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Recurrent pulmonary infections starting from childhood often prompt evaluation for primary immunodeficiency disorders (PIDs). Hyper IgE syndrome (HIES) is a less common PID characterised by recurrent skin and pulmonary infections associated with elevated IgE levels. Staphylococcal infections are more commonly seen in these individuals, resulting in structural lung abnormalities such as pneumatoceles and bronchiectasis. The associated non-immunologic features (characteristic facies, retained primary dentition, scoliosis, osteopenia, and hyperextensible joints) should raise suspicion of this syndrome. We present four cases of HIES and review the pulmonary manifestations in this disease as reported in the Indian literature.

Recurrent pulmonary infections starting from childhood often prompt evaluation for primary immunodeficiency disorders (PIDs). Hyper IgE syndrome (HIES) is a less common PID characterised by recurrent skin and pulmonary infections associated with elevated IgE levels. Staphylococcal infections are more commonly seen in these individuals, resulting in structural lung abnormalities such as pneumatoceles and bronchiectasis. The associated non-immunologic features (characteristic facies, retained primary dentition, scoliosis, osteopenia, and hyperextensible joints) should raise suspicion of this syndrome. We present four cases of HIES and review the pulmonary manifestations in this disease as reported in the Indian literature. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Respiratory, Critical Care, & Sleep Medicine is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cystic fibrosis (CF) is an autosomal recessive inherited disease caused by variants of cystic fibrosis transmembrane conductance regulation (CFTR) gene. This report presents a case of a Chinese boy diagnosed with CF, attributed to the presence of two specific CFTR gene variations: 4056G > C (NM_000492.4) (p.Gln1352His, legacy: Q1352H) and c.1210-34TG[13]T[5] (NM_000492.4)(legacy: 5T; TG13). A ten-year-old boy was admitted to the hospital due to recurrent pneumonia, cough, and intermittent fever for seven years. Lung auscultation revealed rales, and a lung CT scan indicated parenchymal transformation with infection in both lungs. Whole Exome Sequencing (WES) identified two CFTR gene variants, Q1352H and 5T; TG13, which were significantly associated with clinical phenotype. Following a two-year course of azithromycin combined with inhalation therapy with budesonide, the patient experienced no further episodes of respiratory infections. Moreover, significant improvements were observed in pulmonary function, pulmonary infection, and bronchiectasis. The occurrence of combined variations, Q1352H and 5T; TG13, in the CFTR gene is rare and specific to Chinese populations. WES proves to be a valuable diagnostic tool for detecting CFTR gene variants. [ABSTRACT FROM AUTHOR]

Objective: The aim was to predict the effectiveness of using frailty, defined by the frailty index (FI), for predicting recurrent pneumonia and death in patients 50 years and older with vascular cognitive impairment (VCI) during long-term hospitalization. Measurements: This retrospective cohort study was conducted at a teaching hospital in western China and included VCI patients aged ≥50 years undergoing long-term hospitalization. The relevant data were collected from the electronic medical record system. The FI was based on 31 parameters and groups were defined using a cutoff value (0.2) as robust (FI

Abstract Background Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities. Methods We conducted a retrospective cohort study including children aged $$\ge$$ ≥ 2 months-14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 20 primary referral hospitals in Kenya. Severe pneumonia was defined using the 2013 World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality. Results Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% CI 10.6–11.5) were readmitted. Re-admission was independently associated with age (12–59 months vs. 2–11 months: adjusted odds ratio (aOR) 1.70, 1.54–1.87; >5 years vs. 2–11 months: aOR 1.85, 1.55–2.22), malnutrition (weight-for-age-z-score (WAZ) -2SD: aOR 2.05, 1.84–2.29); WAZ − 2 to -3 SD vs. WAZ> -2SD: aOR 1.37, 1.20–1.57), wheeze (aOR 1.17, 1.03–1.33) and presence of a concurrent neurological disorder (aOR 4.42, 1.70-11.48). Chest radiography was ordered more frequently among those readmitted (540/2,274 [23.7%] vs. 3,102/18,329 [16.9%], p -2SD: aHR 1.87, 1.71–2.05); WAZ − 2 to -3 SD vs. WAZ >-2SD: aHR 1.46, 1.31–1.63), complete vaccination (aHR 0.74, 0.60–0.91), wheeze (aHR 0.87, 0.78–0.98) and anaemia (aHR 2.14, 1.89–2.43) were independently associated with mortality. Conclusions Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality.

ObjectiveTo study the association between the concentration of calcium, iron, zinc, copper, and magnesium and their ratios in whole blood and the risk of recurrent pneumonia in infants and young children, and to provide guidelines for the prevention and control of recurrent pneumonia in the population. MethodsA case-control study was conducted among 86 children (< 36 months of age) with recurrent pneumonia who were hospitalized between September 2018 and February 2019, and 174 age-matched healthy children who underwent physical examinations during the same period at Tongshan County People's Hospital in Hubei province. Relevant information on the participants was obtained from the hospital's electronic medical records, and venous blood samples were collected to measure the concentrations of the five metal elements and their ratios. Multivariate logistic regression analysis was used to assess risk factors for recurrent pneumonia in infants and young children; and receiver operating cure (ROC) analysis was used to determine the significance of ratios of mental elements in predicting recurrent pneumonia. ResultsThe cases had a lower calcium concentration than the controls (1.59 ± 0.22 vs. 1.66 ± 0.17 mmol/L), with a deficiency rate of 22.09%, but a higher copper concentration (17.62 ± 6.18 vs. 14.11 ± 2.97 μmol/L) and a higher magnesium/calcium ratio (0.95 ± 0.14 vs. 0.90 ± 0.12) and copper/zinc ratio (0.25 ± 0.07 vs. 0.20 ± 0.04). Multivariate logistic regression analysis showed that low blood calcium (odds ratio [OR] = 0.120, 95% confidence interval [CI] : 0.027 to 0.530), high blood copper (OR = 1.209, 95%CI: 1.127 to 1.298), high magnesium/calcium ratio (OR = 1.039, 95%CI: 1.015 to 1.063), and high copper/zinc ratio (OR = 1.216, 95%CI: 1.137 to 1.301) were associated with an increased risk of recurrent pneumonia in infants and young children. ROC curve analysis showed that the area under the curve (AUC) of magnesium/calcium ratio, copper/zinc ratio, and their combination in predicting recurrent pneumonia in infants were 0.608, 0.707, and 0.758, respectively (P < 0.05 for all). ConclusionThe children less than 36 months of age with recurrent pneumonia have reduced whole blood calcium but increased calcium deficiency rate, copper concentration, magnesium/calcium ratio, and copper/zinc ratio, and magnesium/calcium and copper/zinc ratios could predict the risk of recurrent pneumonia in the children to some extent.

Background: Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities. Methods: We conducted a retrospective cohort study including children aged ≥ 2 months-14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 20 primary referral hospitals in Kenya. Severe pneumonia was defined using the 2013 World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality. Results: Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% CI 10.6–11.5) were readmitted. Re-admission was independently associated with age (12–59 months vs. 2–11 months: adjusted odds ratio (aOR) 1.70, 1.54–1.87; >5 years vs. 2–11 months: aOR 1.85, 1.55–2.22), malnutrition (weight-for-age-z-score (WAZ) <-3SD vs. WAZ> -2SD: aOR 2.05, 1.84–2.29); WAZ − 2 to -3 SD vs. WAZ> -2SD: aOR 1.37, 1.20–1.57), wheeze (aOR 1.17, 1.03–1.33) and presence of a concurrent neurological disorder (aOR 4.42, 1.70-11.48). Chest radiography was ordered more frequently among those readmitted (540/2,274 [23.7%] vs. 3,102/18,329 [16.9%], p < 0.001). Readmitted patients more frequently received second-line antibiotics (808/2,256 [35.8%] vs. 5,538/18,173 [30.5%], p < 0.001), TB medication (69/2,256 [3.1%] vs. 298/18,173 [1.6%], p < 0.001), salbutamol (530/2,256 [23.5%] vs. 3,707/18,173 [20.4%], p = 0.003), and prednisolone (157/2,256 [7.0%] vs. 764/18,173 [4.2%], p < 0.001). Inpatient mortality was 2,354/18,329 (12.8%) among children admitted with a first episode of severe pneumonia and 269/2,274 (11.8%) among those who were readmitted (adjusted hazard ratio (aHR) 0.93, 95% CI 0.82–1.07). Age (12–59 months vs. 2–11 months: aHR 0.62, 0.57–0.67), male sex (aHR 0.81, 0.75–0.88), malnutrition (WAZ <-3SD vs. WAZ >-2SD: aHR 1.87, 1.71–2.05); WAZ − 2 to -3 SD vs. WAZ >-2SD: aHR 1.46, 1.31–1.63), complete vaccination (aHR 0.74, 0.60–0.91), wheeze (aHR 0.87, 0.78–0.98) and anaemia (aHR 2.14, 1.89–2.43) were independently associated with mortality. Conclusions: Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is considered the leading cause of morbimortality in children all over the world. About 9% of children with pneumonia will have recurrent pneumonia (RP). RP has a major financial burden on the healthcare system owing to frequent hospitalization. Many studies focused on some underlying diseases that cause RP, RP have several possible causes such as deficits in host defenses or underlying situations affecting lung defense mechanisms. Objective: To evaluate pattern of RP and its accompanying risk factors in children admitted to Mansoura University Pediatric Hospital. Patients and Methods: The present study was an observational cross-sectional study with analytic component that was carried out on 180 patients. All patients were admitted to Mansoura University Children Hospital and aged >2 years old and < 18 years old. Results: RP represented 20% of all cases with pneumonia of studied patient. There was statistically significant positive correlation between RP and positive consanguinity (P <0.001), parental smoking (P 0.03), underweight (P 0.005) and Down syndrome (P 0.02). Conclusion: Recurrent pneumonia is a threatening problem contributing to 20% of total children admitted in Mansoura University with pneumonia during the period of our study. Concerning predisposing factors for RP, our study shows that there was significant increase in prevalence of recurrent pneumonia within cases with positive consanguinity, parental smoking, underweight and Down syndrome. [ABSTRACT FROM AUTHOR]

Tracheobronchomegaly (TBM) is a rare condition characterized by the dilatation of the trachea and bronchi due to severe atrophy of elastic fibers, accompanied by the thinning of the muscularis mucosae and the development of diverticula between cartilaginous rings. The etiology of this condition remains unclear. Tracheobronchopathia osteochondroplastica (TO) is another uncommon airway disease with an unknown etiology. The co-occurrence of these two diseases has not been reported. In this study, we report and discuss a case involving an elderly man with TBM and TO with a history of recurrent pneumonia over the past 6 years.

Pneumonia remains the top most killer of under-five Indian children. Pneumonia in children is usually caused by viral or bacterial infections. However, there are some unusual causes of pneumonia that merit consideration when pneumonia is recurrent or persistent.

Abdul Jamil Rasooly,1 Sahar Noor,1 Saif Ullah,2 Abdul Tawab Baryali,3 Ahmed Maseh Haidary4 1Department of Pediatrics Medicine, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan; 2Department of Medicine, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan; 3Department of Quality and Patient Safety, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan; 4Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, AfghanistanCorrespondence: Ahmed Maseh Haidary, Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan, Email ahmed.maseh9t9@gmail.comBackground: Pig bronchus is rare and usually asymptomatic, but it may also cause significant respiratory symptoms such as recurrent pneumonia, chronic bronchitis, atelectasis, and difficult airway management in surgical and critical care patients. This study is aimed to examine a case of pig bronchus in which the patient presented with recurrent pneumonia in her early days of life.Case Report: A case report is the study design utilized in this assessment of a 40-days-old girl from a consanguineous marriage, who presented with cough and difficulty breathing for approximately a month. She was referred from a provincial hospital with no improvement in respiratory symptoms after three times hospitalization since birth. Radiological investigation revealed pig bronchus as the cause of recurrent pneumonia.Conclusion: Pig bronchi, if not diagnosed on time, may result in severe lung infection that can even result in fatal disease. A high level of clinical suspicion is required to initiate an appropriate diagnostic workup. The gold standard modality for the diagnosis of pig bronchus is computed tomography (CT), ideally with multi-detector three-dimensional (3D) image reconstruction.Keywords: pig bronchus, infant, recurrent pneumonia

Pneumonia remains the top most killer of under-five Indian children. Pneumonia in children is usually caused by viral or bacterial infections. However, there are some unusual causes of pneumonia that merit consideration when pneumonia is recurrent or persistent. [ABSTRACT FROM AUTHOR]

Abstract Background Tracheal compression (TC) due to vascular anomalies is an uncommon, but potentially serious cause of chronic respiratory disease in childhood. Vascular slings are congenital malformations resulting from abnormal development of the great vessels; in this group of disorders the most prevalent entity is the aberrant innominate artery (AIA). Here we provide a report on diagnosis and treatment of AIA in nine children with unexplained chronic respiratory symptoms. We describe the cases, perform a literature review, and provide a discussion on the diagnostic workup and treatment that can help manage AIA. Methods Clinical history, diagnostic procedures and treatment before and after the AIA diagnosis were retrospectively reviewed in nine children (5 boys and 4 girls), who were referred for recurrent-to-chronic respiratory manifestations over 10 years (2012–2022). We performed a comprehensive report on the ongoing clinical course and treatment as well as an electronic literature search on the topic. Results Diagnoses at referral, before AIA was identified, were chronic dry barking cough associated with recurrent pneumonia (n = 8, 89%), lobar/segmental atelectasis (n = 3, 33%), atopic/non atopic asthma (n = 3, 33%); pneumomediastinum with subcutaneous emphysema complicated the clinical course in one case. When referred to our Unit, all patients had been previously treated with repeated antibiotic courses (n = 9, 100%), alone (n = 6, 67%) or combined with prolonged antiasthma medications (n = 3, 33%) and/or daily chest physiotherapy (n = 2, 22%), but reported only partial clinical benefit. Median ages at symptom onset and at AIA diagnosis were 1.5 [0.08–13] and 6 [4–14] years, respectively, with a relevant delay in the definitive diagnosis (4.5 years). Tracheal stenosis at computed tomography (CT) was ≥ 51% in 4/9 cases and ≤ 50% in the remaining 5 subjects. Airway endoscopy was performed in 4 cases with CT evidence of tracheal stenosis ≥ 51% and confirmed CT findings. In these 4 cases, the decision of surgery was made based on endoscopy and CT findings combined with persistence of clinical symptoms despite medical treatment. The remaining 5 children were managed conservatively. Conclusions TC caused by AIA may be responsible for unexplained chronic respiratory disease in childhood. Early diagnosis of AIA can decrease the use of expensive investigations or unsuccessful treatments, reduce disease morbidity, and accelerate the path toward a proper treatment.

Background: Tracheal compression (TC) due to vascular anomalies is an uncommon, but potentially serious cause of chronic respiratory disease in childhood. Vascular slings are congenital malformations resulting from abnormal development of the great vessels; in this group of disorders the most prevalent entity is the aberrant innominate artery (AIA). Here we provide a report on diagnosis and treatment of AIA in nine children with unexplained chronic respiratory symptoms. We describe the cases, perform a literature review, and provide a discussion on the diagnostic workup and treatment that can help manage AIA. Methods: Clinical history, diagnostic procedures and treatment before and after the AIA diagnosis were retrospectively reviewed in nine children (5 boys and 4 girls), who were referred for recurrent-to-chronic respiratory manifestations over 10 years (2012–2022). We performed a comprehensive report on the ongoing clinical course and treatment as well as an electronic literature search on the topic. Results: Diagnoses at referral, before AIA was identified, were chronic dry barking cough associated with recurrent pneumonia (n = 8, 89%), lobar/segmental atelectasis (n = 3, 33%), atopic/non atopic asthma (n = 3, 33%); pneumomediastinum with subcutaneous emphysema complicated the clinical course in one case. When referred to our Unit, all patients had been previously treated with repeated antibiotic courses (n = 9, 100%), alone (n = 6, 67%) or combined with prolonged antiasthma medications (n = 3, 33%) and/or daily chest physiotherapy (n = 2, 22%), but reported only partial clinical benefit. Median ages at symptom onset and at AIA diagnosis were 1.5 [0.08–13] and 6 [4–14] years, respectively, with a relevant delay in the definitive diagnosis (4.5 years). Tracheal stenosis at computed tomography (CT) was ≥ 51% in 4/9 cases and ≤ 50% in the remaining 5 subjects. Airway endoscopy was performed in 4 cases with CT evidence of tracheal stenosis ≥ 51% and confirmed CT findings. In these 4 cases, the decision of surgery was made based on endoscopy and CT findings combined with persistence of clinical symptoms despite medical treatment. The remaining 5 children were managed conservatively. Conclusions: TC caused by AIA may be responsible for unexplained chronic respiratory disease in childhood. Early diagnosis of AIA can decrease the use of expensive investigations or unsuccessful treatments, reduce disease morbidity, and accelerate the path toward a proper treatment. [ABSTRACT FROM AUTHOR]

Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Community-acquired pneumonia (САР) and chronic obstructive pulmonary disease (COPD) are among the main causes of mortality worldwide, and, in addition, they also lead to great economic losses for the health system of all countries. Currently, there is an increase in cases of recurrent pneumonia, both in the general population and, in particular, in patients with COPD. One of the most important risk factors for the development of pneumonia is the previous episode of САР. Potential risk factors for recurrent pneumonia are concomitant diseases such as heart failure, COPD, diabetes mellitus, neurological disorders, swallowing dysfunction, immune deficiency. Aim. To conduct a retrospective analysis of the effect of vaccine prophylaxis with conjugated pneumococcal vaccine (PCV13) and polysaccharide pneumococcal vaccine (PPV23) on the risk of recurrent pneumonia in patients with COPD. Materials and methods. A total of 302 male patients were included in the retrospective study. When analyzing the data, the fact of the development of pneumonia of any etiology during the 5th observation period was taken into account. For the recurrence of pneumonia, more than two episodes of CAP were taken during the year. 13-valent conjugated pneumococcal vaccine Prevenar-13 and 23-valent polysaccharide vaccine Pneumo23 were used for vaccine prophylaxis. The relative risk of the event was calculated. A 95% confidence interval was used. Results and conclusion. A retrospective analysis showed that, firstly, CAP is a fairly frequent complication of COPD: initially, the average percentage of cases of САР was 19.3%. Secondly, the risk of developing repeated episodes of pneumonia remains quite high in unvaccinated patients and tends to increase within 5 years: from 17 to 22%. Thirdly, the pneumococcal vaccines used have different effects on the risk of recurrent pneumonia in patients with COPD, a significant decrease in the number of recurrent pneumonia is observed only with the use of conjugated vaccines.

A patient who presented with sudden shortness of breath, stridor, and recurrent laryngeal nerve paralysis was diagnosed with a tracheal diverticulum. The diagnosis was established through CT scans and confirmed via endoscopy. Distinctive CT findings revealed an air-filled, tubular structure located behind and slightly to the right lateral of the trachea, which communicated with it. Endoscopy demonstrated a narrow-mouthed diverticulum originating from the posterior right wall of the trachea, approximately 8 cm below the level of the true vocal cords. Successful medical treatment was administered, and the patient experienced an uncomplicated recovery.

Background: Oral mucoceles, though frequently seen as asymptomatic lesions in young adults, very little is known about their existence in infants and the complications arising out of them in this age group. Clinical Description: A 4-month-old infant presented with a history of recurrent episodes of breathing difficulty since 15 days of life, every episode being managed as aspiration pneumonia. The child presented in the fifth such episode with tachypnea tachycardia and chest indrawing. Auscultation revealed bilateral crepitations and chest X-ray showed diffuse haziness in the bilateral chest predominantly in the right middle lobe, rest of the systemic examination being normal. Oral cavity examination showed a bluish globular bulge behind the tongue with surrounding congested mucosa and thick secretions. Management and Outcome: The baby was managed with respiratory support in the form of continuous positive airway pressure, intravenous antibiotics Piperacillin-Tazobactam, amikacin and metronidazole, and anti-reflux measures of oral Domperidone. Flexible laryngoscopy showed a cystic lesion behind the tongue and contrast-enhanced computerized tomography confirmed a hypodense lesion arising from the uvula suggestive of a mucocele. Excision of the oro-pharyngeal cystic lesion was done and the histopathological examination confirmed it to be a mucocele. The baby was gradually weaned off oxygen support and proper breastfeeding was re-established. Conclusion: This case creates awareness regarding the fact that an unsuspected oral mucocele may be the cause of recurrent respiratory symptoms in an infant, thereby reiterating the importance of oral examination even in young infants.

Background: Recurrent pneumonia is uncommon in children and few studies investigate the clinical impact of underlying diseases on this issue. This study aimed to explore the difference in clinical manifestations, pathogens, and prognosis of recurrent pneumonia in children with or without underlying diseases. Methods: We conducted a retrospective study of pediatric recurrent pneumonia from 2007 to 2019 in National Taiwan University Hospital. Patients under the age of 18 who had two or more episodes of pneumonia in a year were included, and the minimum interval of two pneumonia episodes was more than one month. Aspiration pneumonia was excluded. Demographic and clinical characteristics of patients were collected and compared. Results: Among 8508 children with pneumonia, 802 (9.4%) of them had recurrent pneumonia. Among these 802 patients, 655 (81.7%) had underlying diseases including neurological disorders (N = 252, 38.5%), allergy (N = 211, 32.2%), and cardiovascular diseases (N = 193, 29.5%). Children without underlying diseases had more viral bronchopneumonia (p < 0.001). Children with underlying diseases were more likely to acquire Staphylococcus aureus (p = 0.001), and gram-negative bacteriae, more pneumonia episodes (3 vs 2, p < 0.001), a longer hospital stay (median: 7 vs. 4 days, p < 0.001), a higher ICU rate (28.8% vs 3.59%, p < 0.001), and a higher case-fatality rate (5.19% vs 0%, p < 0.001) than those without underlying diseases. Conclusion: Children with underlying diseases, prone to have recurrent pneumonia and more susceptible to resistant microorganisms, had more severe diseases and poorer clinical outcomes. Therefore, more attention may be paid on clinical severity and the therapeutic plan.

Background: Pneumonia is the most frequent reason for morbidity and mortality in children worldwide. As many as ten times as many children die from childhood pneumonia in developing countries, compared to developed countries. Aim: This study was conducted to investigate severe recurrent pneumonia in children. Subjects and methods: This prospective & descriptive research were conducted on 200 patients at Tanta University Hospital, Pediatrics Department during the period from the beginning of May 2019 to April 2022. We recruited all patients with advanced recurrent pneumonia (RP). Results: Mean age of advanced RP children is 15.4 months, while the age at 1st episode of pneumonia was 12.7 months. Between children with advanced RP, the majority were males, being twice compared with females. Cough was the prevalent symptom in 99% of cases then wheezing (63%) and fever (60%). Respiratory abnormalities were the most prevalent (28%) as underlying causes of advanced RP patients, then immune disorders (22%) and congenital heart diseases (16%). The pulmonary hemorrhagic syndrome was the least prevalent cause as it was observed in only 2 cases. Conclusion: Children with underlying diseases had more serious diseases & poorer clinical results because they were more likely to get recurrent pneumonia & were susceptible to resistant microorganisms. As a result, more emphasis can be placed on clinical severity & therapeutic plan. [ABSTRACT FROM AUTHOR]

Childhood pneumonia is a very common cause of morbidity and mortality in children, especially in developing countries. A small proportion of these are due to recurrent pneumonias. This is defined as the occurrence of more than one episode of pneumonia within a single year, or greater than 3 episodes within any duration; with radiographically documented clearing between episodes. A diligent, step-wise clinical approach and judicious laboratory investigations are required to establish clinical diagnosis. In this article, we describe the approach used to establish etiology in a case of recurrent pneumonia.

Idiopathic pulmonary hemosiderosis is a rare and severe disease in childhood with a poor prognosis. The main clinical symptoms are a combination of severe hypochromic iron deficiency anemia with severe recurrent pneumonia. The development of a hemolytic component with a moderate increase in indirect bilirubin and enhanced bone marrow erythropoiesis is possible. The disease is close to Goodpasture’s syndrome, in which the formation of antibodies to the basement capillaries membrane of not only the lungs, but also the kidneys has been proven. In the given clinical cases, notes an isolated lesion of lungs capillaries. The disease severity in these children was of varying degrees, but the prognosis is poor due to the progression of fibrotic changes in the lung tissue.

Esophageal-pleural (E-P) fistula is introduced to be an uncommon clinical finding maybe due to non-specific clinical pointers and vague radiologic clues. In this regard, the main drivers are esophageal traumatization, endoscopic dilation, irradiation and corrosive agent ingestion as well as major underlying esophageal diseases like carcinomas and tuberculosis. The presented case is a 51-year-old man with medical record of recurrent pneumonias resulted in right lobectomy who admitted to the medical institution with a significant empyema leading to chest tube insertion. It should be noted that the presence of food particles in the chest bottle in addition to the history of previous surgery raised suspicion of a post-surgical E-P fistula formation. Attempts were made to find fistula tract and insert an esophageal stent bypassing the fistula opening. However, investigations argued against E-P fistula as an ensuing event after surgery and arose the question that whether E-P fistula would be the cause or effect of pneumonia in the presented case?

Pulmonary sequestration is a rare congenital malformation of lung in which a part of the lung is supplied by an anomalous systemic blood supply from thoracic or abdominal aorta. This is a nonfunctioning lung tissue and lacks normal communication with tracheobronchial tree. It develops from accessory lung bud. If developed before pleura formation, it results in intralobar sequestration, and extralobar, if it develops after pleura formation. Usually Intralobar type of pulmonary sequestration presents in late childhood or adolescence with recurrent pulmonary infections. It is less commonly associated with foregut communication or associated anomalies, unlike the latter. Extra lobar type usually presents with respiratory distress while recurrent infections are less common. In the present case report a 76-year-old male patient was diagnosed with intralobar pulmonary sequestration. This patient was presented with recurrent respiratory infections with complaints of fever and cough with expectoration for one week. Previously the patient was misdiagnosed with recurrent pneumonia. Despite the age of patient, consideration of pulmonary sequestration as a differential diagnosis lead to investigations in that direction. This helped in prompt diagnosis and further plan of management. Misdiagnosis of this condition may have lead to development of complications like recurrent infections and abscess. These complications can be avoided by prompt surgical excisions which are curative. This case report was unique because it diagnosed pulmonary sequestration in a 76 years old patient who presented with recurrent pneumonia.

Background: Recurrent pneumonia is defined as at least two episodes of pneumonia in a year or three episodes during a lifetime, with clinical and radiological improvement in between. Clinical Description: A 5-year and 8-month-old boy presented with a history of three episodes of fever and fast breathing of variable duration over 8 months. In between, he had a persistent moist cough with intermittent fever, weight loss, and darkening pigmentation. He had three prior admissions for the same, with X-rays showing multilobar pneumonia. Routine investigations were normal. Tuberculosis workup was negative. Computerized tomography showed changes in consolidation without any evidence of structural abnormality. The child became asymptomatic with short courses of antibiotics and nebulization during these admissions. He was referred to us for further evaluation, and we reviewed his history, examination, and medical records. Management: The darkened complexion was suggestive of Addisonian pigmentation, but serum electrolytes were normal. However, very low levels of morning cortisol and high adrenocorticotrophic hormone were suggestive of adrenal insufficiency. Retrospective history revealed dysphagia with nocturnal cough suggesting aspiration. Barium swallow confirmed achalasia by the presence of a dilated esophagus with distal narrowing. The clinical phenotype was suggestive of Triple A (AAA) syndrome with Addison's disease, alacrimia, and achalasia. A positive Schirmer's test confirmed alacrimia and established the clinical diagnosis. He was started on replacement hydrocortisone and later taken up for Laparoscopic Heller Myotomy with fundoplication. On follow-up, his appetite improved, his cough subsided, he had adequate weight gain, and the pigmentation had decreased. Conclusion: Achalasia should be considered a differential in recurrent pneumonia. AAA syndrome has isolated glucocorticoid deficiency. Therefore, hyperpigmentation in the presence of normal electrolytes should not preclude considering the possibility of adrenal insufficiency.

Monogenic lupus is a subset of lupus caused by single-gene disorders, integrating the paradoxical combination of autoimmunity and immunodeficiency. Pulmonary manifestations with recurrent pneumonia and bronchiectasis have rarely been described as the predominant presentation of juvenile lupus and may suggest an alternate differential like primary immunodeficiency, especially in early childhood. We describe a case of 10-year girl who presented with a history of recurrent pneumonia, arthritis, alopecia, and poor weight gain for the past 2 years. On examination, she had respiratory distress, bilateral diffuse crackles and arthritis of the small joints of hands. Lab investigations showed pancytopenia, low complement levels and high titers of ANA and anti-dsDNA antibodies. The patient was diagnosed with juvenile lupus. Imaging studies revealed evidence of multiple lobar collapse and consolidation with bronchiectasis. She was started on steroids, HCQ and supportive measures for bronchiectasis. The child reported relief in initial symptoms of lupus on follow-up but developed recurrent thrombocytopenia requiring IVIG and escalating the doses of oral steroids. The young age and atypical presentation prompted a screening for monogenic lupus, and clinical exome sequencing revealed a novel homozygous missense variation in exon 20 of the C4Agene with clinically reduced C4 levels, consistent with the diagnosis of C4A deficiency. [ABSTRACT FROM AUTHOR]

Aim: The recognition and diagnosis of primary immunodeficiency disorders (PIDs) is challenging in developing countries. This study aimed to describe the features of PID patients in a tertiary care setting in Egypt and analyse the distribution, clinical features and outcome of PID among paediatric patients. Methods: This cross‐sectional retrospective study was conducted between January 2016 and January 2021, to evaluate all paediatric patients aged below 18 years with PID that were diagnosed according to the International Union of Immunological Societies 2017 classification. We retrospectively studied the clinical features, diagnostic spectrum, laboratory investigations and relevant immunological workup, and treatment options. Results: A total of 61 PID patients were enrolled in the current study. The median age at diagnosis was 22 months. The overall consanguinity rate was 49.2%, and the family history of PID was 19.7%. Among all PIDs, the combined immunodeficiency with syndromic features predominates with 17 cases, accounting for 27.9% of all cases of PIDs. The predominant antibody deficiency was the second common PID that was diagnosed in 14 patients (23%). Recurrent pneumonia was the most common initial presentation, occurring in 77% of patients, followed by failure to thrive (63.9%), and recurrent otitis media (55.7%). The total deaths were 18 patients (29.5%). Conclusion: Paediatric patients with PIDs are not uncommon in Egypt. There is a need to improve PID diagnosis and treatment, for better estimation of PID and to decrease morbidity and mortality. [ABSTRACT FROM AUTHOR]

Abstract SIgMD is a rare immune disorder that occurs in a primary or secondary condition. Patients with recurrent infectious, cancers, and autoimmune disorders should be investigated to determine SIgMD.

Abstract Ataxia‐telangiectasia (A‐T) is known as an uncommon autosomal recessive disorder associated with recurrent infections and other clinical complications. The management of its complications can improve life quality of patients.

Background: Recurrent pneumonia is uncommon in children and few studies investigate the clinical impact of underlying diseases on this issue. This study aimed to explore the difference in clinical manifestations, pathogens, and prognosis of recurrent pneumonia in children with or without underlying diseases.Methods: We conducted a retrospective study of pediatric recurrent pneumonia from 2007 to 2019 in National Taiwan University Hospital. Patients under the age of 18 who had two or more episodes of pneumonia in a year were included, and the minimum interval of two pneumonia episodes was more than one month. Aspiration pneumonia was excluded. Demographic and clinical characteristics of patients were collected and compared.Results: Among 8508 children with pneumonia, 802 (9.4%) of them had recurrent pneumonia. Among these 802 patients, 655 (81.7%) had underlying diseases including neurological disorders (N = 252, 38.5%), allergy (N = 211, 32.2%), and cardiovascular diseases (N = 193, 29.5%). Children without underlying diseases had more viral bronchopneumonia (p < 0.001). Children with underlying diseases were more likely to acquire Staphylococcus aureus (p = 0.001), and gram-negative bacteriae, more pneumonia episodes (3 vs 2, p < 0.001), a longer hospital stay (median: 7 vs. 4 days, p < 0.001), a higher ICU rate (28.8% vs 3.59%, p < 0.001), and a higher case-fatality rate (5.19% vs 0%, p < 0.001) than those without underlying diseases.Conclusion: Children with underlying diseases, prone to have recurrent pneumonia and more susceptible to resistant microorganisms, had more severe diseases and poorer clinical outcomes. Therefore, more attention may be paid on clinical severity and the therapeutic plan. [ABSTRACT FROM AUTHOR]

Background: Inborn errors of immunity, mainly Predominantly Antibody deficiencies with normal IgG levels are unrecognized in adults with lung diseases such as bronchiectasis or recurrent pneumonia. Objective: To determine IgM, IgA, IgG2 subclass deficiencies, and Specific antibody deficiency (anti-pneumococcal polysaccharide antibodies) in adults with non-cystic fibrosis bronchiectasis or recurrent pneumonia. Methods: Cross-sectional study. Consecutive patients with non-cystic fibrosis bronchiectasis or recurrent pneumonia were recruited in Cali, Colombia. IgG, IgA, IgM, and IgE, IgG2subclass and IgG anti-pneumococcal serum levels were measured. Results: Among the 110 participants enrolled, Antibody deficiencies with normal serum IgG levels were found in 11(10%) cases. IgA deficiency (3 cases), IgM deficiency (2 cases) and IgG2 deficiency (2 cases) were the most frequent primary immunodeficiencies. In addition, IgG2+IgA deficiency, Ataxia-telangiectasia, Hyper-IgE syndrome and Specific Antibody Deficiency(anti-polysaccharides) were found in one case each. Conclusions: Predominantly antibody deficiencies with normal IgG levels are an important etiology of non-cystic fibrosis bronchiectasis and recurrent pneumonia in adults. [ABSTRACT FROM AUTHOR]

Foreign body aspiration (FBA) is a life-threatening clinical condition, usually requiring immediate intervention involving the removal of a foreign body from the airways during bronchoscopy. Relevant history taking is a very important element in the diagnosis of FBA. Lack of information about the child’s choking episode may delay making the correct diagnosis, and increase the risk of long-term complications of foreign body retention in the airways, including recurrent pneumonia. The case is presented of a 13-year-old boy diagnosed with pneumonia three times in four months. FBA was diagnosed after performing additional laboratory tests, imaging tests, and repeated history taking from the boy. The case report highlights the need for FBA suspicion if symptoms of pneumonia recur or persist despite proper treatment, even if insufficient evidence of FBA is provided in the initial interview.

Blastomycosis is a rare fungal infection endemic to North America and parts of Africa. It can be challenging to diagnose until it reaches a critical stage. We present a blastomycosis case in Alabama, emphasizing the importance of early recognition and management. A 67-year-old man had a month of worsening respiratory symptoms, which included malaise, cough, shortness of breath, and fever. Despite multiple urgent care visits and treatments with antibiotics and steroids, his condition continued to deteriorate. He was hospitalized with persistent fever and hypoxia. The imaging revealed patchy lung disease and multifocal consolidations, but initial cultures revealed no growth. He ultimately underwent bronchoscopy for budding yeast consistent with blastomycosis, along with influenza A. Treatment with amphotericin B was started, and there was a significant improvement. This case illustrates the need to consider the diagnosis of blastomycosis in a patient presenting with persistent respiratory symptoms unresponsive to conventional treatments., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Umar et al.)

Recurrent pneumonia in children is a rare situation, and foreign body (FB) aspiration is always an important cause to discard, especially in young children. We report a case of a 20-month-old boy with a history of recurrent pneumonia since 13 months of age, associated with chronic diarrhea and failure to thrive. After extensive investigation, chest computed tomography raised the possibility of an FB aspiration, and bronchoscopy confirmed a right upper lobe bronchus obstruction by a fragment of chicken meat. A high degree of clinical suspicion is essential to diagnose inhaled FB, which should be considered in the presence of recurrent pneumonia, even if there was not a known episode of choking.

Congenital lobar emphysema (CLE) is a rare but important lung malformation typically discovered in the newborn period. Some rare cases are reported in adults. It can present with various respiratory symptoms. Diagnosis relies primarily on chest CT scans, and the main treatment is surgery. We present a case of a young girl with recurrent respiratory infections who was misdiagnosed with a pneumothorax. A chest tube was inserted. Later, CLE was identified, and the affected lung lobe was surgically removed. This case highlights the importance of including CLE in the differential diagnosis for hyperinflation of a lung lobe. A CT scan is crucial for confirmation. Congenital lobar emphysema is a rare disease that primarily affects children. Most children with CLE experience symptoms and require surgery. In adults, CLE is uncommon, and surgery is based on the severity of symptoms and radiological findings. • Congenital lobar emphysema (CLE) is a rare lung disorder, particularly in adults. • The majority of CLE cases present in early childhood, with rare occurrences in adults. This rarity in adults can lead to misdiagnosis as pneumothorax. • In some cases, CLE can also be acquired, so it is important to conduct a study to rule out acquired causes if diagnosed in adults. • The basic diagnosis is made through a CT scan of the chest, with emphasis on Echocardiogram to study the accompanying abnormalities. • Surgery is the preferred treatment approach for symptomatic cases. Even for conservatively managed cases, close follow-up is essential. [ABSTRACT FROM AUTHOR]

Objective: Lower respiratory tract infections (LRTI) are the most common reason of mortality for under 5 years old. We aimed to examine serum 25 (OH) vitamin D level of children with LRTI according to age, time of admission and gender. Methods: Children between 1 months-18 years of age with a diagnosis of LRTI admitted to the Health Science University Keciören Research and Training Hospital between July 2018 and July 2019 were included. Sociodemographic characteristics, serum 25 (OH) vitamin D levels, history of recurrent LRTI, and hospitalisation time were recorded. Results: A total of 105 patients, 65 (61.9%) male (M/F:1.6) with a median age of 4 years (1 month-17 years) were included. Twenty nine patients (27.6%) were hospitalised and 76 (72.6%) patients were outpatients. Of them, 44 patients were diagnosed with viral acute lower respiratory tract infection and the remaining 61 with bacterial acute lower respiratory tract infection. Serum 25 (OH) vitamin D level was low in 63 patients (<20 ng/mL), and normal in 42 patients (=20 ng/mL). In 24 patients (22.9%), serum 25 (OH) vitamin D level was <12 ng/mL, in 37 (35.2%) patients, it was in 12-20 ng/mL, and in 44 (41.9%) patients, >20 ng/mL. In 32 patients under 1 year old of age, median serum 25 (OH) vitamin D levels were lower in patients born in winter compared to patients born in other seasons. The serum median 25 (OH) vitamin D level of hospitalised children under 1 year old of age was statistically significantly lower than in outpatients of the same age group, [25.9 ng/mL (1.7-87.7) versus 42.1 ng/mL (16.6-62.6), p=0.035]. Conclusion: We conclude that, vitamin D deficiency/insufficiency may be a risk factor for LRTI presentation, recurrence and outcome in children. [ABSTRACT FROM AUTHOR]

Endobronchial carcinoid tumors, a subset of neuroendocrine tumors, represent a rare but significant entity within pulmonary neoplasms, constituting less than 2% of all lung cancers. Our case report details the clinical presentation, diagnosis, and management of a 56-year-old female patient who presented with intermittent wheezing, mucoid cough, and recurrent pneumonia. Initial imaging and bronchoscopy identified an obstructive mass in the left lower bronchus. Histopathological examination of the bronchoscopic biopsy confirmed the diagnosis of a typical endobronchial carcinoid tumor. The patient underwent a successful left lower lobe lobectomy of the lung through left thoracotomy with regional and mediastinal lymph node dissection. Follow-up evaluations demonstrated no recurrence post-treatment. This case highlights the clinical features, diagnostic challenges, and therapeutic strategies associated with endobronchial carcinoid tumors, emphasizing the efficacy of a multidisciplinary approach in achieving favorable outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Karimi et al.)

CD4 expression identifies a subset of mature T cells primarily assisting the germinal center reaction and contributing to CD8+ T-cell and B-cell activation, functions, and longevity. Herein, we present a family in which a novel variant disrupting the translation-initiation codon of the CD4 gene resulted in complete loss of membrane and plasma soluble CD4 in peripheral blood, lymph node, bone marrow, skin, and ileum of a homozygous proband. This inherited CD4 knockout disease illustrates the clinical and immunological features of a complete deficiency of any functional component of CD4 and its similarities and differences with other clinical models of primary or acquired loss of CD4+ T cells. The first inherited loss of any functional component of CD4, including soluble CD4, is clinically distinct from any other congenital or acquired CD4 T-cell defect and characterized by compensatory changes in T-cell subsets and functional impairment of B cells, monocytes, and natural killer cells. [ABSTRACT FROM AUTHOR]

Ataxia‐telangiectasia (A‐T) is known as an uncommon autosomal recessive disorder associated with recurrent infections and other clinical complications. The management of its complications can improve life quality of patients. [ABSTRACT FROM AUTHOR]

SIgMD is a rare immune disorder that occurs in a primary or secondary condition. Patients with recurrent infectious, cancers, and autoimmune disorders should be investigated to determine SIgMD. [ABSTRACT FROM AUTHOR]

Pneumonia is one of the most common acute infections and the single greatest infectious cause of death in children worldwide. In uncomplicated, community-acquired pneumonia in immunocompetent patients, the diagnosis is clinical and imaging has no role. The first role of imaging is to identify complications associated with pneumonia such as pleural effusion, pulmonary abscess, and bronchopleural fistula. Radiographs are recommended for screening for these complications and ultrasound and CT are recommended for confirmation. The second role of imaging is to identify underlying anatomic conditions that may predispose patients to recurrent pneumonia. CT with intravenously administered contrast is recommended for this evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Common Variable Immunodeficiency (CVID) is a form of primary immunodeficiency disorder characterised by hypogammaglobulinemia and recurrent sino-pulmonary infections. Its diagnosis is based on the presence of low serum IgG (< 2 SD below normal for age) with or without low IgA/ IgM levels and presentation beyond two years of age. These children also have disorders of autoimmunity with majority of them presenting as autoimmune cytopenias, predominantly thrombocytopenia and some having anaemia and neutropenias. Here we report a nine years old boy with past history of recurrent pneumonia, presenting this episode with fungal pneumonia, thrombocytopenia and anaemia eventually diagnosed as CVID. [ABSTRACT FROM AUTHOR]

Pneumonia is one of the most common acute infections and the single greatest infectious cause of death in children worldwide. In uncomplicated, community-acquired pneumonia in immunocompetent patients, the diagnosis is clinical and imaging has no role. The first role of imaging is to identify complications associated with pneumonia such as pleural effusion, pulmonary abscess, and bronchopleural fistula. Radiographs are recommended for screening for these complications and ultrasound and CT are recommended for confirmation. The second role of imaging is to identify underlying anatomic conditions that may predispose patients to recurrent pneumonia. CT with intravenously administered contrast is recommended for this evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]