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PubMed2003

Viral lower respiratory tract infection in the elderly: a prospective in-hospital study.

The objective of this prospective study was to evaluate the clinical and laboratory parameters distinguishing viral from nonviral lower respiratory tract infection in elderly patients and to determine the yield of virological diagnostics in elderly patients with lower respiratory tract infection. The study was conducted in a 184-bed geriatric department in a university hospital during 4 winter months. All consecutive elderly persons admitted with a lower respiratory tract infection were included in the study. Clinical and laboratory parameters, a nasopharyngeal swab, and serological results for respiratory viruses were obtained for all participants. Available blood and sputum cultures were analysed. A total of 165 elderly persons (mean age, 82+/-6.8 years) were hospitalised with a lower respiratory tract infection. Familial flu-like illness (OR, 4.25; 95%CI, 1.4-13), better functionality (OR, 4; 95%CI, 1.3-14.15), and leucocyte count <10(10)/l (OR, 3; 95%CI, 1.3-7.1) were predictive for viral lower respiratory tract infection. Sixty (36.5%) definite diagnoses (positive blood culture, viral culture, or serological test) and seven (4.2%) probable diagnoses (positive sputum culture) were obtained. An early diagnosis (within 72 h) was possible in 38 (23%) and a late diagnosis in 29 (17.6%) participants. A nasopharyngeal swab contributed in 60.5% of the cases to an early diagnosis. Viral culture identified half (22/43) of the lower respiratory tract infections caused by influenza but only one of six lower respiratory tract infections caused by respiratory syncytial virus. In conclusion, a history of flu-like illness in family members and a total leucocyte count within normal limits makes a viral cause more likely in elderly people hospitalised with a lower respiratory tract infection during winter. Viral culture and rapid antigen detection are insensitive in elderly patients hospitalised with a lower respiratory tract infection.

Age Factors↗
PubMed2000

Surveillance for outbreaks of respiratory tract infections in nursing homes.

BACKGROUND: Outbreaks of respiratory tract infections are common in long-term care facilities for older people. The objective of our study was to determine both the frequency of such outbreaks and their clinical and epidemiological features. METHODS: Prospective surveillance for outbreaks of respiratory tract infections and a retrospective audit of surveillance records were conducted in 5 nursing homes in metropolitan Toronto over 3 years. The clinical manifestations of infected residents were identified and microbiological investigations for causal agents were conducted. RESULTS: Sixteen outbreaks, involving 480 of 1313 residents, were identified prospectively during 1 144 208 resident-days of surveillance, for an overall rate of 0.42 infections per 1000 resident-days. Another 30 outbreaks, involving 388 residents, were identified retrospectively. Outbreaks occurred year-round, with no seasonal pattern. Pathogens included influenza virus, parainfluenza virus, respiratory syncytial virus, Legionella sainthelensi and Chlamydia pneumoniae. Multiple pathogens were detected in 38% (6/16) of the prospectively identified outbreaks. Of the 480 residents in the prospectively identified outbreaks 398 (83%) had a cough, 194 (40%) had fever and 215 (45%) had coryza. Clinical findings were nonspecific and could not be used to distinguish between causal agents. Pneumonia developed in 72 (15%) of the 480 residents, and 58 (12%) required transfer to hospital. The case-fatality rate was 8% (37/480). INTERPRETATION: Our findings emphasize the importance of adequate surveillance for outbreaks of respiratory tract infections in nursing homes and of early diagnosis so that appropriate interventions can be promptly instituted.

Aged↗
PubMed2003

[Meta-analysis of clarithromycin compared to other antibiotics for the treatment of lower respiratory tract infections].

Clarithromycin is a macrolide antibiotic commonly used for the treatment of respiratory infections. The aim of this study was to assess its effectiveness for the treatment of lower respiratory tract infections. A number of meta-analyses of clinical trials comparing clarithromycin to the antibiotics most frequently used in the treatment of lower respiratory tract infections, such as cephalosporins, amoxicillin-clavulanic acid, erythromycin and azithromycin, have been performed. Clarithromycin's effectiveness for the treatment of lower respiratory tract infections was better than that for cephalosporins (OR = 1.43; 95% CI = 1.09-1.86) and, although not to the same extent, that for amoxicillin-clavulanic acid (OR = 1.58; 95% CI = 0.92-2.70); however, the efficacy was only similar to that shown for azithromycin (OR = 0.57; 95% CI = 0.19-1.68). The fourth meta-analysis compared the effectiveness of clarithromycin to that of erythromycin for the treatment of pneumonia and showed a superior odds ratio in favor of clarithromycin (OR = 1.46; 95% CI = 0.97-2.2). Meta-analyses comparing clarithromycin's safety to that of the same drugs in the same conditions used in the assessment of effectiveness showed a similar incidence of adverse events compared to amoxicillin-clavulanic acid, and azithromycin, a slightly lower incidence compared to erythromycin, and a slightly higher incidence compared to cephalosporins. In conclusion, these meta-analyses show that clarithromycin is an effective and safe antibiotic for the treatment of lower respiratory tract infections. Furthermore, a new once-daily dose formulation with a positive impact on therapeutic compliance is currently available, making clarithromycin a first-line treatment for lower respiratory tract infections.

Anti-Bacterial Agents↗
PubMed2000

Association between infection of the respiratory tract attributable to bovine coronavirus and health and growth performance of cattle in feedlots.

OBJECTIVE: To determine the association between respiratory tract infection with bovine coronavirus (BCV), treatment for respiratory tract disease, pulmonary lesions at slaughter, and average daily gain in cattle in feedlots. ANIMALS: 837 calves in feedlots in Ohio and Texas. PROCEDURE: Nasal swab specimens were obtained from cattle at arrival in a feedlot (day 0) and at various times during the initial 28 days after arrival. Specimens were tested for BCV, using an antigen-capture ELISA. Serum samples were obtained at arrival and again 28 days after arrival and tested for antibodies to BCV, using an antibody-detection ELISA. Information was collected regarding treatment for cattle with respiratory tract disease and average daily gain during the feeding period. Pulmonary lesions were evaluated at slaughter. RESULTS: Cattle shedding BCV from the nasal cavity and developing an antibody response against BCV were 1.6 times more likely to require treatment for respiratory tract disease than cattle that did not shed the virus or develop an immune response against BCV. Additionally, cattle that shed BCV from the nasal cavity were 2.2 times more likely to have pulmonary lesions at slaughter than cattle that did not shed the virus. The BCV shedding or seroconversion status did not affect average daily gain. CONCLUSIONS AND CLINICAL RELEVANCE: Bovine coronavirus infects feedlot cattle and is associated with an increased risk for cattle developing respiratory tract disease and pulmonary lesions. Development of appropriate control measures could help reduce the incidence of respiratory tract disease.

Animals↗
PubMed1992

Progesterone receptor immunoreactivity in pancreatic endocrine tumors. An immunocytochemical study of 156 neuroendocrine tumors of the pancreas, gastrointestinal and respiratory tracts, and skin.

BACKGROUND: The immunoreactivity for progesterone receptors (PR) of the majority of endocrine cells of the human pancreas has prompted the authors to investigate if PR expression is maintained in pancreatic endocrine tumors and is correlated with the main clinicopathologic features of these neoplasms. Furthermore, the study has been extended to other neuroendocrine cells and tumors to determine whether PR immunoreactivity is a common feature of neuroendocrine cells and tumors other than those of the pancreas. METHODS: One hundred fifty six neuroendocrine tumors of the pancreas, gastrointestinal and respiratory tracts, and skin were immunostained for PR with three different monoclonal antibodies and for estrogen receptors (ER). Additional immunostainings for general neuroendocrine markers and for pancreatic hormones were performed in selected cases. RESULTS: Nuclear immunoreactivity for PR has been documented in the neoplastic cells of 56 (58.33%) of 96 pancreatic endocrine tumors. PR immunoreactivity was not influenced by the sex and age of the patients or the occurrence of a clinical syndrome related to inappropriate hormone secretion. Tumors synthesizing pancreatic polypeptide, glucagon, and insulin expressed PR in higher percentages (80%, 75%, and 66%, respectively) than those producing other pancreatic hormones or those that were not functioning. Irrespective of the functionally different tumor types, PR immunoreactivity showed a significant correlation (P = 0.0003) with the absence of metastases and the lack of tumor invasion of neighboring organs or of large vessels. As opposed to normal and neoplastic islet cells, the neuroendocrine cells and tumors of the gastrointestinal tract, respiratory tract, and skin did not show any PR immunoreactivity, with the single exception of a typical carcinoid tumor of the lung. ER were not identified in any pancreatic or extrapancreatic neuroendocrine cells or tumors. CONCLUSIONS: Nuclear PR are immunocytochemically detectable in most pancreatic endocrine tumors and are correlated significantly to the absence of pathologic evidence for malignancy. Conversely, PR expression has not been found in normal and neoplastic endocrine cells and tumors investigated.

Adenoma, Islet Cell↗
PubMed1987

Childhood upper respiratory tract infections: to what degree is incidence affected by day-care attendance?

Risk factors for acute upper respiratory tract disease in childhood were evaluated in a population-based sample of the Atlanta metropolitan area. Mothers from 449 households containing 575 children less than 5 years of age were selected by random-digit dialing and questioned about upper respiratory tract infection and ear infection occurring in their children during the preceding 2 weeks. Household demographic and socioeconomic characteristics, maternal smoking history and child day-care attendance and breast-feeding information were also obtained. For children less than 5 years of age, the reported incidence of upper respiratory tract infection was 24%, and of ear infection, 6%. Controlling for the other variables measured, day-care attendance was associated with a significantly increased risk of both illnesses. For upper respiratory tract infection, increased risk was present for all children attending day care (P = .02, odds ratio = 1.6), whereas for ear infection, risk could be demonstrated only for full-time attendees (P = .005, odds ratio = 3.8). Maternal smoking was a second independent risk factor for a child's having upper respiratory tract infection (odds ratio = 1.7, P = .01). Thirty-one percent of all upper respiratory tract infection among day-care attendees and 66% of all ear infections among full-time day-care attendees were attributable to day-care attendance. Given the proportion of children in day care, 9% to 14% of the total burden of upper respiratory tract disease in this population was day care related.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Day Care Centers↗
PubMed1996

Polymerase chain reaction versus culture for detection of Ureaplasma urealyticum and Mycoplasma hominis in the urogenital tract of adults and the respiratory tract of newborns.

The efficiency of the polymerase chain reaction (PCR) was compared with that of culture for detection of Ureaplasma urealyticum and Mycoplasma hominis in 726 clinical specimens comprising 189 gynecological samples, 362 urological samples, and 175 samples from newborn infants. The sensitivity of PCR versus culture was 95% for both organisms, while the sensitivity of culture versus PCR was 91% for Ureaplasma urealyticum and 84% for Mycoplasma hominis. Furthermore, PCR tests were faster than culture tests, allowing the time to diagnosis to be reduced from two to five days to 24 h.

Adult↗
PubMed1995

Respiratory tract cryptosporidiosis in immunosuppressed rat is associated with an epithelial metaplasia.

Cryptosporidium parvum is an opportunistic protozoa that chronically infects the digestive tract of immunocompromised hosts. Respiratory cryptosporidiosis, which was reported in AIDS patients, is an uncommon feature of mammalian cryptosporidiosis models. In this study, we document the respiratory lesion; observed in an immunosuppressed rat model of cryptosporidiosis. Twenty rats were immunosuppressed with corticosteroids and low protein diet. They were challenged intratracheally with 10(6) C. parvum sporozoites. Lungs and ileums were examined on D3, D6, D10, D14. On D10 and D14, C. parvum were present in the respiratory tract of all animals in association with the progressive appearance of an immature malpighian metaplasia. On D14, an intestinal infection was also detected in 2/4 animals. The respiratory tract appears to be a fully permissive area for the protozoa in immunosuppressed rats. Introduction of parasites on the respiratory mucosa seems a requisite to induce respiratory cryptosporidiosis. This experimental protocol yields a low mortality rate, and so modelizes late and/or chronic stages of respiratory cryptosporidiosis.

Animals↗
PubMed1994

[The efficacy and tolerance of Bay-o-9867 (ciprofloxacin) in the treatment of infections of the urinary tract and of the lower respiratory tract].

A clinical trial was performed to evaluate efficacy and tolerability of Bay-o-9867 in the treatment of UTI and LRTI. 40 patients were admitted to the study: 27 affected with LRTI, mainly exacerbations of COPD, and 15 affected with UTI. Two patients were affected concomitantly with a UTI and LRTI. The patients were treated with Bay-o-9867 (ciprofloxacin) administered orally at a daily dosage of 500 mg (250 q 12 h) in 30 patients and of 1000 mg (500 q 12 h) in 10 patients, depending on the severity of infection. Clinical results were extremely favourable as complete clinical resolution of infective episode was achieved in 38 patients (15/15 in UTI patients; 25/27 in LRTI patients), whereas improvement was achieved in 2 (in LRTI). Overall clinical efficacy was therefore successful in 100% of cases. Concerning bacteriological results, 38 pathogens were isolated from infective sites before starting treatment, and all were eradicated (eradication rate: 100%). Tolerability was assessed as good: no adverse event was observed.

Adult↗
PubMed1980

Second primary respiratory tract malignancies in glottic carcinoma.

Of 740 cases of glottic cancer, a second respiratory tract tumor developed in 48. Only 14 cases would have been expected in a sample of the same age and sex distribution drawn from the general population of Ontario. Of 25 patients with second tumors in the lung, 23 are dead. Of these 23, 17 had been cured of Stage T1 glottic cancer. An actuarial method for calculating the risk of developing a second respiratory tract tumor amongst the survivors of glottic cancer is described. Of the survivors, 12% will have a second respiratory tract tumor within ten years following initial diagnosis of glottic cancer. Of patients with Stage T1 glottic cancer, 7% will die of a second respiratory tract tumor within ten years. This rate is slightly more than that for those who die of laryngeal cancer in this stage grouping. Late recurrences and/or second primary tumors in the larynx following radiotherapy are rare. Methods for reducing the risk of death from a second respiratory tract tumor are discussed.

Canada↗
PubMed1994

The role of selective digestive tract decontamination on mortality and respiratory tract infections. A meta-analysis.

PURPOSE: To review available clinical trials of selective digestive decontamination (SDD) in patients requiring intensive care. DATA SOURCES: All relevant English-language articles from 1982 through 1992 were identified through MEDLINE search and article bibliographies. STUDY SELECTION: Twenty-one articles were identified; 16 articles were selected for analysis based on inclusion and exclusion criteria. DATA EXTRACTION: Occurrence rates for mortality, acquired pneumonia, and acquired tracheobronchitis were extracted for patients treated with SDD and for control patients. Cumulative risk differences were calculated for each of these outcomes. RESULTS: There was no significant difference between cumulative mortality rates for control patients (0.262; n = 1,165) and patients receiving SDD (0.243; n = 1,105) (p = 0.291; beta error rate = 0.16). The acquired pneumonia greater than that in patients receiving SDD (0.074; n = 1,031) (p < 0.0001). The acquired tracheobronchitis rate in control patients (0.117; n = 549) was also significantly greater than that in patients receiving SDD (0.065; n = 494) (p = 0.004). The rate of acquired pneumonia due to Gram-positive bacteria was similar between the control patients (0.033; n = 660) and the SDD-treated patients (0.033; n = 646) (p = 0.933). Colonization with pathogenic Gram-positive bacteria and pneumonia due to antibiotic-resistant Gram-positive bacteria appeared to occur more frequently in SDD-treated patients. CONCLUSIONS: These results suggest that SDD decreases the overall incidence of acquired pneumonia and tracheobronchitis in patients requiring intensive care. SDD had no apparent effect on the hospital mortality rate. The routine use of SDD cannot be supported by this meta-analysis. SDD may be useful in specific circumstances where a particular ICU or ICU population is found to have an excessive incidence of acquired infections. Any use of SDD should include careful patient surveillance for the emergence of infection due to bacteria not covered by the prophylaxis regimen and due to antibiotic-resistant bacteria.

Anti-Bacterial Agents↗
PubMed2003

Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus.

BACKGROUND: A study was undertaken to evaluate the efficacy of dexamethasone in patients mechanically ventilated for lower respiratory infection caused by respiratory syncytial virus (RSV-LRTI). METHODS: In a multicentre randomised controlled trial patients were randomised to receive either intravenous dexamethasone (0.15 mg/kg 6 hourly for 48 hours) or placebo. End points were the duration of mechanical ventilation, length of stay (LOS) in the pediatric intensive care unit (PICU) and in hospital, and the duration of supplemental oxygen administration. RESULTS: Thirty seven patients received dexamethasone and 45 received placebo. There was no significant difference in any of the end points between the two groups. In a post hoc analysis patients were stratified into those with mild gas exchange anomalies (PaO(2)/FiO(2) >200 mm Hg and/or mean airway pressure </= 10 cm H(2)O, bronchiolitis group) and those with severe gas exchange anomalies (PaO(2)/FiO(2) </=200 mm Hg and mean airway pressure >10 cm H(2)O, pneumonia group). In the 39 patients with bronchiolitis the duration of mechanical ventilation was 4.3 days shorter in the dexamethasone group than in the placebo group (4.9 v 9.2 days, 95% CI -7.8 to -0.8, p=0.02) and the duration of supplemental oxygen was 3.6 days shorter (7.7 v 11.3 days, 95% CI -8.0 to -0.1, p=0.048). No differences in end points were found in the pneumonia group. CONCLUSIONS: Dexamethasone had no beneficial effect in patients mechanically ventilated for RSV-LRTI but was found to have a beneficial effect in patients with bronchiolitis.

Blood Pressure↗
PubMed2001

Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background.

The following principles of appropriate antibiotic use for adults with nonspecific upper respiratory tract infections apply to immunocompetent adults without complicating comorbid conditions, such as chronic lung or heart disease.1. The diagnosis of nonspecific upper respiratory tract infection or acute rhinopharyngitis should be used to denote an acute infection that is typically viral in origin and in which sinus, pharyngeal, and lower airway symptoms, although frequently present, are not prominent. 2. Antibiotic treatment of adults with nonspecific upper respiratory tract infection does not enhance illness resolution and is not recommended. Studies specifically testing the impact of antibiotic treatment on complications of nonspecific upper respiratory tract infections have not been performed in adults. Life-threatening complications of upper respiratory tract infection are rare.3. Purulent secretions from the nares or throat (commonly observed in patients with uncomplicated upper respiratory tract infection) predict neither bacterial infection nor benefit from antibiotic treatment.

Adult↗
PubMed2001

Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background.

The following principles of appropriate antibiotic use for adults with nonspecific upper respiratory tract infections apply to immunocompetent adults without complicating comorbid conditions, such as chronic lung or heart disease. 1. The diagnosis of nonspecific upper respiratory tract infection or acute rhinopharyngitis should be used to denote an acute infection that is typically viral in origin and in which sinus, pharyngeal, and lower airway symptoms, although frequently present, are not prominent. 2. Antibiotic treatment of adults with nonspecific upper respiratory tract infection does not enhance illness resolution and is not recommended. Studies specifically testing the impact of antibiotic treatment on complications of nonspecific upper respiratory tract infections have not been performed in adults. Life-threatening complications of upper respiratory tract infection are rare. 3. Purulent secretions from the nares or throat (commonly observed in patients with uncomplicated upper respiratory tract infection) predict neither bacterial infection nor benefit from antibiotic treatment.

Acute Disease↗
PubMed1989

[Therapy of chronic recurrent respiratory tract infections].

In 1987, the most frequently identified pathogens in chronic respiratory tract infections in our clinic were Haemophilus influenzae, Pseudomonas aeruginosa, Branhamella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. Recurrent infection is a common phenomenon in patients with chronic respiratory tract infections, including chronic bronchitis, chronic bronchiolitis and bronchiectasis. H. influenzae is the most common pathogen in such patients. Macrolides, tetracyclines and new quinolones were effective to protect against recurrent infection of H. influenzae and these finding suggested that L-forms of H. influenzae may be significant in the recurrence of infection in patients with chronic respiratory tract infection. Bacterial colonization of the oropharynx is the initial event in most lower respiratory tract infections. Gargling protects against bacteria colonization of the oropharynx and occurrence of acute exacerbation.

Anti-Bacterial Agents↗