Posters / Paediatric Respiratory Reviews 14S2 (2013) S55–S85 S65

with MMP (n=21) and non-MP pneumonia (n = 20). We selected

patients during the same period with bronchial foreign body, airway

malformations and chronic cough as the control group (n =20). BALF

were collected from all cases at acute phase and recovery phase.

The levels of IL-5 and VEGF in BALF and serum were measured by

ELISA. All data is statistically analyzed by the application SPSS17.0.

Results:

1. The levels of IL-5 and VEGF in BALF and serum in patients

with wheeze were higher than those in non-wheeze, non-MP

pneumonia group and control group, there was a statistically

significant difference of them (P < 0.01).

2. The BALF in all patients was in accordance with serum in two

kinds of specimens examination result of the levels of IL-5 and

VEGF. The cytokine concentration in BALF was higher than that

of serum, both positive related.

3. There was no statistically significant difference between the

convalescence phase of MPP and the control group (P > 0.05).

Conclusion: IL-5 and VEGF may play important roles in airway

inflammation in children with mycoplasma pneumonia and

wheeze.

C07-186-1

Levels and clinical significance of MIP-1a, ECP in serum from

children with bronchiolitis

H.-M. Qiao1, J.-Z. Li2, L. Liu1, H.-L. You1, H.-J. Cheng1. 1First Hospital

of Jilin University, Changchun, China; 2Taizhou People’s Hospital,

Pediatrics, Taizhou, China

Objective: To investigate the levels and clinical significance of

MIP-1a, ECP in serum from children with bronchiolitis and analyze

the correlation between the levels of MIP-1a, ECP in the acute phase

of bronchiolitis and the more recurrent wheezing after recovery

period.

Methods: The object is the children enrolled with bronchiolitis.

Select the children without infection during the same period

as the control group. Double antibody sandwich enzyme-linked

immunosorbent assay is used to determine the levels of MIP-1aand ECP in acute phase, recovery phase and control group. We

followed up six to twelve months after the recovery of bronchiolitis

and observed whether the wheezing relapse. All data is statistically

analyzed by the application SPSS17.0.

Results:

1. The levels of serumMIP-1a and ECP in children with bronchiolitis

of the acute phasewere higher than those in the recovery phase

and the control group; the difference was statistically significant

(P < 0.01).

2. The levels of serumMIP-1a and ECP in children with bronchiolitis

of recovery phase were higher than the control group; the

difference was statistically significant (P < 0.05).

3. The levels of serum MIP-1a and ECP in children who had

wheezing relapse after the recovery of bronchiolitis were higher

than those who did not have wheezing again, P < 0.05.

4. The level of serum MIP-1a in children with bronchiolitis in acute

phase was positively correlated with ECP, r = 0.646, P < 0.01.

Conclusion: MIP-1a and ECP may play a role in the pathogenesis

of bronchiolitis. The level of serum MIP-1a in acute phase was

positively correlated with ECP.

C08-134-2

Results of QuantiFERON-TB Gold in-tube and skin testing

with recombinant proteins CFP-10-ESAT-6 in children and

adolescents with TB or latent TB infection

L.V. Slogotskaya1, V. Litvinov1, E. Ovsyankina1, D. Kudlay2,

P. Seltsovsky1, N. Seltsovsky, D. Ivanova1. 1Scientific and Clinical

Antituberculosis Center Clinical Research, Moscow, Russia; 2OJSC

“Pharmstandard” Research Department, Moscow, Russia

After decoding Mycobacterium tuberculosis genome and discovering

genes of specific proteins CFP-10 and ESAT-6 new in vitro

interferon-g release assays are commercially licensed. So,

QuantiFERON-TB Gold in tube (QFT-GIT) measure INF-g production

to three specific antigens – CFP-10, ESAT-6 and TB 7.7. But

application of laboratory tests in children is significantly restricted

by expensive costs, need for equipped laboratories and intravenous

manipulations. The solution was found in use of skin testing with

recombinant protein CFP-10-ESAT-6 (DIASKINTEST) (DST).

Aim: To compare results of skin test (DST) and QFT-GIT.

Subjects and Methods: 122 children and adolescents aged 6 to 17

(average age 12.9±3.34, median 12) were followed up. Pulmonary

TB was in 111 subjects (44% intrathoracic lymph nodes TB, 16%

focal TB, 23% primary TB complex, 12% infiltrative TB); LTBI in 11

(positive tuberculin and DST reactions). All the children received a

course of chemotherapy for at least 2 months (patients with LTBI)

and 6 months (with active TB). All the children were examined

within one day by two procedures: first QFT and then DST (0.2mkg

in 0.1ml).

Results: Positive skin test (DST) was observed in 108 out of 122

subjects (88.5%; 95%CI 81.5–93.6%). The mean positive reaction

was 16.6±4.56mm. Positive QFT-GIT was registered in 109 (89.3%;

95%CI 82.5–94.2%) subjects. The results of both tests agreed in

115 patients (94.3%; 95%CI 88.5–97.7%). The kappa coefficient of

concordance was 0.709 (95%CI 0.605–0.813; p < 0.0001). Discordant

reactions were observed in 7 (5.7%; 95%CI 2.3–11.5%) patients with

TB; moreover, in 4 patients with positive reactions to QFT and

negative reactions to DST the latter corresponded in clinical and

X-ray findings to the stage of the process (there was a phase

of resolution or calcination). This result was associated with the

reversion of a reaction to DST during cure. Three patients were

found to have a negative reaction to QFT (the level corresponded to

the threshold value) with a remaining positive reaction to DST.

Conclusion: DST and QFT-GIT have comparable high sensitivity

with a high agreement between the results; the discordance of

tests in 5.7% possibly results by near-threshold variability of QFT-

GIT values and dynamics of DST during chemotherapy.

C09-32

The value of sonography in diagnosing pediatric necrotizing

pneumonia

S.-H. Lai1, S.-L. Liao2, K.-S. Wong1. Department of Pediatrics, Chang

Gung Memorial Hospital and Chang Gung University, 1Taoyuan and2Keelung, Taiwan, Republic of China

Background: Necrotizing pneumonia (NP) is a severe complication

of pediatric community-acquired pneumonia, and the incidence

is increasing over recent years. NP is usually diagnosed by chest

computed tomography (CT). However, considering the medical costs

and radioactive exposure, CT exam should not be routinely used.

In this study, we aim to determine the role of sonography in early

diagnosis of NP.

Materials and Methods: We retrospectively reviewed the medical

records of children with pneumonia during the period of 2008–

2011. Children who underwent chest doppler sonography followed

by CT exam within 5 days were enrolled in the study. The diagnosis

of NP was based on findings of CT imaging. Doppler results

were classified as decreased or poor perfusion. Severity of lobar

necrosis was further graded to mild, moderate and severe necrosis.

The demographic data and clinical outcome were also reviewed.

Statistical analysis was performed by student t test, chi-square test,

and ROC curve.

Results: A total of 83 patients were enrolled with a mean age

of 5.16 years. Streptococcus pneumoniae was the most common

pathogen (68.3%). After analyzing the disease severity on CT and

sonographic findings by using ROC curve, moderate lobar necrosis

in CT imaging and decreased doppler perfusion had the highest area

under ROC curve with sensitivity of 77.8%, specificity of 91.5%, and

positive predictive value of 87.5%. Poor perfusion in sonography

and severe necrosis in CT imaging had a high relative risk (poor

S66 Posters / Paediatric Respiratory Reviews 14S2 (2013) S55–S85

perfusion, 10.56; severe necrosis, 16) for predicting the requirement

of lobectomy as a later rescue therapy for severe lobar necrosis.

Conclusion: Sonography is a valuable tool that is able to early detect

necrotizing pneumonia, especially in the presence of moderate lobar

necrosis. Poor lobar perfusion in sonography had a high sensitivity

and specificity in predicting subsequent rescue lobectomy for

severe NP. Routine and regular usage of sonography should be

advocated in clinical setting of pediatric community-acquired

pneumonia.

Category 4. Noninfectious Respiratory Disorders

D01-59

A single centre review of open lung biopsies in infants less

than 1 year of age

R. O’Reilly1, D. Kilner1, M. Ashworth2, P. Aurora1. 1Great Ormond

Street Hospital for Children Department of Paediatric Respiratory

Medicine, London, UK; 2Great Ormond Street Hospital for Children

Department of Pathology, London, UK

Introduction: Interstitial lung disease (ILD) in infants is rare, and

recommendations on classification and management are based

upon limited data. Clinical and radiological features are often non-

specific, and overlap with growth disorders and infection. Lung

biopsy is the gold standard for diagnosis, but the risk and diagnostic

yield of this procedure is incompletely understood.

Lung biopsies <1 year (n=27) Age 2.5 (0.1-11.6) months

Diffuse Developmental Disorders (n=6) Aveolar Capillary Dysplasia (n=6) Surfactant dysfunction disorders (n=4) Surfactant B deficiency (n=1) Surfactant like deficiency (n=1) Chronic pneumonitis of infancy (n=1) Non specific interstitial pneumonitis (n=1) Growth abnormalities reflecting deficient alveolarisation (n=3) Chronic neonatal lung disease (n=2) Chromosomal disorders (n=1) Pulmonary Interstitial Glycogenosis (n=1)* (also had surfactant C deficiency)

Chronic Cellular Interstitial Process (n=1) Meconium Aspiration Syndrome (n=2) Infection (n=2) Bordetella pertussis and Influenza B (n=1) CMV (n=1)

Pulmonary Lymphangiectasia (n=4) Aspiration (n=2) Normal lung architecture (n=1) Unclasssified (n=1)

Died shortly after lung biopsy (n=10) Followed up at local hospital (n=3)

Median age of last follow up (n=14) = 0.5 (0.39 -5.81) years 3 remain long term oxygen dependent 1 oxygen dependent and referred for transplant 1 death 18 months post lung biopsy from cardiac causes

Figure 1. Histopathological diagnosis in infants (<1 year) who had open lung biopsy

between 1/01/2005 and 31/3/2012.

Aim: To retrospectively review infants undergoing open lung

biopsy for suspected ILD at a large national referral centre; to

determine morbidity and mortality for the procedure; and to

describe subsequent diagnosis and outcome.

Methods: Lung biopsies performed in infants (aged <1 year)

between 1/01/2005 and 31/3/2012 were identified and clinical

data was collected from patient notes. Biopsies were reclassified

according to the ChILD classification system for diffuse lung

disorders in infants.

Results: 27 infants were identified, with the number of biopsies

performed each year increasing over the study period. Mortality

from the procedure was zero, and morbidity was negligible. The

range and proportions of diagnoses seen was very similar to that

reported by the ChILD network, Figure 1. Histopathological diagnosis

was not compatible with life in 10/27 (37%) of patients, and

management plans were altered appropriately. Of the 14 children

longitudinally followed up at our centre (median 0.5 (0.4–5.81)

years, only 4 continued to require supplemental oxygen.

Conclusion: Lung biopsy in infants with suspected ILD is a

safe procedure, and histopathological diagnosis frequently assists

treatment decisions, particularly with regard to withdrawal of care.

D02-171

Brain abscess caused by paradoxical embolism secondary to

pulmonary arteriovenous malformation. An unusual etiology.

Case report

G. Montesinos, I.E. Paredes, E. Lomas, P. Escobedo, E. Figueroa,

G. Vazquez, L. Hernandez. Hospital general Manuel Gea Gonzalez,

Distrito Federal, Mexico

Background: Cerebral abscess commonly occurs secondary to

trauma, hematogenous spread from distant infection or contiguity;

20% of these are called cryptogenic when it is not possible to identify

the cause. This might be as a result of the presence of rare entities

such as pulmonary arteriovenous fistula (PAVF), and because of this,

it is often overlooked. The following case reports a cerebral abscess

secondary to PAVF.

Case description: A 9-year-old girl entered the emergency room

with fatigue, headache, fever, projectile vomiting, right parasternal

noncardiac murmur, nail clubbing and positive meningeal

signs. Hemogram showed leukocytosis and polycythemia. Chest

radiograph revealed right basal opacity. Cranial computed

tomography (CT) demonstrated a left occipital intraparenchymal

brain abscess. The patient was treated with triple antibiotic

therapy and brain abscess drainage. Despite the treatment she

continued to rely on supplemental oxygen, with cyanosis and

oxygen saturation of 80–85%. High resolution chest CT evidenced

a right inferior pulmonary vein malformation (arteriovenous).

Pulmonary gammagram reported complex right basal PAVF. She

underwent percutaneous embolization of the fistula. After the

percutaneous procedure the patient had adequate clinical control.

Conclusions: Simple clinical features such as cyanosis, hypoxia and

polycythemia help early diagnosis suspect. The most prominent

associated complications of PAVF are neurologic events, including

brain abscesses. The high-resolution CT is the most sensitive

technique for diagnosis and percutaneous embolization has shown

good results. This report highlights the need to consider MAVP as

an etiology of cerebral abscess when no source is detected.

D03-149

Drowning: Clinical course of lung injury and outcomes in

children

W. Ratanakorn. Chonburi Hospital Pediatric Department, Chonburi,

Thailand

Background: Anoxic encephalopathy is the most dreaded

consequence of drowning accidents; respiratory involvement is also

very common in these patients.