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Short-term prospective study in children hospitalized with acute bronchiolitis
98
Tubercle and Lung Disease: Supplement
In this series, 63 % of the patients had positive cultures in at least one of the maxillary sinuses. The most common bacteria isolated were Haemophilus influenzae (51%) and Streptococcus pneumoniae (30%). Anaerobic bacteria were isolated in 20 % of the maxillary sinus secretions and fungi in 10%. Sore throat, nasal and post-nasal purulent secretions were statiscally more frequent in Group A. Complete opacification of the maxillary sinuses was the radiologic finding observed in most patients in this subset, with sensitivity of 79 % and specificity of 86%.
362 A MODEL FOR RESPIRATORY SYNCYTIAL VIRUS (RSV) INFECTION BASED ON EXPERIMENTAL AEROSOL INEECTION WITH BOVINE RSV IN CALVES Otto, P.,’ Elschner, M.,’ Reinhold, P.,’ Streckert, H.-J.,2 Werchau, H.,2 Philippou, S.3 t Institute for Veterinary Medicine of Federal Health Office, 07722 Jena, Germany; 2 Department of Virology, Ruhr-University Bochum, 44780 Bochum, Germany; 3 Department of Pathology, Ruhr-University Bochum, 44780 Bochum, Germany.
Since respiratory infections with RS virus occur naturally in humans, as well as in bovines, an infection model has been established in calves in order to clarify the mechanisms of pathogenesis and pathophysiological changes of this disease. Five conventionally kept and colostrum-fed calves aged 17-24 days were infected with the Bovine RSV strain 375 (ATCC No.: VR-1339) on either 2 or 4 consecutive days. The virus (4,5 ml, lo4 to lo5 TICDsc) was administered as an aerosol (180 to 220 htres daily) produced by means of a jet nebulizer. Each calf had to breathe the virus-containing aerosol using a tightly fitting face mask. A mouthpiece with respiration valves was used in order to filtrate the expiratory flow for virus retention. Few days after the first inhalation of RSV, a mild clinical disease could be observed in all calves characterized by cough, tears, and nasal discharge. A decrease in tidal volume and an increase in respiratory rate, as well as in expiratory flow were the main changes in lung function testing. The calves were necropsied at day 7 after the first infection. Gross findings consisted of irregularly distributed atelectasis developed both in central and peripheral regions mainly in the basal parts of the upper, middle and lower lung lobes. Viral antigen was present in the cytoplasm of epithelial cells of the collapsed bronchioli and in the vicinity of the intraluminal cellular debris. The reaction to the antibody 18FI2 (directed towards the F protein) was more intensive than the reaction to the antibody 3C4 (directed towards the P protein). The bronchial epithelium, in which there was no inflammatory reaction, showed a negative reaction. Viral antigen was also detected in the tracheal epithelium with both anti‘bodies. The infection strain of RSV has been reisolated from bronchoalveolar lavage fluid of all infected calves on bovine turbinate cells. The typical cytopathic effect due to Bovine RSV was obtained 3 to 4 days after inoculation of the cells. In conclusion, this animal model of RSV-infection was found to be suitable for further immunological and pathophysiological investigations with respect to viral respiratory infections in humans.
363 SHORT-TERM
PROSPECTIVE
STUDY
IN
CHILDREN HOSPITALIZED WITH ACUTE BRONCHIOLITIS Holgado, D., Misol, A., Halty, M., Sarachaga, M., Hortul, M., Russi, .I., Lozano, W.; Hospital Pereira Rossell, Montevideo, Uruguay
The authors report the clinical and biological findings of 36 children hospitalized with a first episode of acute bronchiolitis. A prospective study was possible in 23 of them with a follow up of 1 year. The children will be controlled yearly up to 6 years. The RSV was found in the nasopharingeal secretions in 91.3 % The total serum IgE was elevated in 44.5 % and normal in 41.7 % . There was a family history of asthma in 72.2 % Parental smoking was present in 80 % The prospective study shows that 56.5% has recurrent wheezing. The severity of the bronchiolitis does not correlate with the subsequent symptoms. There is a higher incidence of asthma in first degree relatives of those infants who developed recurrent wheezing (92.3%). There is no difference neither in the IgE values nor in the parental smoking between the group who wheezes (I) and the symptom free group (II). The compliance was below normal values in 58.1% of the group I and 57.7% of the group II. The total respiratory resistance was elevated in 42.3% of the group I and 25.8 % of the group II. After the 6th month this value was normal in the group II; being still abnormal in the 62.5% of the group I. The follow up of a control group of infants matched for sex and month of birth showed: recurrent wheezing in 26%. These children had a family history of asthma in 83.3 % The incidence of parental smoking was: 83.3% for the patients with wheezing and 64.7% in those without wheezings.
364 ASSESSMENT OF QUALITY CARE FOR THE RESPIRATORY DISEASE IN CHILDREN Duchiade, M. P., Costa, M. T.; National School of Public Health, Rua Leopold0 Bulhdes, 1480 - sala 820, CEP 21041-210, Rio de Janeiro, Brazil
Acute Respiratory Infection (ARI) is one of the chief causes of mortality in developing countries. Around twenty per cent of the estimated 2500 deaths among children under five years of age occurring each year in city of Rio de Janeiro are attribuited to ARI. The National AR1 Prog. in Brazil has been implemented since 1984. The severity and case fatality of AR1 is greater amoung young children. Acute respiratory infection, particularly during early infancy, presents a special challenge with respect to both assessment and management. A large majority of investigations have reported how good care dramatically reduced the case fatality rate from ARI. This study was conducted to asses the reliability and validity of a medical review instrument used to determine whether inpatient care was appropriate. Consensus criteria for the manegement of children admitted to a pediatric hospital with AR1 was established from questionnaires sent to pediatricians of the Infection Respiratory Diseases Commitee. A public hospital was selected for this study and the reliability of the instrument was
Tubercle and Lung Disease: Supplement
In this series, 63 % of the patients had positive cultures in at least one of the maxillary sinuses. The most common bacteria isolated were Haemophilus influenzae (51%) and Streptococcus pneumoniae (30%). Anaerobic bacteria were isolated in 20 % of the maxillary sinus secretions and fungi in 10%. Sore throat, nasal and post-nasal purulent secretions were statiscally more frequent in Group A. Complete opacification of the maxillary sinuses was the radiologic finding observed in most patients in this subset, with sensitivity of 79 % and specificity of 86%.
362 A MODEL FOR RESPIRATORY SYNCYTIAL VIRUS (RSV) INFECTION BASED ON EXPERIMENTAL AEROSOL INEECTION WITH BOVINE RSV IN CALVES Otto, P.,’ Elschner, M.,’ Reinhold, P.,’ Streckert, H.-J.,2 Werchau, H.,2 Philippou, S.3 t Institute for Veterinary Medicine of Federal Health Office, 07722 Jena, Germany; 2 Department of Virology, Ruhr-University Bochum, 44780 Bochum, Germany; 3 Department of Pathology, Ruhr-University Bochum, 44780 Bochum, Germany.
Since respiratory infections with RS virus occur naturally in humans, as well as in bovines, an infection model has been established in calves in order to clarify the mechanisms of pathogenesis and pathophysiological changes of this disease. Five conventionally kept and colostrum-fed calves aged 17-24 days were infected with the Bovine RSV strain 375 (ATCC No.: VR-1339) on either 2 or 4 consecutive days. The virus (4,5 ml, lo4 to lo5 TICDsc) was administered as an aerosol (180 to 220 htres daily) produced by means of a jet nebulizer. Each calf had to breathe the virus-containing aerosol using a tightly fitting face mask. A mouthpiece with respiration valves was used in order to filtrate the expiratory flow for virus retention. Few days after the first inhalation of RSV, a mild clinical disease could be observed in all calves characterized by cough, tears, and nasal discharge. A decrease in tidal volume and an increase in respiratory rate, as well as in expiratory flow were the main changes in lung function testing. The calves were necropsied at day 7 after the first infection. Gross findings consisted of irregularly distributed atelectasis developed both in central and peripheral regions mainly in the basal parts of the upper, middle and lower lung lobes. Viral antigen was present in the cytoplasm of epithelial cells of the collapsed bronchioli and in the vicinity of the intraluminal cellular debris. The reaction to the antibody 18FI2 (directed towards the F protein) was more intensive than the reaction to the antibody 3C4 (directed towards the P protein). The bronchial epithelium, in which there was no inflammatory reaction, showed a negative reaction. Viral antigen was also detected in the tracheal epithelium with both anti‘bodies. The infection strain of RSV has been reisolated from bronchoalveolar lavage fluid of all infected calves on bovine turbinate cells. The typical cytopathic effect due to Bovine RSV was obtained 3 to 4 days after inoculation of the cells. In conclusion, this animal model of RSV-infection was found to be suitable for further immunological and pathophysiological investigations with respect to viral respiratory infections in humans.
363 SHORT-TERM
PROSPECTIVE
STUDY
IN
CHILDREN HOSPITALIZED WITH ACUTE BRONCHIOLITIS Holgado, D., Misol, A., Halty, M., Sarachaga, M., Hortul, M., Russi, .I., Lozano, W.; Hospital Pereira Rossell, Montevideo, Uruguay
The authors report the clinical and biological findings of 36 children hospitalized with a first episode of acute bronchiolitis. A prospective study was possible in 23 of them with a follow up of 1 year. The children will be controlled yearly up to 6 years. The RSV was found in the nasopharingeal secretions in 91.3 % The total serum IgE was elevated in 44.5 % and normal in 41.7 % . There was a family history of asthma in 72.2 % Parental smoking was present in 80 % The prospective study shows that 56.5% has recurrent wheezing. The severity of the bronchiolitis does not correlate with the subsequent symptoms. There is a higher incidence of asthma in first degree relatives of those infants who developed recurrent wheezing (92.3%). There is no difference neither in the IgE values nor in the parental smoking between the group who wheezes (I) and the symptom free group (II). The compliance was below normal values in 58.1% of the group I and 57.7% of the group II. The total respiratory resistance was elevated in 42.3% of the group I and 25.8 % of the group II. After the 6th month this value was normal in the group II; being still abnormal in the 62.5% of the group I. The follow up of a control group of infants matched for sex and month of birth showed: recurrent wheezing in 26%. These children had a family history of asthma in 83.3 % The incidence of parental smoking was: 83.3% for the patients with wheezing and 64.7% in those without wheezings.
364 ASSESSMENT OF QUALITY CARE FOR THE RESPIRATORY DISEASE IN CHILDREN Duchiade, M. P., Costa, M. T.; National School of Public Health, Rua Leopold0 Bulhdes, 1480 - sala 820, CEP 21041-210, Rio de Janeiro, Brazil
Acute Respiratory Infection (ARI) is one of the chief causes of mortality in developing countries. Around twenty per cent of the estimated 2500 deaths among children under five years of age occurring each year in city of Rio de Janeiro are attribuited to ARI. The National AR1 Prog. in Brazil has been implemented since 1984. The severity and case fatality of AR1 is greater amoung young children. Acute respiratory infection, particularly during early infancy, presents a special challenge with respect to both assessment and management. A large majority of investigations have reported how good care dramatically reduced the case fatality rate from ARI. This study was conducted to asses the reliability and validity of a medical review instrument used to determine whether inpatient care was appropriate. Consensus criteria for the manegement of children admitted to a pediatric hospital with AR1 was established from questionnaires sent to pediatricians of the Infection Respiratory Diseases Commitee. A public hospital was selected for this study and the reliability of the instrument was