RESUMO
BACKGROUND: Post-bronchoscopy and bronchoalveolar lavage (BAL) fever in children has been described by several authors. OBJECTIVES: This study aimed at assessing the occurrence of fever after these examinations and associated risk factors. METHODS: The study was performed in the Bronchoscopy Unit of Hôpital Necker-Enfants Malades, Paris, France, from June 2004 to July 2005. 148 children who underwent fiberoptic bronchoscopy and BAL, and remained in the Unit for 24 h, were included. RESULTS: 37.8% of the patients presented post-BAL fever. In the multivariate analysis of the selected factors (age, immunodeficiency, general or local anesthesia, mucosal biopsy, inflammation and suppuration at the moment of the examination, abnormal bronchoalveolar fluid cellularity and infection), only age <2 years and presence of infection remained associated with fever. CONCLUSIONS: The occurrence of fever is a frequent event in children who underwent BAL. In order to reduce post-BAL fever, antibiotic strategies should be devised based on prospective studies assessing identification of predictive air-way infection criteria and/or rapid bacteriological result analysis.
Assuntos
Lavagem Broncoalveolar/estatística & dados numéricos , Febre/epidemiologia , Adolescente , Distribuição por Idade , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia/estatística & dados numéricos , Causalidade , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Síndromes de Imunodeficiência/epidemiologia , Incidência , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Estudos Retrospectivos , Fatores de Risco , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
OBJECTIVES: To determine the value of open lung biopsy (OLB) in terms of diagnosis, morbidity, mortality, and benefits in immunocompromised children with pulmonary involvement. STUDY DESIGN: We retrospectively reviewed 36 OLBs performed in 32 immunocompromised children between 1985 and 1998. Seventeen biopsies were performed in patients with primary immunodeficiency syndromes and 19 in patients with secondary immunodeficiency syndromes. Twenty-eight biopsies were performed because of a lack of response to ongoing antimicrobial treatments with negative or positive findings on bronchoalveolar lavage (BAL) and a deteriorating clinical or radiologic course, and 8 biopsies were performed because of persistent chest x-ray infiltrates. RESULTS: Diffuse pulmonary infiltrates were observed on chest x-ray in 28 cases, hyperinflation in 3 cases, and nodular infiltrates in 5 cases. A histopathologic diagnosis was possible for all 36 OLBs. Specific diagnosis was obtained in 22 (61%) (12 infectious agents, 6 tumors, 4 bronchiolitis obliterans) and non-specific diagnosis in 14 (39%). Fungi were the main infectious agents (8 of 12). For the diagnosed infections, BAL provided 4 true-positive, 3 false-positive, and 6 false-negative results. Specific treatment was changed in 77% of cases, providing real benefits in 12 (33%) cases. The morbidity and overall mortality rates were 31% and 33%, respectively. The mortality rate was significantly higher in the first 30 days after OLB in patients receiving ventilatory assistance (58%). CONCLUSIONS: OLB in immunocompromised children with deteriorating clinical or radiologic course is a sensitive diagnostic tool.
Assuntos
Hospedeiro Imunocomprometido , Síndromes de Imunodeficiência/complicações , Pneumopatias/diagnóstico , Pulmão/patologia , Adolescente , Biópsia , Líquido da Lavagem Broncoalveolar , Criança , Pré-Escolar , Humanos , Síndromes de Imunodeficiência/epidemiologia , Síndromes de Imunodeficiência/mortalidade , Lactente , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Pneumopatias/mortalidade , Paris/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To evaluate the outcome of children who received prolonged intravenous immunoglobulin (IVIg) replacement therapy early in life for X-linked agammaglobulinemia (XLA). STUDY DESIGN: We performed a retrospective study of the clinical features and outcome of patients with genetic and/or immunologic results consistent with XLA. Patients receiving IVIg replacement therapy within 3 months of the diagnosis and for at least 4 years between 1982 and 1997 were included. RESULTS: Thirty-one patients began receiving IVIg replacement therapy at a median age of 24 months and were followed up for a median time of 123 months. IVIg was given at doses >0.25 g/kg every 3 weeks, and mean individual residual IgG levels ranged from 500 to 1140 mg/dL (median, 700 mg/dL). During IVIg replacement, the incidence of bacterial infections requiring hospitalization fell from 0.40 to 0.06 per patient per year (P <. 001). However, viral or unidentified infections still developed, including enteroviral meningoencephalitis (n = 3) causing death in one patient, exudative enteropathy (n = 3), and aseptic arthritis (n = 1). At last follow-up, 30 patients were alive at a median age of 144 months (range, 58 to 253 months). Among 23 patients who were evaluated by respiratory function tests and computed tomography, 3 had an obstructive syndrome, 6 had bronchiectasis, and 20 had chronic sinusitis. CONCLUSION: Early IVIg replacement therapy achieving residual IgG levels >500 mg/dL is effective in preventing severe acute bacterial infections and pulmonary insufficiency. More intensive therapy may be required to fully prevent the onset of bronchiectasis, chronic sinusitis, and nonbacterial infections, particularly enteroviral infections, in all cases.
Assuntos
Agamaglobulinemia/genética , Agamaglobulinemia/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Agamaglobulinemia/complicações , Agamaglobulinemia/imunologia , Criança , Pré-Escolar , Seguimentos , Ligação Genética , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Imunofenotipagem , Lactente , Infecções/etiologia , Estudos Retrospectivos , Cromossomo XRESUMO
We evaluated CD1a-positive cells in bronchoalveolar lavage samples from children with Langerhans cell histiocytosis (LCH). All children with multifocal LCH and pulmonary symptoms scored higher than 5% (30.6% +/- 7.2%), whereas those with other lung disorders scored much less than 5%. In children with multifocal LCH, bronchoalveolar lavage fluid abnormalities can precede pulmonary symptoms. During chemotherapy the CD1a-positive cell count lends to decrease.
Assuntos
Antígenos CD1/análise , Líquido da Lavagem Broncoalveolar/imunologia , Histiocitose de Células de Langerhans/diagnóstico , Adolescente , Análise de Variância , Líquido da Lavagem Broncoalveolar/citologia , Contagem de Células , Criança , Pré-Escolar , Humanos , Técnicas Imunoenzimáticas , Lactente , Pneumopatias/diagnósticoRESUMO
OBJECTIVE: To study the value of a rapid diagnostic method based on the amplification by polymerase chain reaction (PCR) of a fragment of the IS6110 insertion element for the detection of Mycobacterium tuberculosis in children. DESIGN: We tested 199 specimens obtained from 68 children referred for evaluation of suspected tuberculosis. RESULTS: In 83.3% of children with active disease and 38.9% with tuberculous infection but no evidence of disease, at least one positive PCR result was observed. No child without tuberculosis had positive PCR results (100% specificity). The sensitivity of the PCR was increased by testing of multiple samples from the same child and use of Chelex particles (Bio-Rad Laboratories, Ivry, France) rather than guanidine isothiocyanate-silica particles for DNA extraction. Bronchoalveolar lavage samples were no more useful than gastric aspirates. CONCLUSIONS: If appropriate laboratory methods are used, DNA amplification is a reliable method for the early diagnosis of tuberculosis in children and appears to be very helpful in clinical pediatric practice when the diagnosis of active tuberculosis is difficult or needs to be rapidly confirmed.