RSV is Temozolomide known to be the most important and severe cause of lower respiratory tract infections

in all children, and certain groups (e.g. preterm infants) are identified early in infancy to have a high risk of RSV infection and receive immunological prophylaxis against this disease. Of note, a subsequent study [14] showed that hospitalization for RSV-induced lower respiratory tract infection in children with DS did not increase significantly the risk for recurrent wheezing or long-term airway morbidity. This study reported that the incidence of recurrent wheeze was higher among DS children at about 30%, regardless of whether or not they had a history of RSV-induced lower respiratory tract illness. Megged and Schlesinger [15] pointed out that DS infants with RSV are older and require longer hospitalization than non-DS infants, possibly reflecting the association with cardiac disease. More recently, a study of health services utilization by a cohort of DS subjects

in Western Australia compared surveys conducted in 1997 and 2004. A reduction of the incidence of Erlotinib in vitro overall infections, but mainly upper respiratory infections, were noted. Further analysis of association with other clinical findings showed that the decrease of ear infections was seen only in DS patients without heart disease. Pneumonias, tonsillitis and bronchitis were observed to have a decreasing trend in both groups with and without heart disease, suggesting that cardiac function was not a determinant of the risk of infections. Streptococcus pneumoniae, Haemophilis influenzae and Moraxella catarrhalis are the three most common bacteria known to cause acute otitis media and pneumonia in children [16,17]. There are few studies on the pathogens causing recurrent respiratory infections or otitis media in DS children, with isolated case reports that describe uncommon aetiologies

(i.e. Bordetella bronchiseptica), which probably do not represent the large majority of infections among DS children. Of more relevance, changes in the frequency and microbiology of infections after the introduction of the recommended anti-pneumococcal immunization in 1999 have not Chorioepithelioma been studied in this patient population. Even though some DS children may not present with frequent infections, the course of their infection illnesses might be prolonged and have increased severity compared with non-DS children. In the study by Hilton et al. [12], the median length of stay and cost of admission for DS children was two to three times greater than in non-DS subjects. A higher incidence of acute lung injury secondary to pneumonia was found among DS children when compared to normal control children.