Asthmatic symptoms are already present during the infantile period, but diagnosis of asthma in the early stage of life is not easy.It has been suggested that there are some phenotypes in infantile recurrent wheezers.This study is an epidemiological survey of wheezers and asthma in preschool children in one village in Gunma Prefecture, Japan, from 2001 to 2007.A questionnaire based on ATS-DLD was completed by all of the parents, and lung function tests including bronchial hyperresponsiveness measurement using methacholine inhalation challenge were performed on the subjects who agreed to participate in our trial.Among 587 subjects, wheezers constituted 21 .8% (n=128), and diagnosed asthma constituted 10.4% (n=61).The value of Dmin in the wheezers without asthma group was significantly lower than that of the control group (p<0.001), but not with that of the asthma group (p>0.1).There was no significant difference in pulmonary function tests or in Dmin between with or without parental smoking, pet breeding and air pollution.We concluded that a half of infantile wheezers in preschool children were asthmatic, and they were not diagnosed by lung function tests or bronchial hyperresponsiveness measurement.

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There are still few studies that evaluated QuantiFERON TB-2G (QFT) response in children with tuberculosis (TB).We evaluated the performance of this assay in 38 children with active TB disease (including 17 children with bacteriologically confirmed TB disease) treated in 4 hospitals.Before starting anti-TB chemotherapy, 29 (82.9%) of 35 children with active TB disease were positive in the QFT test, suggesting that this assay might be very useful for diagnosing active TB disease also in children.However, negative results were found in 2 cases with smear-positive pulmonary TB.In these two cases, as negative QFT results and lower responses to non-specific mitogen, PHA, were observed, cellular immunity was suggested to be lowered.Thus, in the cases with lowered cellular immunity, negative QFT results should not be used to exclude active TB disease.

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Objectives: To describe clinical features of infantile perussis and investigate the risk factors for severe infantile pertussis.Methods: Retrospective review of medical records of infants hospitalized with a diagnosis of pertussis in our hospital in past 20 years.The risk factors for severe disease (defined as in need of assisted ventilation) were analyzed.Results: 46 infants were enrolled;19 (41%) were <3 months old.None of the subjects had received immunization for pertussis.Complications included seizures in five cases (11%), hypoxia in 18 (39%), apnea in 12 (26%).Nine patients (20%) received assisted ventilation.The factors associated with an increased risk of severe disease were younger infants (<3 months) (odds ratio (OR) 7.3, 95% confidence interval (CI) 1.3 to 40.5), having a comorbidity (OR 8.8, 95%CI 1.3 to 40.5), presenting apnea (OR 22.4, 95%CI 3.6 to 140.0), elevated leukocyte count (>20×10⁹/l) on admission (OR 6.2, 95%CI 1.3 to 30.1), elevated lymphocyte count (>15×10⁹/l) on admission (OR 8.3, 95%CI 1.7 to 41.2), higher maximum C-reactive protein (>1.0 mg/dl) (OR 14.0, 95%CI 2.0 to 97.3).Conclusions: Severe disease is frequent in infantile pertussis.These risk factors should be evaluated early in the course, and those who have a risk factor should be treated carefully.

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Pediatric tuberculosis (TB) measures should change their emphasis from group and uniform measures to individual and specific measures because the number of patients with pediatric TB is decreasing. Following the change in TB measures, the“Clinical conference on pediatric TB in medical institutions and public health centers”has been held each year since 2003 in Osaka.During the conference, doctors, nurses and public officials from medical institutions and public health centers discuss individual patients with pediatric TB to achieve common understanding about TB prevention, treatment support and patient background.Discussion during the conference has been utilized to establish treatment support and preventative measures.The number of delegates at the conference has been increasing, and participants other than doctors, nurses and public officials have recently attended.TB measures such as this conference may be preferable to develop TB measures in Japan because many cases of pediatric TB are seen in Japanese cities.

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The characteristics of Mycoplasma pneumoniae pneumonia in adult are nonproductive cough, lack of rales, and the white blood cell counts are<10, 000/μL.The aim of this study was to investigate the clinical characteristics of hospitalized cases with M.pneumoniae pneumonia in children younger than 6 years old.A retrospective analysis of 83 children (0-15 years old) at the Chiba Municipal Kaihin Hospital in 2005 was performed.Serologic diagnosis was made based on a 4-fold rise or single titers>/=1: 640, which were measured by particle aggulutination (PA) test.Children younger than 6 years old accounted for 51.8% (43 cases) of the cases.Among the children younger than 6 years old, 90.0% had productive cough.Rales and altered breath sounds could be heared in 83.7% and white blood cell counts were elevated higher than 10, 000/μL in 31.8% of patients without athma and bacterial infection.37.2% of patients complicated bronchiolitis or infectious asthma.41.9% of patients had found to have mixed bacterial infection and/or viral infection.In conclusion, the clinical characteristics M. pneumoniae pneumonia in children younger than 6 years old differ evidently from those of adults because of mixed bacterial infection and/or viral infection, and complicated bronchiolitis or infectious asthma.

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We report the case of a 11-month-old girl who fell from a low table with a ballpoint pen in her mouth.When she presented at our hospital, there was no bleeding in her oral cavity, and she did not have dyspnea.A computed tomography scan and a radiograph revealed diffuse cervical subcutaneous emphysema and mediastinal emphysema.On examining her mouth using a penlight, no wound could be detected.Perforation of the piriform recess, trachea, or esophagus requires prompt surgical intervention.On examination using a fliberoptic laryngoscopy, a wound with coagulated blood was observed at the pharyngeal posterior wall.But there was no perforation from trachea to carina.We began oxygen administration, vital sign monitoring, and empiric antibiotic therapy.The patient did not show symptoms of severe infection or signs of respiratory distress.Subcutaneous emphysema and mediastinal emphysema improved immediately.She was discharged 9 d after admission.A delay in the recognition and management of pharyngeal trauma can lead to avoidable complications such as retropharyngeal abscess, mediastinitis, and airway compromise.We concluded that bronchoscopic examinations are minimally invasive and useful for detecting pharyngeal injury.

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Spinal muscular atrophy (SMA), a degenerative disease of motor neurons, is characterized by atrophy of the proximal muscles of the trunk and limbs. In addition, its prognosis is influenced by the progression of respiratory disorder caused by respiratory muscle atrophy. We encountered a female who was diagnosed with type I SMA based on clinical course and muscle biopsy at eight months old. The patient underwent tracheostomy and mechanical ventilation at the age of two years and eight months, and was discharged to home at the age of three years. She had shown a favorable clinical course for approximately 11 years. At age 14, she developed atelectasis, and exacerbation of respiratory status, despite the aggressive medical therapy. Consequently, she required removing of mucus plug by bronchoscopy. In addition to the primary disease, her condition by scoliosis and tracheomalacia may have been caused by prolonged bedridden state. The patient has been receiving respiratory care based on multidisciplinary cooperation to prevent relapse of plastic bronchitis, and is showing a favorable course.

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