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Cohen R, Shteinberg M. Unravelling the "frequent exacerbator" phenotype in cystic fibrosis. Eur Respir J 2024; 63:2400068. [PMID: 38388000 DOI: 10.1183/13993003.00068-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Raya Cohen
- Pulmonology Institute and CF center, Carmel Medical Center, Haifa, Israel
- The B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology Haifa, Haifa, Israel
| | - Michal Shteinberg
- Pulmonology Institute and CF center, Carmel Medical Center, Haifa, Israel
- The B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology Haifa, Haifa, Israel
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2
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Corcoran A, Faig W, Ren CL. Clinical features associated with pulmonary exacerbation diagnosis in infants and young children with cystic fibrosis. Pediatr Pulmonol 2023. [PMID: 38131505 DOI: 10.1002/ppul.26838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
RATIONALE Diagnosing cystic fibrosis (CF) pulmonary exacerbations (PEx) in very young people with CF <3 years (VY-PwCF) is challenging because of the frequency of respiratory viral infections in this age group, and there are limited data on the clinical features associated with the diagnosis of PEx in this age group. The goal of this study was to identify clinical features associated with the diagnosis of PEx in VY-PwCF. METHODS We reviewed the medical records of VY-PwCF followed at the Children's Hospital of Philadelphia born between 2013 and 2019. We collected data from all encounters with respiratory symptoms. PEx was defined by treatment with oral or intravenous antibiotics. Clinical features of PEx and non-PEx encounters were compared using descriptive statistics, and odds ratios of PEx diagnosis were calculated. RESULTS A total of 78 patients were included in the analysis. The mean (SD) number of PEx per patient was 6.17 (5.88). The presence of a wet or nighttime cough and symptoms >3 days in duration were significantly associated with PEx diagnosis (p < .001). In contrast, symptoms such as sore throat or rhinorrhea were not associated with a higher likelihood of PEx. CONCLUSIONS The presence of a wet or night-time cough and longer symptom duration are common features of PEx in VY-PwCF, whereas symptoms suggestive of upper respiratory viral infection are not. Our results will be helpful in counseling families of VY-PwCF in the signs and symptoms of PEx and in planning future research in PEx in this age group.
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Affiliation(s)
- Aoife Corcoran
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Walter Faig
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Clement L Ren
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Pulmonary Exacerbations in Pediatric Patients: Retrospective Study in a Portuguese Cystic Fibrosis Center. CHILDREN 2022; 9:children9020157. [PMID: 35204878 PMCID: PMC8869878 DOI: 10.3390/children9020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/08/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
(1) Background: Cystic fibrosis (CF) is a multisystemic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Lung disease, the leading cause of morbimortality, is marked by acute worsening of symptoms—such as pulmonary exacerbations (PEx). The objectives of this study were: Identifying the frequency of PEx in pediatric CF patients; Characterizing each PEx; Finding association between the frequency and characteristics of the PEx and patients’ features. (2) Methods: Retrospective analysis of all PEx from a period of January 2015 to December 2019 in a group of pediatric patients from a single CF center. Data were collected from medical records. Descriptive statistics and chi-square/Fisher’s test were used. (3) Results: Thirty-four pediatric patients contributed to the total sample used in this study and 198 PEx were identified, median of 1.0 PEx/patient/year. Most frequent PEx symptoms were increased cough (93.9%) and change in secretions (88.4%), most common pathogens were Staphylococcus aureus (54.9%) and Pseudomonas aeruginosa (24.9%). The majority were treated as outpatient (85.9%). Most common antibiotics included amoxicillin/clavulanate (35.9%) and ciprofloxacin (22.7%). Outcome was favorable in all PEx. (4) Conclusion: Results were consistent with what has been described in literature. More studies are necessary for a better characterization of CF PEx, in order to develop standardized protocols for their management.
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Landini N, Ciet P, Janssens HM, Bertolo S, Ros M, Mattone M, Catalano C, Majo F, Costa S, Gramegna A, Lucca F, Parisi GF, Saba L, Tiddens HAWM, Morana G. Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging. Front Pediatr 2022; 10:1084313. [PMID: 36814432 PMCID: PMC9940849 DOI: 10.3389/fped.2022.1084313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/28/2022] [Indexed: 02/09/2023] Open
Abstract
Respiratory tract exacerbations play a crucial role in progressive lung damage of people with cystic fibrosis, representing a major determinant in the loss of functional lung tissue, quality of life and patient survival. Detection and monitoring of respiratory tract exacerbations are challenging for clinicians, since under- and over-treatment convey several risks for the patient. Although various diagnostic and monitoring tools are available, their implementation is hampered by the current definition of respiratory tract exacerbation, which lacks objective "cut-offs" for clinical and lung function parameters. In particular, the latter shows a large variability, making the current 10% change in spirometry outcomes an unreliable threshold to detect exacerbation. Moreover, spirometry cannot be reliably performed in preschool children and new emerging tools, such as the forced oscillation technique, are still complementary and need more validation. Therefore, lung imaging is a key in providing respiratory tract exacerbation-related structural and functional information. However, imaging encompasses several diagnostic options, each with different advantages and limitations; for instance, conventional chest radiography, the most used radiological technique, may lack sensitivity and specificity in respiratory tract exacerbations diagnosis. Other methods, including computed tomography, positron emission tomography and magnetic resonance imaging, are limited by either radiation safety issues or the need for anesthesia in uncooperative patients. Finally, lung ultrasound has been proposed as a safe bedside option but it is highly operator-dependent and there is no strong evidence of its possible use during respiratory tract exacerbation. This review summarizes the clinical challenges of respiratory tract exacerbations in patients with cystic fibrosis with a special focus on imaging. Firstly, the definition of respiratory tract exacerbation is examined, while diagnostic and monitoring tools are briefly described to set the scene. This is followed by advantages and disadvantages of each imaging technique, concluding with a diagnostic imaging algorithm for disease monitoring during respiratory tract exacerbation in the cystic fibrosis patient.
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Affiliation(s)
- Nicholas Landini
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC - Sophia, Rotterdam, Netherlands.,Department of Radiology, University Cagliari, Cagliari, Italy.,Department of Pediatrics, division of Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hettie M Janssens
- Department of Pediatrics, division of Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Silvia Bertolo
- Department of Radiology, S. Maria Ca'Foncello Regional Hospital, Treviso, Italy
| | - Mirco Ros
- Department of Pediatrics, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Monica Mattone
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy
| | - Fabio Majo
- Pediatric Pulmonology & Cystic Fibrosis Unit Bambino Gesú Children's Hospital, IRCCS Rome, Rome, Italy
| | - Stefano Costa
- Department of Pediatrics, Gaetano Martino Hospital, Messina, Italy
| | - Andrea Gramegna
- Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy.,Respiratory Disease and Adult Cystic Fibrosis Centre, Internal Medicine Department, IRCCS Ca' Granda, Milan, Italy
| | - Francesca Lucca
- Regional Reference Cystic Fibrosis Center, University Hospital of Verona, Verona, Italy
| | - Giuseppe Fabio Parisi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Luca Saba
- Department of Radiology, University Cagliari, Cagliari, Italy
| | - Harm A W M Tiddens
- Department of Radiology and Nuclear Medicine, Erasmus MC - Sophia, Rotterdam, Netherlands.,Department of Pediatrics, division of Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Giovanni Morana
- Department of Radiology, S. Maria Ca'Foncello Regional Hospital, Treviso, Italy
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Bal Topçu D, Tugcu G, Ozcan F, Aslan M, Yalcinkaya A, Polat SE, Hizal M, Yalcin EE, Ersoz DD, Ozcelik U, Kiper N, Lay I, Oztas Y. Plasma Ceramides and Sphingomyelins of Pediatric Patients Increase in Primary Ciliary Dyskinesia but Decrease in Cystic Fibrosis. Lipids 2020; 55:213-223. [PMID: 32120452 DOI: 10.1002/lipd.12230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/09/2020] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
We investigated plasma sphingomyelin (CerPCho) and ceramide (Cer) levels in pediatric patients with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). Plasma samples were obtained from CF (n = 19) and PCD (n = 7) patients at exacerbation, discharge, and stable periods. Healthy children (n = 17) of similar age served as control. Levels of 16-24 CerPCho and 16-24 Cer were measured by LC-MS/MS. Concentrations of all CerPCho and Cer species measured at exacerbation were significantly lower in patients with CF than PCD. 16, 18, 24 CerPCho, and 22, 24 Cer in exacerbation; 18, 24 CerPCho, and 18, 20, 22, 24 Cer at discharge; 18, 24 CerPCho and 24 Cer at stable period were significantly lower in CF patients than healthy children (p < 0.001 and p < 0.05). All CerPCho and Cer levels of PCD patients were significantly higher except 24 CerPCho and 24 Cer during exacerbation, 24 CerPCho at discharge, and 18, 22 CerPCho levels at stable period (p < 0.001 and p < 0.05) compared with healthy children. There was no significant difference among exacerbation, discharge, and stable periods in each group for Cer and CerPCho levels. This is the first study measuring plasma Cer and CerPCho levels in PCD and third study in CF patients. The dramatic difference in plasma levels of most CerPCho and Cer species found between two diseases suggest that cilia pathology in PCD and CFTR mutation in CF seem to alter sphingolipid metabolism possibly in opposite directions.
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Affiliation(s)
- Dilara Bal Topçu
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Gokcen Tugcu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Filiz Ozcan
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Konyaaltı, 07070, Turkey
| | - Mutay Aslan
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Konyaaltı, 07070, Turkey
| | - Ahmet Yalcinkaya
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Mina Hizal
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Ebru Elmas Yalcin
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Deniz Dogru Ersoz
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Incilay Lay
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Yesim Oztas
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
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Tabatabaii SA, Khanbabaee G, Sadr S, Farahbakhsh N, Aghdam MK, Lotfollahzadeh S, Hosseini A, Dara N, Nanbakhsh M, Gorji FA. Microbial contamination of home nebulizers in children with cystic fibrosis and clinical implication on the number of pulmonary exacerbations. BMC Pulm Med 2020; 20:33. [PMID: 32028925 PMCID: PMC7006379 DOI: 10.1186/s12890-020-1059-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/23/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Early detection of pulmonary contamination in children with cystic fibrosis (CF) is essential since these children are vulnerable to Pseudomonas aeruginosa (P. aeruginosa) colonization. In Iran, home nebulization of antibiotics is a widespread practice in treatment for patients with CF and, to the best our knowledge, no bacteriological surveys have been conducted till date in this regard. METHOD This observational, cross sectional study was conducted on 61 children with CF at Mofid Children's Hospital, Tehran, from September 2017 to march 2018. The swab sampling was performed from 61 home nebulizers used by children diagnosed with CF. Contemporaneous sputum sample or deep nasopharyngeal swab was taken from each patient for bacterial and fungal testing. Medical records of the patients were reviewed and the number of exacerbations were recorded over the last 12 months prior to the study enrollment. RESULTS The results of study showed that, 43 (70.5%) nebulizers were contaminated; 31 (50.8%) mouthpieces, 21 (34.4%) reservoirs, and 11 (18%) connecting tubes. The most common organism to be isolated was P. aeruginosa and was recovered from 19 (31%) nebulizers, 16 of them belonged to patients chronically colonized with P. aeruginosa. The remaining three had at least one positive sputum culture for P. aeruginosa in the past 1 year before the study. There was a significant increase in the number of CF exacerbations with an average number of exacerbation being 1.5 ± 1(SD) over last 12 months in children who had pathogenic organisms recovered from their home nebulizers compared with 0.4 ± 0.7(SD) exacerbations per year in whom non-pathogenic organisms were isolated from their nebulizers (P < 0.001). CONCLUSION The majority of domiciliary nebulizers used by children with CF were contaminated with microorganisms indicating that the nebulizers may serve as potential reservoirs of pathogens for the patients' lung. Perpetuating colonization is a possible concern in the ones recently colonized with P. aeruginosa and, therefore, decontamination of nebulizer requires more attention to prevent ongoing infection. The negative impact of contamination of nebulizer on CF exacerbation requires serious attention and further investigations.
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Affiliation(s)
- Seyed Ahmad Tabatabaii
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghamartaj Khanbabaee
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Sadr
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Farahbakhsh
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Kazemi Aghdam
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saran Lotfollahzadeh
- Pediatric surgery Research Center, Research Institute for Children's Health, Shahid Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naghi Dara
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Nanbakhsh
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdollah Gorji
- Medical Research Development Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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