Background: Recent epidemiological data associated enterovirus D68 (EV-D68) to severe respiratory tract infections (RTI) in children. Aim: To determine whether children afflicted by EV-D68 infection suffer a more severe disease course than peers infected with other enteroviruses (EV). Methods: Medical charts of children hospitalised for RTI and who were PCR EV positive by nasopharyngeal swabs in the period from June to October 2014 were analysed. Clinical data of EV-D68 infected patients were compared to those infected with other types of EV. Results: 15 patients infected with EV-D68 (mean age 5.0 yrs, SD 2.6; 53.3% boys) were compared with 13 patients infected with other types of EV (mean age 3.3 yrs, SD 1.8; 61.5% boys). A high percentage of patients in both groups showed a positive history for physician diagnosed asthma (53.3% vs. 38.5%) or recurrent wheeze (13.3% vs. 30.8%). More patients with EV-D68 required oxygen treatment on admission (80.0% vs. 53.8%). During hospitalisation a high proportion of patients were hypoxemic in both groups (86.5% vs. 84.7%) and required oxygen treatment in mean duration of 2.1 (SD 1.4) days and 1.6 (SD 1.3) days, respectively. A higher percentage of patients with EV-D68 required treatment with bronchodilators (100.0% vs. 76.9%; p=0.043). Treatment with steroids was frequent (80.0% vs. 53.8%). Average hospital stay was 4.1 days (SD 1.9) vs. 3.4 days (SD 1.4). No intensive care treatment was required. Conclusions: Our data indicate that infection with EV-D68 could influence the severity of RTI as the majority of patients with EV-D68 required oxygen treatment already on admission and all received bronchodilators. Nevertheless larger studies are needed to confirm our results.

Background: During epidemics, higher number of patients and differences in clinical phenotype may lead to different treatment and outcome. Aim: To assess if Mycoplasma pneumoniae (MP) lower respiratory tract infection (LRTI) treatment and outcome differed during a recent epidemic. Methods: We analysed data of all children younger than 15 years who presented to Department of Infectious Diseases Ljubljana in 2014 with signs of LRTI and tested positive for MP by PCR from pharyngeal swabs. We compared patients who presented during the epidemic from October to December 2014 with those treated previously. Results: 247 children (mean age 7.1 yrs, SD 3.2 yrs) were PCR positive for MP during the 3-month epidemic compared to 101 (mean age 6.7 yrs, SD 3.7 yrs) in previous 9 months. The groups did not differ in clinical and laboratory characteristics. The majority of patients received antibiotic treatment in both groups (95.6% vs. 97.9%). The choice of antibiotic differed: midecamycin was the most common choice during the epidemic (74.0%) and azithromycin in other patients (53.2%). Deterioration on therapy was low in both groups (4.5% vs. 5.0%) and no macrolide resistance was suspected. A lower percentage of children was hospitalised during the epidemic (19.5% vs. 33.7%, p=0.005), with a shorter mean length of hospital stay (0.50 vs. 0.95 days, p=0.037) and no difference in the need for oxygen therapy. Conclusions: During the epidemic, antibiotic choice was different and a lower percentage of children required hospitalisation with a shorter length of stay. No differences in outcomes were observed. It is important that reasons for observed differences are evaluated and an optimal clinical path is defined.

Background: In 2014 several outbreaks of enterovirus D68 (EV-D68) infection were reported worldwide. Aim: To assess the characteristics of hospitalized patients during the EV-D68 outbreak, from June to October 2014, at the University Children9s Hospital Ljubljana, Slovenia. Methods: Data of children who tested positive for EV-D68 by PCR from nasopharyngeal swabs, cerebrospinal fluid or stool in the aforementioned period were analyzed. Results: Out of 282 samples, a total of 18 (6.4%) children (median age 4.1 yrs, IQR 2.9 to 7.1 yrs, 50.0% boys) tested positive for EV-D68, all by nasopharyngeal swabs. Fifteen patients presented with signs of respiratory tract infection (RTI), 66.7% of those had a history of asthma or recurrent wheeze. On admission, respiratory distress was present in all patients presenting with RTI, 86.7% were hypoxemic. All were treated with bronchodilators and 80.0% with systemic steroids. Average hospital stay was 4.1 (SD 1.9) days. None of the patients with RTI was admitted to the intensive care unit. Besides, two patients presented with non-RTI signs: one with deterioration of prediagnosed acute disseminated encephalomyelitis and the other with worsening of known epilepsy. Of note, a patient with Omenn syndrome tested EV-D68 positive during allogeneic stem cell transplantation workout, without any clinical signs. Conclusion: Our results imply a possibility for serious disease course in the presence of EV-D68 infection. Due to a single center data and a small sample, further studies are needed to confirm our results.

Background: Asthma and exercise-induced bronchoconstriction (EIB) are common in highly trained athletes. An accurate evaluation with exercise bronchial provocation testing (EBPT) is necessary to justify specific treatment of EIB or EIB with asthma. Aim: To assess the incidence of EIB, EIB with asthma and vocal cord dysfunction (VCD) in adolescent athletes with dyspnea on exertion in Slovenia. Methods: We performed a two year retrospective chart review of highly trained adolescent athletes with dyspnea on exertion referred to our tertiary centre. Patients' medical history and results of pulmonary function testing (PFT) were evaluated, including % predicted FEV1 (%FEV1), fractional exhaled nitric oxide (FeNO), methacholine challenge (MC) and EBPT. EIB was defined as ≥10% fall in %FEV1 from the pre-exercise level. VCD was diagnosed if exercise-induced inspiratory stridor was observed by a physician, or with flexible laryngoscopy during exercise. Results: 40 highly trained athletes (57.5% girls) were reviewed in our centre (mean age 15.5 yrs., SD 2.3). %FEV1 showed normal lung function in all subjects, median FeNO level was 16.4 (IQR 10.7-36.1), 37.5% of athletes who had an MC performed had a positive result. Diagnosis of asthma was made in 25.0% of subjects prior to EBPT. The latter showed EIB in 32.5% and EIB with asthma in 7.5%. VCD was present in 27.5% of all athletes. Finally, 50.0% of athletes had neither EIB nor asthma. Conclusion: Half of the athletes had only subjective symptoms. Our data imply that although mostly negative, EBPT is mandatory in order to avoid overdiagnosed EIB with asthma and subsequent overtreatment.

Background: Exercise-induced bronchoconstriction (EIB) and vocal cord dysfunction (VCD) are frequent causes of exercise-induced dyspnea. The two entities can coexist, which is difficult to differentiate and manage properly. Aim: To identify risk factors for EIB, VCD and their combination from patients' gender, history and pulmonary function tests. Methods: We performed a two year retrospective analysis of patients referred to our tertiary pulmonary centre because of respiratory complaints on exercise. They underwent exercise bronchial provocation testing. EIB was defined as ≥10% fall in %FEV1 from the pre-exercise level. VCD was diagnosed if exercise-induced inspiratory stridor was observed by a physician, or visualised by flexible laringoscopy during exercise testing. Sex, atopy, positive family history for asthma, %FEV1 and vital capacity (VC) were used as predictor variables in logistic regression model to assess the odds ratio (OR) for EIB, VCD and their combination. Results: Records from 79 patients (64.6% girls), mean age 15.4 yrs. (SD 2.3) were included. Atopy was present in 55.7% of patients and positive family history for asthma in 36.7%. Mean %FEV1 was 104.3 (SD 14.6) and mean VC 98.0% (SD 13.1%). The model for VCD showed significant relationships for sex ( p =.019, girls having 9.3 times higher odds for VCD), VC ( p =.04, OR 1.1), and %FEV1 ( p =.005, OR 0.9). The models for EIB and for EIB with VCD combined showed no significant relationship with predictor variables. Conclusion: EIB is best diagnosed with exercise testing. For VCD, our data show potential predicting value of gender and results of pulmonary function tests.

Background: Recent studies suggest that vitamin D has significant anti-infective actions. Appropriate 25-hydroxyvitamin D (25OHD) serum level can be linked to enhanced airways’ antibacterial mechanisms in cystic fibrosis (CF) patients. Aim: To determine whether 25OHD serum level correlates with airway bacterial colonization in children with CF. Methods: Data were extracted from patients’ medical documentation. 25OHD serum level was determined by immunoassay once per year. Chronic airway colonization with Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA) was defined by Leeds criteria. Additionally, presence of Stenotrophomonas maltophilia (SM), Acinetobacter baumanii (AB), methicillin-resistant Staphylococcus aureus (MRSA) and Achromobacter xylosoxidans (AX) in respiratory samples was assessed. Results: Sixty-one 25OHD serum levels from 27 children (14 males), mean age 7.9 (± 1.8) years were recorded in a 5–year period. Mean 25OHD serum levels was 79.1 (± 25.9) nmol/l. Deficiency (level < 75 nmol/l) was present in 49.2 % of cases. No PA chronic colonization was identified, but SA chronic colonization was frequent (90.2%). SA colonized children had lower 25OHD serum levels (76.3 (± 24.5) vs. 104.8 (± 29.2) nmol/l, P < 0.005). SM colonization was present in 13.1%, AB and AX both in 4.9% of patients, neither was significantly correlated with serum 25OHD levels. Conclusion: Lower serum 25OHD levels are associated with chronic airway SA colonization in CF children. The results emphasize the importance of appropriate vitamin D supplementation in these patients.

Introduction and Aims: Serratia marcescens (Sm) is an opportunistic pathogen in patients with cystic fibrosis (CF). CF patients acquire Sm infection mostly following manipulative airway procedures in hospitals, through patient-to-patient contacts or from the environment. This retrospective review aimed to present a case of an outbreak of Sm detections at a paediatric CF centre. Methods: Respiratory sampling, antibiotic susceptibility testing and antibiotic prescribing guidance were assessed. All isolates of Sm were additionally characterised by pulse field gel electrophoresis (PFGE) to determine the strain relatedness. Results: From April to July 2012 Sm was found in 5 patient’s airways’ samples (mean age 9.8 yrs, range 2−19 yrs, Centre size 63 patients, no Sm detected before). Three patients presented with pulmonary exacerbation and S. aureus, concomitantly. All received eradication therapy with TMP-SMX for 14 days based on antibiotic susceptibility. Treatment was repeated in 2 (40%) patients. Strict patient segregation and hygiene measures were implemented. The isolates of Sm did not differ in phenotypic and antibiotic susceptibility, but PFGE showed that all strains were biologically different, thus excluding cross-infection among patients or acquisition in the hospital. Patients therefore probably acquired Sm in a community-related setting. All patients were Sm free 10 months after first detection. Conclusions: Sm infection is of great concern due to its increasing resistance to antibiotics. Accurate identification is important in defining and managing outbreaks. PFGE can be a useful tool for understanding the molecular epidemiology.