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.

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.

The objective of this study was to determine the importance of respiratory syncytial virus (RSV) for hospitalization in the north east of Germany and to obtain molecular epidemiological data of the circulating strains. Using a rapid and sensitive reverse transcriptase-PCR, it was found that a quarter of pediatric respiratory disease admissions were due to RSV. Infections caused by RSV in hospitalized patients were determined over the whole year. Both RSV groups A and B were identified with a predominance of RSV A (86%) over the entire period. The analysis of the deduced amino acid sequences by direct sequencing showed that very similar RSV strains are circulating in the community.

Human herpesvirus 8 (HHV-8) is the etiologic agent of Kaposi's sarcoma (KS). Several studies indicate horizontal HHV-8 transmission among children in areas where KS is endemic, but few studies have assessed acquisition of HHV-8 by children in low seroprevalence areas. Antibody screening was carried out for HHV-8 and Epstein-Barr virus (EBV) on 787 serum specimens from children living in two areas where HHV-8 is not endemic, the United States (US) and Germany, and on 184 specimens from children living in a KS-endemic area (Nigeria). For children in the US and Germany, the results showed low HHV-8 seroprevalence rates (3-4%). However, US children aged 6 months to 5 years had higher HHV-8 antibody titers than did 6-17-year-old children (P < 0.01), a finding consistent with more recent infections being detected in the younger children. Compared with seroprevalence rates and antibody titers in US and German children, those in Nigerian children were significantly higher, and seroprevalence increased with age. There was no evidence of cross-reactivity between assays for HHV-8 and EBV, despite the genetic similarity of these two herpesviruses. The data indicate that HHV-8 transmission among children where HHV-8 is not endemic occurs, but is uncommon. The findings also suggest that HHV-8 antibodies, as measured by current tests, may not persist for long periods in populations at low risk for KS and that vertical transmission is rare, although longitudinal studies are necessary to address directly these issues.

Respiratory syncytial virus (RSV) is one of the most important virus respiratory pathogens in infants and young children. A rapid and sensitive diagnosis is essential to focus any outbreak due to this virus. A real-time RT-PCR method was designed using a primer/probe pair from the F gene. Simultaneously with nested RT-PCR and antigen ELISA, 71 consecutive specimens from hospitalized children with clinical symptoms of acute respiratory distress were evaluated to confirm the incidence of RSV infection. RSV was detected in 25 (35.2 %) specimens by real-time RT-PCR and in 19 (26.7 %) by nested RT-PCR. The assay was specific for RSV. The procedure offers a rapid and sensitive alternative to conventional RT-PCR. Closed-tube detection eliminates the risk of contamination.

Objective: Intrauterine parvovirus B19-infection can lead to hydrops fetalis. Controlled studies concering the long-term development of surviving children are rare. We compared the morphologic and somatic development of 12 children with connatal B19-infection with a control group of 12 children without infection until the 2nd year of age. Patients and methods: Within the first 2 weeks of life sera of 558 newborns were examined for B19-DNA by PCR and for B19-IgM and -IgG-antibodies by ELISA. Connatal B19-infection was confirmed by a positive B19-PCR in 12 newborns (2.15%). We compared the morphologic (congenital malformations, morbidity during the first two years of life) and somatic development (weight, length, head circumference) of the children with connatal B19-infection (study group) with a control group of 12 children without infection during the first 2 years of age. Children of both groups were examined by an ophthalmologist including fundoscopy. Results: Two patients with connatal B19-infection (16.7%) were born with a heart defect (p > 0.05) but the risk for congenital malformations or ocular disease was not signficantly raised. At the end of the 2nd year of age both groups did not differ significantly concerning their mean weight, length and head circumference. One patient with a brain atrophy developed microcephalus. Conclusions: The somatic and morphologic development of children with a connatal B19-infection does not seem to be disturbed in the long term.

Intrauterine parvovirus B19-infection can lead to hydrops fetalis. In rare cases surviving newborns developed thrombocytopenia or chronic anemia. We compared the hematological values of 12 children with a connatal parvovirus B19-infection (study group) with a group of 12 control patients until the age of 2 years. Virological (PCR), serological (ELISA) and clinical follow-up was done in order to determine the risk of persistent infection, vaccinational complications or immunological disorders. We did not find a higher risk of chronic anemia, thrombocytopenia or leucopenia in children with a connatal B19-infection. One patient with persisting B19-viremia showed normal hematological values. Only one patient with connatal B19-infection seroconverted during the first year of life. Vaccinational complications or clinical signs of chronic immunosuppression were not observed. Conclusions: Chronic hematological abnormalities in children with a connatal B19-infection seem to be rare. Vaccinational complications or immunological disorders are probably not to be expected. B19-IgM-Antibodies at birth and seroconversion during the first year of life are often missing. Therefore postnatal direct viral demonstration is essential for the diagnosis of connatal parvovirus B19 infection.

Introduction: Skeletal Tuberculosis is a result of haematogenous spreading of Mycobacterium tuberculosis and manifests itself mainly in the vertebral column. It is a late complication of tuberculosis and has become a veryrare entity since the introduction of antituberculous therapy. Case Report: A 2-year-old boy was presented to us after he fell off on the right leg. He avoided walking for a while after which he continuously limped but without restriction of movement of the particular leg. Clinical recovery was observed after a month. During the course of time, recurrent periods of low-grade intermittent fever without clinical inflammatory signs were documented. Diagnosis: The skeletal scintigraphy revealed high activity and perfusion of the distal right tibia. The Tuberculin skin test (10TU) was negative. Chest radiographs showed no signs of pulmonary tuberculosis whereas a long periosteal reaction on the right tibia was revealed on the leg radiograph. The resultant biopsy showed a fibrous, myxoid bone lesion. Mycobacterium tuberculosis were detected through PCR and were microscopically documented after enrichment in Bouillon. An antituberculosis chemotherapy with INH, RMP and PZA over a period of 6 months was initiated. Conclusion: In skeletal processes, it is mandatory to always think about the possibility of skeletal tuberculosis even though the Mantoux test has turned out to be negative; malignant diseases must of course have to have been ruled out!

GER can be treated either by physical means (positioning) or by medical therapy with antacidic or prokinetic drugs. The different prokinetic drugs have to be throroughly tested in order to find out the best drug for the individual patient. Twenty four (24)-hour pH-monitoring of the distal esophagus was carried out in 63 children (age range 3 months-16 years) with recurrent or chronic respiratory diseases. Thirty three (33) of the patients (52%) had a GER. In 24 patients with GER therapy tests with metoclopramide (Cerucal®), cisapride (Propulsin®) and a placebo were carried out under pH-monitoring. The most effective drug was then administered to the patient for 6 weeks and 12-17 weeks thereafter another pH-monitoring was initiated (control). The 2 prokinetic drugs showed a marked reduction of the reflux episodes although cisapride had upper hand by affecting more reflux parameters as compared to metoclopramide. The effectiveness of cisapride was witnessed mostly when the stomach was empty and during the end of sleep. Only 2/19 patients had GER at the end of therapy. We are going to discuss the various mechanisms of cisapride and metoclopramide in regard to their influences on GER especially in children with chronic bronchopulmonary diseases.

Primary infections with herpes simplex - virus type I in childhood usually affect the oral mucosa (Stomatitis aphthosa et ulcerosa). Atypically located primary manifestations may lead to difficulties in differential diagnosis. Case report: An eight-month-old girl presented with a primary HSV-infection of her left big toe accompanied by a mild Stomatitis aphthosa. The left toe had been used for sucking. A complete recovery was observed after nine days of aciclovir therapy. Conclusions: In children, primary HSV-infections have to be considered even if the findings are atypically located. Severe manifestations should be treated intravenously with aciclovir.

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.