Tamas Fazekas

Iota-carrageenan is a potent inhibitor of influenza A virus infection.

The 2009 flu pandemic and the appearance of oseltamivir-resistant H1N1 influenza strains highlight the need for treatment alternatives. One such option is the creation of a protective physical barrier in the nasal cavity. In vitro tests demonstrated that iota-carrageenan is a potent inhibitor of influenza A virus infection, most importantly also of pandemic H1N1/2009 in vitro. Consequently, we tested a commercially available nasal spray containing iota-carrageenan in an influenza A mouse infection model. Treatment of mice infected with a lethal dose of influenza A PR8/34 H1N1 virus with iota-carrageenan starting up to 48 hours post infection resulted in a strong protection of mice similar to mice treated with oseltamivir. Since alternative treatment options for influenza are rare, we conclude that the nasal spray containing iota-carrageenan is an alternative to neuraminidase inhibitors and should be tested for prevention and treatment of influenza A in clinical trials in humans.

Selective iga deficiency in children with recurrent parotitis of childhood

Recurrent parotitis of childhood is defined as the relapsing form of juvenile (idiopathic) parotitis and represents a rare inflammatory disorder of the parotid gland with potentially significant morbidity. We reviewed the charts of patients who were diagnosed with inflammatory parotid diseases in our institution between 1992 and 2002. There were 91 patients presenting with juvenile parotitis (1 of 6117 of all clinical visits). Of these 91 cases, 23 patients (28%) had the relapsing form of juvenile parotitis, and the median number of episodes was 5 (range, 2–20). Laboratory investigations revealed that 5 patients had selective IgA deficiency. The prevalence (22%) is different from the cumulative prevalence of IgA deficiency in a healthy population (0.3%; P < 0.001).

Lessons learned from a double-blind randomised placebo-controlled study with a iota-carrageenan nasal spray as medical device in children with acute symptoms of common cold

BackgroundCommon cold is caused by a variety of respiratory viruses. The prevalence in children is high, and it potentially contributes to significant morbidity. Iota-carragenan, a polymer derived from red seaweed, has reduced viral load in nasal secretions and alleviated symptoms in adults with common cold.MethodsWe have assessed the antiviral and therapeutic activity of a nasal spray containing iota-carrageenan in children with acute symptoms of common cold. A cohort of 153 children between 1–18 years (mean age 5 years), displaying acute symptoms of common cold were randomly assigned to treatment with a nasal spray containing iota-carrageenan (0.12%) as verum or 0.9% sodium chloride solution as placebo for seven days. Symptoms of common cold were recorded and the viral load of respiratory viruses in nasal secretions was determined at two consecutive visits.ResultsThe results of the present study showed no significant difference between the iota carrageenan and the placebo group on the mean of TSS between study days 2–7. Secondary endpoints, such as reduced time to clearance of disease (7.6 vs 9.4 days; p = 0.038), reduction of viral load (p = 0.026), and lower incidence of secondary infections with other respiratory viruses (p = 0.046) indicated beneficial effects of iota-carrageenan in this population. The treatment was safe and well tolerated, with less side effects observed in the verum group compared to placebo.ConclusionIn this study iota-carrageenan did not alleviate symptoms in children with acute symptoms of common cold, but significantly reduced viral load in nasal secretions that may have important implications for future studies.Trial registrationISRCTN52519535, http://www.controlled-trials.com/ISRCTN52519535/

Prevalence and clinical course of viral upper respiratory tract infections in immunocompromised pediatric patients with malignancies or after hematopoietic stem cell transplantation.

Background: Respiratory tract infections (RTI) in immunosuppressed pediatric patients with malignancies or after hematopoietic stem cell transplantation (HSCT) are associated with significant morbidity and mortality. Prospective data on the incidence and clinical role of infections by respiratory viruses in this population have been lacking. Methods: In this prospective study, 191 children between 0 and 18 years of age were investigated by real-time polymerase chain reaction for the presence of 8 common respiratory virus types in transnasal aspirations. The study included 110 children with leukemia, lymphoma, or solid tumors (subgroup 1); 31 children after HSCT (subgroup 2); and 50 immunocompetent control patients. Results: In comparison with the control group, immunocompromised children showed a significantly higher incidence of positive virus tests (subgroup 1: 53%; subgroup 2: 81%; controls: 24%; P<0.0001), and more frequently experienced ensuing viral infections in the lower respiratory tract (subgroup 1: 74%; subgroup 2: 88%; controls: 25%; P<0.0001). Sixteen percent of these children had coinfections by 2 or more viruses and revealed more severe respiratory illness. Conclusions: The present epidemiologic study on viral upper RTI in immunocompromised children revealed a high virus-associated morbidity which was particularly prominent in HSCT recipients. In these children, detection of viral coinfections was identified as a risk factor for a severe course of lower RTI.

Long-term remission in pediatric Wegener granulomatosis following allo-SCT after reduced-intensity conditioning.

Long-term remission in pediatric Wegener granulomatosis following allo-SCT after reduced-intensity conditioning

Lethal pulmonary complications after pediatric allogeneic hematopoietic stem cell transplantation.

Introduction: Hematopoietic stem cell transplantation (HSCT) in children is accompanied by a transplant-related mortality of 10% to 30%, which is the result of lethal pulmonary complications (LPCs) in many cases. Methods: We retrospectively assessed prevalence and risk factors of LPC following 234 allogeneic HSCTs in 228 patients for malignant or nonmalignant diseases at a single institution. Results: Pulmonary complications (PCs) were observed following 81 of 234 transplants (35%). LPCs were observed in 4% of HSCT within 100 days and in 14% within 5 years after HSCT. Late PCs after day 100 were lethal in 56% (22/39) of the patients with PCs, who are 11% (22/202) of all evaluable patients still alive after day +100. Causes of LPC after day 100 were viral (10 cases), bacterial (1 case), fungal (5 cases) pulmonary infection, or noninfectious (6 cases) PCs. Abnormal pretransplant pulmonary function test was not associated with an increased risk of LPC. Children older than 10 years and those undergoing a second HSCT had an increased incidence of overall LPC. T-cell depletion and mismatched donor HSCT (P = 0.001), but not age, were associated with an increased risk of lethal viral pneumonia. Conclusions: Transplant-related mortality up to 5 years after HSCT in children was associated with LPC in 14%. There were more late (>100 days) than early LPCs, predominantly due to infectious etiologies and affecting children >10 years of age.

Mitral valve endocarditis caused by ulcerative colitis followed by septic embolic occlusion of the superior mesenteric artery

Acute endocarditis is a rare complication of ulcerative colitis. We report on a young woman, who initially presented with fever, elevated inflammatory markers, and symptoms of ulcerative pancolitis but without any cardiac co-morbidity. A few days after total colectomy, the patient complained of acute abdominal pain which led to the suspected diagnosis of mesenteric ischaemia caused by a septic embolus. Transthoracic and transoesophageal echocardiography showed a large vegetation on the anterior leaflet of the mitral valve. The patient was successfully treated by an operative approach including mitral valve replacement.

Nodular pulmonary lesions in children after autologous stem cell transplantation: a source of misinterpretation

In children with malignant disorders, autologous haematopoietic stem cell transplantation (HSCT) represents a therapeutic option, but several possible complications, such as life‐threatening pulmonary disease, make appropriate diagnostic procedures essential. We describe two cases with bronchiolitis obliterans with organizing pneumonia after HSCT, with a brief review of important differential diagnoses.

Dornase alpha inhalations as a treatment option for recurrent lower respiratory tract infections in a child with Sotos syndrome

SummaryRecurrent episodes of lower respiratory tract infections (LRTIs) are a rare complication of muscular hypotonia in patients with Sotos syndrome. We report on a male child suffering from repeated LRTIs including bronchitis, pneumonia, and atelectasis during infancy despite inhalations with salbutamol and fluticasone combined with manual chest percussion therapy. After initiation of dornase alpha inhalations in addition to the current treatment, we observed an improvement in the respiratory symptoms as well as a reduction in the rate of hospitalizations and in the occurrence of LRTIs. We assume that dornase alpha inhalations, in combination with airway clearance techniques, reduced the viscosity of airway secretions and by this improved mucociliary clearance and coughing efficiency.ZusammenfassungRezidivierende Infektionen der unteren Atemwege sind eine seltene Komplikation einer muskulären Hypotonie bei Patienten mit einem Sotos Syndrom. Wir berichten über einen Knaben, der während seines ersten Lebensjahres an einer Vielzahl von Bronchitiden, Lungenentzündungen und Atelektasen erkrankt ist, trotz Inhalationen mit Salbutamol und Fluticason kombiniert mit manueller Atemphysiotherapie. Zusätzlich zu der bereits bestehenden Therapie wurde mit Dornase Alpha Inhalationen begonnen, woraufhin es zu einer Verbesserung der respiratorischen Symptomatik, sowie zu einer Reduktion der stationären Aufenthalte und der Infektionen der unteren Atemwegen gekommen ist. Wir vermuten, dass Dornase Alpha Inhalationen die Viskosität der bronchialen Sekrete reduziert. Zusammen mit der manuellen Atemphysiotherapie scheint dies zu einer verbesserten mukozilliären Clearence und einem effizienteren Husten zu führen.