Role of respiratory syncytial virus in pediatric pneumonia

Respiratory viral infections represent the leading cause of hospitalization in infants and young children worldwide and the second leading cause of infant mortality. Among these, Respiratory Syncytial Virus (RSV) represents the main cause of lower respiratory tract infections (LRTIs) in young children worldwide. RSV manifestation can range widely from mild upper respiratory infections to severe respiratory infections, mainly bronchiolitis and pneumonia, leading to hospitalization, serious complications (such as respiratory failure), and relevant sequalae in childhood and adulthood (wheezing, asthma, and hyperreactive airways). There are no specific clinical signs or symptoms that can distinguish RSV infection from other respiratory pathogens. New multiplex platforms offer the possibility to simultaneously identify different pathogens, including RSV, with an accuracy similar to that of single polymerase chain reaction (PCR) in the majority of cases. At present, the treatment of RSV infection relies on supportive therapy, mainly consisting of oxygen and hydration. Palivizumab is the only prophylactic method available for RSV infection. Advances in technology and scientific knowledge have led to the creation of different kinds of vaccines and drugs to treat RSV infection. Despite the good level of these studies, there are currently few registered strategies to prevent or treat RSV due to difficulties related to the unpredictable nature of the disease and to the specific target population

Congenital malformations potentially affecting respiratory function: Multidisciplinary approach and follow-up

Background and aim. Congenital malformations such as oesophageal atresia (OA) and tracheoe-sophageal fistula (TOF), congenital pulmonary airway malformations (CPAMs), congenital diaphragmatic hernia (CDH) and vascular rings (VRs) can affect lung development and respiratory function. This observa-tional study describes our multidisciplinary approach and respiratory follow-up of children with such congenital malformations. Methods. Clinical data of children followed at the Pediatric Respiratory Unit of Parma University Hospital (Italy) between January 2015 and January 2020 were collected. Results. Twenty-three patients with congenital malformation affecting lung development were identified. Almost half of our patients were diagnosed with fetal ultrasound. Children attended the clinic at a mean age of 3 (3.7) years and follow-up visits were scheduled every 6 months average. More than half of our patients were hospitalized for lower respiratory tract infections. Six out of 9 children able to perform spirometry showed anomalies in lung function. Chest physiotherapy was recommended especially in children with OA. Conclusions. Children with congenital malformations affecting lung development are at risk of short and long-term respiratory complications, especially in the first years of life. OA was the malformation more associated to respiratory problems. Multidisciplinary approach and appropriate personalized follow-up are recommended for the best management of these children. (www.actabiomedica.it)

Determination of deoxynivalenol and nivalenol producing chemotypes of Fusarium graminearum isolated from durum wheat in different Italian regions

Durum wheat production in Italy is economically of great importance. Fusarium graminearum is the main fusarium head blight (FHB) causal agent in wheat, reducing both yield and grain quality. F. graminearum produces several mycotoxins and, among trichothecenes, deoxynivalenol (DON) and nivalenol (NIV) are the most studied for their toxicity towards humans and animals. DON-producing isolates can be further distinguished on the basis of the predominant acetyl-DON derivative in 3-acetyldeoxynivalenol (3-ADON) or 15acetyldeoxynivalenol (15-ADON). In order to evaluate possible mycotoxin contamination risks in food, it is very important to know which chemotype is the prevalent in a F. graminearum population. F. graminearum sensu stricto strains were collected from symptomatic durum wheat heads and grains of several naturally infected fields located mostly in Emilia – Romagna, The Marche, Lazio, Tuscany and Umbria. A multiplex PCR in the region of genes Tri12, located in the terminal gene cluster of trichothecenes, was used to characterize 187 single-spore isolates of F. graminearum as NIV, 3-ADON and 15-ADON chemotypes. All the three chemotypes were present in the F. graminearum population studied. The most frequent chemotype was 15-ADON (83.4%), followed by 3-ADON (10.7%) and NIV (5.9%). NIV-producing isolates were found only in Emilia-Romagna (3.5%), Umbria (33.3%) and The Marche (5.7%)

Management of infants with brief resolved unexplained events (Brue) and apparent life-threatening events (alte): A rand/ucla appropriateness approach

Unexpected events of breath, tone, and skin color change in infants are a cause of consider-able distress to the caregiver and there is still debate on their appropriate management. The aim of this study is to survey the trend in prevention, decision-making, and management of brief resolved unexplained events (BRUE)/apparent life-threatening events (ALTE) and to develop a shared proto-col among hospitals and primary care pediatricians regarding hospital admission criteria, work-up and post-discharge monitoring of patients with BRUE/ALTE. For the study purpose, a panel of 54 experts was selected to achieve consensus using the RAND/UCLA appropriateness method. Twelve scenarios were developed: one addressed to primary prevention of ALTE and BRUE, and 11 focused on hospital management of BRUE and ALTE. For each scenario, participants were asked to rank each option from ‘1’ (extremely inappropriate) to ‘9’ (extremely appropriate). Results derived from panel meeting and discussion showed several points of agreement but also disagreement with different opinion emerged and the need of focused education on some areas. However, by combining previous recommendations with expert opinion, the application of the RAND/UCLA appropriateness permit-ted us to drive pediatricians to reasoned and informed decisions in term of evaluation, treatment and follow-up of infants with BRUE/ALTE, reducing inappropriate exams and hospitalisation and highlighting priorities for educational interventions