STUDI E RICERCHE

Di seguito potete trovare gli abstract di alcuni lavori pubblicati negli anni scorsi su importanti riveste nazionali ed internazionali che sono legati più 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. Sono disponibili anche i lavori più recenti

LAVORI SCIENTIFICI DEGLI ANNI 2004-2007

The value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children

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

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.

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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.

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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.
 

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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.

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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.

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Nuovi patogeni delle infezioni respiratorie infantili e loro ruolo nella malattia asmatica
Review in Asma & Allergia [in press]
Don M., Canciani M.

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Lavori scientifici degli anni 2004-2007

Simkania negevensis is a rare but real cause of pneumonia in children

Clinical and laboratory findings in the diagnosis of bacterial pneumonia in children

Simkania negevensis in community-acquired pneumonia in Italian children

Hyper- and hypo-glycaemia in children with community-acquired pneumonia

Recurrent respiratory infections and phagocytosis in childhood

Simkania negevensis is a rare but real cause of pneumonia in children

Letter to the Editors in The Pediatric Infectious Disease Journal 2006;25(5):470-471

Lettera citata nel Journal of Clinical Microbiology 2007;45:234-236

Massimiliano DON,¹ Mika PALDANIUS,² Lolita FASOLI,¹ Mario CANCIANI¹ and Matti KORPPI.³

1. Pediatric Department, School of Medicine, DPMSC, University of Udine, Italy

2. National Public Health Institute, Oulu, Finland

3. Department of Pediatrics, Kuopio University and University Hospital, Kuopio, Finland

Clinical and laboratory findings in the diagnosis of bacterial pneumonia in children

Letter to the Editor in Swiss Med Wkly [in press]

Massimiliano DON, MD¹ Mario CANCIANI, MD¹ Francesca VALENT, MD² and Matti KORPPI, prof.³

1. Pediatric Department, School of Medicine, DPMSC, University of Udine, Italy

2. Hygiene Department, School of Medicine, DPMSC, University of Udine, Italy

3. Paediatric Research Centre, Tampere University and University Hospital, Tampere, Finland

Simkania negevensis in community-acquired pneumonia in Italian children

Short communication in Scandinavian Journal of Infectious Diseases [in press]

Lolita FASOLI¹, Mika PALDANIUS², Massimiliano DON¹, Francesca VALENT³, Luigi VETRUGNO¹, Matti KORPPI⁴ and Mario CANCIANI¹.

1. Pediatric Department, School of Medicine, DPMSC, University of Udine, Italy

2. National Public Health Institute, Oulu, Finland

3. Hygiene Department, School of Medicine, DPMSC, University of Udine, Italy

4. Paediatric Research Center, Tampere University and University Hospital, Tampere, Finland

Simkania  negevensis, a recently found Chlamydia-like organism,  has been associated with respiratory infections in children and pneumonia adults, but S. negevensis findings have been common also without any infection. The aims of the present paper were to evaluate S. negevensis in the etiology of  pediatric community-acquired pneumonia (CAP), its sero-prevalence in North-Italian children, and if there is cross-reactivity between S. negevensis and Chlamydia pneumoniae serology.

Antibodies to S. negevensis were measured by micro immunofluorescence (MIF) in 101 frozen paired sera obtained from children with CAP.

Serological evidence (>4-fold increase or decrease in IgM or IgG) of acute S. negevensis infection was achieved in 5 (5%) cases. Two were mixed infections with Mycoplasma pneumoniae and one with respiratory syncytial virus. In all, 20-30% of the children had measurable antibodies to S. negevensis, with no association with age. No cross-reactivity was observed between antibodies to S. negevensis and C. pneumoniae.

S. negevensis seems to be a real, though rare cause of CAP in children.

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Hyper- and hypo-glycaemia in children with community-acquired pneumonia

Original article in Journal of Pediatric Endocrinology & Metabolism [in press]

Massimiliano DON,¹ Giuliana VALERIO,² Matti KORPPI³ and Mario CANCIANI.¹

1. Pediatric Department, School of Medicine, DPMSC, University of Udine, Italy

2. School of  Movement Sciences (DiSIST), University Parthenope, Naples, Italy

3. Paediatric Research Center, Tampere University and University Hospital, Tampere, Finland

Few clinical conditions characterized by sufficient biologic stress may be associated with hyperglycaemia. Aim of the present study was to evaluate whether stress induced by community-acquired pneumonia (CAP) is associated with disturbances in glucose metabolism in children.

Plasma glucose was measured in 108 children with CAP. The dependence between plasma glucose and clinical/laboratory characteristics of CAP was studied by multiple linear regression. The aetiology of CAP was achieved by serological methods.

Mean±SD plasma glucose level was 100.3±21.2 mg/dL. Only one patient developed hyperglycaemia (167 mg/dL), and hypoglycaemia (<60 mg/dL) was present in 4 patients (3.7%). Plasma glucose had a significant association only with body temperature.

Hyperglycaemia was rare, about 1%, and the severity or aetiology of CAP was not predictive for plasma glucose levels. However, about 4% of the patients had hypoglycaemia, which could be explained by reduced calory intake during acute infection or by the effect of stress-induced cytokines.

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MASSIMILIANO DON¹, FRANCESCA VALENT², MATTI KORPPI³, EDMONDO FALLET1⁴, ALESSANDRO DE CANDIA⁵, LOLITA FASOLI¹, ALFRED TENORE¹ AND MARIO CANCIANI¹
From the Departments of ¹Paediatrics, ²Hygiene and ³Laboratory, ⁵Institute of Radiology, School of Medicine, DPMSC, University of Udine, Italy, and ⁴Department of Paediatrics, Kuopio University and University Hospital, Kuopio, Finland

Pubblicato sullo Scandinavian Journal of Infectious Diseases, 2007; 39: 129-137

Abstract

Microbe-specific diagnosis of community-acquired pneumonia (CAP) in childhood is difficult in clinical practice. Chest radiographs and non-specific inflammatory markers have been used to separate presumably bacterial from viral infection but the results have been inconsistent. The aim of the present study was to evaluate the usefulness of procalcitonin (PCT) in assessing the severity as well as the bacterial or viral aetiology of CAP. Serum PCT was measured by an immunoluminometric assay in 100 patients with CAP; 26 were treated as inpatients and 74 as outpatients. The pulmonary infiltrate was considered to be alveolar in 62 and interstitial in 38 cases, according to the radiological diagnosis. The bacterial and viral aetiology of pneumonia was studied by an extensive serological test panel. No differences were found in PCT concentrations between the 4 aetiological (pneumococcal, atypical bacterial, viral, unknown) and the 3 age (<2,2-4 and ≥5 y) groups. Scrum PCT was >0.5 ng/ml in 69%, > 1.0 ng/ml in 54% and >2.0ng/ml in 47% of all patients. PCT was higher in patients that were admitted than as outpatients (medians 17.81 vs 0.72 ng/ml, respectively, p <0.01) and higher in alveolar than in interstitial pneumonia (medians 9.43 vs 0.53 ng/ml, respectively, p <0.01). In conclusion, serum PCT values were found to be related to the severity of CAP in children even though they were not capable, at any level of serum concentration, to differentiate between bacterial and viral aetiology.

Abstract

Background: About 10% of pre-school children has recurrent respiratory infections (RRI), which could be related to environmental and/or immunological factors. The aim of the present study has been to evaluate the impact of phagocytosis (FAG) and reactive oxygen intermediates (ROI) production deficiencies on pediatric RRI by the measurement of FAG and ROI activity of the polymorphonuclear neutrophils.

Methods: Serum immunoglobulins, IgG subclasses, lymphocytic subpopulations, FAG and ROI tests were measured in 90 children with RRI, in a moment of well-being and off all medications for at least 4 weeks. FAG and ROI tests were also measured in 19 healthy children.

Results: FAG (91.4 ± 11.5%) and ROI (81.8 ± 17.5%) of patients resulted in significantly decreased measurements compared to the control values (95.2 ± 1.8% and 89.7 ± 4.8%. respectively). No significant difference was manifest between the mean values of FAG and ROI tests among the patients when they were divided for age (above and below 6 years). A significant decreased likelihood of abnormal ROI (odds ratio. 0.3: 95% confidence interval, 0.07-0.97) was found in the patients with low IgA.

Conclusions: The authors' results permit only to suppose an etiological role of FAG and ROI deficiencies of polymorphonuclear neutrophils in the genesis of pediatric RRI, irrespective of the age of the patients, and further studies are necessary for confirmation.

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L'empiema pleurico nel bambino: un approccio a più voci

MARIO CANCIANI¹, MASSIMILIANO DON², BARBARA DEL PIN¹, LOLITA FASOLI¹, TIZIANA GUERRERA¹, ALESSANDRO DE CANDIA³, ANGELO MORELLI^4
1Servizio di Allergo-Pneumologia, Clinica Pediatrica, DPMSC, Università di Udine
²UOC di Pediatria, Ospedale S. Antonio. San Daniele del Friuli (Udine)
³Istituto di Radiologia, Università di Udine
⁴UOS di Chirurgia Toracica, Azienda Ospedaliera, Udine

Pubblicato su Medico e Bambino 2007,26:89-96 - PLEURAL EMPYEMA IN CHILDREN

MASSIMILIANO DON¹, LOLITA FASOLI¹, MIKA PALDANIUS², RAIJA VAINIONPAA¹, MARJAANA KLEEMOLA⁴, RIITTA RATY⁴, MAIJA LEINONEN², MATTI KORPPI⁵, ALFRED TENORE¹ & MARIO CANCIANI¹
From the ¹Department of Paediatrics, School of Medicine DPMSC, University of Udine, Udine, Italy, ²National Public Health Institute, Oulu, ³Department of Virology, University of Turku, Turku, ⁴Department of Microbiology, National Public Health Institute, Helsinki, and ⁵Department of Paediatrics, Kuopio University and University Hospital, Kuopio, Finland

Pubblicato sullo Scandinavian Journal of Infectious Diseases, 2005; 37: 806-812

Abstract

Serological methods are routinely used in the diagnosis of viral and atypical bacterial respiratory infections. Recently, they have also been applied to typical bacteria, such is Streptococcus pneumoniae, The aim of this study was to determine the aetiology of paediatric community-acquired pneumonia (CAP) in both ambulatory and hospitalized patients, by using antibody assays. During a 15-month prospective surveillance, paired sera were studied for antibodies to 14 microbes in 101 children with symptoms of acute infection and infiltrates compatible with pneumonia on chest radiographs. A potential causative agent was detected in 66 (65%) patients. Evidence of bacterial, viral and mixed viral-bacterial infection was demonstrated in 44%, 42% and 20% of the CAP cases, respectively. The most commonly found agents included Mycoplasma pneumoniae (27%), Pneumococcus (18%) and respiratory syncytial virus (17%). Human metapneumovirus (hMPV) was detected in 5 (5%) children. Pneumococcal infections were evenly distributed among the age groups studied. Our results confirm the role of S. pneumoniae in paediatric CAP at all ages, those of M. pneumoniae at >2 y of age and emphasize the emerging role of hMPV. The high proportion of mixed viral-bacterial infections highlights the need to treat all children with CAP with antibiotics.

La discinesia ciliare primitiva. Un approccio pratico

MARIO CANCIANI, MASSlMlLIANO DON
Servizio di Allergo-Pneumologia, Clinica Pediatrica. Università di Udine

Pubblicato su Medico e Bambino 2004; 23:425-433 - Primary ciliary dyskinesia

La discinesia ciliare primitiva è la seconda causa monogenetica, dopo la fibrosi cistica, di malattia respiratoria cronica. Il deficit di alfa-1-antitripsina si esprime a danno del polmone solo in età adulta e interessa il pediatra solo ai fini della prevenzione (astensione dal fumo). Se la fibrosi cistica è la malattia del film mucoso, la discinesia è la malattia della macchina che lo trasporta: non sorprende dunque che dia gli stessi sintomi della fibrosi cistica, a cominciare dalle bronchiectasie.