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espanolContinuamos con la serie de casos clinicos en Cardiologia pediatrica revisando los motivos de consulta y datos exploratorios frecuentes en las consultas de Pediatria de Atencion Primaria, y presentados de forma breve y practica. En este numero se presenta el caso de un nino de 7 anos al que se le detecta un soplo sistolico en el contexto de una infeccion respiratoria virica. Se discute como la exploracion y los hallazgos electrocardiograficos orientan el manejo diagnostico de este paciente. EnglishWe continue the series of clinical cases in Pediatric Cardiology checking frequent reasons for consultation in the pediatric offices of Primary Care as well as exploratory signs, and presenting them in a brief and practical way. In this paper we present the case of a 7 years old boy to whom a systolic murmur is noticed in the context of a viral respiratory infection. The way the physical exploration and the electrocardiographic findings guide the diagnosis of this patient is discussed.

We determined the rate of nosocomial viral respiratory infection in infants and the effect of an infection control program during 4 winter seasons. The rate of nosocomial viral respiratory infection decreased from 6.09 episodes per 100 patients admitted during the first study year to 1.46 episodes per 100 patients admitted during the last study year.

A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7%. In bronchiolitis, respiratory syncytial virus (RSV) was detected in 36% of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3%) and RSV (7.7%). There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3%) showed a borderline significance (p = 0.055, Fisher's exact test) as compared to those with adenovirus (87.5%). The overall case fatality rate in this study was 2.7%, and adenovirus showed a significantly higher case fatality rate (25%) than RSV (2.8%) (p = 0.005). Injected antibiotics were used in 49% of the children with RSV and 60% of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.

Sinusitis generally develops as a complication of viral or allergic inflammation of the upper respiratory tract. The bacterial pathogens in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, while anaerobic bacteria and Staphylococcus aureus are predominant in chronic sinusitis. Pseudomonas aeruginosa has emerged as a potential pathogen in immunocompromised patients and in those who have nasal tubes or catheters, or are intubated. Many of these organisms recovered from sinusitis became resistant to penicillins either through the production of beta-lactamase (H. influenzae, M. catarrhalis, S. aureus, Fusobacterium spp., and Prevotella spp) or through changes in the penicillin-binding protein (S. pneumoniae). The pathogenicity of beta-lactamase-producing bacteria is expressed directly through their ability to cause infections, and indirectly through the production of betalactamase. The indirect pathogenicity is conveyed not only by surviving penicillin therapy, but also by ‘shielding’ penicillin-susceptible pathogens from the drug. The direct and indirect virulent characteristics of these bacteria require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections. The antimicrobials that are the most effective in management of acute sinusitis are amoxycillin-clavulanate (given in a high dose), the newer quinolones (gatifloxacin, moxifloxacin) and the second generation cephalosporins (cefuroxime, cefpodoxime, cefprozil or cefdinir). The antimicrobials that are the most effective in management of chronic sinusitis are amoxycillinclavulanate, clindamycin and the combination of metronidazole and a penicillin.

Highlights • We compared current viral respiratory diagnostic techniques with NGS. • NGS is able to detect respiratory viruses in clinical diagnostic samples. • With the current sample preparation method, NGS is less sensitive than RT-PCR. • NGS provided additional sequence and typing information compared with RT-PCR., Background Molecular assays are the gold standard methods used to diagnose viral respiratory pathogens. Pitfalls associated with this technique include limits to the number of targeted pathogens, the requirement for continuous monitoring to ensure sensitivity/specificity is maintained and the need to evolve to include emerging pathogens. Introducing target independent next generation sequencing (NGS) could resolve these issues and revolutionise respiratory viral diagnostics. Objectives To compare the sensitivity and specificity of target independent NGS against the current standard diagnostic test. Study design Diagnostic RT-PCR of clinical samples was carried out in parallel with target independent NGS. NGS sequences were analyzed to determine the proportion with viral origin and consensus sequences were used to establish viral genotypes and serotypes where applicable. Results 89 nasopharyngeal swabs were tested. A viral pathogen was detected in 43% of samples by NGS and 54% by RT-PCR. All NGS viral detections were confirmed by RT-PCR. Conclusions Target independent NGS can detect viral pathogens in clinical samples. Where viruses were detected by RT-PCR alone the Ct value was higher than those detected by both assays, suggesting an NGS detection cut-off – Ct = 32. The sensitivity and specificity of NGS compared with RT-PCR was 78% and 80% respectively. This is lower than current diagnostic assays but NGS provided full genome sequences in some cases, allowing determination of viral subtype and serotype. Sequencing technology is improving rapidly and it is likely that within a short period of time sequencing depth will increase in-turn improving test sensitivity.

The concordance of nasal compared with nasopharyngeal swabs was assessed for the diagnosis of respiratory viral infections, and the degree of discomfort associated with each procedure was compared. The use of nasal swabs was shown to be as accurate but significantly less painful than nasopharyngeal swabs for virus diagnosis.

Attempts to relieve the misery of the common cold have been made since long before current understanding of its viral origin. Although current symptomatic therapies provide some relief, any effective treatment must incorporate an antiviral to address the infection. Symptom production is related not only to viral cytopathic effect but also to the early activation of several inflammatory pathways. Antiviral treatment alone may not be able to prevent these events. Combining an antiviral with selected therapeutic agents that block these inflammatory pathways has been shown to improve the effectiveness of cold treatment. Early diagnosis and initiation of treatment combined with regular dosing until symptoms subside appears to be the most effective treatment strategy to maximize therapeutic outcomes. This strategy reduces viral shedding in nasal fluid, provides treatment for the period of maximum symptom burden, and may reduce the frequency and severity of the sinus disease that accompanies colds.

We report the cases of two infants with meningitis due to parainfluenza virus type 3. This is the first time that documented clinical and laboratory details have been reported for a 1-month-old infant with meningitis due to parainfluenza virus type 3 (our second case). We reviewed the literature and determined that CNS involvement by parainfluenza virus type 3 appears rare. Clinicians should be aware that parainfluenza virus type 3, one of the most common causes of viral respiratory infection in infancy, can also produce infection of the CNS and that hemadsorption testing of CSF specimens submitted for viral culture is necessary for detecting these paramyxoviruses.

Colvin JM, Muenzer JT, Jaffe DM, et al. Detection of viruses in young children with fever without an apparent source. Pediatrics. 2012; 130( 6): e1455- e1462; doi: 10.1542/peds.2012-1391[OpenUrl][1][Abstract/FREE Full Text][2] Investigators from Washington University, St. Louis and Biological Mimetics, Inc., Frederick, MD conducted a study to better understand the viral etiologies of fever without an apparent source (FWS) in young children. Children aged 2 to 36 months who presented to the emergency department (ED) at St. Louis Children’s Hospital with a temperature of ≥38°C without an apparent source and who had blood obtained for clinical management were enrolled. Children with symptoms suggestive of a viral respiratory infection or who had a positive rapid test for influenza were excluded. Two comparison groups of children were also enrolled: (1) children aged 2 to 36 months who presented to the ED with a temperature of ≥38°C but had a probable or definite bacterial infection, and (2) afebrile … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2012-1391%26rft_id%253Dinfo%253Apmid%252F23129086%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=130/6/e1455&atom=%2Faapgrand%2F29%2F3%2F27.atom

K Rueter, J Bizzintino, AC Martin. J Pediatr. 2012;160(1):82–87 To examine the influence of viral respiratory infection (VRI) on treatment response in acute asthma. A total of 218 children (mean age, 6.6 years) with acute asthma were recruited. Clinical symptoms were recorded, an asthma severity score was determined, and, whenever possible, a per-nasal aspirate was obtained for detection of viruses. Each child’s response to inhaled β2-agonists was assessed after 6, 12, and 24 hours. The 168 children with …

Background: Standardization of a compound Ayurvedic formulation is a critical and essential issue to be considered in assuring the therapeutic efficacy and safety and to rationalize their use in the health care. Sitopaladi churna is a reputed polyherbal formulation of Ayurveda. It is prescribed for the treatment of pleurodynia, intercostal neuralgia, cold, cough associated with bronchitis, pneumonia, tuberculosis, viral respiratory infection, and in pharyngeal and chest congestion. Objective: The present study aimed at physico-chemical standardization of in-house and two marketed brands of Sitopaladi churna. Materials and Methods: In our investigation, in-house churna and two commercial brands of Sitopaladi churna were standardized based on powder microscopy, physico-chemical evaluations, thin layer chromatography (TLC) and high performance thin layer chromatography (HPTLC) finger printing as per standard procedures. Results: The set parameters were sufficient to evaluate the churna based on various physico-chemical parameters. Conclusion: The data evolved can be adopted for laying down the standards for the manufacturing units of Sitopaladi churna.

Bacterial tracheitis after an upper viral respiratory infection is a well-recognized entity in the pediatric literature. Bacterial tracheitis has only recently been reported in adults, and it is a potentially life-threatening illness. We report a case of bacterial tracheitis in a patient with AIDS.

Csonka P, Kaila M, Laippala P, et al. J Pediatr. 2003;143:725–730 Systemic corticosteroid use for the treatment of acute wheezing among preschool-aged children is controversial, with a recent meta-analysis finding only marginal positive effects with orally administered corticosteroids among children

A total of 131 infants were monitored from birth through the first year of life for respiratory viral infection and illness and evaluated for the relationship that these had to certain social and familial factors. The results showed no general patterns of association between viral infection and the study factors, but there were several significant individual associations. Excess influenza virus infection was found for black infants, infants with at least one sibling, and especially those with school age siblings. Rhinovirus infection rates were highest among girls attending daycare. In addition, significantly higher rates of lower respiratory disease (LRD) were seen in daycare infants and low socioeconomic infants and a definite trend to increasing amounts of LRD was seen with increasing family size. Protection from LRD seen in girls was apparently lost in daycare. No convincing differences for viral infection or respiratory illness were seen with parental smoking as an isolated factor.

Certain viruses, e.g. measles, influenza and varicella are transmitted by aerosols and hence aerosolized vaccine against the respective virus has potential immunologic merit. For measles v...

DEFINITIONS of ‘asthma’ remain unsatisfactory. Patients and their doctors commonly use the word to mean intermittent wheezy breathlessness with or without cough or phlegm. This condition can be triggered by a wide variety of agents which induce the wheezy symptoms in a number of different ways, so that definitions based either on particular causes or upon mechanisms of bronchial narrowing are unsatisfactory because they are either unwieldy or incomplete. One practical way of defining asthma within our inadequate state of knowledge is in terms of function, as an increase of airways resistance which is completely or partially reversible either spontaneously or as a result of treatment. It is accepted that this definition includes clinical disorders such as those seen in children who wheeze with bacterial or viral respiratory infection and those in adults with acute or chronic bronchitis (defined in terms of cough and expectoration) who can be shown to have a variability in airways resistance. A major problem in the diagnostic use of the word ‘asthma’ is its differentiation from chronic bronchitis: many patients have features common to both conditions, and so long as asthma is defined in terms of function and bronchitis in terms of symptoms (chronic cough and sputum), a logical clear cut differentiation is impossible. Overlapping features are not, however, found in all patients, and it remains possible to identify typical patients who have a dominant history of

Aerosol-induced murine influenza was evaluated as a model through which effects of environmental stresses on the pathogenesis of viral respiratory infection can be studied. Infection rate and amount of pneumonia produced in mice in response to small-particle aerosol exposure to either A2/J305/57 or A/PR8/34 influenza virus are quantitative phenomena closely related to vital exposure dose. Mice are highly susceptible to aerosol-induced influenza infection, ie, one mouse infectious dose (MID50) was equivalent to approximately two to three egg infectious doses. The amount of pneumonia which developed in response to infection and its timecourse was also related to viral exposure dose. Between the dose range of 1 to 100 MID50 the amount of lung consolidation ranged between 25% to 60% The results from exposure to the A2 and PR8 influenza viral subtypes were similar.

In spite of many difficulties in the development of antiviral agents, progress has been made both in laboratory works and clinical studies. In the field of viral respiratory infections, N1, N1-anhydrobis- (β-hydroxyethyl) biguanide HCl (ABOB) and amantadine are now available.The effect of ABOB in the treatment of influenza (A2 and B) and pharyngoconjunctival fever (caused by adenovirus type 3) was shown by shorter duration of fever in treated group than in the control by double blind method. Amantadine was also revealed to be effective for influenza (A2 and Hongkong) in double blind test. Some data were shown in regard to these antiviral agents.Possibilities of clinical administration of interferon and interferon inducers were also discussed.

Background Human rhinovirus is most prominently associated with asthma exacerbations in humans. The U-BIOPRED project of the Innovative Medicine Initiative (IMI) aims to define biomarkers of asthma exacerbations. Within this context, this study aimed to establish a mouse model of asthma exacerbations induced by viral respiratory infection on the background of chronic allergic airway inflammation.