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Objectives Lung Clearance Index (LCI) is a promising tool to identify early lung disease in children with cystic fibrosis (CF). This retrospective study presents the findings in bronchoalveolar lavage (BAL) in children with CF and an increasing LCI-value and the possibility to reverse the LCI-value with a BAL-directed therapy. Methods 70 children with CF were monitored annually between October 2007 and April 2014 with Multiple Breath Washout (MBW) using SF6 as tracer gas. During this period 23 of 70 children (median 6.6 yrs, range 0.8–13.8 yrs) with an increasing LCI (not responding to treatment) or positive pseudomonas (PA) serum antibodies with negative PA sputum cultures underwent 31 BALs (minimum 1.9 yrs between BALs performed in the same child). Antibiotic treatment was ended 3 days prior to BAL. Results LCI and BAL-neutrophils correlated significantly (r = 0.572, p = 0.001). In children with LCI≥7.8, 18 of 21 BAL-cultures were positive (≥1000 cfu/ml or a positive fungus culture) and only 2 of 10 BAL-cultures were positive when LCI<7.8 (p = 0.001). LCI was ≥7.8 in all 11 fungus positive BAL-cultures. In three of these, fungus was the only pathogen detected. LCI increased over time before BAL (mean increase 0.55, CI 0.0–1.11, p = 0.05). Mean LCI before BAL was 8.95 (median 68 days prior to BAL) and decreased with a BAL-directed therapy (mean decrease 0.59, CI 0.1–1.1, p = 0.02). Conclusion An increasing LCI in CF patients correlates with neutrophil inflammation and infection in BAL. An increasing LCI might be an indication for BAL to achieve a more effective treatment. Fungus may play an active role in causing neutrophil inflammation and an increasing LCI. [ABSTRACT FROM AUTHOR]

Unlabelled: We report on two children with cerebral tuberculomas leading to late dramatic clinical exacerbation after appropriate antituberculous chemotherapy and high-dose corticosteroids. A 6-year-old girl with tuberculous meningoencephalitis initially fully recovered. However, after 9 months of continuous therapy she presented with acute increased intracranial pressure caused by tuberculomas requiring rapid drainage of CSF. A 16-year-old boy with miliary pulmonary tuberculosis and severe meningoencephalitis had reached a stable condition for more than 10 months although still suffering from a left-dominant spasticity and motor dysphasia. Fifteen months after initiation of therapy he presented with an acute central paralysis of the left facial nerve, progressive hemiplegia, severe ataxia and increasing lethargy caused by a cerebral tuberculoma with a perifocal oedema. Prolonged treatment with antituberculous chemotherapy and high-dose corticosteroids led to complete recovery in the younger patient and marked improvement in the older patient who remains severely handicapped.Conclusion: Patients with initially successful treatment of central nervous system tuberculosis should undergo an alert follow-up for the development of late cerebral tuberculomas. Treatment should consist of prolonged courses of antituberculous chemotherapy and high-dose corticosteroids. [ABSTRACT FROM AUTHOR]