paediatric sarcoidosis.
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Affiliation(s)
- Nadia Nathan
- Pediatric Pulmonary Department, AP-HP, Hôpital Trousseau, Paris, France Université Pierre et Marie Curie-Paris6, Paris, France UMR S-U933, Inserm, Paris, France
| | - Pierre Marcelo
- Pediatric Department, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Véronique Houdouin
- Pediatric Pulmonary Department, AP-HP, Hôpital Robert Debré, Paris, France
| | - Ralph Epaud
- Pediatric Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France U955, Equipe 11, Inserm, Créteil, France Faculté de Médecine, Université Paris-Est, Créteil, France
| | - Jacques de Blic
- Pediatric Pulmonary Department, AP-HP, Hôpital Necker Enfants Malades, Paris, France Université Paris Descartes-Paris5, Paris, France
| | - Dominique Valeyre
- AP-HP, Hôpital Avicenne, Pulmonary Department and l'Université Paris 13, COMUE Sorbonne Paris Cité, EA 2363, Bobigny, France
| | - Anne Houzel
- Pediatric Department, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | | | - Harriet Corvol
- Pediatric Pulmonary Department, AP-HP, Hôpital Trousseau, Paris, France Université Pierre et Marie Curie-Paris6, Paris, France UMR S-U933, Inserm, Paris, France
| | - Antoine Deschildre
- Pediatric Department, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Annick Clement
- Pediatric Pulmonary Department, AP-HP, Hôpital Trousseau, Paris, France Université Pierre et Marie Curie-Paris6, Paris, France UMR S-U933, Inserm, Paris, France
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Vougiouka O, Moustaki M, Nicolaidou P, Fretzayas A. The diversity of juvenile sarcoidosis symptoms. Prague Med Rep 2012; 113:240-5. [PMID: 22980565 DOI: 10.14712/23362936.2015.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We report a case of juvenile sarcoidosis, emphasizing the variety of clinical manifestations. The child had uveitis, which is among the most common manifestations of the disease. However, fever of unknown origin, glomerulonephritis and lymphadenopathy were also noticed, underscoring the diversity of the clinical spectrum of the disease.
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Affiliation(s)
- O Vougiouka
- 2nd Department of Pediatrics, Athens University School of Medicine, Athens, Greece
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8
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Nathan N, Taam RA, Epaud R, Delacourt C, Deschildre A, Reix P, Chiron R, de Pontbriand U, Brouard J, Fayon M, Dubus JC, Giovannini-Chami L, Bremont F, Bessaci K, Schweitzer C, Dalphin ML, Marguet C, Houdouin V, Troussier F, Sardet A, Hullo E, Gibertini I, Mahloul M, Michon D, Priouzeau A, Galeron L, Vibert JF, Thouvenin G, Corvol H, Deblic J, Clement A. A national internet-linked based database for pediatric interstitial lung diseases: the French network. Orphanet J Rare Dis 2012; 7:40. [PMID: 22704798 PMCID: PMC3458912 DOI: 10.1186/1750-1172-7-40] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/15/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILDs) in children represent a heterogeneous group of rare respiratory disorders that affect the lung parenchyma. After the launch of the French Reference Centre for Rare Lung Diseases (RespiRare®), we created a national network and a web-linked database to collect data on pediatric ILD. METHODS Since 2008, the database has been set up in all RespiRare® centres. After patient's parents' oral consent is obtained, physicians enter the data of children with ILD: identity, social data and environmental data; specific aetiological diagnosis of the ILD if known, genetics, patient visits to the centre, and all medical examinations and tests done for the diagnosis and/or during follow up. Each participating centre has a free access to his own patients' data only, and cross-centre studies require mutual agreement. Physicians may use the system as a daily aid for patient care through a web-linked medical file, backed on this database. RESULTS Data was collected for 205 cases of ILD. The M/F sex ratio was 0.9. Median age at diagnosis was 1.5 years old [0-16.9]. A specific aetiology was identified in 149 (72.7%) patients while 56 (27.3%) cases remain undiagnosed. Surfactant deficiencies and alveolar proteinosis, haemosiderosis, and sarcoidosis represent almost half of the diagnoses. Median length of follow-up is 2.9 years [0-17.2]. CONCLUSIONS We introduce here the French network and the largest national database in pediatric ILDs. The diagnosis spectrum and the estimated incidence are consistent with other European databases. An important challenge will be to reduce the proportion of unclassified ILDs by a standardized diagnosis work-up. This database is a great opportunity to improve patient care and disease pathogenesis knowledge. A European network including physicians and European foundations is now emerging with the initial aim of devising a simplified European database/register as a first step to larger European studies.
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Affiliation(s)
- Nadia Nathan
- AP-HP, Hôpital Trousseau, Pediatric Pulmonary Department, Paris, France.
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Abstract
Isolated cutaneous sarcoidosis is a rare multisystemic granulomatous disorder of unknown etiology. Cutaneous lesions have been classified into specific and nonspecific depending on the presence of noncaseating granulomas on histopathologic studies. Macrophages most likely initiate the response of sarcoidosis by presenting unidentified antigens to CD4+ lymphocytes. A persistent poorly degradable antigen-driven CMI response leads to cytokine cascade, granulomaformation, and fibrosis. In the present study, we report a case of isolated cutaneous sarcoidosis, localized to the face, in an adolescent girl without systemic manifestations which is a rare entity.
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Affiliation(s)
- Sumir Kumar
- Department of Dermatology, GGS Medical College and Hospital, Faridkot, Punjab, India
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The puzzling clinical spectrum and course of juvenile sarcoidosis. World J Pediatr 2011; 7:103-10. [PMID: 21574025 DOI: 10.1007/s12519-011-0261-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 12/18/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Juvenile sarcoidosis is a rare, chronic, multisystem, granulomatous disease of obscure etiology which is seen in childhood and adulthood. The disease in childhood has a course different from that in adulthood. DATA SOURCES PubMed database was searched using terms sarcoidosis, children or childhood sarcoidosis or juvenile sarcoidosis in combination with one of the following terms: epidemiology, clinical manifestations, genetics, diagnosis, treatment, and prognosis. We also retrieved the terms such as early onset sarcoidosis and Blau syndrome. Furthermore, e-medicine and European Respiratory Society monographs for sarcoidosis were reviewed. RESULTS Sarcoidosis in childhood presents with two age dependent, distinct forms. In younger children it is clinically evident before the age of four years and characterized by the triad of rash, arthritis and uveitis. In their older counterparts, the juvenile late onset sarcoidosis involves several organs and its clinical appearance resembles the adult type of the disease, with the respiratory system being most frequently affected (hilar lymphadenopathy, pulmonary infiltrations). Steroid is the main agent of treatment whereas methotrexate is also used for beneficial steroid sparing effects. New, novel therapies may change the outcome of the disease especially in difficult morbid cases. CONCLUSIONS Sarcoidosis in childhood is recognized as a systemic disease affecting various organs and having diverse clinical course depending on the age of onset.
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Clement A, Nathan N, Epaud R, Fauroux B, Corvol H. Interstitial lung diseases in children. Orphanet J Rare Dis 2010; 5:22. [PMID: 20727133 PMCID: PMC2939531 DOI: 10.1186/1750-1172-5-22] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 08/20/2010] [Indexed: 12/30/2022] Open
Abstract
Interstitial lung disease (ILD) in infants and children comprises a large spectrum of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. These disorders are characterized by inflammatory and fibrotic changes that affect alveolar walls. Typical features of ILD include dyspnea, diffuse infiltrates on chest radiographs, and abnormal pulmonary function tests with restrictive ventilatory defect and/or impaired gas exchange. Many pathological situations can impair gas exchange and, therefore, may contribute to progressive lung damage and ILD. Consequently, diagnosis approach needs to be structured with a clinical evaluation requiring a careful history paying attention to exposures and systemic diseases. Several classifications for ILD have been proposed but none is entirely satisfactory especially in children. The present article reviews current concepts of pathophysiological mechanisms, etiology and diagnostic approaches, as well as therapeutic strategies. The following diagnostic grouping is used to discuss the various causes of pediatric ILD: 1) exposure-related ILD; 2) systemic disease-associated ILD; 3) alveolar structure disorder-associated ILD; and 4) ILD specific to infancy. Therapeutic options include mainly anti-inflammatory, immunosuppressive, and/or anti-fibrotic drugs. The outcome is highly variable with a mortality rate around 15%. An overall favorable response to corticosteroid therapy is observed in around 50% of cases, often associated with sequelae such as limited exercise tolerance or the need for long-term oxygen therapy.
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Affiliation(s)
- Annick Clement
- Pediatric Pulmonary Department, Reference Center for Rare Lung Diseases, AP-HP, Hôpital Trousseau, Inserm UMR S-938, Université Pierre et Marie Curie-Paris 6, Paris, F-75012 France.
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Abstract
BACKGROUND The purpose of this study was to report our experience with intravenous propofol (IVP) sedation for flexible bronchoscopy (FB) in children. METHODS The following data were collected: demographics, pre- and post-procedure diagnoses, induction time (IT), sedation time (ST), procedure time (PT), time to discharge from the hospital (TTD), induction dose (ID) of IVP, total dose (TD) of IVP, and complications. HR, RR, systolic BP (SBP), diastolic BP (DBP), and SpO(2) were recorded every 5 min. RESULTS One hundred three (66 males, 37 females) consecutive patients (age: 4.7 +/- 4.3 years) and (weight: 21.2 +/- 16 kg) were enrolled over a 3-year-period. Airway Abnormalities were diagnosed in 93 (90%) patients leading to a change in therapy in 68 (66%) patients. In 20 (19.4%) patients abnormalities unrelated to the primary indication for FB were found. IT was 4.64 +/- 2 min, PT was 6.2 +/- 3.1 min, ST was 27 +/- 14 min, and TTD was 80 +/- 44 min.The ID and TD for IVP were 2.8 +/- 0.1 mg/kg, and 3.1 +/- 0.1 mg/kg respectively. Patients 4-7 years of age required higher induction doses (IDs) of propofol (3.5 +/- 1 mg/kg) compared to infants (2.8 +/- 0.9 mg/kg), 1-3 years of age (2.7 +/- 0.78 mg/kg) and 8-17 years of age (2.4 +/- 0.7 mg/kg) (P < 0.001). There was a correlation between the TD of IVP and TTD from the hospital (r = 0.5, P < 0.01). The drop in SBP (104 +/- 15 vs. 92 +/- 13 mm Hg, P < 0.05) and DBP (57 +/- 13 vs. 46 +/- 9 mm Hg, P < 0.05) during IVP were statistically significant compared to baseline, however none of the patients met the criteria for hypotension. Two patients developed short (<20 sec) respiratory pauses without hypoxia. No patient required fluid resuscitation or endotracheal intubation. CONCLUSIONS FB may be performed successfully in children using IVP and is associated with insignificant cardio-respiratory complications.
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Affiliation(s)
- Rashed A Hasan
- St. Vincent Mercy Children's Hospital, Toledo, Ohio, USA.
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Shetty AK, Gedalia A. Childhood sarcoidosis: A rare but fascinating disorder. Pediatr Rheumatol Online J 2008; 6:16. [PMID: 18811966 PMCID: PMC2559831 DOI: 10.1186/1546-0096-6-16] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 09/23/2008] [Indexed: 12/22/2022] Open
Abstract
Childhood sarcoidosis is a rare multisystemic granulomatous disorder of unknown etiology. In the pediatric series reported from the southeastern United States, sarcoidosis had a higher incidence among African Americans. Most reported childhood cases have occurred in patients aged 13-15 years. Macrophages bearing an increased expression of major histocompatibility class (MHC) II molecules most likely initiate the inflammatory response of sarcoidosis by presenting an unidentified antigen to CD4+ Th (helper-inducer) lymphocytes. A persistent, poorly degradable antigen driven cell-mediated immune response leads to a cytokine cascade, to granuloma formation, and eventually to fibrosis. Frequently observed immunologic features include depression of cutaneous delayed-type hypersensitivity and a heightened helper T cell type 1 (Th1) immune response at sites of disease. Circulating immune complexes, along with signs of B cell hyperactivity, may also be found. The clinical presentation can vary greatly depending upon the organs involved and age of the patient. Two distinct forms of sarcoidosis exist in children. Older children usually present with a multisystem disease similar to the adult manifestations, with frequent hilar lymphadenopathy and pulmonary infiltrations. Early-onset sarcoidosis is a unique form of the disease characterized by the triad of rash, uveitis, and arthritis in children presenting before four years of age. The diagnosis of sarcoidosis is confirmed by demonstrating a typical noncaseating granuloma on a biopsy specimen. Other granulmatous diseases should be reasonably excluded. The current therapy of choice for sarcoidosis in children with multisystem involvement is oral corticosteroids. Methotrexate given orally in low doses has been effective, safe and steroid sparing in some patients. Alternative immunosuppressive agents, such as azathioprine, cyclophosphamide, chlorambucil, and cyclosporine, have been tried in adult cases of sarcoidosis with questionable efficacy. The high toxicity profile of these agents, including an increased risk of lymphoproliferative disorders and carcinomas, has limited their use to patients with severe disease refractory to other agents. Successful steroid sparing treatment with mycophenolate mofetil was described in an adolescent with renal-limited sarcoidosis complicated by renal failure. Novel treatment strategies for sarcoidosis have been developed including the use of TNF-alpha inhibitors, such as infliximab. The long-term course and prognosis is not well established in childhood sarcoidosis, but it appears to be poorer in early-onset disease.
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Affiliation(s)
- Avinash K Shetty
- Division of Pediatric Rheumatology, Louisiana State University Medical Center and Children's Hospital of New Orleans, LA, USA.
| | - Abraham Gedalia
- Division of Pediatric Rheumatology, Louisiana State University Medical Center and Children's Hospital of New Orleans, LA, USA
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Hoffmann AL, Milman N, Byg KE. Childhood sarcoidosis in Denmark 1979-1994: incidence, clinical features and laboratory results at presentation in 48 children. Acta Paediatr 2007. [PMID: 14989436 DOI: 10.1111/j.1651-2227.2004.tb00670.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A L Hoffmann
- Department of Paediatrics, Hvidovre Hospital, University of Copenhagen, Denmark
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Lachman RS. S. TAYBI AND LACHMAN'S RADIOLOGY OF SYNDROMES, METABOLIC DISORDERS AND SKELETAL DYSPLASIAS 2007. [PMCID: PMC7315357 DOI: 10.1016/b978-0-323-01931-6.50027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Heyer CM, Mueller KM, Seiffert P, Nicolas V, Rieger CHL, Nuesslein TG. Pulmonary sarcoidosis in a 14-year-old boy diagnosed by low-dose CT-guided transthoracic lung biopsy. Pediatr Pulmonol 2006; 41:269-74. [PMID: 16429435 DOI: 10.1002/ppul.20354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary sarcoidosis is a rare disease in the pediatric age group, characterized by the presence of epitheloid-cell granulomas. In stage 3 sarcoidosis, pulmonary infiltrates without hilar lymphadenopathy occur. Definitive diagnosis requires a histopathological specimen, which might be difficult to obtain by transbronchial biopsy. Multidetector computed tomography (MDCT)-guided transthoracic lung biopsy (TLB) is a well-established procedure in adults, but has only rarely been applied in children.A 14-year-old boy was admitted to hospital for evaluation of a chronic systemic disease with severe pulmonary manifestation. All investigations, including bronchosopy and bronchoalveolar lavage with microbiological and virological testing, had been negative. MDCT-guided TLB was performed on a 16-section scanner with a low-dose protocol (single slices, 120 kV, 20 mAs), using a 16-gauge biopsy device. The total effective dose was 0.4 mSv for the biopsy procedure. Histopathological examination revealed multiple epitheloid-cell granulomas with giant cells in the absence of microbiological or virological abnormalities. A diagnosis of stage 3 pulmonary sarcoidosis was made and systemic anti-inflammatory therapy was administered, which led to complete remission within weeks. MDCT-guided TLB can be a valuable instrument in assessing pulmonary manifestations of pediatric sarcoidosis, enabling precise histopathological diagnosis and adequate therapy. The use of low-dose protocols can substantially reduce radiation exposure without relevant loss of image information. MDCT-guided lung biopsy should be considered prior to open-lung surgery in selected patients with unclear pulmonary disease.
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Affiliation(s)
- C M Heyer
- Institute of Diagnostic Radiology, Interventional Radiology, and Nuclear Medicine, Berufgenossenschaftliche Kliniken Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany.
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Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown aetiology, most commonly affecting young adults. Divergent prevalence rates and clinical appearances in different races indicate the existence of predisposing genes, with probably a major effect of the major histocompatibility complex. The diagnosis is relatively rare in children. Lesions can occur in almost any tissue or organ but the lungs, lymph nodes, eyes, skin and liver are the most commonly involved. Clinical symptoms are non-specific and often minor. The diagnosis can only be supported by typical histopathological findings with non-caseating epithelioid-cell granulomas. The prognosis seems to be more severe in younger children and in cases of multi-organ involvement. Corticosteroids are the therapeutic agents most commonly used and are indicated in cases of significant lung or eye lesions, cardiac, neurological, or multiorgan involvement. Close monitoring is mandatory during and after treatment because relapses are common.
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Affiliation(s)
- Brigitte Fauroux
- Pediatric Pulmonology and Research Unit INSERM U719, Hôpital Armand Trousseau, 28 avenue du Docteur Arnold Netter, 75012 Paris, France.
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Abstract
The spectrum of pediatric interstitial lung disease (PILD) includes a diverse group of rare disorders characterized by diffuse infiltrates and disordered gas exchange. Children with these conditions typically present with tachypnea, crackles, and hypoxemia. Recent advances have been made in the identification of different types of PILD that are unique to infancy. More exciting has been the discovery of genetic abnormalities of surfactant function, now described in both children and adults. A systematic evaluation of the child presenting with diffuse infiltrates of unknown etiology is essential to the diagnosis. Most often, lung biopsy is required. Current treatment options remain less than satisfactory, and morbidity and mortality remain considerable.
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Affiliation(s)
- Leland L Fan
- Pediatric Pulmonary Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston 77030-2399, USA.
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Fauroux B, Onody P, Gall O, Tourniaire B, Koscielny S, Clément A. The Efficacy of Premixed Nitrous Oxide and Oxygen for Fiberoptic Bronchoscopy in Pediatric Patients. Chest 2004; 125:315-21. [PMID: 14718459 DOI: 10.1378/chest.125.1.315] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE s: The aim of the study was to evaluate the efficacy and safety of premixed 50% nitrous oxide and oxygen on the quality of sedation and pain control during fiberoptic bronchoscopy (FB) in children. DESIGN A prospective, randomized, double-blind study. SETTING Pediatric pulmonary department in a pediatric tertiary university hospital. PATIENTS One hundred five children aged 1 month to 18 years. INTERVENTIONS Patients inhaled after sedation and local anesthesia either premixed 50% nitrous oxide and oxygen (nitrous oxide group) or premixed 50% nitrogen and oxygen (control group) during FB. MEASUREMENT AND RESULTS The rate of failure was significantly greater in the control group (62%) than in the nitrous oxide group (21%, p = 0.00003). The efficacy of premixed 50% nitrous oxide and oxygen was also demonstrated with higher satisfaction scores (p = 0.000001), lower Children's Hospital of Eastern Ontario Pain Scores (p = 0.002), better visual analog scale ratings (p = 0.03), and improved behavior scores. Side effects were minor and similar in both groups. CONCLUSIONS This study demonstrates the improved efficacy of sedation, pain control, and safety of premixed 50% nitrous oxide and oxygen for FB in children.
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Affiliation(s)
- Brigitte Fauroux
- Service de Pneumologie Pédiatrique et INSERM 213, Hôpital d'Enfants Armand Trousseau, Paris, France.
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Baculard A, Blanc N, Boulé M, Fauroux B, Chadelat K, Boccon-Gibod L, Tournier G, Clement A. Pulmonary sarcoidosis in children: a follow-up study. Eur Respir J 2001; 17:628-35. [PMID: 11401056 DOI: 10.1183/09031936.01.17406280] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Progression of pulmonary sarcoidosis in children remains poorly documented. The aim of this work was to gather follow-up information on pulmonary outcomes in children with sarcoidosis and to obtain data of relevance to a discussion of the optimal length and regimen of glucocorticoid therapy. In the present study, the authors experience of pulmonary sarcoidosis in 21 children referred to the paediatric pulmonary department over a 10-yr period is reported with a documented follow-up of at least 4 yr. Evaluation of the disease during the follow-up included analysis of clinical manifestations, chest radiographs, pulmonary function tests with measurements of the vital capacity (VC), dynamic lung compliance (CL,dyn), lung transfer for CO (TL,CO), and arterial blood gases, as well as bronchoalveolar lavage (BAL) with determination of total and differential cell counts. After initial evaluation the decision was a careful observation of four children without therapy. Corticosteroid treatment was initiated in 17 children. Analysis of results indicated that after 6-12 months of treatment most clinical manifestations of the disease and chest radiograph abnormalities disappeared, and beneficial effects on VC and TL,CO were apparent. After 18 months of steroids no benefit on pulmonary function tests could be noticed, with mainly persistence of alterations of CL,dyn. Results of BAL studies documented the presence of an alveolitis with increased lymphocyte populations throughout the follow-up. Relapses were observed in four children during tapering of prednisone; they were not reported after discontinuation of steroid therapy. Taken together data obtained in the presented population can lead to the following suggestions for the management of pulmonary sarcoidosis in children. BAL should be performed at the initial evaluation to document alveolitis; however, nothing seems to be gained from repeating this investigation during follow-up in the absence of specific reasons. Once the decision to initiate glucocorticoid therapy is made, 18 months may be a reasonable treatment duration. Discontinuation of therapy can be decided even if the pulmonary function tests remain abnormal, but the child should then be carefully monitored for a relapse.
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Affiliation(s)
- A Baculard
- Dept de Pneumologie Pediatrique-INSERM U515, Hĵpital Armand Trousseau, Paris, France
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Abstract
Diagnostic flexible endoscopy for pediatric respiratory diseases is performed in many centers. Technical advances have resulted in performance of interventional bronchoscopies, and new diagnostic indications are being explored. Indications with documented clinical benefit include congenital or acquired progressive or unexplained airway obstruction. Pulmonary infections in immunodeficient children who do not respond to empirical antibiotic treatment may be diagnosed by bronchoscopy and bronchoalveolar lavage (BAL). The potential usefulness of bronchoscopy and BAL for managing chronic cough, wheeze, or selected cases with asthma or cystic fibrosis requires further study. The use of transbronchial biopsies (TBB) is established in pediatric lung transplantation. The role of TBB in the diagnosis of chronic interstitial lung disease in children remains to be determined. For a number of interventional applications, rigid endoscopy is required, and pediatric bronchoscopists should be trained in its use. Complications in pediatric bronchoscopy are rare, but severe nosocomial infection or overdosing with local anesthetics has occurred. The issues of quality control, video documentation, interobserver variability of findings, and educational standards will have to be addressed in the future as bronchoscopy use becomes less restricted to only large pediatric pulmonary units.
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Affiliation(s)
- T Nicolai
- Universität Kinderklinik München, Dr. von Haunerschen Kinderspital, Munich, Germany.
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Hacking D, Smyth R, Shaw N, Kokia G, Carty H, Heaf D. Idiopathic pulmonary fibrosis in infants: good prognosis with conservative management. Arch Dis Child 2000; 83:152-7. [PMID: 10906025 PMCID: PMC1718422 DOI: 10.1136/adc.83.2.152] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pulmonary interstitial fibrosis in children is a disease of unknown aetiology, usually associated with a poor prognosis. METHODS In this case series we describe 11 children presenting over a 10 year period, managed conservatively and associated with a good prognosis. RESULTS In six, symptoms were present from birth and 10 had symptoms at or before 3 months. Diagnosis was made using chest computed tomography and percutaneous lung biopsy. All patients were treated with oral prednisolone. In five no steroid response was noted. One patient responded to hydroxychloroquine. Home oxygen was required in five patients. At follow up all patients are alive at a median age of 6 years (range 1 to 12 years). The two recently diagnosed children have significant symptoms, seven have dyspnoea on exercise, and two are symptom free. CONCLUSION The good prognosis seen in these patients is different to previous case reports, indicating a greater than 50% mortality.
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Affiliation(s)
- D Hacking
- Neonatal Unit, Royal Children's Hospital, Flemington Road, Melbourne, Australia.
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Schellhase DE, Tamez JR, Menendez AA, Morris MG, Fowler GW, Lensing SY. High fever after flexible bronchoscopy and bronchoalveolar lavage in noncritically ill immunocompetent children. Pediatr Pulmonol 1999; 28:139-44. [PMID: 10423314 DOI: 10.1002/(sici)1099-0496(199908)28:2<139::aid-ppul10>3.0.co;2-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) have been applied increasingly to the evaluation of pulmonary disease in children. Although several complications have been reported following FB and BAL, high fever after BAL in immunocompetent children has not previously been reported. To determine the frequency, clinical characteristics, and outcome of these complications in children who developed high fever post-BAL, we retrospectively reviewed all bronchoscopic procedures done on an outpatient basis between August 1995 and July 1997. We identified 78 immunocompetent noncritically ill children who had undergone FB and BAL as an outpatient procedure for evaluation of underlying pulmonary disease, of whom 13 (17%) developed temperature (T) higher than or equal to 39 degrees C (fever group). The 13 patients in the fever group had a median age of 10 (range, 4-48) months and a reported T of 39.4 degrees C (39.1-40.6 degrees C) occurring 7.5 (4-12) hr after BAL. To determine if there were differences in clinical or BAL fluid (BALF) characteristics, we compared each child in the fever group to two children in the nonfever group, based upon primary indications and age. There were no differences in demographic or clinical characteristics between the two groups. Lymphocyte concentrations in BALF were significantly reduced in the fever group (P = 0.03). An abnormal BALF cell differential (defined as one or more of the following: neutrophils >10%, lymphocytes >30%, or eosinophils >1%) was significantly more common in the fever group (P = 0.008, odds ratio 3.6). We conclude that high fever is a frequent adverse event following BAL in noncritically ill immunocompetent children with underlying pulmonary disease. Pre-BAL clinical characteristics are not associated with development of high fever. However, the finding of an abnormal BALF cell differential is strongly associated with development of high fever post-BAL.
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Affiliation(s)
- D E Schellhase
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Desmarquest P, Tamalet A, Fauroux B, Boule M, Boccon-Gibod L, Tournier G, Clement A. Chronic interstitial lung disease in children: response to high-dose intravenous methylprednisolone pulses. Pediatr Pulmonol 1998; 26:332-8. [PMID: 9859902 DOI: 10.1002/(sici)1099-0496(199811)26:5<332::aid-ppul5>3.0.co;2-q] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The prognosis for children with chronic interstitial lung disease is poor and the mortality rate is high, especially in infants. This explains the many therapeutical protocols which have been proposed and investigated by several authors. In the present work, we evaluated the response of three infants with idiopathic pulmonary fibrosis to high-dose intravenous prednisolone pulses. The patients were referred to the department at the age of 4, 17, and 3 months, respectively. The diagnosis was confirmed by open lung biopsy and intravenous pulse methyl prednisolone therapy was started with the following protocol: 300 mg/m2 methylprednisolone daily for 3 days, repeated every 4 to 6 weeks. Because of the extreme severity of the respiratory distress at the time of diagnosis, the intravenous pulse treatments were initially complemented by oral prednisone. Clinical improvement was noticed within 6 months with progressive correction of hypoxemia. After follow-up for 3.5 to 4 years, with a total number of pulses of 37, 26, and 32, respectively, the children are symptom-free and do not require oxygen supplementation. During this period, no side effects and no adrenal insufficiency could be documented. Based on current knowledge of steroid action, it can be speculated that the response to intermittent high-dose intravenous methylprednisolone may explain the ability of this mode of hormone administration to maintain an adequate level of glucocorticoid receptor expression. More information and trials through multicenter collaborations are needed to assess therapeutical protocols of repeated high-dose intravenous steroid treatment.
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Affiliation(s)
- P Desmarquest
- Department of Pediatric Pulmonology-INSERM U142, Hopital Trousseau, St Antoine Medical School, University of Paris, France
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Abstract
In the development of lung damage induced by oxidative stress, it has been proposed that changes in alveolar macrophages (AM) function with modifications in cytokine production may contribute to altered repair processes. To characterize the changes in profiles of cytokine production by macrophages exposed to oxidants, the effects of hyperoxia (95% O2) on interleukin (IL)-1 beta, IL-6, IL-8, and tumour necrosis factor-alpha (TNF-alpha) expression were studied. Experiments were first performed using AM obtained from control subjects and children with interstitial lung disease. Results showed that a 48 h O2 exposure was associated with two distinct patterns of response: a decrease in TNF-alpha, IL-1 beta and IL-6 expression, and an increase in IL-8. To complete these observations we used U937 cells that were exposed for various durations to hyperoxia. We confirmed that a 48 h O2 exposure led to similar changes with a decrease in TNF-alpha, IL-1 beta and IL-6 production and an increase in IL-8. Interestingly, this cytokine response was preceded during the first hours of O2 treatment by induction of TNF-alpha, IL-1 beta and IL-6. These data indicate that hyperoxia induces changes in the expression of macrophages inflammatory cytokines, and that these modifications appear to be influenced by the duration of O2 exposure.
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Affiliation(s)
- P Desmarquest
- Department of Pediatric Pulmonology-INSERUM U142, Trousseau Hospital, St. Antoine Medical School, University of Paris, France
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Fan LL, Lung MC, Wagener JS. The diagnostic value of bronchoalveolar lavage in immunocompetent children with chronic diffuse pulmonary infiltrates. Pediatr Pulmonol 1997; 23:8-13. [PMID: 9035193 DOI: 10.1002/(sici)1099-0496(199701)23:1<8::aid-ppul1>3.0.co;2-n] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We have investigated the diagnostic value of (BAL) in 29 immunocompetent children (ages 1 month to 18 years) with chronic diffuse pulmonary infiltrates on chest radiograph who presented for evaluation over a 3-year period. The median age at the time of the BAL was 20 months with a range of 1-210 months. Positive results (1) diagnostic of a primary disorder; (2) consistent with a diagnosis; or (3) diagnostic of a secondary disorder, were obtained in 20/29 patients (13 with a single positive BAL finding and 7 with more than one finding). BAL was diagnostic of a primary disorder in only 5 patients (17%) with aspiration detected in 3 and infection in 2. The differential diagnosis was narrowed in 15 patients by the presence of lymphocytosis, neutrophilia, or eosinophilia. A secondary disorder was uncovered in 8 patients. Negative results were obtained in 9 additional patients. We conclude that BAL provided useful information in children with chronic diffuse infiltrates, but its ability to determine the primary cause was limited.
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Affiliation(s)
- L L Fan
- Pediatric Pulmonary Section, Baylor College of Medicine, Houston, Texas, USA
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Osika E, Muller MH, Boccon-Gibod L, Fauroux B, Sardet A, Grosskopf C, Couvreur J, Tournier G, Clement A. Idiopathic pulmonary fibrosis in infants. Pediatr Pulmonol 1997; 23:49-54. [PMID: 9035198 DOI: 10.1002/(sici)1099-0496(199701)23:1<49::aid-ppul6>3.0.co;2-k] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Idiopathic pulmonary fibrosis is a poorly characterized disease in infants. In the present report, we reviewed our experience with 10 infants during a 10-year period. In 9 patients, onset of symptoms occurred before the age of 2 months and included tachypnea, cough, and inadequate weight gain. However, despite the presence of these symptoms, diagnosis was delayed for 3 months at which time the infants were referred to the pediatric pulmonary department, when the diagnosis was confirmed by open lung biopsy. At the time of admission, bronchoscopy with alveolar lavage was performed in 9 children and showed severe alveolitis with an increase in the neutrophil count. Nine infants were treated with prednisone alone or in combination with chloroquine, colchicine, or cyclophosphamide; all these patients died despite treatment. One infant was treated with pulses of methylprednisolone because of a failure in response to oral prednisone. This girl who displayed similar clinical, radiological, and histological abnormalities as the other children at the time of diagnosis is the only child still alive after 3 years of follow-up. She is now free of respiratory symptoms and has a normal growth curve. The present report raised two important points: (1) a thorough evaluation of characteristic symptoms should lead to an early diagnosis of pulmonary fibrosis in infants; and (2) administration of pulse therapy using corticosteroids has been helpful and needs to be evaluated further.
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Affiliation(s)
- E Osika
- Department of Pediatric Pulmonology, Hopital Trousseau, St. Antoine Medical School, University of Paris, France
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Affiliation(s)
- E N Pattishall
- Department of Cardiovascular/Critical Care Medicine, Glaxo Wellcome, Inc., Research Triangle Park, North Carolina, USA
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Tessier V, Chadelat K, Baculard A, Housset B, Clement A. BAL in children: a controlled study of differential cytology and cytokine expression profiles by alveolar cells in pediatric sarcoidosis. Chest 1996; 109:1430-8. [PMID: 8769489 DOI: 10.1378/chest.109.6.1430] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
STUDY OBJECTIVE The development of BAL in children for both research and clinical purposes has been limited so far by the difficulty in establishing reference values. The aim of the study was (1) to define composition of BAL cellular components in control children and to evaluate the ability of these cells to express various cytokines, and (2) to study modifications of differential cytology and BAL cell cytokine responses in children with interstitial lung disorders. POPULATIONS AND METHODS Two groups were investigated: a control group of 16 children who were concluded to be free of parenchymal lung disease after complete pulmonary investigation, and a group of 11 children with pulmonary sarcoidosis. Differential cytology was evaluated by standard techniques. BAL cell cytokine expression was studied at the level of messenger RNA (mRNA) by reverse transcription-polymerase chain reaction (RT-PCR) methods. RESULTS In the control group, differential cell counts appeared to be similar to values reported in adult populations with normal distribution of the data and no influence of age. In this group, no transcripts for interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), IL-6, and transforming (correction of tranforming) growth factor-beta (TGF-beta) could be detected. In children with sarcoidosis, different profiles of IL-1beta, TNF-alpha, IL-6, and TGF-beta expression were individualized which seemed to be related to the activity and/or severity of the disease, IL-6 and TGF-beta mRNA being observed only in the more severe forms. CONCLUSION These data provide information on BAL cell number and function in children. Characterization of BAL cytokine expression patterns during the course of interstitial lung diseases in children may be of great interest for evaluation of disease activity and/or severity and therefore for planning of therapy.
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Affiliation(s)
- V Tessier
- Department of Physiology, Hopital Trousseau, St. Antoine Medical School, University of Paris, France
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