Aims:In children with therapy-refractory bronchitis or pneumonia bronchial Chlamydophila (Cp.) pneumoniae-infection is common and is associated with pathological lung function.Cystic fibrosis (CF) is a hereditary illness and chronic respiratory tract symptoms as well.The aim was to study the prevalence of Cp. pneumoniae infection and a potential association with progression in CE Methods: In a multicenter study, Cp. pneumoniae was detected in sputum by polymerase chain reaction with enzyme immunoassay detection and in paired serum samples with microimmunofluorescence test.Lung function tests and clinical score characterized impairment of CE Results: C~p.pneumoniae-infection was detected in 22 of 63 CF patients.It was associated with P aeruginosa co-infection (21/22 versus 23/41; p 0.001) and obstructive disturbance in 60 cooperative patients with pulmonary function tests (20/20 versus 29/40; p 0.01).In 22 patients with at least six months follow-up a trend line was calculated for every lung function parameter and clinical score by linear logistic regression including all tests.Six months loss of FEV1 was higher in sixteen @.pneumoniae positives ( 2.11 [ 5.04; 1.15] versus 1.63 [ 0.24; 3.04], p 0.008, quartiles of per cent predicted) as well as decrease in Kraemer clinical score ( 0.251 [ 0.39; 0.068] versus 0 [ 0.104; 0.408], p 0.03).A P aeruginosa detection was associated with a higher exacerbation rate in six months (0.812 [0; 1.21] versus 0 [0; 0.189], p 0.059), however, differences in lung function and clinical score were insignificant.

Cannabinoide gehören zu den gebräuchlichsten illegalen Drogen. Die Cannabispflanze ist Ausgangspunkt für die Gewinnung von Marihuana, Haschisch und Haschischöl. Chemischer Bestandteil ist Tetrahydrocannabinol, der im Haschischöl am höchsten ist. Meistens werden allerdings Marihuana und Haschisch konsumiert. Die geschieht in Form von Tabakgenuß.

BACKGROUND:Chlamydophila pneumoniae was frequently found in bronchial secretions of children with therapy-refractory bronchitis or pneumonia. It was studied, how the agent modifies the course of disease and what findings are associated with the infection.PATIENTS AND METHODS:Bronchial secretions obtained at bronchoscopy of 428 children were studied for C. pneumoniae infection using polymerase chain reaction with enzyme immunoassay detection. Children tested negative and positive were compared for their clinical findings.RESULTS:C. pneumoniae was found in 143 children (33 %). A C. pneumoniae infection has been found to be associated with a purulent bronchial inflammation (90/143 vs. 144/285, p = 0.02), a Streptococcus pneumoniae co-infection (13/143 vs. 6/285, p = 0.002) and a restrictive disturbance (11/51 vs. 8/93, p = 0.04). Purulent inflammation (Odds ratio 7.9; 95 % confidence interval [CI] 1.6-39.3), 2 co-infections (Odds ratio 14.3; 95 % CI 1.4-144.4) and co-infection with M. pneumoniae (4/4 versus 9/26, p = 0.03; Mantel Haentzel 3.0; 95 % CI 1.1-8.0) were identified as factors more often associated with a restrictive disturbance in children with bronchial C. pneumoniae infection. An adequate antibiotic therapy improved pulmonary function. No association was found for wheezing, eosinophil inflammation of the nasal mucosa, alpha-1 antitrypsin or immunoglobulin deficiency in serum, level of secretory IgA in bronchial mucus, pathological lung scintigram, gastro-esophageal reflux disease, sweat test and other co-infections.CONCLUSIONS:In children with therapy-refractory bronchitis or pneumonia bronchial C. pneumoniae infection was associated with a more severe disease in case of several, mostly bacterial co-infections. Adequate antibiotic therapy for C. pneumoniae infection has been demonstrated to improve pulmonary function.

Neun Monate alter Knabe mit Aphonie, inspiratorischem Stridor und respiratorischer Insuffizienz. . Kind junger Mutter, Geburt normal, im Kreißsaal kräftig geschrien, ab 2. Lebenswoche heiseres Weinen, inspiratorischer Stridor, abnehmende Stimme. Die Empfehlung zur endoskopischen Diagnostik im Alter von 5 Monaten wurde von der Hausärztin nicht wahrgenommen, der Knabe wurde weiter als „Pseudocroup“ behandelt. Befunde

More than 90% of all bacterial meningitis cases result from hematogenous dissemination of the bacteria during bacteriemia. It is seldom to witness an ascending infection over cerebrospinal fluid fistula in malformations (e.g. myelomenigocele ) or after head trauma, or even continuous infection during sinusitis or mastoiditis. Antrotomy (on both sides) was preformed in an 18-month-old girl with celiac disease suffering from a subacute mastoiditis at that time. Three months later the girl suffered from a pneumococcal meningitis that was treated accordingly with antibiotics. Surgical therapy was performed later on the left lateral skull-base after diagnosis of cerebrospinal fluid otorrhea (dura laceration). Seven months later, the child was admitted again with pneumococcal meningitis. The CT and MRT scans revealed a skull defect on the left petrosal bone with protrusion of brain tissue, however without a fistula; surgical therapy was performed once again. After several surgical revisions on the skull-basis, it is advisable to take into account the possibility of an ascending infection through a cerebrospinal fistula especially in patients with a history of meningitis. Surgical closure of the fistula is an obligation.

The aim of the study was to check and analyse the long-term outcome of infants and toddlers suffering from frequently relapsing and/or (with airway obstruction) and to find prognostic factors. Methods: We observed and analysed the clinical outcome for 2-7 years in 115 children (31 infants/babies and 84 toddlers) suffering from obstructiva recidivans and/or obstructiva chronica in a prospective study. A multivariate analysis was made for the factors disease in other family members/FA, infection of the sex of the patient, associated atopic diseases of the child/patient, the IgE serum (IgE) of the child/patient, chronic bronchopulmonary dysplasia of former pretem infants/bpD, pathological gastroesophageal reflux/GER, significantly secretory eosinophilia/SSE in nasal or bronchial secretion smears (> 13% eosinophils), the concentration of the eosinophilic cationic protein (ECP concentration) of serum and tracheobronchial secretions (TBA). Results: 2/3 of all children became healthy at the end of the study but 1/3 of the infants/toddlers developed a typical bronchial asthma. The FA, associated atopic diseases of the child/patient, the and total serum IgE level of the child/patient could be identified as positive predicting factors for the development of bronchial asthma and had a sensitivity of 50-90% and a specifity of 76-91%. The prognostic values of these 4 factors were increasing from 44-57% (only a single factor was existing) up to 64-91% (in two factors) and finally to 89-100% in 3 and/or 4 factors. Conclusions: In contrast to the literature we found, that the early RSV infection, GER, bpD and ECP of serum and TBA had no statistical link to the development of bronchial asthma in childhood. In young children suffering from frequently relapsing or the following signs have a predictive/prognostic value: Atopic diseases in other family members (FA), other atopic diseases of the child, SSE and elevated serum IgE of the child/patient. These factors indicate that the child's early bronchitis has a poor long-term prognosis and will become a bronchial asthma.

Background: The role of RSV infections in early childhood as a possible risk factor for a later bronchial asthma is discussed controversely. Some authors described the induction of Th 2 -mediated immune response by RSV as a risk factor for asthma development. Objective: We performed a prospective study focused on the possible link between RSV infection and later bronchial asthma. Methods: 115 infants and toddlers suffering from CNSRD (chronic or frequently relapsing obstructive bronchitis) has been checked and observed for the following 2-7 years. We analysed the clinical outcome as well in the group of children with RSV infection initially (group 1: n=24) as in the group of children without any RSV infection (group 2: n=91). Results: 2/3 of all children (n= 115) developed a normal lung function; 1/3 of the children developed a bronchial asthma. No statistical differences were found between the RSV-positive group 1 and the control group 2 (p=0.93). Conclusions: The RSV infection in the early childhood can lead to a prolonged course of chronic or frequently relapsing obstructive bronchitis. 30% of infants and young children with CNSRD develop bronchial asthma in childhood independently from RSV infections. We found no statistical link between RSV infection in early childhood and the development of bronchial asthma in the later childhood.

In some very rare cases children suffer from a combination of asthma and a malignant disease. This study investigated whether intensive chemotherapy might have a positive effect on asthma in these special cases and whether asthma generally relapses after completion of chemotherapy. The authors monitored clinical outcome and lung function of 43 children with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received chemotherapy at the University Children's Hospital of Greifswald between 1993 and 1998. Cytostatic chemotherapy was administered according to the German treatment protocols. Two of the 43 patients had asthma before leukemia was diagnosed. During the course of chemotherapy, asthma symptoms diminished promptly after beginning of chemotherapy but asthma was rediagnosed after completion of chemotherapy in both cases. The third patient developed asthmatic symptoms shortly after completion of chemotherapy for the first time. It can be stated that chemotherapy does not essentially cure asthma. Therefore, it seems mandatory to perform follow-up lung testings after chemotherapy, especially in patients with asthma.

Pediatric PulmonologyVolume 23, Issue 5 p. 389-391 Letter to the Editor Multiple brain abscesses in al 25-year-old patient with cystic fibrosis, successfully treated with an anti-pseudomonas plus anti-mycobacterial antibiotic regimen S.K.W. Wiersbitzky, Corresponding Author S.K.W. Wiersbitzky Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanyDepartment of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorR. Bruns, R. Bruns Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorE.-H. Ballke, E.-H. Ballke Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorR.-D. Stenger, R.-D. Stenger Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorH. Wiersbitzky, H. Wiersbitzky Unit of Pediatric Roentgenology Center of Radiology Greifswald, GermanySearch for more papers by this authorG. Kallwellis, G. Kallwellis Unit of Pediatric Roentgenology Center of Radiology Greifswald, GermanySearch for more papers by this authorB. Panzig, B. Panzig Department of Microbiology, Ernst-Moritz-Arndt University, Greifswald, GermanySearch for more papers by this authorR. Mentel, R. Mentel Department of Microbiology, Ernst-Moritz-Arndt University, Greifswald, GermanySearch for more papers by this author S.K.W. Wiersbitzky, Corresponding Author S.K.W. Wiersbitzky Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanyDepartment of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorR. Bruns, R. Bruns Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorE.-H. Ballke, E.-H. Ballke Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorR.-D. Stenger, R.-D. Stenger Department of Pediatrics, Center for Children and Youth, University Hospital Greifswald, GermanySearch for more papers by this authorH. Wiersbitzky, H. Wiersbitzky Unit of Pediatric Roentgenology Center of Radiology Greifswald, GermanySearch for more papers by this authorG. Kallwellis, G. Kallwellis Unit of Pediatric Roentgenology Center of Radiology Greifswald, GermanySearch for more papers by this authorB. Panzig, B. Panzig Department of Microbiology, Ernst-Moritz-Arndt University, Greifswald, GermanySearch for more papers by this authorR. Mentel, R. Mentel Department of Microbiology, Ernst-Moritz-Arndt University, Greifswald, GermanySearch for more papers by this author First published: 07 December 1998 https://doi.org/10.1002/(SICI)1099-0496(199705)23:5<389::AID-PPUL13>3.0.CO;2-1Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume23, Issue5May 1997Pages 389-391 RelatedInformation

Exercise-induced asthma (EIA) is very common in children with asthma. For this reason they avoid every strenuous exercise because they fear a new asthma attack. Working capacity and maturation of motor performance can be insufficient as a consequence. We investigated whether a special training programme in an asthma sports group has positive effects not only on asthma, but also on working capacity and motor performance. 11 children with extrinsic asthma (4 girls, 7 boys), 8 to 14 years old, were studied before and after a 6-month out-patient rehabilitative sports therapy (sports group) with regard to their degree of bronchial hyperreactivity (BHR), frequency of EIA, cardiopulmonary capacity for exercise; knowledge about their asthma, level of coordination and condition, and their movement-related anxiety. There were 9 children with extrinsic asthma (2 girls, 7 boys), 8 to 15 years old, in a control group. They did not take part in any special training programme. After the sports therapy we found in 3 children of the sports group a decrease in BHR, EIA was now present in only 2 of formerly 4 children. Physical working capacity (PWC) at the aerobic/anaerobic threshold improved in the sports group by about 1 W/kg body weight (p = 0.008), efficiency of work from 23.7% to 27.9% (p = 0.009). We also found a remarkable improvement of motor abilities. Movement-related anxiety decreased in the sports group both in Indoor sports (p = 0.0089) and aquatics (p = 0.026). In the control group there was no significant change. Physical training in children with asthma has many positive effects on lung function and motor performance. We believe that the limit for an EIA release is shifted to a higher PWC. The reduction of the anxiety over sports at a higher level of PWC contributes to an improved quality of life for children with asthma.

The eosinophilic granulocytes are characteristic inflammatory cells in the respiratory mucosa of children and teenagers suffering from allergic rhinitis or allergic bronchial asthma. That is the basis for the concept of eosinophilic mucositis or eosinophilic bronchitis for such diseases in contrast to the neutrophilic mucositis or neutrophilic (purulent) bronchitis due to viral or bacterial infections. By means of their aggressive metabolites (major basic protein (MBP), eosinophilic cationic protein (ECP), eosinophilic protein X (EPX), or eosinophil-derived neurotoxin (EDN), eosinophilic peroxidase (EPO)) the eosinophils play a central role in the pathophysiology Of the transition from frequently relapsing obstructive bronchitis in early childhood due to infections to relapsing obstructive bronchitis of later childhood (= bronchial asthma) due to allergy, in most cases resulting from bronchial hyperreactivity. A significant secretory eosinophilia (i.e, more than 13% eosinophils in the cytological smears of nose, pharynx or the tracheo-bronchial wall), is an indicator for the existence of bronchial hyperreactivity, as a rule due to respiratory allergy. The intensity of the airway obstruction (nose, bronchus) does not correlate with the percentage of eosinophilia. Bronchoalveolar lavage (BAL) is not a suitable method for detecting secretory eosinophilia. Moreover, persistent eosinophilia of the respiratory secretions are a sensitive indicator for the continuous existence of inflammatory processes in the mucosa. Usually such cases require not only allergen elimination but also additional (topical) steroid administration. Bronchial asthma is under control only if the asthmatic symptoms and the lung function test have been normalized and the eosinophilia in the respiratory secretion has disappeared. The traditional counting of the eosinophils and the quantitative measurement of ECP give comparable results, but in many patients they can vary considerably. The counting of eosinophils should be given preference for routine cases (lower cost) whereas for large scale research the ECP determination can be more effective.

We report about 15 years of parents and patient education in regard to children with chronic lung diseases (bronchial asthma, chronic bronchitis) by members of the University Children's Hospital Greifswald, Children's Hospital Neubrandenburg and partners. The context of the educational conception is as follows: once a year a whole day supplementary course for children and youth together with their parents running over a period of 3 years, whereby the medical, psychological and social aspects are covered. In addition to chat we offer 2 supplementary (refresher) courses every year, especially for doctors and co-workers, who are in charge of children suffering from lung diseases. To date, approximately 2,500 people (75% adults, 25% children) have participated. The compliance has become better for long-time therapy and fight against disease. We believe patient education through qualified doctors should be part of the long-time therapy, it should be accepted and recognized as a way of quality preservation and as an achievement which deserves honour.