Thirty years have passed since the Korean Association of Pediatric Allergy and Respiratory Disease was founded. There have been great changes in the pattern of respiratory diseases in Korean children during the last 30 years with economic development in the country. Pneumonia remains the leading cause of childhood morbidity, despite advances in the prevention and management. The incidence and mortality of pneumonia caused by typical bacterial pathogens have been reduced. However, the predominance of Mycoplasma pneumoniae or virus-associated diseases is emerging, which suggests that novel diagnostic and therapeutic strategies are needed. Viral bronchiolitis is one of the most substantial health burdens for infants and young children worldwide. Although respiratory syncytial virus is the most common pathogen, molecular diagnostic techniques have identified many other viruses including human rhinovirus causing bronchiolitis. Bronchiectasis is a chronic respiratory condition characterized by chronic infection, airway inflammation, and progressive lung function decline. Research into the interactions between early life respiratory infections and development of bronchiectasis is imperative to halt the disease in its origin and improve adult outcomes. Acute respiratory distress syndrome (ARDS) is a severe, life-threatening lung disease with diffuse inflammatory lung injury leading to pulmonary edema and hypoxia. Although many modalities to treat ARDS have been studied, supportive therapies and lung protective ventilator support remains the mainstay. This review focuses on the current trends in research on these childhood respiratory diseases through literature review and aims to investigate the impact of Korean study results in this field.
Adult ; Anoxia ; Bronchiectasis ; Bronchiolitis ; Bronchiolitis, Viral ; Child ; Economic Development ; Humans ; Hypersensitivity ; Incidence ; Infant ; Inflammation ; Korea* ; Lung ; Lung Diseases ; Lung Injury ; Molecular Diagnostic Techniques ; Mortality ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Rhinovirus ; Ventilators, Mechanical

OBJECTIVETo investigate the correlation between CMV reactivation and obliterative bronchiolitis (BO) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSFrom January 2011 to December 2013, 769 patients underwent allo-HSCT. The CMV infection was diagnosed by fluorescence quantitative PCR method for detecting the level of CMV-DNA and immunofluorescence staining of PP65 antigen in white blood cell. The frequency of BO in patients with and without CMV infection was compared, and the correlation between CMV infection and BO was analyzed. The clinical data of CMV infection patients with and without BO were analyzed and compared.

RESULTSOf 259 diagnosed CMV infection patients, BO occurred in 32 cases, the incidence rate was 12.35%, while in 510 cases without CMV infection, BO occurred in 8 cases, the incidence was 1.56%. The incidence rate of BO is significantly higher in patients with CMV infection than that in patients without CMV infection (P<0.001). The CMV related clinical data between the 32 cases with BO and 227 cases without BO were analyzed among the 259 cases of diagnosed CMV infection patients. BO incidence is higher in patients with more than 10⁵ copies/ml CMV-DNA than that in patients with less than 10² copies/ml CMV-DNA.

CONCLUSIONAmong the risk factors related to BO post allo-HSCT, CMV infection is one of them to be worthy of attention. CMV reactivation with high virus titer, multiple CMV reactivations and CMV pneumonia are the risk factors.

Allografts ; Bronchiolitis ; Bronchiolitis Obliterans ; Cytomegalovirus ; Cytomegalovirus Infections ; Hematopoietic Stem Cell Transplantation ; Humans ; Real-Time Polymerase Chain Reaction ; Risk Factors ; Viral Load ; Virus Activation

Acetates ; administration & dosage ; therapeutic use ; Asthma ; drug therapy ; etiology ; metabolism ; Bronchiolitis, Viral ; drug therapy ; Cysteine ; metabolism ; Humans ; Infant ; Infant, Newborn ; Leukotriene Antagonists ; administration & dosage ; therapeutic use ; Leukotrienes ; biosynthesis ; Nasopharynx ; secretion ; Quinolines ; administration & dosage ; therapeutic use ; Respiratory Syncytial Virus Infections ; drug therapy ; metabolism ; virology ; Risk Factors

OBJECTIVETo study the pulmonary pathology in patients died of fatal human influenza A(H1N1) infection.

METHODSEight cases of fatal human influenza A (H1N1) infection, including 2 autopsy cases and 6 paramortem needle puncture biopsies, were enrolled into the study. Histologic examination, immunohistochemitry, flow cytometry and Western blotting were carried out.

RESULTSThe major pathologic changes included necrotizing bronchiolitis with surrounding inflammation, diffuse alveolar damage and pulmonary hemorrhage. Influenza viral antigen expression was detected in the lung tissue by Western blotting. Immunohistochemical study demonstrated the presence of nuclear protein and hemagglutinin virus antigens in parts of trachea, bronchial epithelium and glands, alveolar epithelium, macrophages and endothelium. Flow cytometry showed that the apoptotic rate of type II pneumocytes (32.15%, 78.15%) was significantly higher than that of the controls (1.93%, 3.77%).

CONCLUSIONNecrotizing bronchiolitis, diffuse alveolar damage and pulmonary hemorrhage followed by pulmonary fibrosis in late stage are the major pathologic changes in fatal human influenza A (H1N1) infection.

Adolescent ; Adult ; Aged ; Alveolar Epithelial Cells ; pathology ; Antigens, Viral ; metabolism ; Apoptosis ; Autopsy ; Biopsy, Needle ; Bronchiolitis, Viral ; pathology ; Child ; Child, Preschool ; Female ; Hemagglutinin Glycoproteins, Influenza Virus ; metabolism ; Humans ; Influenza A Virus, H1N1 Subtype ; immunology ; Influenza, Human ; metabolism ; mortality ; pathology ; virology ; Lung ; immunology ; metabolism ; pathology ; Male ; Middle Aged ; Nuclear Proteins ; metabolism ; Pulmonary Alveoli ; pathology ; Pulmonary Fibrosis ; pathology ; Young Adult

Acute viral bronchiolitis (AVB) is an obstructive lung disease which frequently develops in infants and the most common functional involvement is a V/Q ratio change caused by small airway obstruction. We report a case showing the redistribution of pulmonary blood flow by multiple perfusion scan defects in an infant with AVB. A 15 month-old male infant visited ER due to respiratory difficulty. He manifested decreased lung sound in the left lung field, hyperinflation of the left lung on chest x-ray, and metabolic acidosis in blood gas analysis. A perfusion scan showed multiple perfusion defects of both lungs without the evidence of pulmonary embolism on a following cardiac CT and echocardiography. Human Rhinovirus PCR in a nasopharyngeal aspirate was positive. With supportive care, the symptom was resolved in 4 days. AVB can show multiple perfusion defects by the redistribution of pulmonary blood flow of which the direction is opposite to the usual distribution of pulmonary blood flow in children.
Acidosis ; Airway Obstruction ; Blood Gas Analysis ; Bronchiolitis, Viral ; Child ; Echocardiography ; Humans ; Infant ; Lung ; Lung Diseases, Obstructive ; Male ; Perfusion ; Polymerase Chain Reaction ; Pulmonary Embolism ; Respiratory Sounds ; Rhinovirus ; Thorax

PURPOSE: This study was performed to investigate the epidemiologic and clinical features of 13 respiratory viruses in children with acute lower respiratory tract infections (ALRIs). METHODS: Nasopharyngeal aspirates were prospectively obtained from 325 children aged 15 years or less from May 2008 to April 2009 and were tested for the presence of 13 respiratory viruses by multiplex real-time-polymerase chain reaction (RT-PCR). RESULTS: Viruses were identified in 270 children (83.1%). Co-infections with > or =2 viruses were observed in 71 patients (26.3%). Respiratory syncytial virus (RSV) was the most common virus detected (33.2%), followed by human rhinovirus (hRV) (19.1%), influenza virus (Flu A) (16.9%), human metapneumovirus (hMPV) (15.4%), parainfluenza viruses (PIVs) (8.3%), human bocavirus (hBoV) (8.0%), adenovirus (ADV) (5.8%), and human coronavirus (hCoV) (2.2%). Clinical diagnoses of viral ALRIs were bronchiolitis (37.5%), pneumonia (34.5%), asthma exacerbation (20.9%), and croup (7.1%). Clinical diagnoses of viral bronchiolitis and pneumonia were frequently demonstrated in patients who tested positive for RSV, hRV, hMPV, or Flu A. Flu A and hRV were most commonly identified in children older than 3 years and were the 2 leading causes of asthma exacerbation. hRV C was detected in 14 (4.3%) children, who were significantly older than those infected with hRV A (mean+/-SD, 4.1+/-3.5 years vs. 1.7+/-2.3 years; P=0.009). hBoV was usually detected in young children (2.3+/-3.4 years) with bronchiolitis and pneumonia. CONCLUSION: This study described the features of ALRI associated with 13 respiratory viruses in Korean children. Additional investigations are required to define the roles of newly identified viruses in children with ALRIs.
Adenoviridae ; Aged ; Asthma ; Bronchiolitis ; Bronchiolitis, Viral ; Child ; Coinfection ; Coronavirus ; Croup ; Human bocavirus ; Humans ; Metapneumovirus ; Multiplex Polymerase Chain Reaction ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia ; Prospective Studies ; Respiratory Syncytial Viruses ; Respiratory System ; Respiratory Tract Infections ; Rhinovirus ; Viruses

Bronchiolitis ; epidemiology ; virology ; Case-Control Studies ; Child, Preschool ; China ; epidemiology ; DNA, Viral ; Female ; Human bocavirus ; isolation & purification ; Humans ; Infant ; Male ; Metapneumovirus ; isolation & purification

PURPOSE: The aim of this study was to determine the diagnostic value of serum procalcitonin (PCT) compared with that of C-reactive protein (CRP) and the total white blood cell count (WBC) in predicting bacterial infections in febrile infants <6 months of age. METHODS: A prospective study was performed with infants <6 months of age who were admitted to the Department of Pediatrics with a fever of uncertain source between July and September 2008. Spinal taps were performed according to clinical symptoms and physical examination. Serum PCT levels were measured using an enzyme-linked fluorescent assay. RESULTS: Seventy-one infants (mean age, 2.62 months) were studied. Twenty-six infants (36.6%) had urinary tract infections (UTIs), and 22 infants (31.0%) had viral meningitis. The remaining infants had acute pharyngitis (n=1), herpangina (n=1), upper respiratory tract infections (n=7), acute bronchiolitis (n=8), acute gastroenteritis (n=4), and bacteremia (n=2). The median WBC and CRP levels were significantly higher in infants with UTIs than in infants with viral meningitis. However, there were no differences in the median PCT levels between the groups (0.14 ng/mL vs. 0.11 ng/mL, P=0.419). The area under the receiver operating characteristic curve was 0.792 (95% CI, 0.65-0.896) for WBC, 0.77 (95% CI, 0.626-0.879) for CRP, and 0.568 (95% CI, 0.417-0.710) for PCT. An elevated WBC count (>11,920/microliter) and an increased CRP level (>1.06 mg/dL) were significant predictors of UTIs based on multiple logistic regression analysis. CONCLUSION: Serum PCT concentrations should be interpreted with caution in infants <6 months of age with a fever of uncertain source.
Bacteremia ; Bacterial Infections ; Bronchiolitis ; C-Reactive Protein ; Calcitonin ; Fever ; Gastroenteritis ; Herpangina ; Humans ; Infant ; Leukocyte Count ; Logistic Models ; Meningitis, Viral ; Oligopeptides ; Pediatrics ; Pharyngitis ; Physical Examination ; Prospective Studies ; Protein Precursors ; Respiratory Tract Infections ; ROC Curve ; Spinal Puncture ; Urinary Tract Infections

Asthma ; immunology ; virology ; Bronchiolitis, Viral ; complications ; immunology ; virology ; Child ; Humans ; Respiratory Syncytial Virus Infections ; complications ; genetics ; immunology ; Risk Factors ; Severity of Illness Index

PURPOSE: To evaluate the effect of inhaled hypertonic saline solution in hospitalized infants with bronchiolitis. METHODS: A randomized double blind trial was performed from October 2003 to May 2004. A total of eighty patients <1 year of age with a clinical diagnosis of acute viral bronchiolitis were enrolled and assigned to receive either of the following:inhalation of 2 mL(0.5 mg) fenoterol added to 2 mL of 0.9 percent saline solution(group 1; n=40) or 2 mL(0.5 mg) fenoterol added to 2 mL of 3 percent saline solution(group 2; n=40). This therapy was repeated at six hours interval after admission. They were evaluated daily just before and 20 minutes after nebulization. The outcome measures included changes in clinical severity score(based on respiratory rate, presence of wheezing, retraction, and general condition) after nebulization and duration of hospitalization. RESULTS: In the clinical severity score, a significant improvement was observed during the 72 hours of hospitalization in both groups(P<0.05). The basic clinical severity scores before inhalation were decreased significantly faster in group 2 as compared to group 1 on each day of treatment(P<0.05). The mean duration of hospital stay was significantly reduced in group 2 than group 1(5.9+/-1.9 days versus 7.4+/-2.0 days, P<0.05). No adverse effects were associated with inhaled therapy. CONCLUSION: These results suggest that a nebulized 3 percent saline solution plus 0.5 mg fenoterol may be more effective than a 0.9 percent saline solution plus 0.5 mg fenoterol in accelerating the clinical recovery of infants with viral bronchiolitis.
Bronchiolitis* ; Bronchiolitis, Viral ; Diagnosis ; Fenoterol* ; Hospitalization ; Humans ; Infant* ; Inhalation ; Length of Stay ; Outcome Assessment (Health Care) ; Respiratory Rate ; Respiratory Sounds ; Saline Solution, Hypertonic* ; Sodium Chloride