Intrapulmonary protein leakage in immunocompromised children and adults with pneumonia
a Children's
Hospital, University of Essen, Hufelandstrasse 55, D-45122 Essen,
Germany, b Department of Internal Medicine II, University
of Lübeck, Germany
Correspondence to: Dr F Ratjen.
Received 22 July 1998; Returned to authors 8 October 1998; Revised version received 17 November 1998; Accepted for publication 12 January 1999
BACKGROUND
Pulmonary
infections are associated with an increase in capillary permeability
but information regarding age related differences in the local
inflammatory response is lacking. To quantify the degree of capillary
leakage during inflammation, the concentrations of the plasma proteins
albumin, 
1-antitrypsin, 2-macroglobulin and the locally produced proteins elastase, myeloperoxidase,
lactoferrin and fibronectin were studied in the bronchoalveolar lavage
(BAL) fluid of immunosuppressed children and adults with pneumonia.
METHODSSixteen
children aged 2-16 years and 15 adults who developed pneumonia while
receiving immunosuppressive therapy for haematological malignancies
were included in the study. Bronchoalveolar lavage was performed via a
flexible bronchoscope with three aliquots of 1 ml/kg body weight in
children and 200 ml in adults. Protein concentrations in BAL fluid
were determined using highly sensitive immunoluminometric assays.
RESULTSDespite
considerable variability, the median concentrations of all proteins in
BAL fluid were significantly higher in both patient populations than in
previously collected age adjusted reference values. The concentrations
of serum derived proteins were significantly higher in children with
pneumonia than in adult patients. In contrast, no differences were
observed between the two groups for locally produced proteins.
CONCLUSIONSThese data
suggest that the degree of protein exudation is more pronounced in
immunosuppressed children with pneumonia than in adults in a similar
clinical situation. This is in agreement with our studies in healthy
individuals and may reflect a greater permeability of the
alveolar-capillary membrane in children, regardless of disease status.
Keywords: bronchoalveolar lavage; immunocompromised children; pneumonia; protein leakage
© 1999 by Thorax
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