Current opinion in pediatrics
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Curr. Opin. Pediatr. · Feb 2005
ReviewFever in the new millennium: a review of recent studies of markers of serious bacterial infection in febrile children.
Evaluation of a febrile infant or child for serious bacterial infections (SBI) can be a challenging task; there is no single reliable predictor of SBI in infants. This review examines some of the recent work evaluating the usefulness of indicators for SBI, such as white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). ⋯ Much progress has been made in recent years in finding more accurate indicators of SBI than WBC. However, while recent developments have given clinicians some new tools in evaluating febrile infants and children, it remains a formidable undertaking. In the especially vulnerable infant population, the holy grail of a single ideal SBI indicator remains elusive.
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Bronchiolitis is a very common and potentially serious respiratory disease of young children. To date, there is not a single, widely practiced, evidence-driven treatment approach. This review summarizes important recently published studies on the treatment of acute bronchiolitis for both outpatients and hospitalized children. ⋯ The routine and repetitive use of bronchodilators, epinephrine, or corticosteroids to treat bronchiolitis in the absence of demonstrated clinical benefits for individual patients is not justified.
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Curr. Opin. Pediatr. · Dec 2004
ReviewUnderstanding asthma pathogenesis: linking innate and adaptive immunity.
Treatment and even prevention of allergic asthma will require a detailed understanding of disease pathogenesis and in particular identification of factors that govern T-helper type 2 (Th2) immunity. This review defines the priming and differentiation steps necessary to develop antiallergen Th2 immunity and highlights recently identified stimuli that satisfy these requirements. ⋯ The adaptive immune system cannot initiate a response without the "permission" of the innate immune system, and this holds true for Th2 responses to aeroallergens, although induction of Th2 immunity in response to TLR signaling varies with the type and dose of TLR ligand. However, under conditions of ongoing Th2 inflammation, the adaptive immune system can act as its own adjuvant and provide the necessary activating signals to initiate an immune response to foreign protein antigens. This may be the mechanism underlying the clinically observed phenomenon of polysensitization in atopic patients and provides another therapeutic target in asthma.