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PubMed1997

The incidence of respiratory tract infection in adults requiring hospitalization for asthma.

UNLABELLED: Acute respiratory tract infections (RTI) are known to worsen asthma particularly in children. There are few studies in adults assessing the incidence of RTI in patients hospitalized with acute asthma. AIM: To document the incidence of RTI in adults hospitalized with acute asthma. METHODS: A prospective study of patients with acute asthma admitted to the Department of Respiratory Medicine, Western Hospital Footscray, over a 12-month period. A control group was studied from elective surgical inpatients. Patients were investigated with serologic tests for Chlamydia, Mycoplasma, Legionella, and influenza A and B. Nasopharyngeal aspirate (NPA) samples were cultured for influenza, respiratory syncytial virus (RSV), adenovirus, parainfluenza, rhinovirus, and herpes simplex virus. If sputum was available, it was assessed with microscopy and culture. Blood cultures were taken if patients were febrile and all patients had a chest radiograph. Control subjects completed serologic tests and NPA. RESULTS: Seventy-nine patients (33 male and 46 female) and 54 control subjects (26 male and 28 female) were studied. Two patients were enrolled twice. Mean (+/-SD) age of patients was 35+/-15 years (range, 16 to 66 years), and mean age of control subjects was 37+/-15 years (range, 18 to 69 years). In the patient group, 29 (37%) had evidence of recent RTI of which 23 were viral. Five of the control subjects (9%) had evidence of recent RTI (p<0.001). Twenty-four patients were positive on serologic and/or NPA culture. Five patients had positive serologic test results and/or NPA culture to two or more agents. Two patients tested positive on sputum, radiograph, and temperature criteria. Three patients tested positive on the basis of radiographic evidence of consolidation, blood neutrophilia, and temperature. Influenza A (13) and rhinovirus (9) were the most common infectious agents. Other agents identified were RSV (one), influenza B (two), adenovirus (one), and Mycoplasma (one). Influenza and rhinovirus infections occurred predominantly in late and early winter, respectively. Summer hospitalization did not relate to RTI. CONCLUSION: Thirty-seven percent of adult patients with acute asthma admitted to the Department of Respiratory Medicine over a 12-month period had evidence of recent RTI.

Acute Disease↗

PubMed2006

Human coronavirus infection among children with acute lower respiratory tract infection in Thailand.

OBJECTIVE: This study was performed to further identify the previously uncharacterized human coronavirus 229E (hCoV-229E) and human coronavirus OC43 (hCoV-OC43) in Thailand by using the RT-PCR technique. In addition, we performed this study in order to delineate the prevalence, the potential clinical impacts and evaluation of the genetic characterization of this pathogen in young children who presented with acute lower respiratory tract infections (ALRI). METHODS: We obtained nasopharyngeal secretions (NPs) from 226 children <5 years of age who were either attending the outpatient department or hospitalized with ALRI from March 2002 to July 2003. All clinical, laboratory, RT-PCR, direct sequencing and phylogenetic analysis data were collected and analyzed. RESULTS: Of the 226 NPs samples from infants and young children presented with ALRI, 8 (3.54%) were positive for hCoV-229E, 2 (0.88%) were positive for hCoV-OC43, and 1 (0.44%) had co-infection. The following clinical presentations were noted: fever (100%), rhinitis (44%), acute bronchiolitis (44%), viral pneumonia (33%), viral pneumonia triggering asthma exacerbation (11%) as well as viral pneumonia causing BPD exacerbation (11%). All positive samples were subjected to direct sequencing. The amino acid sequences had 82-99% similarity to previous sequences stored in the GenBank database. CONCLUSION: The molecular technique we applied to detect human coronavirus appears justified as a valuable diagnostic approach to elucidate the prevalence, cause and clinical implications of ALRI among infants and young children.

Adolescent↗

PubMed1988

The incidence of Legionella pneumophila as the cause of acute ambulatory lower respiratory tract infection.

Seventy-nine ambulatory patients with acute lower respiratory tract infection were evaluated for Legionella pneumophila by acute and convalescent antibody titers. None of the patients met the traditional criteria for the diagnosis of acute infection caused by Legionella pneumophila. Currently accepted criteria for diagnosing legionellosis by serologic means may or may not be applicable to mild respiratory tract infections.

Ambulatory Care Facilities↗

PubMed1984

Increase in proteinuria and/or microhematuria following upper respiratory tract infections in patients with IgA nephropathy.

Exacerbation of urinary abnormalities after upper respiratory tract infections in patients with IgA nephropathy was examined. Twenty patients with IgA nephropathy and fourty patients with other glomerular diseases were evaluated in this study. The incidence of exacerbation in microhematuria after upper respiratory tract infections was significantly higher in patients with IgA nephropathy than those with other glomerular diseases. The improvement of microhematuria after upper respiratory tract infections was significantly delayed in some patients with IgA nephropathy. It is indicated that upper respiratory tract infections might be a risk factor of exacerbation in patients with IgA nephropathy.

Glomerulonephritis↗

PubMed1996

Tannic acid supplemented fixation improves ultrastructural evaluation of respiratory epithelium in children with recurrent respiratory tract infections.

Samples of the respiratory mucosa of children with recurrent respiratory infections suspected of having primary ciliary dyskinesia are routinely fixed with glutaraldehyde before ultrastructural examination. This standard technique, however, may not be optimal for visualizing ciliary components or for preserving several cellular and extracellular structures during dehydration and embedding procedures. In this study, brushes of nasal (28 samples) and/or tracheal (9 samples) mucosa from 32 children with recurrent respiratory tract infections were examined. Twenty-nine samples were fixed with glutaraldehyde supplemented with tannic acid to determine if the ultrastructural analysis of respiratory epithelium and bronchial secretions could be improved. Eight samples were conventionally fixed with glutaraldehyde alone. Lesions of the cellular membrane and damaged cells were easily visualized using tannic acid supplemented fixation. Internal ciliary structures including individual microtubules and dynein arms were also more clearly observed. In addition, the internal structure of microvilli of the respiratory epithelium could be studied and the presence of phospholipid-rich surfactant-like material within nasal and tracheal secretions were visualized after tannic acid supplemented fixation. We suggest that addition of tannic acid during fixation is useful for accurate ultrastructural evaluation of respiratory mucosa in both clinical and experimental situations.

Adolescent↗

PubMed1991

Immunoglobulin G subclass deficiency in children with recurrent respiratory tract infections.

With monoclonal antibodies serum immunoglobulin G(IgG) subclasses were measured in seventy children aged 2 to 13 years with recurrent respiratory tract infections including upper respiratory tract infections, otitis media, sinusitis, asthmatic bronchitis and pneumonia. 211 healthy, aged-matched children served as control. IgG subclass deficiency was found in 19 out of the 70 patients (27.1%, single IgG1 deficiency in 7, IgG2 deficiency in 4, combined IgG1-IgG3 deficiency in 5, IgG1-IgG2-IgG3-IgG4 deficiency, IgG1-IgG2-IgG4 deficiency and IgG2-IgG4 deficiency each in 1). The incidence of IgG subclass deficiencies was in the sequence as follows: IgG1, 20%; IgG2, 10%; IgG3, 8.6% and IgG4, 4.3%. The results suggest that IgG subclass deficiency indicate a common disorder in children with recurrent respiratory tract infections.

Adolescent↗

PubMed2002

Rational use of antibiotics to treat respiratory tract infections.

OBJECTIVES: To foster the appropriate use of antimicrobial agents for respiratory tract infections and to review factors that should help achieve this objective. STUDY DESIGN: Review of evidence-based guidelines and recommendations for proper antibiotic drug use for respiratory tract infections. RESULTS AND CONCLUSIONS: Antibiotic drug overuse and inappropriate antibiotic drug selection are associated with increased drug resistance among respiratory pathogens (most notably, Streptococcus pneumoniae), possible progression to chronic disease, and increased treatment costs. Awareness of clinical manifestations that help differentiate viral from bacterial infection and the use of guidelines can promote the appropriate management of respiratory tract infections. Community-acquired pneumonia, acute bacterial rhinosinusitis, and selected cases of acute exacerbations of chronic bronchitis (50%) warrant antimicrobial therapy, whereas otitis media with effusion, acute bronchitis, and most rhinosinusitis are viral and do not require antibiotic therapy.

Anti-Bacterial Agents↗

PubMed1992

[Respiratory tract infections in the elderly, advances and limitations in the diagnosis and treatment].

Advances and limitations in the diagnosis and treatment of respiratory tract infections were discussed in relation to the prognosis of the elderly patients. Haemophilus influenzae and Streptococcus pneumoniae are the major pathogens in the community-acquired respiratory tract infections. On the other hand, methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa are the major pathogens in the nosocomial respiratory tract infections. Detection of MRSA-PBP genes and antibiotic sensitivity tests are important for the diagnosis of MRSA. Vancomycin or arbekacin is the first-choice antibiotic for the treatment of severe infection caused by MRSA, and a combination therapy using one of the above agents and a partner antibiotic is necessary in some cases of MRSA infections. Reports concerning the significance of anaerobic bacteria in respiratory tract infections in Japan have been rare, presumably because procedures to recover anaerobic bacteria from specimens other than sputum, for example transtrancheal aspiration (TTA), bronchoscopic procedure and transcutaneous lung biopsy, are required for the diagnosis of the anaerobic respiratory tract infections. Nowadays, identification of cytomegalovirus (CMV) is a prerequisit for the rapid diagnosis of CMV infection. Therefore attempts are being made to detect a specific substance, for example messenger RNA during the stage of reactivation of CMV. Prophylaxis as well as treatment is necessary for the control of acute exacerbation of chronic respiratory tract infections. In this regard, long-term administration of a small dose of erythromycin or new-quinolone is promising.

Aged↗

PubMed2003

[Patients compliance with antibiotherapy of respiratory tract infections].

Non-compliance frequently occurs during outpatient antibiotherapy of respiratory tract infections. The most frequent form of non-compliance in such circumstances is omittion of single doses. Patient non-compliance during antibiotherapy is of practical importance. It leads to therapy failure, need of additional health services, growth of direct and indirect therapy cost and development of resistant strains. This paper summarises the methods of evaluating compliance and the results of research on compliance during antibiotherapy of respiratory tract infections. The reasons of patient non-compliance as well as the factors influencing this phenomenon are reviewed. Practical methods of augmenting compliance are suggested with particular stress on the relationship between dosage frequency and compliance. It should be remembered that when the antibiotic is needed for respiratory tract infections treatment, once daily dosing ensures the best possible compliance.

Anti-Bacterial Agents↗

PubMed1998

[Efficacy and tolerance of fenspiride in adult patients with acute respiratory tract infections].

Fenspiride is an antiinflammatory drug targeted for the respiratory tract. In our study clinical efficacy and tolerance of drug were evaluated in 392 adult patients with acute respiratory tract infections. According to clinical criteria all observed symptoms were classified as mild, moderate and severe. The most of observed patients were included into moderate symptom score. Cough and nose obturation were dominant symptoms. All noticed changes in the upper respiratory tract were decreased after fenspiride therapy in 7 days trial. In 168 observed patients systemic and in 60 local acting antibiotics were successfully applied. Excellent tolerance of fenspiride was documented in 59% and good tolerance --in 34% of patients. Observed adverse reactions were classified as mild and in 20 patients fenspiride was rejected. Authors suggest that fenspiride therapy is save and successful in patient with acute respiratory tract infection. Good results in patients with bronchitis in decreasing of bronchospasm indicate fenspiride as a good tool in bronchial infection.

Acute Disease↗

PubMed1990

[Microbiological diagnosis of lower respiratory tract infections].

Successful microbiological diagnosis of lower respiratory tract infections demands a close cooperation between clinician and clinical microbiologist. Because of the broad spectrum of possible respiratory pathogens precise requests are necessary for adequate laboratory procedures. The high rate of potential pathogens requires quantitative microbiological and cytological data in order to differentiate between colonisation and infection. Pathophysiological reactions on microbial colonisation of the bronchial tree may contribute to acute exacerbations of a chronic bronchitis. The precise role of microbial nocuous agents, however, remains to be clarified.

Bronchi↗

PubMed1987

[Susceptibility of bacteria isolated from the patients with lower respiratory tract infections to antibiotics (1984)].

Bacterial isolates from patients with pulmonary infections have been collected over the last 4 years in collaboration with investigators at 14 hospitals in various parts of Japan to study isolation frequency of pathogens from patients and drug susceptibilities of these isolates. Possible causative pathogens mainly isolated from sputum of patients with lower respiratory tract infections were collected during a period from September 1984 to March 1985. We first determined types of respiratory diseases and found that, between 1981 and 1983, 57.9 approximately 64.5% of the examined diseases were chronic respiratory infections such as chronic bronchitis, chronic bronchiolitis and bronchiectasis, and that these infections including diffuse panbronchiolitis accounted for 63.1% in 1984. Bacterial pneumonia was found to be 24.8% in 1981, but it was 11.0% in 1983 and 15.1% in 1984. These results seemed to reflect decreases in the occurrence of bacterial pneumonia in young population. We then investigated the correlations between these infections and isolates and found that distributions of causative organisms of chronic bronchitis and bronchiectasis during the 4 years were similar while the detection rate of Staphylococcus aureus from bacterial pneumonia increased in 1982 and 1983, and that of Gram-positive organisms such as Enterococcus faecalis rose in 1984. Branhamella catarrhalis was considered to be a non-pathogenic organism normally harbored in the upper respiratory tract. Recently, however, respiratory infections caused by this organism have been reported by some investigators. In our research also, this Gram-negative diplococcus was isolated as a causative organism of respiratory infections as 6 strains were found in 1983 and 29 strains in 1984, hence an increase was observed.

Adult↗

PubMed2002

Gatifloxacin in community-based treatment of acute respiratory tract infections in the elderly.

The elderly are at increased risk for respiratory tract infections. To evaluate the safety and efficacy of gatifloxacin in adults of any age with community-acquired respiratory tract infections, this open-label, multicenter, noncomparative study in community-based practices enrolled male and female outpatients at least 18 years old with a clinical diagnosis of community-acquired pneumonia (CAP), acute-bacterial exacerbation of chronic bronchitis (AECB), or acute uncomplicated maxillary sinusitis. Gatifloxacin 400 mg was administered once daily for seven to 14 days. Of 14781 clinically evaluable patients, 2505 were at least 65 years old, 499, at lest 80. Cure rates for CAP, AECB, and sinusitis ranged from 91.6% to 95.5% for patients less than 65 years old, 91.1% to 96.2% for those 65 to 79 years of age, and 89.5% to 94.8% for those at least 80 years old. Each age group, including patients with concomitant cardiovascular or diabetic conditions, tolerated treatment well. Gatifloxacin is efficacious and well tolerated in adult outpatients of any age with respiratory tract infections and is an important therapeutic option, particularly in communities with a high prevalence of resistant pathogens.

Administration, Oral↗

PubMed1999

Cotinine in meconium indicates risk for early respiratory tract infections.

1. In order to identify potential risks for lower respiratory tract symptoms during early infancy, the concentration of cotinine was measured in meconium of 91 newborns as a parameter of prenatal exposure to tobacco, and a questionnaire was performed with parents at birth. Infants were followed up for the first year of life by monthly telephone interviews. 2. Lower respiratory tract infections during the first 6 months of life were associated with a high concentration of cotinine in meconium (cotinine higher than median vs lower than median; odds ratio 4.9, 95% confidence interval 1.2 to 20.3), while none of the other variables tested including selfreport of parental, prenatal or postnatal tobacco consumption, parents history of atopy, maternal age, presence of siblings, socio-economic status, duration of gestation, birth weight, gender, and duration of breast feeding were identified as independent risks. The occurrence of a lower respiratory tract infection during the first 6 months of life was predicted correctly in 77% of the infants by a cotinine excretion in meconium exceeding the group median. 3. In conclusion, quantification of cotinine in meconium is preferred to historical parameters as an estimate of the risk for early respiratory tract infections.

Adult↗

PubMed1999

Upper respiratory tract infections.

In reviewing recent advances in upper respiratory tract infections, we focus on five key topics. First, the use of ribavirin in the treatment of respiratory syncytial virus infection has been limited to the immunosuppressed. Prophylaxis in high-risk patients with specific immunoglobulin is effective and a new monoclonal antibody shows promise. Second, the efficacy of neuraminidase inhibitors in the treatment of influenza has become established. There are unresolved concerns about early implementation of therapy without a firm diagnosis; resource implications are enormous. Third, an outbreak of influenza due to avian influenza virus (H5N1) raised the possibility of a new pandemic. However, there was minimal person-to-person spread although much was learned about pathogenesis of infection. Fourth, evidence favoring the use of ciprofloxacin rather than rifampicin for meningococcal chemoprophylaxis is reviewed. Efficacy in eradicating nasopharyngeal carriage is excellent. Finally, the management of sore throat has been considered. This remains controversial but evidence supporting antibiotic therapy in adults is lacking. If treatment is indicated in childhood, shorter courses of antibiotics may be effective.

Adult↗

PubMed2000

[Detection of Mycoplasma genitalium in throat by nested polymerase chain reaction and analysis of DNA sequencing in pediatric patients with acute upper respiratory tract infections].

OBJECTIVE: To explore the relation between Mycoplasma genitalium (Mg) and acute upper respiratory tract infection in pediatric patients by using nested polymerase chain reaction(nPCR) and analysis of DNA sequencing techniques. METHODS: The specimens of throat swab were obtained in 62 acute upper respiratory tract infections children and 80 health children. The two kinds of Mg species-specific, in which the sequences of I-III and V-VII variable regions of Mg 16Sr RNA gene were detected by using nPCR technique. DNA sequences of positive product were detected and analysed. RESULTS: The Positive rate of health children is 5% (4/80), while the acute upper respiratory tract infection children is 21% (13/62). The difference is significant (P < 0.001). The DNA sequences of positive product shows that: there are two point mutation(T-->C) in the sequences of V-VII variable regions of throat swab of one pediatric patient, other sequences are same as those Mg type strain(G-37T). CONCLUSIONS: Acute upper respiratory tract infection of pediatric patients have relation with Mg. There are Mg mutant strain in China.

Adhesins, Bacterial↗

PubMed1992

Clinical comparative study of azithromycin versus erythromycin in the treatment of acute respiratory tract infections in children.

The efficacy and tolerability of azithromycin and erythromycin in the treatment of acute respiratory tract infections in children were compared in an open, multicenter, randomized trial. A total of 151 children, aged from 2 months to 14 years, suffering from upper airways infections (60), or lower respiratory tract infections (91), were randomized to be treated either with azithromycin, 10 mg/Kg/day per os once daily for 3 or 10 mg/Kg/day 1 and 5 mg/Kg/days 2-5 (77 patients) or with erythromycin, 50 mg/Kg/day thrice daily for at least 7 days (74 patients). The two treatment groups did not significantly differ as to sex, age, weight, type and severity of infection, and infecting pathogens. Clinical evaluation was performed prior to therapy, on treatment days 1, 3, 5 and 7, and on day 10. Microbiological and laboratory assessment were carried out at baseline and after the end of therapeutic course. Chest X-ray and serologic assays for Mycoplasma pneumoniae infection were obtained in patients suspected to have lower respiratory tract infections. At the end of therapy, clinical cure was achieved in 73 out of 77 patients (94.8%) in the azithromycin group, and in 60/72 evaluable subjects (83.3%) in the erythromycin group. A significantly more rapid remission of several illness-related signs and symptoms was observed in patients treated with azithromycin. A total of 75 bacterial pathogens were isolated at baseline microbiological examination; at the end of the therapeutic course bacteriological eradication was obtained in 34/34 cases (100%) treated with azithromycin, and in 40/41 children (97.5%) treated with erythromycin.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMedDate not supplied

Summary of worldwide clinical trials of aztreonam in patients with lower respiratory tract infections.

Aztreonam was administered to 226 patients with lower respiratory tract infections--primarily pneumonia (181 patients)--due to gram-negative bacilli. The clinical response rate was 93%, and the microbiologic cure rate was 78%. Most patients received 1-g or 2-g intravenous doses of aztreonam three times daily for at least five days. Ninety-eight of the 226 patients were involved in a randomized comparison of aztreonam with tobramycin; the latter drug was administered to a group of 34 patients. The overall microbiologic cure rates for the two drugs were 86% and 71%, respectively. Aztreonam is effective for the treatment of lower respiratory tract infections due to susceptible gram-negative bacilli.

Aztreonam↗