© Borgis - New Medicine 3/2008, s. 64-66
*Małgorzata Dębska1, Joanna Peradzyńska2, Mieczysław Chmielik1, Marek Kulus2
EXAMINATION OF THE ULTRASTRUCTURE OF THE RESPIRATORY EPITHELIUM CILIA IN CHILDREN WITH RECURRENT INFECTION OF THE RESPIRATORY TRACT
1Department of Paediatric Otorhinolaryngology, Medical University of Warsaw
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
2Department of Child Pneumonology and Allergology, Medical University of Warsaw
Head of Department: Prof. Marek Kulus, MD, PhD
Introduction: The article presents the comprehensive diagnostics of recurrent infections of the respiratory tract in children. The indications for examination of the ultrastructure of the cilia in the respiratory epithelium were analysed.
Aim: To analyse the clinical value of selected diagnostic methods used for recurrent respiratory tract infections.
Material and methods: Patients with recurrent respiratory tract infections hospitalized in the Clinic of Pulmonology and Allergology and the Clinic of Paediatric Laryngology in 2006 and 2007. All the patients underwent basic tests, several of CT of the sinuses, spirometry and bacteriological examination.
Results: In all patients (except one) the results of the basic exams as well as of the chloride levels of sweat were correct. The results of the chest radiography were positive in 18 cases. In all patients the respiratory epithelium was sampled for examination of the cilium ultrastructure. It was sampled from the nose in 27 cases and from the trachea in 4 cases. The most common pathology in the cilium ultrastructure was missing dynein arms.
Conclusions: In almost 100% of cases of children with recurrent infections of the respiratory tract, no cilia or very few of them were present in the respiratory epithelium. Sampling of the respiratory epithelium is a valuable diagnostic method in children with recurrent infection of the respiratory tract.
The article presents the comprehensive diagnostics of recurrent infections of the respiratory tract in children. The indications for examination of the ultrastructure of the cilia in the respiratory epithelium were analysed.
The diagnosis of recurrent infections of the upper and lower respiratory tract requires an interdisciplinary approach. Children with this condition seek consultation of a paediatrician, an allergologist, a laryngologist or an immunologist (6, 11,1 3). The diagnostics includes the following tests (3, 4, 7, 10, 12):
– basic: blood count, blood sedimentation, CRP,
– immunological: levels of IGA, IgG, IgM, IgA; examination of the subpopulation of lymphocytes; chemiluminescence in granulocytes, etc.,
– allergological: allergy tests, total and specific IgE levels, spirometry,
– radiological: chest radiography, nasopharyngeal radiography, CT scan of the sinuses and the chest, examination of the gastrointestinal tract and ultrasound of the abdominal cavity,
– infectious factors: IgG and IgM antibodies to Mycoplasma pneumoniae, Chlamydia pneumoniae, RS virus, Cytomegaly virus, Ebstein-Barr virus, adenoviruses; tests for Mycobacterium tuberculosis,
– tests for cystic fibrosis.
An attempt to analyse the clinical value of selected diagnostic methods used for recurrent respiratory tract infections.
Patients with recurrent respiratory tract infection hospitalised in the Clinic of Pulmonology and Allergology and the Clinic of Paediatric Laryngology of the SPDSK in 2006 and 2007 were included. The analysis concerned 31 patients, 19 boys and 12 girls aged 1 to 15 (8 years old on average). The largest group (18 patients) consisted of children aged 6 to 10; seven children were 6 to 10 years old, and six children were over 10. The children were healthy during the hospitalisation. Only individual cases of acute infections were observed.
An analysis of the diagnostic methods in recurrent respiratory tract infections in children presenting diagnostic difficulties was carried out. All the patients underwent basic tests: peripheral blood count, blood sedimentation, CRP, total immunoglobulin A, G, M and E levels, chloride levels of sweat, chest radiography, allergic examination of the mucous membrane of the nose or bronchi in order to analyse the ultrastructure of the respiratory epithelium cilia. 14 patients underwent a CT of the sinuses, and several of them underwent spirometry and bacteriological examination of the nasal, pharyngeal or bronchial secretions (also for tuberculosis infection).
In all patients but one (who had anaemia), the results of the basic exams as well as of the chloride levels of sweat were correct. In 3 cases the level of IgA was lowered and in one case the level of IgM was lowered.
Three children had positive Chlamydia pneumoniae serology, one positive Mycoplasma pneumoniae serology, two positive RSV serology, one positive Adenovirus serology, and one positive EBV serology.
Results of the chest radiography were positive in 18 patients, and in four cases bronchiectasis was suspected (and confirmed by chest CT scan in 3 cases and excluded in one). Four patients presented with situs inversus, two with inflammatory changes and one with atelectatic changes. Lung cavity distention was observed in two patients, but additional tests excluded a TB aetiology.
Allergic tests showed food allergy in 9 cases and inhalation allergy in 7 cases. In 8 patients allergic rhinitis was diagnosed or confirmed, in 13 bronchial asthma, in 1 atopic dermatitis. A therapy was initiated or modified in accordance with the findings.
In all patients the respiratory epithelium was sampled for the examination of the cilium ultrastructure. It was sampled from the nose in 27 cases and from the trachea in 4 patients when the previous nasal sample had not determined a diagnosis.
Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Płatny dostęp do wszystkich zasobów Czytelni Medycznej
1. Carson JL, Collier AM, Hu SS, et al.: Acquired cilliary defecttss In nassal epithelium of children with acute viral upper respiratory infections. Med. 1985 Feb 21; 312 (8): 463-8. 2. Al Rawi MM, Edelstein DR, Erlandson RA.: Changes In nasal epithelium In patients with severe chronic sinusitis: a clinicopathologic and elektron microscopic study. Laryngoscope 1998 Dec; 108 (12): 1816-23. 3. Pod red. A Milanowskiego. Choroby układu oddechowego. PZWL, W-wa 2000. 4. Pod red. A Boznańskiego. Choroby alergiczne wieku rozwojowego. PZWL, W-wa 2003. 5. Pod red. A Krzeskiego i G Janczewskiego.: Choroby nosa i zatok. Sanmedia, W-wa 1997. 6. Woodson GE.: Choroby uszu, nosa i gardła w podstawowej opiece zdrowotnej. Via Media, Gdańsk 2002. 7. Pod red. Naumann HH.: Diagnostyka różnicowa w otolaryngologii. PZWL, W-wa 1996. 8. Ilustrowana anatomia człowieka. PZWL W-wa 2003. 9. Monini S, Torrisi MR, et al.: Ultrastructural ciliary winding in nasal obstructive diseases. Rhinology, 2005 Dec; 43 (4): 251-6. 10. Pod red. Chmielika M.: Otorynolaryngologia wieku rozwojowego. PZWL, W-wa. 11. Pod red. Kossowskiej E.: Otorynolaryngologia wieku rozwojowego. PZWL, W-wa 1988. 12. Pod red. Ligęzińskiego A, i Jurkiewicza D.: Postępy w rozpoznawaniu i leczeniu chorób górnych dróg oddechowych o podłożu immunologicznym. Urban & Partner, Wrocław 1999. 13. Pod red. Chazan R.: Zakażenia układu oddechowego. Alfa-Medica Press, Bielsko-Biała.