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Implemented control measures brought about by the coronavirus disease 2019 (COVID-19) pandemic have changed the prevalence of other respiratory viruses, often relegating them to a secondary plan. However, it must not be forgotten that a diverse group of viruses, including other human coronaviruses, rhinoviruses, respiratory syncytial virus, human metapneumoviruses, parainfluenza and influenza, continue to be responsible for a large burden of disease. In fact, they are among the most common causes of acute upper and lower respiratory tract infections globally. Viral respiratory infections can be categorised in several ways, including by clinical syndrome or aetiological agent. We describe their clinical spectrum. Distinctive imaging features, advances in microbiological diagnosis and treatment of severe forms are also discussed.Educational aimsTo summarise the knowledge on the spectrum of disease that respiratory viral infections can cause and recognise how often they overlap.To learn the most common causes of respiratory viral infections and acknowledge other less frequent agents that may target certain key populations (e.g. immunocompromised patients).To improve awareness of the recent advances in diagnostic methods, including molecular assays and helpful features in imaging techniques.To identify supportive care strategies pivotal in the management of severe respiratory viral infections.

BackgroundBronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries.MethodsWe conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling.ResultsIn total, 42 916 children were included. We observed an overall cumulative 78% (95% CI −100– −54%; pConclusionsSeveral NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.

Resumo: Introdução: Ao Staphylococcus aureus resistente à meticilina (MRSA) é classicamente reconhecido um papel patogénico no âmbito da fibrose quística (FQ).Objectivos: Avaliação da evolução da prevalência e incidência da colonização por MRSA, impacto clínico no ano após o primeiro isolamento, factores de risco e padrão de resistência antimicrobiana.Métodos: Estudo retrospectivo dos doentes pediátricos colonizados por MRSA seguidos no centro de FQ do Hospital de Santa Maria de 2003 a 2007.Resultados: O MRSA foi isolado em secreções respiratórias de 12 dos 60 doentes seguidos durante este período (colonização crónica em 3 doentes). A idade média à data do primeiro isolamento foi de 9 anos e 10 meses e o tempo médio entre o diagnóstico de FQ e a aquisição de MRSA de 5 anos e 7 meses.Verificou-se um aumento da prevalência e incidência de colonização por MRSA, com um máximo atingido em 2007 (prevalência 14,3% e incidência 8,9%). Quatro doentes cumpriram antibioticoterapia profiláctica antiestafilocócica com flucloxacilina.No ano após o primeiro isolamento de MRSA, constatou-se um aumento do número de dias de internamento em 4 doentes (2 com colonização crónica) e deterioração da função pulmonar em 5, incluindo a totalidade dos doentes com colonização crónica. Apenas um doente apresentou diminuição de percentil de índice de massa corporal.As resistências mais frequentemente encontradas foram à rifampicina e à clindamicina.Conclusões: Este estudo revelou ocorrência de deterioração clínica relevante em doentes com colonização crónica por MRSA, reforçando a importância da implementação de estratégias eficazes e precoces de erradicação.Rev Port Pneumol 2010; XVI (4): 527-542 Abstract: Background: Methicillin-resistant Staphylococcus aureus (MRSA) plays a well-recognised pathogenic role in cystic fibrosis (CF).Aims: To evaluate the prevalence and incidence of colonisation by MRSA, clinical impact of MRSA colonisation (year after first MRSA isolation), risk factors and pattern of antimicrobial resistance.Methods: Retrospective review of paediatric CF patients colonised with MRSA followed-up at the CF Unit of Hospital de Santa Maria 2003-2007.Results: Twelve of the 60 patients followed-up during this period were MRSA-positive at some time (chronic colonisation in 3 patients). Mean age at acquisition was 9 years 10 months and mean time interval between CF diagnosis and MRSA acquisition 5 years 7 months.An important rise in MRSA colonisation prevalence and incidence was observed, with the highest rate seen in 2007 (prevalence 14.3% and incidence 8.9%).Four patients had received anti-staphylococcal prophylaxis with flucloxacillin.An increase in the total number of in-patient days was observed in four patients (two with chronic colonisation). Deterioration in lung function was seen in five patients (including the three patients with chronic colonisation). Only one patient had a decrease in body mass index percentile. Resistance to clindamycin and rifampin was the most frequently seen.Conclusions: This study revealed significant clinical deterioration in patients with chronic colonisation by MRSA, reinforcing the importance of effective and timely decolonisation strategies.Rev Port Pneumol 2010; XVI (4): 527-542 Palavras-chave: Fibrose quística, MRSA, erradicação, Key-words: Cystic fibrosis, MRSA, decolonisation

Background: Methicillin-resistant Staphylococcus aureus (MRSA) plays a well-recognised pathogenic role in cystic fibrosis (CF). Aims: To evaluate the prevalence and incidence of colonisation by MRSA, clinical impact of MRSA colonisation (year after first MRSA isolation), risk factors and pattern of antimicrobial resistance. Methods: Retrospective review of paediatric CF patients colonised with MRSA followed-up at the CF Unit of Hospital de Santa Maria 2003â2007. Results: Twelve of the 60 patients followed-up during this period were MRSA-positive at some time (chronic colonisation in 3 patients). Mean age at acquisition was 9 years 10 months and mean time interval between CF diagnosis and MRSA acquisition 5 years 7 months.An important rise in MRSA colonisation prevalence and incidence was observed, with the highest rate seen in 2007 (prevalence 14.3% and incidence 8.9%).Four patients had received anti-staphylococcal prophylaxis with flucloxacillin.An increase in the total number of in-patient days was observed in four patients (two with chronic colonisation). Deterioration in lung function was seen in five patients (including the three patients with chronic colonisation). Only one patient had a decrease in body mass index percentile.Resistance to clindamycin and rifampin was the most frequently seen. Conclusions: This study revealed significant clinical deterioration in patients with chronic colonisation by MRSA, reinforcing the importance of effective and timely decolonisation strategies. Resumo: Introdução: Ao Staphylococcus aureus resistente à meticilina (MRSA) é classicamente reconhecido um papel patogénico no âmbito da fibrose quística (FQ). Objectivos: Avaliação da evolução da prevalência e incidência da colonização por MRSA, impacto clínico no ano após o primeiro isolamento, factores de risco e padrão de resistência antimicrobiana. Métodos: Estudo retrospectivo dos doentes pediátricos colonizados por MRSA seguidos no centro de FQ do Hospital de Santa Maria de 2003 a 2007. Resultados: O MRSA foi isolado em secreções respiratórias de 12 dos 60 doentes seguidos durante este período (colonização crónica em 3 doentes). A idade média à data do primeiro isolamento foi de 9 anos e 10 meses e o tempo médio entre o diagnóstico de FQ e a aquisição de MRSA de 5 anos e 7 meses.Verificou-se um aumento da prevalência e incidência de colonização por MRSA, com um máximo atingido em 2007 (prevalência 14,3% e incidência 8,9%). Quatro doentes cumpriram antibioticoterapia profiláctica antiestafilocócica com flucloxacilina.No ano após o primeiro isolamento de MRSA, constatou-se um aumento do número de dias de internamento em 4 doentes (2 com colonização crónica) e deterioração da função pulmonar em 5, incluindo a totalidade dos doentes com colonização crónica. Apenas um doente apresentou diminuição de percentil de índice de massa corporal.As resistências mais frequentemente encontradas foram à rifampicina e à clindamicina. Conclusões: Este estudo revelou ocorrência de deterioração clínica relevante em doentes com colonização crónica por MRSA, reforçando a importância da implementação de estratégias eficazes e precoces de erradicação. Key-words: Cystic fibrosis, MRSA, decolonisation, Palavras-chave: Fibrose quística, MRSA, erradicação

Type 1 Diabetes Mellitus (T1DM) is the most common endocrine-metabolic disease in children. It is associated with vascular and neuropathic complications, and may also affect growth and development.To correlate the metabolic control and disease duration with growth and puberty in patients with T1DM followed in a Pediatric Endocrinology Outpatient Clinic.Retrospective analysis. Sample obtained from patients with T1DM followed in Hospital Santa Maria Pediatric Endocrinology Outpatient Clinic (Lisbon - Portugal) since 1994 until March 2011.patients diagnosed before the onset of puberty and who had attained their final height during the follow-up.sex, age, weight and height at diagnosis and final, parents' height, growth velocity, pubertal height gain, age at menarche and metabolic control during puberty.39 patients, 51% female, 82% diagnosed less than five years before puberty. Fifty-four percent presented an average HbA1c between 8-10%, what we considered reasonable. There seems to be a trend towards an inverse association between HbA1c and the maximum speed of growth and pubertal height gain, although not statistically significant. These patients were taller than average at diagnosis (z-score: male 0.9; female: 0.5) and lost height during puberty, yet attained final heights within normal range and matching their target heights.Although HbA1c seems to negatively influence maximum growth rate and pubertal height gain, there was no compromise in final height in this group of patients.