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ABSTRACT. Objective. To evaluate the effect of systemic prednisolone as an adjunct to conventional treatment with ␤2-agonist, respiratory support, and fluid replacement in hospitalized infants <24 months of age with respiratory syncytial virus (RSV) infection.Methods. The study was randomized, double-blind, and placebo-controlled. During the winter of 1995-1996, 147 infants <2 years of age, hospitalized with RSV infection, were allocated to treatment with either systemic prednisolone mixture 2 mg/kg daily or placebo for 5 days.Main Outcome Measures. The acute effect variables were duration of stay in hospital, use of medicine, and supportive measures while in hospital. At follow-up 1 month after discharge, the acute effect variables were duration of illness, start in day care center, morbidity, and use of medicine. At follow-up 1 year after discharge, the acute effect variables were morbidity, use of medicine, and skin prick tests with allergens.Results. Prednisolone treatment had no effect on any of the outcome measures.Conclusions. Our randomized prospective study in infants hospitalized with acute RSV infection showed no effect of systemic prednisolone treatment either in the acute state of RSV infection, nor in the follow-up 1 month and 1 year after admission to hospital. We find our results in agreement with the largest studies reported earlier; therefore, corticosteroid, whether by the systemic route or by inhalation, should not be prescribed to infants with RSV infection. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/cgi/content/full/104/6/e77; infants, respiratory syncytial virus, prednisolone, corticosteroids, treatment, randomized controlled trial.ABBREVIATIONS. RSV, respiratory syncytial virus; IV, intravenous; CPAP, continuous positive airway pressure. P revious studies have shown that a majority of infants are infected with respiratory syncytial virus (RSV) during their first or second year of life.1 However, only a minority of these children are admitted to hospital. 2Because of many clinical and presumed pathophysiological similarities between RSV infection and asthma, corticosteroid has been used widely for treatment of RSV infections. [3][4][5] Of the reports of randomized, controlled studies of systemic corticosteroid treatment of RSV infection in infants, 7 have shown conflicting results.6 -12 However, these studies are not directly comparable because of the differences of diagnostic criteria, exclusion criteria, and measures of effect.This study investigates the short-term and longterm effects of systemic corticosteroid treatment in a large, unselected group of infants hospitalized with RSV infection. METHODSThe 3 participating pediatric departments serve the County of Copenhagen and 1 neighboring county with a joint population of ϳ34 000 infants Ͻ2 years of age. A total of 147 hospitalized infants were included prospectively between November 1995 and April 1996. Inclusion CriteriaPatients Ͻ2 years of age hospitalized with respiratory infection and a positive RSV test were included i...

In two children with recurrent parotitis, labial salivary gland biopsies showed chronic sialoadenitis. Immunofluorescence studies disclosed deposits of immunoglobulins and complement in juxta-acinar small vessels. Case 1 had gluten enteropathy, IgA deficiency and high titres of antinuclear antibodies (ANA), and in vivo fixation of ANA to nuclei of different cells in lip, skin and jejunum was present. Case 2 showed deposition of IgM in the dermo-epidermal junction of the skin. These findings suggest that autoimmune reactivity and immune complexes may play a role in the pathogenesis of this disorder.

Samples of nasopharyngeal secretions (NPS) obtained from 140 infants and children with acute respiratory disease were examined for the presence of respiratory syncytial (RS) virus by ELISA. An antiserum produced in rabbits against RS-virus polypeptides was used both as the "capture" antibody and as conjugate in a double-antibody sandwich technique. RS virus was detected by ELISA in specimens of NPS obtained from 72 (51%) of the patients. By comparison RS virus was shown to be present in 86 (61%) of the patients when the immunofluorescent antibody (IF) technique was employed. Samples obtained from 78 of the 140 patients were also examined by inoculation into tissue cultures, and RS-virus was isolated from 47 patients. RS virus was detected by ELISA in 37 (79%) and by IF technique in 43 (91%) of these 47 patients. The IF technique was found to be more sensitive than ELISA, especially in patients older than 9 months and for the examination of specimens of NPS containing only a small percentage of RS-virus antigen-positive cells.

Høiby, N., Friis, B., Jensen, K., Koch, C, Møller, N.E., Støvring, S. and Szaff, M. (Statens Seruminstitut, Departments of Clinical Microbiology at Rigshospitalet and Hvidovre Hospital, and Paediatric Department TG, Rigshospitalet, Copenhagen, Denmark). Antimicrobial chemotherapy in cystic fibrosis patients. Acta Paediatr Scand 1982; suppl 301: 75‐100. — Every effort should be undertaken to combat recurrent and chronic bacterial respiratory tract infections in patients with cystic fibrosis because infections are the main pathogenetic factors of lung damage in these patients. The principles and antibiotics used to treat bacterial infections in the Danish Cystic Fibrosis centre are outlined. The chemotherapy is based on microbiological diagnosis of secretions from the lower respiratory tract. S. aureus infections are efficiently treated with oral fusidic acid in combination with isoxazolyl penicillins or rifampicin in case of penicillin allergy or methicillin‐resistant S. aureus. H. influenzae infections are treated efficiently with oral pivampicillin or amoxicillin or with erythromycin sometimes in combination with rifampicin in case of penicillin allergy or ampicillin‐resistant H. influenzae. As a result of the efficient chemotherapy S. aureus and H. influenzae infections are now minor problems generally not related to prognosis of cystic fibrosis patients. Chronic P. aeruginosa infections are treated regularly four times per year with intravenous anti‐pseudomonas β‐lactam antibiotics in combination with tobramycin. P. aeruginosa is rarely permanently eradicated by this treatment, but significantly improved survival of the patients is obtained. The problems of resistant bacterial strains, allergy, and other side effects caused by the antibiotics are discussed.