EASINESS TO UPPER
RESPIRATORY TRACT INFECTIONS:
AN INVESTIGATION ON
510 DOWN’S SYNDROME PERSONS
Renato COCCHI MD,
neurologist and medical psychologist
Summary
In clinical records taken at 1st
consultation of a consecutive series of 510 Down's syndrome persons not treated
by drugs (292 M + 218 F; M/F = 133.94; chromosomal diagnosis: 90.39% standard
trisomy 21; 3.14% mosaicisms; 3.33% translocations and 3.14% unknown, only
clinical diagnosis; average age 71.37+/- 69.71 months) easiness to Upper
Respiratory Tract Infections (URTI) was noted in 504 of them with a severity
scale ranging from 0 to URTI easiness' prevalence in this age interval is about
43% with more severe forms in 15% of children.wo years' intervals from 2 to 16
years and a cumulative interval for 16+ ages.
That people showed maximal easiness to
URTI (80% of the Ss) in 2-4 years old children, with a progressive decreasing
to 25% in 16+ years ages. The severity of URTI is lowering according to age,
with disappearance of more severe forms in the 14-16 years' interval. This
easiness is not gender related.
This is a preliminary investigation to a
next research on drug reduction of URTI in drug treated Downs.
Key words: Down’s syndrome; Upper
Respiratory Tract Infections; Easiness; Age.
Down's Sindrome
Mental retardation
Immunity
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In previous research published more than 16 years
ago and devoted to easiness to Upper Respiratory Tract Infections (URTI) in
depressed children, I noticed its lowering or disappearance following drug
treatment of glutamine, pyridoxine and a low dose benzodiazepine. There I
reported my first Down's syndrome patient, a 9 years old child with URTI
easiness (Cocchi, 1981, patient no. 15).
The therapy aimed to treat this specific
symptom, but the results on other symptoms were so unexpected to encourage
treating other Downs, even when this symptom was not present, as I saw later
(Cocchi, 1990).
This easiness was the starting point for
applying to Downs a drug therapy well working in depressed children. Such a
symptom had always a careful checking during 1st consultations of 510 trisomic
people. Epidemiological and clinical-therapeutical information so collected
were partly processed, as the aim of previous research (Cocchi, 1987; Cocchi
and Bonaduce, 1988; Cocchi, 1990).
I came back on this topic with a larger
casuistry and a more differentiate point of view.
Materials
and methods
This investigation used the clinical
cards referring to a non selected consecutive series of home reared and home
living Downs as seen in outpatients' clinic by the present author between
January 1979 and April 1997.
During their 1st consultation all these
subjects had their easiness to URTI evaluated and recorded by severity, along
with other signs and symptoms.
This easiness was appraised with
reference to the past 12 months (or, in children aged less than one year, with
reference to past months) by recording according to a severity scale as
follows:
(0) = as in a healthy child;
(1) = nasal catarrh usually present;
(2) = 1 + susceptibility to cough and
cold with a few feverish episodes;
(3) = 1 + 2 + easiness to tonsillitis,
pharyngitis, bronchitis with moderate fever and limited need of antibiotics (up
to four regimens per year);
(4) = 1 + 2 + 3 + high temperatures,
occasional otitis and bronchial pneumonia, and frequent use of antibiotics
(more than four regimens per year).
From all the records so pointed out
those pertaining to autistic or PDD DS Ss were discarded because we saw that
this second heavier pathology can modify the URTI easiness (Cocchi and
Bonaduce, 1988).
From the remaining records I collected:
sex; chromosomal diagnosis; age at 1st consultation; easiness to URTI according
to the severity scale.
I processed data by age intervals'
statistics and I applied Chi Square Test, when suitable.
Results
Only 510 records out of 548 fitted the
criteria for this research. Data referring to subjets checked have their
reports in tables 1-12, by sharing them according to two years age intervals,
as for URTI easiness.
Graphs 1-2 show time course of this
easiness and its severity according to age.
Tab. 1: Epidemiological data
|
No. of Ss |
510 |
100.00% |
|
malesi |
292 |
57.25% |
|
females |
218 |
42.57% |
|
M/F ratio |
133.94/100 |
|
|
Chromosomal diagnosis |
|
|
|
standard trisomy 21 |
461 |
90.39% |
|
mosaicisms |
16 |
3.14% |
|
translocations |
16 |
3.14% |
|
Unknown, only clinical diagn. |
17 |
3.33% |
|
|
|
|
|
Age at 1st consultation (months) |
|
|
|
range |
6-510 |
|
|
mean +/- SD |
71.37 +/- 69.71 |
|
As we can see in Table 1, the M/F ratio overlaps
the same ratio in live born Italian DS babies (Camera e Mastroiacovo, 1984).
Even the distribution of chromosomal anomalies fitted the variance range for
Italian and International samples.
For these reasons we ought to maintain
the present sample as representative at least of the Italian Downs population.
Tab. 2: URTI easiness of the whole sample.
|
URTI easiness |
No. of Ss |
previous surgery * |
% |
|
not recorded |
6 |
|
1.46 |
|
not present (0) |
174 |
(10) |
33.98 |
|
present / mild (1) |
58 |
(1) |
11.37 |
|
present / moderate (2) |
67 |
(5) |
13.14 |
|
present / severe (3) |
135 |
(3) |
26.47 |
|
present / profound (4) |
70 |
(2) |
13.58 |
|
totals |
510 |
(21) |
100.00 |
* on tonsils (13 Ss), adenoids (3 Ss) or both (5 Ss)
I found URTI easiness in more than 65%
of sample Ss, with greater severity in about 40% of them. In spite of surgical
removal of tonsils, adenoids or both this easiness did not disappear in 11
individuals.
In Tables 3-4 I analyzed URTI easiness
in infants up to 24 months, and a possible gender influence in infants up to 12
months.
Tab. 3: URTI easiness up to 24 months
|
URTI easiness |
No. of Ss |
% |
|
not recorded |
2 |
1.36 |
|
|
|
|
|
not present (0) |
39 |
26.53 |
|
|
|
|
|
Present, mild (1) |
20 |
13.61 |
|
moderate (2) |
22 |
14.97 |
|
severe (3) |
40 |
27.21 |
|
profound (4) |
24 |
9.72 |
|
totals |
147 |
100.00 |
In this age interval the prevalence of
URTI easiness is about 72%, with nearly 37% of larger severity.
.
Tab. 4: URTI easiness in infants up to 12 months
according to gender
|
URTIeasiness |
No. of F Ss |
No of M Ss |
|
not recorded |
0 |
1 |
|
|
|
|
|
not present (0) |
6 |
12 |
|
|
|
|
|
present, mild (1) |
6 |
6 |
|
moderate (2) |
6 |
2 |
|
severe (3) |
3 |
8 |
|
profound (4) |
4 |
3 |
|
totals |
25 |
32 |
Chi Square = 5.187 with 5 df and p = 0.445 NS
In first 12 months of life there is not
any gender difference to URTI easiness
Tab. 5: URTI easiness in children aging 25-48 months
|
URTI easiness |
No. of Ss |
% |
|
not recorded |
2 |
1.98 |
|
|
|
|
|
not present (0) |
19 |
18.81 |
|
|
|
|
|
present, mild (1) |
8 |
7.92 |
|
moderate (2) |
12 |
11.88 |
|
severe (3) |
34 |
33.66 |
|
profound (4) |
26 |
25.74 |
|
totals |
101 |
100.00 |
In this age interval, URTI easiness
prevalence sums about 81% with a larger severity in about 60% of the children.
Tab. 6: URTI easiness in 49-72 months aged children
|
URTI easiness |
No. of Ss |
% |
|
not recorded |
1 |
1.35 |
|
not present (0) |
17 |
22.97 |
|
present, mild (1) |
9 |
12.16 |
|
moderate (2) |
8 |
10.81 |
|
severe (3) |
29 |
39.19 |
|
profound (4) |
4 |
13.52 |
|
totals |
74 |
100.00 |
In this age interval URTI easiness prevalence
runs around 75% and severe forms are catched by 53% od the children..
Tab. 7: URTI easiness in 73-96 months aged children.
|
Urti easiness |
No. of Ss |
% |
|
not present (0) |
14 |
35.90 |
|
present, mild (1) |
7 |
17.95 |
|
moderate (2) |
4 |
10.26 |
|
severe (3) |
11 |
28.20 |
|
profound (4) |
3 |
7.69 |
|
totals |
39 |
100.00 |
In 73-96 months age interval URTI
easiness prevalence is about 65%, and more severe forms run in about 36% of the
children.
Tab. 8: URTI easiness in 97-120 months old children
|
Urti easiness |
No. of Ss |
% |
|
not present (0) |
24 |
47.06 |
|
present, mild (1) |
2 |
3.92 |
|
moderate (2) |
10 |
19.61 |
|
severe (3) |
11 |
21.57 |
|
profound (4) |
4 |
7.84 |
|
totals |
51 |
100.00 |
URTI prevalence in this age interval is
about 53% with more severe forms in 29% of the children.
Tab. 9: URTI easiness in 121-144 months old children
|
URTI easiness |
No. of Ss |
% |
|
not present (0) |
23 |
57.50 |
|
|
|
|
|
presente, mild (1) |
4 |
10.00 |
|
moderate (2) |
7 |
17.50 |
|
severe (3) |
4 |
10.00 |
|
profound (4) |
2 |
5.00 |
|
totals |
40 |
100.00 |
URTI easiness prevalence in this age
interval is about 43% with more severe forms in 15% of children.
Tab. 10: URTI easiness prevalence in DS people
aged 145-168 months
|
URTI easiness |
No. of Ss |
% |
|
not present (0) |
9 |
56.25 |
|
|
|
|
|
present, mild (1) |
4 |
25.00 |
|
moderate (2) |
1 |
6.25 |
|
severe (3) |
1 |
6.25 |
|
profound (4) |
1 |
6.25 |
|
totals |
16 |
100.00 |
URTI easiness prevalence in these
145-168 months old people counts about 44% with more severe forms in 13% of
them.
Tab. 11: URTI prevalence in 169-192 months old people.
|
URTI easiness |
No. of Ss |
% |
|
not present (0) |
14 |
66.67 |
|
|
|
|
|
present, mild (1) |
2 |
9.52 |
|
moderate (2) |
2 |
9.52 |
|
severe (3) |
3 |
14.29 |
|
profound (4) |
0 |
0.00 |
|
totals |
21 |
100.00 |
URTI prevalence in this age people goes around
33% with moderate severity in (grade 3) about 14% of them, having the more
severe grade four disappeared.
Tab. 12: URTI prevalence in people aged more than
196 months (ie. 16 years)
|
URTI easiness |
No. of Ss |
% |
|
not recorded |
1 |
4.76 |
|
|
|
|
|
not present (0) |
15 |
71.44 |
|
|
|
|
|
present, mild (1) |
2 |
9.52 |
|
moderate (2) |
1 |
4.76 |
|
severe (3) |
2 |
9.52 |
|
profound (4) |
0 |
0.00 |
|
totals |
21 |
100.00 |
URTI easiness’ prevalence in people aged
more than 16 years counts 24% with moderate severity in about 10% of them.
Graphic one shows now the trend of URTI
easiness according to age and Graphic 2 the trend of URTI severity according to
age.
As we can see, URTI easiness as
the sum of four severity grades, decreases in a spontaneous way according to
age coming from 80% in years 2-4 to less than 25% after 16. It is to note that
20% of 2-4 years DS children do not catch URTI.
From Graphic 2 we can see that the more severe form (grade 4) goes to a
null rate in 14-16 years, while less severe forms do not exceed 10% after this
age.
Discussion
This first research is the first step
for next research on URTI easiness results in drug treated Down persons. The
graduation of the scale used to evaluate URTI easiness is the same I used in
previous research (Cocchi, 1987, Cocchi e Bonaduce, 1988; Cocchi, 1990).
The examined sample represents at least
the Italian population of 21 trisomics. This is so for its extent, the coming
from all Italian regions and the M/F ratio that overlaps what already found in
live births of Italian Down children (Camera e Mastroiacovo, 1984)
The distribution of chromosomal
diagnoses too, is not far from what usually found either in Italy and foreign
countries (Camera e Mastroiacovo, 1984, Hook, 1981).
Fewer subjects with only clinical
diagnosis have two explanations. Most of them were adults when they come for
1st consultation, and were born when chromosomal diagnosis did not exist or was
not a usual procedure.
Remaining cases refer to babies born in
little country hospitals where the clinical evidence was assumed to be enough
for the diagnosis. It deals with babies seen only once, and the parents had
advice about the need to have a chromosomal diagnosis because the genetic risk
of ignoring the presence of a translocation coming out from the balanced
translocation of one parent. Since they never came back for checkup, I was
unable to update the failing datum, even if the parents had my advice followed.
As for the results, it is immediately to
note that the surgical removal of tonsils, adenoids or both did not necessarily
make this URTI easiness disappeared. Such surgical removals could have its
severity reduced.
In my previous research (Cocchi, 1990)
there was a significant gender difference for up to 12 months' babies. I
supposed it was a bias due to the small sample. By checking it up in this
research, it is to exclude a gender influence along with remaining age
intervals, already so evaluated in my previous research (Cocchi, 1990)
The use of two graphics to separate URTI
easiness from its severity led to observe both parameters in a more exact way.
Down persons with more than 16 years have still URTI easiness in about 25% but
with a reduced severity by having the grade four disappeared.
Conclusions
The epidemiological research on data I
collected during 1st consultations of 510 DS persons allowed to outline the
time course of URTI easiness and its severity as a function of age. The 2-4
years' interval represents the more vulnerable age with 80% of sufferers.
The 20% of non sufferers are always a
noticeable datum that does not match diffused thinking stereotypes.
Twenty-five percent maintain this URTI
easiness among people aged more than 16. Its severity reaches higher rates in
infancy but shows a decreasing time course.
This is a preliminary research on drug
therapies results on URTI easiness.
References
Camera G.,
Mastroiacovo P.: Epidemiologia della sindrome di Down. In. Ce.Pi.M. (ed):
Aspetti epidemiologici, genetici, clinici, riabilitativi e sociali della
sindrome di Down. Ce.Pi.M., Genova 1984: 225-230
Cocchi R.
Susceptibility to infective respiratory diseases in depressed children.
Epidemiological survey of 126 subjects, clinical-therapeutic report of 61
cases. Acta psychiat. belg. 1981, 81: 350-365.
Cocchi R.: Reduction
of susceptibility to upper respiratory tract infections in Down syndrome
children following treatment with GABAergic drugs: Report of 70 cases. Int. J.
Psychosom. (Philadelphia) 1987, 34/2: 3-7.
Cocchi R.: Facilita’
alle malattie infettive respiratorie nei Down. Indagine epidemiologica su 450
casi. Riv. It. Disturbo Intellet. 1990, 3: 131-136.
Cocchi R., Bonaduce
D.: Suscettibilita’ alle malattie infettive respiratorie in bambini psicotici
Down e non-Down. Riv. It. Disurbo Intellet. 1988, 1: 173-178.
Hook E.B.: Down
syndrome: Frequency in human population and factors pertinent to variation in
rates. In: De la Cruz F.F., Gerald P.S. (eds): Trisomy 21 (Down Syndrome)
research perspectives. University Park Press, Baltimore, 1981.
Printed on It. J. Intellect. Impair. 1997, 10: 143-149
Author's
address::
Renato COCCHI MD, via Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Italuan translation
Down's Sindrome
Mental retardation
Immunity
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