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Background: Recurrent pneumonia (RP) is one of the most frequent causes of pediatric non-cystic fibrosis (CF) bronchiectasis (BE) and a consequent accelerated decline in lung function. The aim of this study was to analyse the clinical records of children with RP in attempt to identify factors that may lead to an early suspicion of non-CF BE. Methods: We recorded the demographic and clinical data, and lung function test results of children without CF attending our outpatient RP clinic between January 2009 to December 2013 who had undergone chest high-resolution computed tomography ≥8 weeks after an acute pneumonia episode and ≤6 months before enrolment. Results: The study involved 42 patients with RP: 21 with and 21 without non-CF BE. The most frequent underlying diseases in both groups were chronic rhinosinusitis with post-nasal drip and recurrent wheezing (81 % and 71.4 % of those with, and 85.7 % and 71.4 % of those without BE). FEV1 and FEF25-75 values were significantly lower in the children with non-CF BE than in those without (77.9 ± 17.8 vs 96.8 ± 12.4, p = 0.004; 69.3 ± 25.6 vs 89.3 ± 21.9, p = 0.048). Bronchodilator responsiveness was observed in seven children with BE (33.3 %) and two without (9.5 %; p = 0.13). Conclusions: Reduced FEV1 and FEF25-75 values seem associated with an increased risk of developing non-CF BE in children with RP. This suggests a need for further studies to confirm the diagnostic usefulness use of spirometry in such cases. [ABSTRACT FROM AUTHOR]

A 35-year-old lady was seen in the outpatient clinic owing to fever, cough with mucopurulent expectoration, and breathlessness for the duration of 1 month. She had history of similar episodes treated with antibiotics four times during last 2 years. There was no history of recurrent sinusitis, diarrhea, and skin or soft tissue infection. She had no history of diabetes mellitus or steroid intake. She denied any history of facial trauma or dental infection in the past. There was no history of tuberculosis in her or in the family. Radiograph and CT scan of the chest revealed right upper lobe consolidation. Flexible fibreoptic bronchoscopy revealed multiple nodules at opening of right upper lobe bronchus. This clinicopathological conference describes the details of differential diagnoses, difficulties in achieving the final diagnosis and management of such patient. [ABSTRACT FROM AUTHOR]

Congenital lobar emphysema (CLE) is a rare pulmonary anomaly that causes respiratory distress in infancy. CLE presents significant challenges in diagnosis and management, particularly in low-resource settings. We report the case of a three-month old infant with CLE and pneumonia. After a delay in diagnosis, lobectomy was performed under general anesthesia in a tertiary care public hospital in New Delhi, India. Initially, resolution of pneumonia was sought, but continued compression atelectasis warranted emergency surgery. Ventilatory management of our patient of CLE with pneumonia was especially challenging and is discussed. [ABSTRACT FROM AUTHOR]

Tracheo-esophageal fistula (TEF) without associated esophageal atresia or H-type fistula is a rare congenital anomaly. H-type fistula is usually missed in the neonatal period as the presenting symptoms are either of recurrent pneumonia or gastro-esophageal reflux which always lead to delay in diagnosis and infant undergoes unnecessary treatment. We report a case of H-type of TEF, diagnosed within 12 days of birth based upon choking and cyanosis on the first trial of spoon feeds. Diagnosis was confirmed with contrast esophagogram. The infant was operated for it and was successfully discharged. [ABSTRACT FROM AUTHOR]

Endobronchial carcinoid tumors (ECT) are the most common pulmonary neuroendocrine tumor in the pediatric population. We report two cases of ECT in children who presented with recurrent pneumonia and bronchial asthma-like symptoms. Rigid bronchoscopy revealed an endobronchial mass with biopsy confirming the diagnosis. Both children underwent surgical resection with an uneventful post-operative course. Neither of children required adjuvant chemotherapy nor radiotherapy and with a mean of follow-up of 8 years with no recurrence. Physicians should be aware that children with recurrent pneumonia and asthma-like symptoms may have ECT. Appropriate investigations including CT scan, bronchoscopy, and biopsy would ensure early diagnosis and surgery. [ABSTRACT FROM AUTHOR]

The rates and risk factors for developing recurrent pneumonia remain poorly understood. Our population-based cohort study, conducted over a 5-year follow-up period, found a recurrence rate of 9%, with lack of functional independence being the most predictive factor for recurrence.Background. The rates and risk factors for developing recurrent pneumonia following hospitalization with community-acquired pneumonia (CAP) are poorly understood.Methods. We examined a population-based cohort of patients with CAP who survived hospital admission and who were free of pneumonia for at least 3 months. We collected clinical, functional, and medication-related information and pneumonia severity index (PSI). Using linked databases we followed patients for 5 years and captured any clinical episode of pneumonia 90 days or more post-discharge. We used Cox proportional hazards models (adjusted for age, sex, PSI, functional status, medications) to determine rates and independent correlates of recurrent pneumonia.Results. The final cohort included 2709 inpatients; 43% were 75 years or older, 34% were not fully independent, and 56% had severe pneumonia. Over 5 years of follow–up, 245 (9%; 95% confidence interval [CI], 8%–10%) patients developed recurrent pneumonia, and 156 (64%) of these episodes required hospitalization. Rate of recurrence was 3.0/100 person–years and median time to recurrence was 317 days (interquartile range, 177–569); 32 (13%) patients had 2 or more recurrences. In multivariable analyses only age >75 years (adjusted P = .047) and less than fully independent functional status (12% recurrence rate with impaired functional status vs 7% for fully independent; adjusted hazard ratio, 1.7; 95% CI, 1.3–2.2; P < .001) were significantly associated with recurrent pneumonia.Conclusions. One of 11 patients who survived CAP hospitalization had recurrent pneumonia over 5 years and those with impaired functional status were at particularly high risk. Recurrent pneumonia is common and more attention to preventive strategies at discharge and closer follow-up over the long-term seem warranted. [ABSTRACT FROM AUTHOR]

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Abstract: Primary endobronchial tumors are rare in children and often are misdiagnosed, resulting in a delay of appropriate treatment. Here, we present a case of 4-year-old girl with primary endobronchial lymphoma who presented with persistent pneumonia despite medical treatment. Her chest radiograph showed left atelectasis, and a bronchial foreign body was initially suspected. Bronchoscopic examination demonstrated a granulomatous tumor occupying the left main bronchus. Localized Burkitt's lymphoma in the left trachea was diagnosed histopathologically. This case emphasizes the consideration of endobronchial tumor and bronchoscopy in children who show persistent atelectasis or recurrent pneumonia. [Copyright &y& Elsevier]

Aim Because the few previous studies on underlying causes of recurrent pneumonia in children have come from tertiary care referral centres where selection bias may be important, the aim of this study was to examine underlying causes of recurrent pneumonia in children in a general hospital. Methods We performed a retrospective chart review in a general hospital of 62 children with recurrent pneumonia over a 7.5 years period. Results In 19 patients (30.6%), no cause was identified, commonly because favourable natural history obviated the need for a full and invasive diagnostic work-up. Other underlying causes included recurrent aspiration in 16 patients (25.7%), lung disease (airway stenosis, bronchiectasis, middle lobe syndrome or tracheooesophageal fistula) in 10 patients (16.1%) and immune deficiency in 10 patients (16.1%). In contrast to previous studies, asthma was never diagnosed as an underlying cause, but diagnostic confusion between asthma (or recurrent upper respiratory tract infections) and recurrent pneumonia was common. Conclusion The cause of recurrent pneumonia in children remains elusive in almost a third of patients, partly because the favourable natural history consistent with immune system maturation eliminates the need for further diagnostic procedures. Asthma is more likely a differential diagnostic consideration than an underlying cause of recurrent pneumonia in children. A standardised diagnostic guideline is needed to improve knowledge on causes of recurrent pneumonia in children. [ABSTRACT FROM AUTHOR]

Background Persistent or recurrent pneumonia in children can pose a significant challenge to paediatricians and respiratory physicians. Aim The aim of this study is to determine the role of flexible bronchoscopy ( FB) in evaluation of recurrent or persistent pneumonia that remain otherwise unexplained by non-invasive diagnostic tests in children. Methods Retrospective evaluation of patients who underwent FB with an indication of recurrent or persistent pneumonia from 1997 to 2011. Results Among 2600 FB procedures, 434 (17%) were performed with the indication of recurrent or persistent pneumonia. There were 237 (54%) boys. Median age at presentation was 84 months, and median duration of symptoms was 9 months. FB led to specific diagnosis in 33% of the cases. The most common diseases diagnosed by FB were malacia disorders ( n: 32, 7%), aspirated foreign body ( n: 30, 7%), endobronchial tuberculosis ( n: 20, 5%), congenital airway anomalies ( n: 14, 3%), mucus plugs ( n: 14, 3%), pulmonary haemosiderosis ( n: 12, 3%) and middle lobe syndrome ( n: 11, 3%). During FB, only 6% of the patients had minor complications such as transient hypoxia, stridor and tachycardia. Conclusions In our study, FB proved to be a safe and effective tool in evaluation of children with persistent or recurrent pneumonia. FB is indicated for children with recurrent or persistent pneumonia where the underlying diagnosis remains unclear even after non-invasive diagnostic tests. [ABSTRACT FROM AUTHOR]

Summary: Many children are affected by recurrent lower respiratory tract infections (LRTIs), but the majority of them do not suffer from serious lung or extrapulmonary disease. The challenge for clinicians is to distinguish the recurrent RTIs with self-limiting or minor problems from those with underlying disease. The aim of this review is to describe a practical approach to children with recurrent LRTIs that limits unnecessary, expensive and time-consuming investigations. The children can be divided into three groups on the basis of their personal and family history and clinical findings: 1) otherwise healthy children who do not need further investigations; 2) those with risk factors for respiratory infections for whom a wait-and-see approach can be recommended; and 3) those in whom further investigations are mandatory. However, regardless of the origin of the recurrent LRTIs, it is important to remember that prevention by means of vaccines against respiratory pathogens (i.e. type b Haemophilus influenzae, pertussis, pneumococcal and influenza vaccines) can play a key role. [Copyright &y& Elsevier]

Summary: We review the limited available evidence on underlying causes of recurrent pneumonia in children, supplemented by our own clinical experience. Diagnosing recurrent pneumonia in children is difficult. Diagnostic confusion is possible with recurrent upper respiratory tract infections and asthma. In our series of children with recurrent pneumonia, we never identified asthma as an underlying cause. Because the frequency or severity of recurrent pneumonia does not always justify additional invasive investigations, the diagnostic work-up may be incomplete in a number of cases. This may help to explain why an underlying cause for recurrent pneumonia cannot be found in approximately 30% of cases. Finally, the paradigm that recurrent pneumonia in the same lung lobe has a differential diagnosis different from those recurring in multiple lobes was not borne out in our case series. A stepwise and pragmatic approach to evaluating children with recurrent lower respiratory tract infections is recommended. [ABSTRACT FROM AUTHOR]

The article presents a study which discusses the pulmonary infections and risk of lung cancer among patients with AIDS. It mentions that the researchers evaluate lung cancer hazard ratios (HRs) using Cox regression and investigate whether AIDS-defeining pulmonary infections affected the risk of subsequent lung cancer. The authors concluded that increased lung cancer associated with pneumonia supports that chronic pulmonary inflammation contributes to lung carcinogenesis.

Objective: The aim of this study was to determine the relative frequency and describe the predisposing causes of recurrent pneumonia in children. Material and methods: We retrospectively reviewed the medical records of patients with pneumonia at Uludag University Medical Faculty, Department of Pediatrics, between January 1998 and December 2007. Recurrent pneumonia was defined as at least two episodes in a 1 year period or at least three episodes over a lifetime. Patients with recurrent pneumonia were included in this study. Results: During the study period, 1617 children were admitted to hospital with a diagnosis of pneumonia, 185 (11.4%) met the criteria for recurrent pneumonia. The mean age of patients was 16±32 months (3 months-14 years) and 61% were male. An underlying cause was identified in 143 patients (77%). Of these, the underlying cause was diagnosed prior the pneumonia in 25 patients (17%), during the first episode in 30 (21%), and during recurrence in 88 (62%). Underlying causes included congenital cardiac defects in 32 patients (17.2%), gastroesophageal reflux in 31 patients (16.7%), aspiration syndrome in 27 patients (14.5%), asthma in 16 patients (8.6%), cystic fibrosis in 12 patients (6.4%) immune disorders in 10 patients (5.4%), tuberculosis in 9 patients (4.8%) and anomalies of the chest and lung in 6 patients (3.2%). No predisposing illness could be demonstrated in 42 patients (33%). Conclusion: Recurrent pneumonia occurred in 11.4% of all children hospitalized for pneumonia. The underlying cause was identified in 77% of the children. The most common causes were congenital cardiac defects, gastroesophageal reflux and aspiration syndrome. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to determine the relative frequency of recurrent pneumonia in children and to describe its underlying illnesses. Materials and methods: Children between 3 months and 16 years old who had a history of 2 or more episodes of pneumonia per year, or 3 or more episodes in a lifetime were investigated retrospectively at Doctor Sami Ulus Children's Training and Research Hospital between January 2002 and December 2004. Results: Out of 595 children admitted for pneumonia, 62 (10.42%) met the criteria for recurrent pneumonia. An underlying illness was demonstrated in 56 patients (90.32%). In this study, the underlying illness was diagnosed during recurrence in all patients. The patients with persistent pneumonia were excluded from the study. Underlying diseases were bronchial asthma (30.64%), immune deficiency disorders (17.75%), aspiration syndromes (17.75%), and congenital anomalies (16.12%). No predisposing illness could be demonstrated in 6 patients (9.68%). Conclusion: Approximately 1 in 10 children with pneumonia in our hospital had recurrent pneumonia. Most of these children had an underlying illness, which was demonstrated. Bronchial asthma was the most common underlying illnesses for undiagnosed recurrent pneumonia in children. [ABSTRACT FROM AUTHOR]

The authors report two patients with esophageal atresia and double fistula, one of whom was diagnosed intraoperatively and the other preoperatively through upper pouch contrast study. Patients with proximal and distal fistula do not present with excessive oral secretion and drooling because they can swallow the saliva/meals that reach the trachea from the proximal esophagus via the proximal fistula and then from the trachea to the distal esophagus via the distal fistula. Thus, since this clinical entity can be easily overlooked, some radiological and clinical signs that are helpful for preoperative and intraoperative diagnosis of a proximal fistula are discussed. [ABSTRACT FROM AUTHOR]

Congenital Lobar Emphysema (CLE) is a medical condition which is quiet rarely seen especially in neonates. The disease is characterized by over inflation of lungs which is produced due to inhibition of escape of inspired air from lungs. This condition usually occurs in infants due to partial obstruction of the bronchus and can be reversed with timely and planned anaesthetic management. Here in, we are presenting a case of an infant who was merely four months of age. CLE was affecting his left upper lobe since birth which was being treated as lobar pneumonia outside at some peripheral health center. The case presented to hospital with the symptoms acute respiratory distress and was taken up for urgent surgical management. Left upper lobectomy was performed which relived his symptoms. Case was discharged from hospital after 10 days of uneventful hospital stay. The case was challenging, as it involved careful and planned anaesthetic management of lung separation as well as prevention of hyperventilation of the un-involved lung. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to evaluate the bronchoscopy results of children with undiagnosed recurrent cough and pneumonia presumed to be due to foreign body aspiration according to the literature. Material and Method: Thirty-seven children followed by the Yuzuncu Yil University Medical Faculty with chronic cough and recurrent pneumonia not responding to medical treatment, were included in this study between 2004-2008. Bronchoscopy was carried out with a rigid/flexible bronchoscope under general anesthesia in the operating room. Intergroup differences were compared with Mann-Whitney U test, two-tailed Chi-square test was used for group frequency and Fisher's Exact test for group items less than five. A P value of 0.05 was considered to indicate statistical significance. Results: Cases consisted of 21 males (56,8%) and 16 (43,2%) females. Eighteen cases with chronic cough and nineteen cases with recurrent pneumonia were followed up. A foreign body was determined in twelve (32,4%) cases with rigid bronchoscopy. Foreign body diagnosis was detected significantly more frequently in recurrent pneumonia cases than in chronic cough cases ( p<0,0012). Conclusion: Bronchoscopy is valuable in diagnosing and treating children not responding to medical therapy with chronic cough and recurrent pneumonia. [ABSTRACT FROM AUTHOR]

Summary: Background: Bronchiectasis remains a significant cause of morbidity among specific populations world wide, including many indigenous groups. Data on prevalence in Australian adults are lacking. Indigenous children in Central Australia have the highest rates of bronchiectasis in the world. Outcomes for these individuals after they become adults are not currently available. Methods: We performed a retrospective case review of the presentation and likely aetiology of adult patients presenting to the Alice Springs Hospital with a primary diagnosis of bronchiectasis. Results: Sixty-one patients and 166 admissions were identified. Fifty-nine patients were indigenous (97%). Mean age was 42±15 years. Forty-three patients (70%) had past histories notable for recurrent respiratory tract infections. No predisposing factors could be identified in 11 patients (18%). Human T-cell lymphotropic virus type 1 (HTLV-1) serology was positive in 72% of those studied. Eight (13%) patients died during the study period. Conclusion: Bronchiectasis remains a significant cause of morbidity and mortality in Central Australia, with notably different patient characteristics and disease aetiology to other published cohorts. Recurrent respiratory infection is the major cause of illness. Associated factors include indigenous ethnicity, HTLV-1 positivity and childhood in a remote region. [Copyright &y& Elsevier]

The hyperimmunoglobulin E syndrome was discribed for Buckley, and it also called the Job syndrome. There are two types: dominant autosomal and recessive autosomal. It is a primary, rare and complex immunodeficiency, characterized clinically by recurrent skin abscesses for Staphylococcus aureus, recurrent pneumonia, and pneumatoceles, hypereosinophylia, high serum levels of immunoglobulin E (> 2,000 UI/mL), early eczema and late loss of primary dentition. Recently a STAT3 mutation has been described as origin of dominant autosomal hyperimmunoglobulin E syndrome. Since 1972, 250 cases have been reported around the world. The diagnosis is done with the Grimbacher criteria and the prognosis depends on the opportune diagnosis and treatment. The incidence is same in women and men. The differential diagnosis is with allergic bronchopulmonary aspergillosis, chronic granullomatose disease, T cell lymphoma, and atopic dermatitis. The treatment is with prophylactic antibiotic, intravenous immunoglobulin or recombinant INF gamma. [ABSTRACT FROM AUTHOR]

Hodgkin's disease (HD) represents a group of lymphomas with distinct clinical and histopathological features that account for &thksim;5% of cancers in patients who are <15 years old and &thksim;15% in patients who are 15–19 years old. Although the cause of HD is unknown, serologically confirmed infectious mononucleosis has been associated with an increased risk of HD, in addition to its known association with Burkitt's lymphoma. The Reed-Sternberg (RS) cell, a large and multinucleated cell with unique morphology, is the hallmark cell of HD. RS cells are clonal tumor cells that recently have been shown to be derived from B cells originating from germinal centers. Of four histological subtypes of HD, three have a good to excellent prognosis when recognized and treated early. We report a case of HD in a 15-year-old adolescent with a 14-month history of recurrent pneumonia. Open lung biopsy ultimately led to the diagnosis of HD. Although uncommon in this age group, the need to consider the possibility of neoplasm in the setting of recurrent respiratory infection is illustrated in this case. Early diagnosis and intervention may determine the prognosis of such neoplasms. [ABSTRACT FROM AUTHOR]