PEDIATRIC RESPIRATORY PAPILLOMATOSIS - PROGNOSTIC ROLE OF VIRAL TYPING AND COFACTORS

Children with recurrent respiratory papillomatosis vary greatly in the ir clinical disease course. Many have mild disease with eventual remis sion while others present with an early aggressive airway obstructive course. This study consisted of 24 pediatric patients whose specimens underwent polymerase chain reaction analysis for cytomegalovirus (CMV) , herpes simplex virus (HSV), and human papillomavirus (HPV) type. Nin eteen of 24 specimens contained enough DNA for this study. None of the specimens were found to contain DNA from HPV-16, -18, -31, -33; CMV; or HSV, which contrasts with our previous findings in adults. Ten pati ents were infected by HPV-11 and seven of these underwent tracheotomy because of an aggressive tumorigenic clinical course. Nine patients we re infected by HPV-6 alone of whom only two required a tracheotomy (P = 0.05, Fisher's Exact Test). The early airway obstructive course asso ciated with HPV-11, however, had no bearing on achieving eventual dise ase remission, with decannulation achieved in eight of nine children.