LAVORI SCIENTIFICI RECENTI DI INTERESSE GENERALE
Di seguito potete trovare gli abstract di alcuni dei pił recenti lavori pubblicati su importanti riveste nazionali ed internazionali che sono legati pił o meno direttamente ai problemi allergo-pneumologici. Per questioni di copyright non possiamo presentare i lavori completi, ma in caso siate interessati vi sono le indicazioni per poterli reperire contattando la rivista, cercando su internet (si consiglia il sito www.pubmed.gov) o presso le biblioteche.
Hyponatremia in pediatric community-acquired pneumonia
Human metapneumovirus pneumonia in children: results of an Italian study and mini-review
Differentiation of bacterial and viral community-acquired pneumonia in children
Hyponatremia as a marker of invasiveness of pediatric respiratory tract infections
Nuovi patogeni delle infezioni respiratorie infantili e loro ruolo nella malattia asmatica
Clicca qui per i lavori scientifici degli anni precedenti
The value of clinical features in
differentiating between viral, pneumococcal and atypical bacterial pneumonia in
children
Articolo originale in Acta Paediatrica
2008;97:943-947
Korppi M., Don M., Valent F., Canciani M.
OBJECTIVE: To
evaluate the value of clinical features in differentiating between viral,
pneumococcal and atypical bacterial pneumonia in children. DESIGN: A
retrospective analysis of clinical signs and symptoms, supplemented with chest
radiograph and serum procalcitonin data, in 101 children with community-acquired
pneumonia. Viral and bacterial aetiology was studied prospectively by antibody
assays, and pneumococcal infection was found in 18, atypical bacterial infection
in 28 and viral infection alone in 22 cases. METHODS: Chest radiographs and
serum procalcitonin were studied in all cases. Data on clinical signs and
symptoms were retrospectively collected from the medical cards of the patients.
RESULTS: Among symptoms, cough was present in 89% and fever (>37.5 degrees C) in
88% of the cases. Among physical signs, crackles were present in 49% and
decreased breath sounds in 58%. No significant associations were found between
any of the clinical signs or symptoms and the aetiology of pneumonia. In
multivariate analyses, age over 5 years and serum procalcitonin over 1.0 ng/mL
were the only independent predictors of bacterial aetiology, but no finding was
able to screen between pneumococcal and atypical bacterial aetiology of
infection. CONCLUSION: No clinical or radiological characteristic was helpful in
the separation between viral, pneumococcal and atypical bacterial aetiology of
community-acquired pneumonia (CAP) in children.
Hyponatremia in
pediatric community-acquired pneumonia
Articolo originale in Pediatric Nephrology
2008;23(12):2247-2253
Don M., Valerio G., Korppi M., Canciani M.
Studies focusing on serum sodium disorders in
children with community-acquired-pneumonia (CAP) are nearly entirely lacking,
though clinical experience suggests that at least hyponatremia (HN) might be
rather common. We evaluated the incidence of hypo- and hypernatremia, in
relation to other clinical, laboratory and etiological findings, in pediatric
CAP. Serum sodium concentration was measured in 108 ambulatory and hospitalized
children with radiologically confirmed CAP of variable severity. The etiology of
CAP was revealed by serology in 97 patients. HN (serum sodium < 135 mmol/l) was
present in 49 (45.4%) children, and it was mild (> 130 mmol/l) in 92% of the
cases. On admission, hyponatremic patients had higher body temperature (38.96
degrees C vs 38.45 degrees C, P = 0.008), white blood cell count (21,074/microl
vs 16,592/microl, P = 0.008), neutrophil percentage (78.93% vs 69.33%, P =
0.0001), serum C-reactive protein (168.27 mg/l vs 104.75 mg/l, P = 0.014), and
serum procalcitonin (22.35 ng/ml vs 6.87 ng/ml, P = 0.0001), and lower
calculated osmolality (263.39 mosmol/l vs 272.84 mosmol/l, P = 0.0001) than
normonatremic ones. No association was found with plasma glucose, type of
radiological consolidation or etiology of CAP. HN is common but usually mild in
children with CAP. HN seems to be associated with the severity of CAP, assessed
by fever, need of hospitalization and serum non-specific inflammatory markers.
Human
metapneumovirus pneumonia in children: results of an Italian study and
mini-review
Articolo originale in Scandinavian Journal of
Infectious Diseases 2008;40(10):821-826
Don M., Korppi M., Valent F., Vainionpaa R., Canciani M.
Human metapneumovirus (hMPV) is a newly identified paramyxovirus
causing lower respiratory tract infections (LRTI). Current knowledge on hMPV is
mainly based on retrospective studies performed in stored respiratory and serum
samples. We found 15 previous prospective clinical studies on LRTI (11 clinical
and 4 epidemiological studies) that have been reviewed. Our aims were to analyse
the role of hMPV in community acquired pneumonia (CAP) and the seroconversion
rate to hMPV in a prospective study in North Italian children. During a 15-month
study period, 124 children were admitted due to presumptive CAP and, in 116 of
them, CAP was radiologically confirmed. The aetiology of CAP was assessed by
serology to 15 microorganisms, including enzyme immunoassay to hMPV. hMPV
infection was found in 5 children (4.9%), being single in 2 and mixed in 3 cases.
The seroconversion rate to hMPV increased with age, reaching nearly 100%
seropositivity rate at school age. In conclusion, hMPV caused 0% to 17.5% of
LRTI cases in children in the mini-review. The figure was about 5% in the
present and in the only earlier paediatric CAP study. Thus, hMPV is a real but
rare cause of paediatric CAP, although seroconversion to hMPV in most children
takes place in early childhood.
Differentiation of bacterial and viral community-acquired pneumonia in
children
Articolo originale in Pediatrics International [in
press]
Don M., Valent F., Korppi M., Canciani M.
AIM. Microbe-specific diagnosis of pediatric community-acquired
pneumonia (CAP) and the distinction between typical-bacterial,
atypical-bacterial and viral cases are difficult. Aim of the present paper was
to evaluate the role of four serum non-specific inflammatory markers and their
combinations, supplemented by chest radiological findings, in the screening of
bacterial aetiology of paediatric CAP. METHODS. Serum procalcitonin-PCT, serum
C-reactive protein-CRP, blood erythrocyte sedimentation rate-ESR and white blood
cell counts-WBC were determined in 101 children with CAP, all confirmed by chest
radiograph. Evidence of aetiology was achieved in 68 (67%) patients mainly by a
serologic test panel including 15 pathogens.
RESULTS. By the combination of CRP>100 mg/L, WBC>15x109/L, PCT>1.0 ng/mL and ESR>65
mm/h, the likelihood ratio for a positive test result (LR+) was 2.7 in the
distinction between pneumococcal and viral CAP and 3.9 between atypical and
viral CAP. If there was a higher value in one of these four parameters (CRP>200
mg/L, WBC>22x109/L, PCT>18 ng/mL or ESR>90 mm/h) LR+ changed to 3.4 or more,
which means a significant increase from pre-test to post-test disease
probability. An alveolar radiological infiltration was associated with higher
values in non-specific inflammatory markers when compared with interstitial
infiltrates, but there were no significant associations between radiological and
etiological findings.
CONCLUSIONS. CRP, WBC, PCT and ESR or their combinations have some but limited
role in the screening between bacterial and viral pediatric CAP. If all or most
of these markers are elevated, bacterial aetiology is highly probable, but low
values do not rule bacterial aetiology out.
Hyponatremia as a marker of invasiveness
of pediatric respiratory tract infections
Lettera all'Editore in Pediatric Nephrology [in
press]
Don M., Valerio G., Canciani M., Korppi M.
Nuovi
patogeni delle infezioni respiratorie infantili e loro ruolo nella malattia
asmatica
Review in Asma & Allergia [in press]
Don M., Canciani M.