SUNScholar - Browsing by Author "Goussard, Pierre"

Browsing by Author "Goussard, Pierre"

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Acquired neonatal bronchial stenosis after selective intubation : successful managed with balloon dilatation
(Wiley Open Access, 2019) Goussard, Pierre; Morrison, Julie; Bekker, Adrie; Fourie, Barend
ENGLISH ABSTRACT: Premature babies are prone to airway‐related complications. Selective intubation for the management of pulmonary interstitial emphysema may cause acquired bronchial stenosis. Balloon dilatation under fluoroscopy is a safe minimal invasive and successful intervention for acquired bronchial stenosis. Follow‐up bronchoscopy is needed due to risk of restenosis.
Bronchoscopic assessment and management of children presenting with clinically significant airway obstruction due to tuberculosis
(Stellenbosch : Stellenbosch University, 2015-04) Goussard, Pierre; Gie, R. P.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
ENGLISH ABSTRACT: Tuberculosis (TB) in children is a common infectious disease in the world affecting approximately 550 000 children annually and contributing to approximately 10-15% of the TB caseload. The estimate is that 75% of the children who have TB live in the 22 countries that have the highest burden of TB disease. In these 22 countries, the technology required to make the diagnosis and manage complicated cases is limited. The epidemiological data required to estimate the proportion of children with severe disease requiring intervention at a global level are lacking. Airway involvement is commonly seen in children with primary TB, but only in a small group of children the compression is severe, needing intervention. The incidence of children with airway obstruction requiring intervention due to primary TB in the chemotherapeutic era is not known. The incidence of complicated lymph node disease in two recent reports varied from 8-38% in children younger than 15 years of age. Flexible bronchoscopy (FB) is an invasive procedure performed under general anesthetic is used to assess the airways of children. Few studies have been published on the use of FB in the diagnosis of paediatric TB and most have concentrated on the use of bronchoscopy as an intervention for obtaining samples to diagnose pulmonary TB (PTB). All previous studies only examined broncho-alveolar lavage (BAL) for Ziehl Neelsen (ZN) positive organisms and mycobacterial culture. All the published studies are from developed countries with a very low incidence of PTB in children. It has been postulated that HIV positive children with TB are more likely to have airway obstruction, but this hypothesis has not been studied. The same is true for children infected with drug-resistant strains of tuberculosis. Similarly, there have been few reports on the correlation between the findings at bronchoscopy and those found on chest computer tomography (CT). The aim of this research project was to systematically determine airways involvement in childhood pulmonary TB and assess the role paediatric bronchoscopy plays in the diagnosis, sample collection and the management of severe airway obstruction. The first part of the thesis describes the bronchoscopic assessment of airway obstruction due to pulmonary TB in children, specifically concentrating on the areas of the airway involved and the severity of the obstruction. We investigated which factors determine the severity of airway obstruction and this included age, sex, HIV status and drug sensitivities. We have shown that there was no difference in airway obstruction in HIV positive children and in children with drug resistance TB. More severe airway obstruction was seen in the younger child. The second question that was analysed is the value of flexible bronchoscopy in collecting samples for TB culture and drug sensitivity testing. It has previously been reported that BAL culture was inferior to gastric lavage in isolating the bacilli. We set out to evaluate which factors determine if a child will be culture-positive on BAL. Most childhood pulmonary TB is postulated to have a low yield of ZN positive cases. We found a higher yield from BAL as was previously reported, and the yield was increased if segmental or lobar pneumonia was present on the chest radiography. We developed novel interventions of finding the organism and increasing the yield from BAL. About 80% of children with PTB have enlarged subcarinal lymph nodes. We performed a trans-bronchial needle aspiration (TBNA) biopsy of these lymph nodes for culture. This technique enables us to differentiate the cause of enlarged mediastinal lymph nodes. This is especially important in children who are HIV positive, as they are prone to have other causes of enlarged lymph nodes. We successfully performed TBNA, even in very young infants, which resulted in a diagnostic yield of 55%. The use of Xpert has been described on other tissue, but not on BAL. We wanted to test if the use of Xpert on BAL is feasible in children, and determine if it will increase the diagnostic yield by using BAL samples. The third aspect of this research was to compare flexible bronchoscopy findings with those of chest CT scan finding. Firstly, the aim was to describe the CT scan findings of mediastinal glands and lungs in children with significant airway obstruction due to PTB. The second aim was to investigate how these two investigations of airway obstruction compared, with particular emphasis on their advantages and disadvantages. The areas of airway obstruction as well as the severity of the obstruction as determined by CT scan were very similar to the findings with bronchoscopy. The final part under this aspect of the study was to analyze airway shape using a computer model to asses if this could predict TB. This was done by extracting components of the airway surface mesh and branch radius and orientation features. This method showed the potential of computer-assisted detection of TB and other airway pathology by using airway shape deformation analysis. The fourth aspect investigated was to determine which children with severe airway obstruction would benefit from a surgical intervention. Surgical enucleation is done via a lateral thoracotomy in children with severe airway obstruction. We investigated which factors determine the need for surgical enucleation, the optimal timing of this intervention, and – if surgical enucleation was done as an emergency intervention – which factors would predict for this. The combination of trachea, left main bronchus and bronchus intermedius involvement was the best predictor for children requiring surgical enucleation. Involvement of the smaller airway divisions did not play a significant role. Children needing enucleation were younger and had more severe airway obstruction. The fifth aspect of this thesis was to measure the outcome following surgical enucleation. Measurements used included clinical measurements, radiological measurements and bronchoscopy. The response in children treated surgically were compared to those treated medically by estimating airway size with flexible bronchoscopy. Both groups showed significant improvement with the magnitude of improvement greater in those surgically treated. We have demonstrated in this thesis that the site and severity of severe airway obstruction can be assessed by either bronchoscopy or chest CT scan. Approximately one third of children with severe airway compression due to TB lymph nodes can be successfully treated surgically with a low morbidity and mortality.
Bronchoscopy in children with COVID‐19 : a case series
(John Wiley & Sons, 2020) Goussard, Pierre; Van Wyk, Lizelle; Burke, Jonathan; Malherbe, Annemie; Retief, Francois; Andronikou, Savvas; Mfingwana, Lunga; Ruttens, Dries; Van der Zalm, Marieke; Dramowski, Angela; Da Costa, Aishah; Rabie, Helena
Introduction: The coronavirus disease‐2019 (COVID‐19) era is a challenging time for respiratory teams to protect their patients and staff. COVID‐19 is predominantly transmitted by respiratory droplets; in the clinical setting, aerosol generating procedures pose the greatest risk for COVID‐19 transmission. Bronchoscopy is associated with increased risk of patient‐to‐health care worker transmission, owing to aerosolized viral particles which may be inhaled and also result in environmental contamination of surfaces. Methods: We describe our experience with the use of modified full‐face snorkeling masks for pediatric bronchoscopy procedures in four COVID‐19 infected children when filtering facepieces/respirators were in limited supply. Results: Bronchoscopy was urgently required in four children, and could not be delayed until COVID‐19 test results were available. During the pandemic peak, when respirators were in short supply, modified full‐face snorkel masks (SEAC Libera, SEAC, Italy) were worn by the bronchoscopy team. Each mask was fitted with an O‐ring, adapter, and heat and moisture exchanger filter. To date, there have been no COVID‐19 infections among the bronchoscopy team staff, whereas the overall Hospital staff COVID‐19 prevalence rate has exceeded 13.5% (667/4949). Conclusion: Emergency bronchoscopy procedures on COVID‐19 infected patients or patients with unknown infection status can be safely performed using modified full‐ face snorkel masks.
Child with tuberculous meningitis and COVID-19 coinfection complicated by extensive cerebral sinus venous thrombosis
(BMJ Publishing Group, 2020) Essajee, Farida; Solomons, Regan; Goussard, Pierre; Van Toorn, Ronald
We herein report a case of a child with tuberculous meningitis and COVID-19 coinfection complicated by hydrocephalus, arterial ischaemic stroke and extensive cerebral sinus venous thrombosis. Both conditions induce a proinflammatory cytokine drive resulting, among others, in a prothrombotic state. The disruption of the coagulation system in this case was supported by elevated D-dimers, fibrinogen and ferritin levels, consistent with thrombotic complications reported in some adult patients infected with COVID-19. The child also exhibited prolonged viral shedding that suggests severe disease.
Clinical experience with severe acute respiratory syndrome Coronavirus 2-related illness in children : hospital experience in Cape Town, South Africa
(Oxford University Press, 2020-11-10) van der Zalm, Marieke M.; Lishman, Juanita; Verhagen, Lilly M.; Redfern, Andrew; Smit, Liezl; Barday, Mikhail; Ruttens, Dries; da Costa, A’ishah; van Jaarsveld, Sandra; Itana, Justina; Schrueder, Neshaad; Van Schalkwyk, Marije; Parker, Noor; Appel, Ilse; Fourie, Barend; Claassen, Mathilda; Workman, Jessica J.; Goussard, Pierre; Van Zyl, Gert; Rabie, Helena
Background: Children seem relatively protected from serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease, but little is known about children living in settings with high tuberculosis and human immunodeficiency virus (HIV) burden. This study reflects clinical data on South African children with SARS-CoV-2. Methods: We collected clinical data of children aged <13 years with laboratory-confirmed SARS-CoV-2 presenting to Tygerberg Hospital, Cape Town, between 17 April and 24 July 2020. Results: One hundred fifty-nine children (median age, 48.0 months [interquartile range {IQR}, 12.0-106.0 months]) were included. Hospitalized children (n = 62), with a median age of 13.5 months (IQR, 1.8-43.5 months) were younger than children not admitted (n = 97; median age, 81.0 months [IQR, 34.5-120.5 months]; P < .01.). Thirty-three of 159 (20.8%) children had preexisting medical conditions. Fifty-one of 62 (82.3%) hospitalized children were symptomatic; lower respiratory tract infection was diagnosed in 21 of 51 (41.2%) children, and in 11 of 16 (68.8%) children <3 months of age. Respiratory support was required in 25 of 51 (49.0%) children; 13 of these (52.0%) were <3 months of age. One child was HIV infected and 11 of 51 (21.2%) were HIV exposed but uninfected, and 7 of 51 (13.7%) children had a recent or new diagnosis of tuberculosis. Conclusions: Children <1 year of age hospitalized with SARS-CoV-2 in Cape Town frequently required respiratory support. Access to oxygen may be limited in some low- and middle-income countries, which could potentially drive morbidity and mortality. HIV infection was uncommon but a relationship between HIV exposure, tuberculosis, and SARS-CoV-2 should be explored.
Corrosive injury of the trachea in children
(Wiley Open Access, 2019) Goussard, Pierre; Mfingwana, Lunga; Morrison, Julie; Ismail, Zane; Wagenaar, Riegart; Janson, Jacques
ENGLISH ABSTRACT: The secondary injury may present weeks to months after the initial insult and repeat bronchoscopy, and long‐term follow‐up is required for the respiratory complications of CSI. Ingestion of caustic fluid may cause severe tracheal stenosis. Repeated airway dilatation may be a lifesaving intervention until such point that surgery can be performed.
Effect of exogenous surfactant on Paediatric Bronchoalveolar lavage derived macrophages’ cytokine secretion
(BMC (part of Springer Nature), 2019-12-05) Van Rensburg, Lyne; Van Zyl, Johann M,; Smith, Johan; Goussard, Pierre
Background: Bronchoalveolar lavage is a useful bronchoscopy technique. However, studies in “normal” children populations are few. Furthermore, the anti-inflammatory effects of exogenous pulmonary surfactants on the bronchoalveolar cellular components are limited. Methods: Thirty children, aged 3 to 14 years, underwent diagnostic bronchoscopy and bronchoalveolar lavage. Differential cytology, cytokine and chemokine measurements were performed on the fluid after exogenous surfactant exposure. The aim of the study was to investigate the potential anti-inflammatory effects of exogenous surfactants on the bronchoalveolar lavage fluid, specifically alveolar macrophages of healthy South African children. Results: Alveolar macrophages were the predominant cellular population in normal children. Patients with inflammatory pneumonopathies had significantly more neutrophils. Levels of inflammatory cytokines were significantly lower after exogenous surfactant exposure. Moreover, IL-10 and IL-12 cytokine secretion increased after exogenous surfactant exposure. Conclusion: This study provides the first data on bronchoalveolar lavage of healthy South African children. Bronchoalveolar lavage fluid from patients with pulmonary inflammation was characterised by neutrophilia. Finally, we propose that exogenous surfactant treatment could help alleviate inflammation in diseased states where it occurs in the tracheobronchial tree.
Hybrid lesion in a child presenting with cough, fever and haemoptysis
(BMJ Publishing Group, 2020-10-08) Goussard, Pierre; Andronikou, Savvas; Mfingwana, Lunga; Janson, Jacques
ENGLISH ABSTRACT: A 10-year-old boy presented with minimal haemop-tysis after 1 week of cough and fever. He had a similar presentation 3 years earlier; the diagnosis at that stage was right lower lobe pneumonia. He is HIV uninfected and has no known tuberculosis exposure. Investigations revealed a raised white cell count of 19.0×109 /L, raised C reactive protein 217 mg/L, normal clotting studies and the GeneXpert MTB/RIF was negative.
The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV
(Taylor & Francis, 2016-12) Webster, Irwin; Goussard, Pierre; Gie, Robert; Janson, Jacques; Rossouw, Gawie; Stellenbosch University. Faculty of Medicine and Health Sciences. Department of Paediatrics and Child Health
Background: Bronchoscopy is an important investigation in the diagnosis and management of childhood respiratory diseases widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). Aims and Objectives: Aim of this study was to describe the indications, findings and complications of paediatric bronchoscopy in a middle income country with a high prevalence of tuberculosis (TB) and HIV. Methodology: A retrospective analysis of a database which included all bronchoscopies on neonates and children over a 3.5 year period (January 2010 to June 2013) in a tertiary care children’s hospital in South Africa. Results and Discussion: A total of 509 bronchoscopies, of which 502 (98%) were fibre-optic bronchoscopies, were performed on neonates (2.3%) and children (median age = 18 months; range 1 day- 14.6 years)( (male=58%) of which 5.1% were HIV-infected. The main indications were: large airway compression 40% (n = 204) complicated pneumonia (25 %) and persistent stridor (15 %). Pathology was observed in 64% (n = 319) of bronchoscopes . The most common pathology seen was lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being removing foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications occurred during or following bronchoscopy. Conclusion The diagnostic yield of paediatric bronchoscopy did not significantly differ from those reported from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.
The simple bread tag – a menace to society?
(Health and Medical Publishing Group, 2015) Karro, Ryan; Goussard, Pierre; Loock, James; Gie, Robert
ENGLISH ABSTRACT: Foreign bodies (FBs) are potentially life-threatening when inhaled by a child, depending on where they lodge. Symptoms can range from acute upper airway obstruction to mild, vague respiratory complaints. Between 80% and 90% of inhaled FBs occlude the bronchi, while the larynx is a less common site. The commonest inhaled paediatric FBs are organic, e.g. seeds or nuts. Plastic FBs are less common and more difficult to diagnose. They are generally radiolucent on lateral neck radiographs and are often clear and thin. We report three cases of an unusual plastic laryngeal FB, the bread tag. Plastic bread tags were first reported in the medical literature as an ingested gastrointestinal FB in 1975. Since then, over 20 cases of gastrointestinal complications have been described. We report what is to our knowledge the first paediatric case of an inhaled bread tag, and also the first case series, briefly discuss the symptoms and options for removal of laryngeal FBs, and highlight the dangers of the apparently harmless bread tag. Images of the bread tags in situ and after their removal are included.
Tuberculosis and pneumonia in HIV-infected children : an overview
(BioMed Central, 2016-11-24) Rabie, Helena; Goussard, Pierre
ENGLISH ABSTRACT: Pneumonia remains the most common cause of hospitalization and the most important cause of death in young children. In high human immunodeficiency virus (HIV)-burden settings, HIV-infected children carry a high burden of lower respiratory tract infection from common respiratory viruses, bacteria and Mycobacterium tuberculosis. In addition, Pneumocystis jirovecii and cytomegalovirus are important opportunistic pathogens. As the vertical transmission risk of HIV decreases and access to antiretroviral therapy increases, the epidemiology of these infections is changing, but HIV-infected infants and children still carry a disproportionate burden of these infections. There is also increasing recognition of the impact of in utero exposure to HIV on the general health of exposed but uninfected infants. The reasons for this increased risk are not limited to socioeconomic status or adverse environmental conditions—there is emerging evidence that these HIV-exposed but uninfected infants may have particular immune deficits that could increase their vulnerability to respiratory pathogens. We discuss the impact of tuberculosis and other lower respiratory tract infections on the health of HIV-infected infants and children.
Usefulness of lateral radiographs for detecting tuberculous lymphadenopathy in children - confirmaiton using sagittal CT reconstruction with multiplanar cross-referencing
(AOSIS Publishing, 2012-09-10) Andronikou, Savvas; Van der Merwe, Dirk Johannes; Goussard, Pierre; Gie, Robert P.; Tomazos, Nicolette
ENGLISH SUMMARY : Background: Diagnosis of pulmonary tuberculosis (PTB) in children remains difficult. Lateral chest radiographs are frequently used to facilitate diagnosis, but interpretation is variable. In this study, lateral chest radiographs (CXRs) are evaluated against sagittal CT reconstructions for the detection of mediastinal lymphadenopathy. Aim: To correlate suspected lymphadenopathy on lateral CXR with sagittal CT reconstructions and determine which anatomical group of lymph nodes contributes to each lateral CXR location. Methods and materials: Thirty TB-positive children’s lateral CXRs were retrospectively reviewed for presence of mediastinal lymphadenopathy in 3 pre-determined locations in relation to the carina: retrocarinal, subcarinal and precarinal. Findings of the CT sagittal reconstructions were then correlated with the CXRs for the presence of lymphadenopathy in the same 3 pre-determined areas across the width of the mediastinum. Axial and coronal CT crossreferencing confirmed the position of the lymphadenopathy. Results: The most frequent locations for lymphadenopathy were the subcarinal (28) and right hilar (25). Sensitivity and specificity values of the CXRs were moderate, with the precarinal region having the best sensitivity and specificity for presence of lymphadenopathy. Contribution to each zonal group on lateral CXR were from multiple anatomical lymph node sites. Conclusion: The precarinal zone on CXR had the best specificity and sensitivity, and represented mainly subcarinal and right hilar lymph node groups. Attention should be paid to this area on lateral CXRs for detecting lymphadenopathy in children with suspected PTB.
Whole-genome sequence of a mycobacterium goodii isolate from a pediatric patient in South Africa
(American Society for Microbiology, 2018) Allam, Mushal; Joseph, Lavania; Ismail, Farzana; Said, Halima; Ismail, Nazir A.; Ismail, Arshad; Mtshali, Senzo; Mnyameni, Florah; Goussard, Pierre; Pekeur, Jade C.; Lourens, Adre; Omar, Shaheed V.
ENGLISH ABSTRACT: We describe here the draft genome sequence of a Mycobacterium goodii isolate from a pediatric patient in Western Cape, South Africa. To our knowledge, this is the second reported genome of this rapidly growing nontuberculous mycobacterial species.

Browsing by Author "Goussard, Pierre"

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