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  3. Lower respiratory tract infections in individuals with trisomy 21
Medical and paramedical


Lower respiratory tract infections

Infectious respiratory pathologies of the lower airways are more frequent and more severe than in the general population, both in children under 5 and in adults with Down’s syndrome over 40, and are a major cause of hospitalization and mortality at all ages. The particular vulnerability of people with Down’s syndrome was sadly highlighted by the COVID 19 pandemic, for which they paid a heavy price.


Prevalence, risk factors, morbidity and mortality, main etiologies, Dr. Hervé Walti, pediatrician at the Institut Jérôme Lejeune, tells you more in this video and the accompanying fact sheet.


Discover below the presentation associated with this video on the subject of “infectious respiratory pathologies of the lower airways”.

  • Ahlström G, Axmon A, Sandberg M, Flygare Wallén E. Health care utilisation among older people with Down syndrome compared to specific medical guidelines for health surveillance: a Swedish national register study. BMC Health Serv Res. 2020 Oct 15;20(1):949. doi: 10.1186/s12913-020-05800-7. PMID: 33059705; PMCID: PMC7559468.
  • Beckhaus AA, Castro-Rodriguez JA. Down Syndrome and the Risk of Severe RSV Infection: A Meta-analysis. Pediatrics. 2018 Sep;142(3):e20180225. doi: 10.1542/peds.2018-0225. Epub 2018 Aug 9. PMID: 30093540.
  • Bittles AH, Bower C, Hussain R, Glasson EJ. The four ages of Down syndrome. Eur J Public Health. 2007 Apr;17(2):221-5. doi: 10.1093/eurpub/ckl103. Epub 2006 Jul 19. PMID: 16857692.
  • Blake JM, Estrada Gomez D, Skotko BG, Torres A, Santoro SL. Pneumonia and respiratory infection in Down syndrome: A 10-year cohort analysis of inpatient and outpatient encounters across the lifespan. Am J Med Genet A. 2021 Oct;185(10):2878-2887. doi: 10.1002/ajmg.a.62355. Epub 2021 May 31. PMID: 34056836.
  • Bloemers BL, van Furth AM, Weijerman ME, Gemke RJ, Broers CJ, van den Ende K, Kimpen JL, Strengers JL, Bont LJ. Down syndrome: a novel risk factor for respiratory syncytial virus bronchiolitis–a prospective birth-cohort study. Pediatrics. 2007 Oct;120(4):e1076-81. doi: 10.1542/peds.2007-0788. PMID: 17908728.
  • Bruijn M, van der Aa LB, van Rijn RR, Bos AP, van Woensel JB. High incidence of acute lung injury in children with Down syndrome. Intensive Care Med. 2007 Dec;33(12):2179-82. doi: 10.1007/s00134-007-0803-z. Epub 2007 Aug 3. PMID: 17673975; PMCID: PMC2092441.
  • Bush D, Abman SH, Galambos C. Prominent Intrapulmonary Bronchopulmonary Anastomoses and Abnormal Lung Development in Infants and Children with Down Syndrome. J Pediatr. 2017 Jan;180:156-162.e1. doi: 10.1016/j.jpeds.2016.08.063. Epub 2016 Sep 22. PMID: 27666181.
  • Bush D, Galambos C, Dunbar Ivy D. Pulmonary hypertension in children with Down syndrome. Pediatr Pulmonol. 2021 Mar;56(3):621-629. doi: 10.1002/ppul.24687. Epub 2020 Feb 12. PMID: 32049444.
  • Boylan MR, Kapadia BH, Issa K, Perfetti DC, Maheshwari AV, Mont MA. Down Syndrome Increases the Risk of Short-Term Complications After Total Hip Arthroplasty. J Arthroplasty. 2016 Feb;31(2):368-72. doi: 10.1016/j.arth.2015.09.031. Epub 2015 Sep 28. PMID: 26482683.
  • Bush D, Galambos C, Ivy DD, Abman SH, Wolter-Warmerdam K, Hickey F. Clinical Characteristics and Risk Factors for Developing Pulmonary Hypertension in Children with Down Syndrome. J Pediatr. 2018 Nov;202:212-219.e2. doi: 10.1016/j.jpeds.2018.06.031. Epub 2018 Jul 17. PMID: 30025669.
  • Cairo SB, Zeinali LI, Berkelhamer SK, Harmon CM, Rao SO, Rothstein DH. Down Syndrome and Postoperative Complications in Children Undergoing Intestinal Operations. J Pediatr Surg. 2019 Sep;54(9):1832-1837. doi: 10.1016/j.jpedsurg.2018.11.013. Epub 2018 Dec 13. PMID: 30611525.
  • Cant AJ, Gibson PJ, West RJ. Bacterial tracheitis in Down’s syndrome. Arch Dis Child. 1987 Sep;62(9):962-3. doi: 10.1136/adc.62.9.962. PMID: 2960275; PMCID: PMC1778583.
  • Capone GT, Chicoine B, Bulova P, Stephens M, Hart S, Crissman B, Videlefsky A, Myers K, Roizen N, Esbensen A, Peterson M, Santoro S, Woodward J, Martin B, Smith D; Down Syndrome Medical Interest Group DSMIG-USA Adult Health Care Workgroup. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Am J Med Genet A. 2018 Jan;176(1):116-133. doi: 10.1002/ajmg.a.38512. Epub 2017 Nov 12. PMID: 29130597.
  • Capone G, Stephens M, Santoro S, Chicoine B, Bulova P, Peterson M, Jasien J, Smith AJ; Down Syndrome Medical Interest Group (DSMIG-USA) Adult Health Workgroup. Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Part II. Am J Med Genet A. 2020 Jul;182(7):1832-1845. doi: 10.1002/ajmg.a.61604. Epub 2020 Apr 27. PMID: 32338447.
  • Carfì A, Romano A, Zaccaria G, Villani ER, Manes Gravina E, Vetrano DL, Bernabei R, Onder G. The burden of chronic disease, multimorbidity, and polypharmacy in adults with Down syndrome. Am J Med Genet A. 2020 Jul;182(7):1735-1743. doi: 10.1002/ajmg.a.61636. Epub 2020 May 25. PMID: 32449279.
  • Chenbhanich J, Wu A, Phupitakphol T, Atsawarungruangkit A, Treadwell T. Hospitalisation of adults with Down syndrome: lesson from a 10-year experience from a community hospital. J Intellect Disabil Res. 2019 Mar;63(3):266-276. doi: 10.1111/jir.12572. Epub 2018 Nov 28. PMID: 30484927.
  • Chicoine B, Rivelli A, Fitzpatrick V, Chicoine L, Jia G, Rzhetsky A. Prevalence of Common Disease Conditions in a Large Cohort of Individuals With Down Syndrome in the United States. J Patient Cent Res Rev. 2021 Apr 19;8(2):86-97. doi: 10.17294/2330-0698.1824. PMID: 33898640; PMCID: PMC8060042.
  • Clift AK, Coupland CAC, Keogh RH, Hemingway H, Hippisley-Cox J. COVID-19 Mortality Risk in Down Syndrome: Results From a Cohort Study of 8 Million Adults. Ann Intern Med. 2021 Apr;174(4):572-576. doi: 10.7326/M20-4986. Epub 2020 Oct 21. PMID: 33085509; PMCID: PMC7592804.
  • Cockerill CC, Frisch CD, Rein SE, Orvidas LJ. Supraglottoplasty outcomes in children with Down syndrome. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:87-90. doi: 10.1016/j.ijporl.2016.05.022. Epub 2016 May 20. PMID: 27368449.
  • De Lausnay M, Ides K, Wojciechowski M, Boudewyns A, Verhulst S, Van Hoorenbeeck K. Pulmonary complications in children with Down syndrome: A scoping review. Paediatr Respir Rev. 2021 Dec;40:65-72. doi: 10.1016/j.prrv.2021.04.006. Epub 2021 May 5. PMID: 34148805.
  • De Lausnay M, Verhulst S, Boel L, Van Hoorenbeeck K. Lower airway microbiota in children with Down syndrome compared to controls with similar respiratory symptomatology. Transl Pediatr. 2021 Jul;10(7):1818-1824. doi: 10.21037/tp-20-460. PMID: 34430429; PMCID: PMC8349956.
  • Dotan M, Zion E, Ben-Zvi H, Yarden-Bilavsky H, Bilavsky E. Adenovirus Infection in Children with Down Syndrome. Isr Med Assoc J. 2021 Jul;23(7):416-419. PMID: 34251123.
  • Doucette A, Jiang X, Fryzek J, Coalson J, McLaurin K, Ambrose CS. Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997-2012. PLoS One. 2016 Apr 6;11(4):e0152208. doi: 10.1371/journal.pone.0152208. PMID: 27050095; PMCID: PMC4822775.
  • Emes D, Hüls A, Baumer N, Dierssen M, Puri S, Russell L, Sherman SL, Strydom A, Bargagna S, Brandão AC, Costa ACS, Feany PT, Chicoine BA, Ghosh S, Rebillat AS, Sgandurra G, Valentini D, Rohrer TR, Levin J, Lakhanpaul M, On Behalf Of The Trisomy Research Society Covid-Initiative Study Group. COVID-19 in Children with Down Syndrome: Data from the Trisomy 21 Research Society Survey. J Clin Med. 2021 Oct 31;10(21):5125. doi: 10.3390/jcm10215125. PMID: 34768645; PMCID: PMC8584980.
  • Englund A, Jonsson B, Zander CS, Gustafsson J, Annerén G. Changes in mortality and causes of death in the Swedish Down syndrome population. Am J Med Genet A. 2013 Apr;161A(4):642-9. doi: 10.1002/ajmg.a.35706. Epub 2013 Feb 22. PMID: 23436430.
  • Fitzgerald P, Leonard H, Pikora TJ, Bourke J, Hammond G. Hospital admissions in children with down syndrome: experience of a population-based cohort followed from birth. PLoS One. 2013 Aug 13;8(8):e70401. doi: 10.1371/journal.pone.0070401. PMID: 23967074; PMCID: PMC3742744.
  • Grut V, Söderström L, Naumburg E. National cohort study showed that infants with Down’s syndrome faced a high risk of hospitalisation for the respiratory syncytial virus. Acta Paediatr. 2017 Sep;106(9):1519-1524. doi: 10.1111/apa.13937. Epub 2017 Jul 21. PMID: 28556255.
  • Guffroy, A., Dieudonné, Y., Uring-Lambert, B. et al.Infection risk among adults with down syndrome: a two group series of 101 patients in a tertiary center. Orphanet J Rare Dis 14, 15 (2019). https://doi.org/10.1186/s13023-018-0989-x
  • Hassler A, Bochennek K, Gilfert J, Perner C, Schöning S, Creutzig U, Reinhardt D, Lehrnbecher T. Infectious Complications in Children With Acute Myeloid Leukemia and Down Syndrome: Analysis of the Prospective Multicenter Trial AML-BFM 2004. Pediatr Blood Cancer. 2016 Jun;63(6):1070-4. doi: 10.1002/pbc.25917. Epub 2016 Jan 27. PMID: 26814618.
  • Hayes C, Johnson Z, Thornton L, Fogarty J, Lyons R, O’Connor M, Delany V, Buckley K. Ten-year survival of Down syndrome births. Int J Epidemiol. 1997 Aug;26(4):822-9. doi: 10.1093/ije/26.4.822. PMID: 9279615.
  • Hayes SA, Kutty S, Thomas J, Johnson JT, Yetman AT. Cardiovascular and general health status of adults with Trisomy 21. Int J Cardiol. 2017 Aug 15;241:173-176. doi: 10.1016/j.ijcard.2017.03.040. Epub 2017 Mar 10. PMID: 28318659.
  • Hilton JM, Fitzgerald DA, Cooper DM. Respiratory morbidity of hospitalized children with Trisomy 21. J Paediatr Child Health. 1999 Aug;35(4):383-6. doi: 10.1046/j.1440-1754.1999.00386.x. PMID: 10457298.
  • Huggard D, Doherty DG, Molloy EJ. Immune Dysregulation in Children With Down Syndrome. Front Pediatr. 2020 Feb 27;8:73. doi: 10.3389/fped.2020.00073. PMID: 32175298; PMCID: PMC7056667.
  • Hüls A, Costa ACS, Dierssen M, Baksh RA, Bargagna S, Baumer NT, Brandão AC, Carfi A, Carmona-Iragui M, Chicoine BA, Ghosh S, Lakhanpaul M, Manso C, Mayer MA, Ortega MDC, de Asua DR, Rebillat AS, Russell LA, Sgandurra G, Valentini D, Sherman SL, Strydom A; T21RS COVID-19 Initiative. Medical vulnerability of individuals with Down syndrome to severe COVID-19-data from the Trisomy 21 Research Society and the UK ISARIC4C survey. EClinicalMedicine. 2021 Mar;33:100769. doi: 10.1016/j.eclinm.2021.100769. Epub 2021 Feb 22. PMID: 33644721; PMCID: PMC7897934.
  • Illouz T, Biragyn A, Frenkel-Morgenstern M, Weissberg O, Gorohovski A, Merzon E, Green I, Iulita F, Flores-Aguilar L, Dierssen M, De Toma I, Lifshitz H, Antonarakis SE, Yu E, Herault Y, Potier MC, Botté A, Roper R, Sredni B, Sarid R, London J, Mobley W, Strydom A, Okun E. Specific Susceptibility to COVID-19 in Adults with Down Syndrome. Neuromolecular Med. 2021 Dec;23(4):561-571. doi: 10.1007/s12017-021-08651-5. Epub 2021 Mar 4. Erratum in: Neuromolecular Med. 2021 May 4;: Erratum in: Neuromolecular Med. 2021 Nov 19;: PMID: 33660221; PMCID: PMC7929736.
  • Illouz T, Biragyn A, Iulita MF, Flores-Aguilar L, Dierssen M, De Toma I, Antonarakis SE, Yu E, Herault Y, Potier MC, Botté A, Roper R, Sredni B, London J, Mobley W, Strydom A, Okun E. Immune Dysregulation and the Increased Risk of Complications and Mortality Following Respiratory Tract Infections in Adults With Down Syndrome. Front Immunol. 2021 Jun 25;12:621440. doi: 10.3389/fimmu.2021.621440. PMID: 34248930; PMCID: PMC8267813.
  • Jackson A, Maybee J, Wolter-Warmerdam K, DeBoer E, Hickey F. Associations between age, respiratory comorbidities, and dysphagia in infants with down syndrome. Pediatr Pulmonol. 2019 Nov;54(11):1853-1859. doi: 10.1002/ppul.24458. Epub 2019 Aug 12. PMID: 31402588.
  • Jama-Alol KA, Moore HC, Jacoby P, Bower C, Lehmann D. Morbidity due to acute lower respiratory infection in children with birth defects: a total population-based linked data study. BMC Pediatr. 2014 Mar 25;14:80. doi: 10.1186/1471-2431-14-80. PMID: 24661413; PMCID: PMC3987821.
  • Jensen KM, Sevick CJ, Seewald LAS, Halbower AC, Davis MM, McCabe ERB, Kempe A, Abman SH. Greater risk of hospitalization in children with Down syndrome and OSA at higher elevation. Chest. 2015 May;147(5):1344-1351. doi: 10.1378/chest.14-1883. PMID: 25654790.
  • Joffre C, Lesage F, Bustarret O, Hubert P, Oualha M. Children with Down syndrome: Clinical course and mortality-associated factors in a French medical paediatric intensive care unit. J Paediatr Child Health. 2016 Jun;52(6):595-9. doi: 10.1111/jpc.13214. PMID: 27333845.
  • Kapoor S, Bhayana S, Singh A, Kishore J. Co-morbidities leading to mortality or hospitalization in children with Down syndrome and its effect on the quality of life of their parents. Indian J Pediatr. 2014 Dec;81(12):1302-6. doi: 10.1007/s12098-014-1389-4. Epub 2014 May 14. PMID: 24820231.
  • Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open. 2018 Feb 5;8(2):e018292. doi: 10.1136/bmjopen-2017-018292. PMID: 29431619; PMCID: PMC5829598.
  • Kristensen K, Hjuler T, Ravn H, Simões EA, Stensballe LG. Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization: a population-based cohort study. Clin Infect Dis. 2012 Mar;54(6):810-7. doi: 10.1093/cid/cir928. Epub 2012 Jan 12. PMID: 22247121.
  • Kusters MA, Bok VL, Bolz WE, Huijskens EG, Peeters MF, de Vries E. Influenza A/H1N1 vaccination response is inadequate in down syndrome children when the latest cut-off values are used. Pediatr Infect Dis J. 2012 Dec;31(12):1284-5. doi: 10.1097/INF.0b013e3182737410. PMID: 22986705.
  • Lee YI, Peng CC, Chiu NC, Huang DT, Huang FY, Chi H. Risk factors associated with death in patients with severe respiratory syncytial virus infection. J Microbiol Immunol Infect. 2016 Oct;49(5):737-742. doi: 10.1016/j.jmii.2014.08.020. Epub 2014 Oct 31. PMID: 25442868.
  • Löwensteyn YN, Phijffer EWEM, Simons JVL, Scheltema NM, Mazur NI, Nair H, Bont LJ; RSV GOLD Study Group. Respiratory Syncytial Virus-related Death in Children With Down Syndrome: The RSV GOLD Study. Pediatr Infect Dis J. 2020 Aug;39(8):665-670. doi: 10.1097/INF.0000000000002666. PMID: 32332221; PMCID: PMC7360096.
  • Luna MS, Manzoni P, Paes B, Baraldi E, Cossey V, Kugelman A, Chawla R, Dotta A, Rodríguez Fernández R, Resch B, Carbonell-Estrany X. Expert consensus on palivizumab use for respiratory syncytial virus in developed countries. Paediatr Respir Rev. 2020 Feb;33:35-44. doi: 10.1016/j.prrv.2018.12.001. Epub 2018 Dec 18. PMID: 31060948.
  • Malle L, Gao C, Hur C, Truong HQ, Bouvier NM, Percha B, Kong XF, Bogunovic D. Individuals with Down syndrome hospitalized with COVID-19 have more severe disease. Genet Med. 2021 Mar;23(3):576-580. doi: 10.1038/s41436-020-01004-w. Epub 2020 Oct 16. PMID: 33060835; PMCID: PMC7936948.
  • Manikam L, Schilder AGM, Lakhanpaul M, Littlejohns P, Alexander EC, Hayward A. Respiratory tract infection-related healthcare utilisation in children with Down’s syndrome. Infection. 2020 Jun;48(3):403-410. doi: 10.1007/s15010-020-01408-5. Epub 2020 Mar 14. Erratum in: Infection. 2020 Apr 27;: PMID: 32172511; PMCID: PMC7095390.
  • Manzoni P, Figueras-Aloy J, Simões EAF, Checchia PA, Fauroux B, Bont L, Paes B, Carbonell-Estrany X. Defining the Incidence and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Children with Chronic Diseases. Infect Dis Ther. 2017 Sep;6(3):383-411. doi: 10.1007/s40121-017-0160-3. Epub 2017 Jun 26. PMID: 28653300; PMCID: PMC5595774.
  • Medrano C, Garcia-Guereta L, Grueso J, Insa B, Ballesteros F, Casaldaliga J, Cuenca V, Escudero F, de la Calzada LG, Luis M, Luque M, Mendoza A, Prada F, del Mar Rodríguez M, Suarez P, Quero C, Guilera M; CIVIC Study Group from the Spanish Society of Pediatric Cardiology and Congenital Heart Disease. Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC Epidemiologic Study. Cardiol Young. 2007 Aug;17(4):360-71. doi: 10.1017/S104795110700042X. PMID: 17662160.
  • Megged O, Schlesinger Y. Down syndrome and respiratory syncytial virus infection. Pediatr Infect Dis J. 2010 Jul;29(7):672-3. doi: 10.1097/INF.0b013e3181d7ffa5. PMID: 20228692.
  • Millman AJ, Finelli L, Bramley AM, Peacock G, Williams DJ, Arnold SR, Grijalva CG, Anderson EJ, McCullers JA, Ampofo K, Pavia AT, Edwards KM, Jain S. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders. J Pediatr. 2016 Jun;173:188-195.e4. doi: 10.1016/j.jpeds.2016.02.049. Epub 2016 Mar 23. PMID: 27017483; PMCID: PMC4897771.
  • Motegi N, Yamaoka Y, Moriichi A, Morisaki N. Causes of death in patients with Down syndrome in 2014-2016: A population study in Japan. Am J Med Genet A. 2021 Oct 7. doi: 10.1002/ajmg.a.62526. Epub ahead of print. PMID: 34622557.
  • Ng N, Flygare Wallén E, Ahlström G. Mortality patterns and risk among older men and women with intellectual disability: a Swedish national retrospective cohort study. BMC Geriatr. 2017 Nov 22;17(1):269. doi: 10.1186/s12877-017-0665-3. PMID: 29166873; PMCID: PMC5700486.
  • Nisihara RM, Utiyama SR, Oliveira NP, Messias-Reason IJ. Mannan-binding lectin deficiency increases the risk of recurrent infections in children with Down’s syndrome. Hum Immunol. 2010 Jan;71(1):63-6. doi: 10.1016/j.humimm.2009.09.361. PMID: 19804807.
  • Oppewal A, Schoufour JD, van der Maarl HJK, Evenhuis HM, Hilgenkamp TIM, Festen DA. Causes of Mortality in Older People With Intellectual Disability: Results From the HA-ID Study. Am J Intellect Dev Disabil. 2018 Jan;123(1):61-71. doi: 10.1352/1944-7558-123.1.61. PMID: 29281322.
  • Orlicek SL, Walker MS, Kuhls TL. Severe mycoplasma pneumonia in young children with Down syndrome. Clin Pediatr (Phila). 1992 Jul;31(7):409-12. doi: 10.1177/000992289203100706. PMID: 1535577.
  • Pérez-Padilla R, Fernández R, García-Sancho C, Franco-Marina F, Aburto O, López-Gatell H, Bojórquez I. Pandemic (H1N1) 2009 virus and Down syndrome patients. Emerg Infect Dis. 2010 Aug;16(8):1312-4. doi: 10.3201/eid1608.091931. PMID: 20678334; PMCID: PMC3298326.
  • Pravit J. Bronchoscopic findings in Down syndrome children with respiratory problems. J Med Assoc Thai. 2014 Jun;97 Suppl 6:S159-63. PMID: 25391189.
  • Ramphul K, Mejias SG, Joynauth J. Children less than 2 with Down syndrome and suffering from respiratory syncytial virus have a longer and more costly hospitalization. J Pediatr. 2019 Mar;206:302. doi: 10.1016/j.jpeds.2018.11.047. Epub 2018 Dec 14. Erratum in: J Pediatr. 2019 Oct 11;: PMID: 30559019.
  • Santoro SL, Chicoine B, Jasien JM, Kim JL, Stephens M, Bulova P, Capone G. Pneumonia and respiratory infections in Down syndrome: A scoping review of the literature. Am J Med Genet A. 2021 Jan;185(1):286-299. doi: 10.1002/ajmg.a.61924. Epub 2020 Oct 19. PMID: 33073471.

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