Pseudomonas aeruginosa (PA) from acute and chronic (e.g. cystic fibrosis [CF]) infections differ in several respects though they can worsen prognosis in each context. Factors that facilitate conversion from an acute to chronic phenotype are poorly understood. Type III (T3) secretion proteins are virulence factors associated with poorer outcomes in acute infections, but little is known about their role in CF. We wished to characterize T3 secretion in CF PA isolates and examine its role in clinical outcomes. One-hundred fourteen CF subjects were divided into 3 cohorts: 1 st infected individuals, chronically infected (CI) children, and adults. Serial respiratory cultures were analyzed for T3 secretion. Serial spirometry and exacerbation data were prospectively collected. In 1 st infection, 45.2% +/− 9.1% of PA isolates secreted T3 proteins compared to 29.1% +/− 4.2% and 11.5% +/− 3.0% in CI children and CI adults, respectively (p<0.001). There was an inverse correlation between duration of PA infection and percent T3 positive isolates (r=−0.32, p<0.001). Overall there was no association between T3 secretion and pulmonary outcomes, but in the subgroup of subjects who had at least one T3 positive organism, T3 secretion was inversely correlated with FEV 1 decline (r=−0.35, p=0.02). In 1 st infection, 82% of cultures grew either all or no T3 positive organisms. In these patients, T3 secretion was associated with greater risk of subsequent PA isolation (p<0.001). In CF, PA T3 secretion decreases with residence time in lung, may predict FEV 1 decline in patients who have detectable T3 organisms, and may facilitate persistence following 1 st infection.

Viral croup is a frequent disease in early childhood. Although it is usually self-limited, it may occasionally become life-threatening. Mild croup is characterized by the presence of stridor without intercostal retractions, whereas moderate-to-severe croup is accompanied by increased work of breathing. A single dose of orally administered dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment with addition of nebulized epinephrine only in cases of moderate-to-severe croup. Nebulized budesonide (2 mg) can be given alternatively to children who do not tolerate oral dexamethasone. Exposure to cold air or administration of cool mist are treatment interventions for viral croup that are not supported by published evidence, but breathing heliox can potentially reduce the work of breathing related to upper airway obstruction. In summary, corticosteroids may decrease the intensity of viral croup symptoms irrespective to their severity on presentation to the emergency department.

Nutrition is an important component of cystic fibrosis (CF) therapy, with a high-fat diet being the cornerstone of treatment. However, adherence to the dietary recommendations for CF appears suboptimal and burdensome for most children and adolescents with CF, leading to malnutrition, inadequate growth, compromised lung function and increased risk for respiratory infections. A cross-sectional approach was deployed to examine the degree of adherence to the nutrition recommendations and diet quality among children with CF. A total of 76 children were recruited from Aghia Sophia’s Children Hospital, in Athens, Greece. In their majority, participants attained their ideal body weight, met the recommendations for energy and fat intake, exceeding the goal for saturated fatty acids consumption. Carbohydrate and fiber intake were suboptimal and most participants exhibited low or mediocre adherence to the Mediterranean diet prototype. It appears that despite the optimal adherence to the energy and fat recommendations, there is still room for improvement concerning diet quality and fiber intake.

WMS is a rare but clearly identifiable syndrome with significant morbidity, predominantly affecting infants below 1,500 g birth weight. The earliest pathology appears to be alveolar air leak. Inflammatory activation induced by cystic interstitial air may cause the subsequent progressive respiratory disease. Management is supportive but should include investigation for pulmonary hypertension.

We report the first isolation of Candida auris in Greece from a sputum culture of a cystic fibrosis patient in their 20s under posaconazole treatment. The pathogen was identified as C. duobushaemulonii by VITEK2YST, but as C. auris by MALDI-TOF MS . This case underscores the need for species-level identification of all non- albicans Candida (NAC) isolates from cystic fibrosis patients and patients with predisposing factors to fungal infection.