Recurrent Pneumonia - Cancer Therapy Advisor
The incidence of recurrent pneumonia in children is unclear . Detailed cough history, pattern, relation to food or exercise, following colds and colour of. Kjellman (11), in his study investigating the relationship between asthma and recurrent pneumonia, noted that 14 of asthmatic children. For the child with recurrent chest symptoms, lack of serial CXR's can make distinguishing "recurrent" from "persistent" pneumonia challenging. If the radiographic.
Microbiological studies, such as sputum samples and nasopharyngeal swabs, were obtained in only a subgroup of patients. Of these, The mean age when recurrent pneumonia was diagnosed was 3. An underlying illness was identified in One hundred fourteen patients View Large Download Patients With Underlying Causes of Recurrent Pneumonia All patients with aspiration disorders had involvement on radiography of more than one lung lobe.
Of these, cerebral palsy accounted for nearly half the causes. The mean age at diagnosis of recurrent pneumonia in children with aspiration disorders was 6. Of the 24 patients who had immune disorders, 13 had malignant neoplasms; 5, dysgammaglobulinemia 3, hypogammaglobulinemia; 1, hyperimmunoglobulin E syndrome; 1, agammaglobulinemia ; 5, HIV infection; and 1, autoimmune pancytopenia.
The mean age at diagnosis of recurrent pneumonia in children with immune disorders was 3. The patients with congenital heart disease included 16 Six other patients had more complex cardiac disorders. The mean age at diagnosis of recurrent pneumonia in children with congenital heart disease was 1.
The mean age at diagnosis of recurrent pneumonia in the 19 children with asthma was 4. Airway and pulmonary anomalies were diagnosed early in life and were found in 18 patients.
The mean age of diagnosis was 4 months age range, 0 days to 6 months. Children with tracheoesophageal fistulas formed the largest group in this category with 7 patients. Two patients each had congenital cystic adenomatoid malformation, vocal cord paralysis, subglottic stenosis, and tracheomalacia. The 3 remaining patients had an esophageal bronchus, a tracheoesophageal cleft, and tracheal stenosis, respectively. The mean age at diagnosis of recurrent pneumonia in children with airway and pulmonary anomalies was 3.
Associated gastroesophageal reflux was found in 13 patients with recurrent pneumonia. In all patients there was a notable association between feeding and subsequent respiratory symptoms.
All of these children were neurologically normal on physical examination.
The mean age at diagnosis of recurrent pneumonia in children with gastroesophageal reflux was 1. Children for whom no underlying etiologic diagnosis was identified had growth, development, and physical examination findings within reference limits.
The mean age at diagnosis of recurrent pneumonia in these children was 4. All were asymptomatic prior to and after the illness leading to hospitalizations. Findings from all hospital investigations were within reference limits.
One hundred seventy-eight patients Aspiration disorders, immune disorders, and congenital heart disease were underlying illnesses that tended to be known prior to the first pneumonia. View Large Download Timing of Underlying Illness Diagnosis Relative to the Number of Pneumonia Episodes Of the 17 underlying illness diagnoses discovered after pneumonia recurrence, asthma was the most common, occurring in 7 patients, followed by oropharyngeal incoordination leading to aspiration in 4.
The remaining causes included gastroesophageal reflux disease in 3 patients, underlying airway anomalies in 2, and immune disorders in 1.
Prior to their asthma diagnosis, children with asthma presented with episodes of pneumonia but were otherwise healthy. They underwent extensive laboratory evaluation, including sweat chloride and quantitative serum immunoglobulin measurements. Growth, development, and physical examination findings were all within reference limits. These children were clinically diagnosed as having asthma multiple episodes of partially reversible airway obstruction or diagnosed by pulmonary function tests.
Recurrent pneumonia prior to a diagnosis of an underlying aspiration disorder was seen in 4 cases. One patient who presented following recurrent pneumonia was found to have oropharyngeal incoordination with hypotonia. This patient was diagnosed as having nemaline rod myopathy after abnormal findings from electromyographic studies.
The second patient had a brainstem tumor and presented with recurrent bilateral pneumonia from silent aspiration; neurological signs and symptoms, including headache, loss of appetite, and weight loss, did not develop until after the second episode of pneumonia.
The remaining 2 patients had familial dysautonomia Riley-Day syndrome but were initially diagnosed as having bronchial asthma. One child had a family history of the disease prior to hospitalization with pneumonia. In the group of patients with gastroesophageal reflux disease, all were diagnosed as a result of having a pneumonia episode. Ten patients were diagnosed before age 1 year during the first episode of pneumonia. Three patients were diagnosed at age 12 to18 months after recurrent pneumonia.
Two patients with an underlying respiratory tract anomaly 1 with congenital cystic adenomatoid malformation and 1 with esophageal bronchus were diagnosed after pneumonia recurrence.
Underlying Causes of Recurrent Pneumonia in Children. | Asthma | JAMA Pediatrics | JAMA Network
Both patients had recurrent pneumonia involving the same lung lobes. Seven patients 2 with tracheoesophageal fistulas; 1, congenital cystic adenomatoid malformation; 2, subglottic stenoses; 1, tracheomalacia; and 1, bronchomalacia were diagnosed during the first episode of pneumonia.
One patient with hypogammaglobulinemia was diagnosed following pneumonia recurrence. This patient also presented with other features of immune disorders, including recurrent otitis media, oral candidiasis, and failure to thrive. Two patients were diagnosed with sickle cell anemia during their first episode of pneumonia. The remaining 8 patients had known sickle cell anemia prior to pneumonia presentation. Five patients with an underlying immune disorder presented with pneumonia 3 with acquired immunodeficiency syndrome, 1 with acute lymphoblastic leukemia, and 1 with a neuroblastoma.
Of the 3 patients with HIV infection, the diagnosis was suspected during the initial episode of pneumonia because of the presence of the classic interstitial pattern on chest radiograph films and multiple etiologic agents on bronchoalveolar lavage specimens, including Pneumocystis carinii, respiratory syncytial virus, influenza, parainfluenza, and cytomegalovirus.
School-age siblings may also transmit viruses. Classical wheeze may or may not be heard. Between exacerbations, particularly in the summer, the child is usually asymptomatic. The wet cough and chest congestion may be apparent to the consultant when the child is examined during an exacerbation. At these times, chest radiographs usually demonstrate retained secretions, bronchial wall thickening and, occasionally, atelectasis often involving the right middle lobe [RML].
Lobar consolidation reflecting airspace disease is rarely observed when radiographs are reviewed by an experienced paediatric radiologist. In this situation, these observations should not be interpreted as ruling out asthma. In addition to antibiotics, the medication list provided by the pharmacist often includes inhaled bronchodilators, corticosteroids and other asthma medications.
The difficulty in diagnosing pneumonia radiographically and the overdiagnosis of pneumonia have been well described 67.
- Underlying Causes of Recurrent Pneumonia in Children
That true recurrent pneumonia can occur in patients with an underlying disorder, such as pulmonary aspiration, congenital cardiac defects, neuromuscular disorders, immunodeficiency, etc, is not questioned. The issue is whether otherwise healthy children are subject to recurrent pneumonia or even whether recurrent pneumonia is a complication of asthma.
Eighteen patients had no underlying etiological diagnosis but detailed testing had not been performed. In cases in which the underlying etiology was discovered after the diagnosis of pneumonia, asthma was the most common.What is recurrent pneumonia
An underlying cause was noted in 59 and no cause in 11, yet all of these children had bronchiectasis. Of note, asthma was identified to be the underlying cause in 10 of 59 patients. The notion that asthma in children can be complicated by recurrent pneumonia has a long history and contributes to the confusion when assessing these children.
This is especially true when the RML is involved. The RML is subject to atelectasis because of the anatomy of the bronchus and the lack of collateral ventilation with other lobes. Excess mucus production in hypersecretory asthma can lead to RML atelectasis. The confusion surrounding this issue dates back to the s and s 10 Kjellman 11in his study investigating the relationship between asthma and recurrent pneumonia, noted that 14 of asthmatic children fulfilled the criteria for recurrent pneumonia and, radiographically, the RML was over-represented but, unfortunately, as the author stated, no distinction was made between atelectasis and pneumonia.
Probably the most illustrative study was that by Eigen et al 4who examined 81 patients referred to their clinic with a diagnosis of persistent or recurrent pneumonia. Of the 61 with no obvious etiology, 30 had a history of allergy or family history of asthma, 19 had a history of wheezing and 11 had wheezing noted on physical examination.
Nineteen patients with no underlying etiology underwent pulmonary function testing, and nine had airflow obstruction, with four of five demonstrating a bronchodilator response. Twelve patients were recalled for pulmonary function testing and three had airways obstruction and bronchodilator response. The nine with normal lung function underwent a methacholine challenge, and eight had positive responses. However, there is the possibility that some patients with PBB have hypersecretory asthma.