Clinical, Laboratory, Radiological, Bronchoscopic, and Outcome Characteristics of Pulmonary Fungal Infection in Children in PICU in Central China: A Case Series

Huang, Chengjiao; Xiao, Shiyi; Chen, Yin; Li, Yong; Zhi, Xiao; Wen, Tian; Shi, Bao; Qin, Chenguang; Xu, Hui; Shu, Xiaolan

doi:10.3389/fped.2022.822043

Cited by 3 publications

(1 citation statement)

References 33 publications

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“…No AdV was detected, however, and the fungal population was surprisingly low. Conversely, this virus was found to be more common in the research conducted by Ma et al and Huang et al [14,17,18], especially with the development of pathogenic metagenomic technology.…”

Section: Discussionmentioning

confidence: 95%

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Sang

et al. 2023

Ital J Pediatr

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Background There is still a lack of effective scoring criteria for assessing the severity of pulmonary infection associated with changes in the endobronchial lining of the bronchus in children. This study aimed to ascertain the timing and value of endoscopic scoring of fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in children with severe pneumonia. Method The clinical data of 229 children with severe pneumonia treated with BAL in the Pediatric Intensive Care Unit of the First Affiliated Hospital of Xinxiang Medical University between November 2018 and December 2021 were collected. According to the severity of the disease, patients were divided into an invasive ventilation group and a non-invasive ventilation group, as well as an early BAL group (receiving BAL within 1 day of admission) and a late BAL group (receiving BAL 2 days after admission). A Student’s t-test, Chi-square test, receiver operating characteristic (ROC) curve and survival curve were used to analyse the bronchitis score, aetiology of BAL fluid and survival data. Results The scores of endoscopic mucosal oedema, erythema and pallor and the total score in the invasive ventilation group were higher than those in the non-invasive ventilation group (P < 0.05), and they were consistent with the Sequential Organ Failure Assessment (SOFA) scores. The secretion colour score was lower in the early BAL group than in the late BAL group (P < 0.05). On the bronchitis scores, which were evaluated using a ROC curve, the difference in the mucosal erythema, pallor, oedema and total score of the invasive and non-invasive groups was statistically significant (P < 0.05), which was consistent with the area under the ROC of the SOFA scores. Acute Physiology and Chronic Health Assessment II and SOFA scores after FOB were lower than those before treatment (P < 0.05). In terms of ICU hospitalisation days and total hospitalisation days, the time of the early FOB patients was shorter than that of the late FOB patients (P < 0.05). A total of 22 patients (9.61%) died. The Kaplan–Meier analysis and log-rank test showed that the survival rate of the non-invasive ventilation group was higher than that of the invasive ventilation group (P < 0.05). Conclusion This study found that FOB combined with BAL is an important method for the diagnosis and treatment of severe pneumonia. Early BAL can reduce hospitalisation and ICU time; however, it cannot improve the survival rate. The endoscopic score has a certain role to play in assessing the severity of pulmonary inflammation, but studies with a large sample are still needed to confirm this.

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Section: Discussionmentioning

confidence: 95%

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Sang

et al. 2023

Ital J Pediatr

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Predictive value of bronchoscopy combined with CT score for refractory mycoplasma pneumoniae pneumonia in children

Lu,

Wu,

et al. 2024

BMC Pulm Med

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Introduction Mycoplasma pneumoniae pneumonia (MPP) is prevalent in paediatric patients and can progress to refractory mycoplasma pneumoniae pneumonia (RMPP). Objective To assess the predictive value of bronchoscopy combined with computed tomography (CT) score in identifying RMPP in children. Methods A retrospective analysis was conducted on 244 paediatric patients with MP, categorising them into RMPP and general mycoplasma pneumoniae pneumonia (GMPP) groups. A paired t-test compared the bronchitis score (BS) and CT score before and after treatment, supplemented by receiver operating characteristic (ROC) analysis. Results The RMPP group showed higher incidences of extrapulmonary complications and pleural effusion (58.10% and 40%, respectively) compared with the GMPP group (44.60%, p = 0.037 and 18.71%, p < 0.001, respectively). The CT scores for each lung lobe were statistically significant between the groups, except for the right upper lobe (p < 0.05). Correlation analysis between the total CT score and total BS yielded r = 0.346 and p < 0.001. The ROC for BS combined with CT score, including area under the curve, sensitivity, specificity, and cut-off values, were 0.82, 0.89, 0.64, and 0.53, respectively. Conclusion The combined BS and CT score method is highly valuable in identifying RMPP in children.

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Invasive Fungal Infections in the Paediatric Intensive Care Unit: A Hong Kong Study

Li,

Hon,

Yan Leung

et al. 2024

CPR

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Introduction: Invasive fungal infections (IFI) cause significant mortality and morbidity in the Paediatric Intensive Care Unit (PICU). Early recognition and prompt treatment of invasive fungal infections are important. This article reviewed the mortality and morbidity of IFIs in the PICU of Hong Kong Children’s Hospital. Methods: Retrospective review of all PICU admissions from April 2019 to May 2021. The following data were retrieved: age, gender, diagnosis, comorbidity, clinical manifestation, type of fungus, duration of stay at PICU, absolute neutrophil count, use of immunosuppressive therapy, presence of central venous catheter and use of total parental nutrition. The primary outcomes were the incidence and mortality of IFIs among PICU patients. The secondary outcomes were risk factors for developing IFI in PICU and clinical course of IFIs. Numerical variables were compared between groups by Mann-Whitney U test and categorical variables by Fisher’s exact test. Results: There were 692 PICU admissions over the study period from April 2019 to May 2021. There were 24 death cases during this period of time. The crude mortality was 3%. Fourteen patients (2%) fulfilling the criteria for IFIs were identified using hospital electronic record system and according to PICU documentation. Eight of these 14 patients (57%) had hematological malignancy, 2 (17%) had solid tumours and 4 had non-oncological conditions. There were 4 (29%) patients who had received hematopoietic stem cells transplant because of oncological problems. Six patients (43%) were neutropenic with absolute neutrophil count less than 1x 109 at diagnosis of IFI. Six (43%) had received immunosuppressive therapy including steroid, cyclosporin A, Mycophenolate mofetil (MMF), Sirolimus or tacrolimus. 12 (86%) had had central venous catheter. Eight (57%) were on parenteral nutrition. Rhizopus or Aspergillus infection (5/14) were associated with nonsurvival (p = 0.031). Conclusion: All patients with IFIs managed in the PICU have haemato-oncology diseases or are recipients of stem cell transplantation. IFIs with Rhizopus or Aspergillus as a group are associated with high mortality in the PICU. Awareness of this pathology with prompt diagnosis and treatment may improve the outcome of these infections and reduce the mortality.

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Clinical, Laboratory, Radiological, Bronchoscopic, and Outcome Characteristics of Pulmonary Fungal Infection in Children in PICU in Central China: A Case Series

Cited by 3 publications

References 33 publications

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Predictive value of bronchoscopy combined with CT score for refractory mycoplasma pneumoniae pneumonia in children

Invasive Fungal Infections in the Paediatric Intensive Care Unit: A Hong Kong Study

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