Pulmonary function testing for pediatric chest diseases.
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BACKGROUND: Among other diseases, Chlamydia trachomatis causes epididymitis and prostatitis in men and urethritis, cervicitis and pelvic inflammatory disease in women. In children, it most usually causes conjunctivitis and is also responsible for lower respiratory tract disease, occasionally requiring hospital admission. OBJECTIVE: To draw attention to this disease, which is usually overlooked and which can be potentially serious. METHODS: We retrospectively reviewed the medical records of infants aged less than 6 months with symptoms of lower respiratory tract disease in whom C. trachomatis antigen was detected by enzyme immunoassay. RESULTS: We identified 18 patients with C. trachomatis between 1993 and 2002. Of these, 17 patients required hospital admission and five required monitoring in the pediatric intensive care unit. The mean length of hospital stay was 9.6 days. Three patients were immigrants. The mean age at admission was 6.6 weeks. Apnea occurred in five infants. Chest x-ray showed interstitial infiltrates in five infants. Sixteen patients were treated with erythromycin and all made a complete recovery. CONCLUSIONS: Although lower respiratory tract disease caused by C. trachomatis is usually managed on an outpatient basis, it sometimes requires hospital admission or even management in the intensive care unit. Therefore, C. trachomatis infection should be ruled out in infants aged less than 6 months with clinical symptoms of lower respiratory tract disease for which no other pathogen can be found.
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To assess the possibility that clinical data available at the time of hospital admission for patients with respiratory syncytial virus infection could predict the length of hospitalization without antiviral therapy, the charts of all 102 patients admitted with laboratory documented respiratory syncytial virus infection during 1982 to 1985 were reviewed. Two thirds (65) of the patients remained hospitalized greater than three days. Prolonged hospitalization could have been predicted for 40 of the 65 patients (61.5%) based on the need for intubation and ventilation on admission (14 patients) or the presence of underlying cardiac or respiratory disease (28 patients). Of the infants hospitalized when they were less than 2 months of age, 40% required intubation and mechanical ventilation, although only 16% had underlying cardiac or respiratory disease. Mechanical ventilation was required at the time of admission or subsequently for 14% (5/36) of the 2- to 4-month-old infants with respiratory syncytial virus infection. Among the 56 patients without underlying cardiac or respiratory disease who did not require intubation at the time of admission, 25 (45%) remained hospitalized longer than three days (mean hospital stay for these 25 patients, regardless of age, was six days). Neither the respiratory rate nor the presence or absence of fever on admission was useful in predicting the likelihood of a longer hospital stay for the patients who did not require intubation. In addition, none of the initial laboratory data, including the WBC count, the percentage of band forms or polymorphonuclear leukocytes, the presence or absence of hypoxia, or the chest x-ray film findings could be correlated with a longer or shorter duration of hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)
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With greater use of a wide variety of diagnostic tools, such as transtracheal washing, respiratory endoscopy, chest radiography, thoracic ultrasonography, blood gas analysis, and lung biopsy, veterinarians are gaining tremendous insight into pathogenic mechanisms of the ruminant respiratory system. We have available many diagnostic aids; some fairly simple and inexpensive, others highly sophisticated and presently at far greater cost than justifiable on most individual food animals. Some methods recently developed, such as same-day viral particle detection in BAL samples,6 have tremendous potential for rapid and accurate diagnosis in ruminant pulmonary medicine. Undoubtedly, future research in this area will provide an ever widening array of powerful and rapid diagnostic aids to deal with respiratory disease of ruminants.
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