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PubMedDate not supplied

[Epidemiology of lower respiratory tract infections in children].

Lower respiratory tract infections--croup, tracheo-bronchitis, bronchiolitis and pneumonia--represent one of the major causes of pediatric consultation. They occur most frequently during the first years of life, are usually not recurrent and require hospitalization in less than 2% of the cases. They are associated in time with epidemics of respiratory virus and Mycoplasma pneumoniae infections, but the role of bacteria as primary infectious agents, or as causes of superinfection is significant.

Bacterial Infections↗

PubMed1995

Upper respiratory tract infections in the immunocompromised host.

Infections of the upper respiratory tract are a major source of morbidity and mortality in the immunocompromised host. The risks and types of infections are dictated by the specific immune defects present in the patient. Infections may involve virtually any of the structures in the upper respiratory tract, including the oral cavity, pharynx, larynx, trachea, ear, and sinuses. Infections may be complicated by abscess formation or invasion of critical central nervous system or neck space structures. Physicians must maintain a high index of clinical suspicion for upper respiratory tract infections, especially because they may present in an atypical fashion or be caused by unusual organisms in immunocompromised patients. For many of these infections, prompt initiation of appropriate antimicrobial therapy may be life saving. Prophylactic use of antibiotics, antifungal drugs, or antiviral agents is indicated in specific groups of immunocompromised patients.

AIDS-Related Opportunistic Infections↗

PubMed2006

Frequent detection of human rhinoviruses, paramyxoviruses, coronaviruses, and bocavirus during acute respiratory tract infections.

Viruses are the major cause of pediatric acute respiratory tract infection (ARTI) and yet many suspected cases of infection remain uncharacterized. We employed 17 PCR assays and retrospectively screened 315 specimens selected by season from a predominantly pediatric hospital-based population. Before the Brisbane respiratory virus research study commenced, one or more predominantly viral pathogens had been detected in 15.2% (n = 48) of all specimens. The Brisbane study made an additional 206 viral detections, resulting in the identification of a microbe in 67.0% of specimens. After our study, the majority of microbes detected were RNA viruses (89.9%). Overall, human rhinoviruses (HRVs) were the most frequently identified target (n = 140) followed by human adenoviruses (HAdVs; n = 25), human metapneumovirus (HMPV; n = 18), human bocavirus (HBoV; n = 15), human respiratory syncytial virus (HRSV; n = 12), human coronaviruses (HCoVs; n = 11), and human herpesvirus-6 (n = 11). HRVs were the sole microbe detected in 37.8% (n = 31) of patients with suspected lower respiratory tract infection (LRTI). Genotyping of the HRV VP4/VP2 region resulted in a proposed subdivision of HRV type A into sublineages A1 and A2. Most of the genotyped HAdV strains were found to be type C. This study describes the high microbial burden imposed by HRVs, HMPV, HRSV, HCoVs, and the newly identified virus, HBoV on a predominantly paediatric hospital population with suspected acute respiratory tract infections and proposes a new formulation of viral targets for future diagnostic research studies.

Acute Disease↗

PubMed1989

Group A streptococcus-associated upper respiratory tract infections in a day-care center.

Little information is available about the epidemiology of group A streptococcal upper respiratory tract infections in child day-care centers. During an initial 3-month period, symptomatic upper respiratory tract infections associated with throat cultures or rapid antigen detection tests positive for group A streptococci developed in 55 of 214 (26%) children and adult staff in one day-care center. When the entire day-care center population (except for those receiving antibiotics at the time) was then surveyed, 52 of 146 (36%) children and two of 24 (8%) adult staff had throat cultures positive for group A streptococci. Of the 54 group A streptococcal isolates found during the survey, the three most frequently encountered serotypes were M2,T2/28 (35%), M3,T3/13 (30%), and M-NT, T25 (20%). Rapid antigen detection was performed at the same time as the throat culture in the first 98 individuals examined during the culture survey but was positive in only 11 (35%) of 31 individuals with positive throat cultures. Sensitivity of the rapid antigen test was related to degree of positivity of the throat culture but not to age. The overall group A streptococcal positivity rate was 49% for 187 children and 33% for 27 adult staff; 18 of 66 (27%) children younger than 31/2 years of age were found to have group A streptococci in their upper respiratory tracts. This is the first report of high prevalence rates of group A streptococci associated with upper respiratory tract infections in a day-care center. The group A Streptococcus may represent a significant upper respiratory tract pathogen in the day-care setting.

Adult↗

PubMed1996

Secretory immunoglobulin A increases during relaxation in children with and without recurrent upper respiratory tract infections.

A diminished mucosal concentration of secretory immunoglobulin A (sIgA) in the upper respiratory tract may increase susceptibility to colds and flu. The aim of the present study was to determine whether sIgA increases during relaxation in children aged between 8 and 12 years with recurrent upper respiratory tract infections. Forty-five healthy children and 45 children with 10 or more upper respiratory tract infections in the previous year were randomly assigned to one of three experimental conditions: relaxation with suggestions to increase immune system proteins, relaxation alone, or a control condition. Samples of saliva were obtained before and after each condition. The concentration of sIgA in the saliva samples was later determined by measuring the rate of precipitation of antigen-antibody complexes to known concentration of sIgA antigen. The concentration of sIgA increased in the relaxation conditions but not in the control condition. The sIgA/albumin ratio (a more specific measure of local mucosal immunity than concentration) increased during the relaxation-suggestion condition but not during the relaxation or control conditions; however, both the concentration of sIgA and the sIgA/albumin ratio increased in proportion to subjective relaxation ratings. Neither response differed between healthy children and children with recurrent infections. The findings indicate that a disturbance in mucosal immunity in children with recurrent colds and flu does not limit increases in sIgA during relaxation. Higher preinfection levels of sIgA correlate with resistance to upper respiratory tract infection, so enhancing the sIgA concentration with relaxation techniques may help children with recurrent infection problems.

Albumins↗

PubMed1995

Respiratory tract infections and concomitant pericoronitis of the wisdom teeth.

OBJECTIVE: To discover if there is an association between respiratory tract infections and pericoronitis of erupting third molars in young adults. DESIGN: Data from male military conscripts' medical records were collected over five years and the incidence of respiratory tract infection before and after acute pericoronitis (191 cases) and before and after standard (722 cases) and operative (741) extractions compared with that in controls (n = 703) who had no infections in the third molar regions. SUBJECTS: 14,500 male military conscripts aged 20. SETTING: Garrisons in Valkeala and Kouvola, Finland. RESULTS: The incidence of respiratory tract infection was significantly higher during the two weeks before acute pericoronitis was diagnosed compared with that in controls. The highest incidence was observed in the three days before pericoronitis (odds ratio 6.8; 95% confidence interval 3.0 to 15.0). The incidence was also increased in the first week after pericoronitis (odds ratio 3.7; 1.6 to 8.4) and three days before (odds ratio 2.6; 0.9 to 7.5) and during the first week after extraction of third molars (odds ratio 2.6; 1.3 to 5.3). CONCLUSIONS: Respiratory tract infection may precipitate and occur concomitantly with acute pericoronitis. Third molar surgery for pericoronitis, on the other hand, may trigger respiratory tract infection.

Acute Disease↗

PubMed1993

[Serum level of Pseudomonas aeruginosa-specific IgA in patients with chronic lower respiratory tract infection and its clinical significance].

Elevation of the serum IgA level has been observed in many cases of chronic lower respiratory tract infection. To determine the specificity of elevated serum IgA for the pathogen colonizing the respiratory tract of patients, we measured Pseudomonas aeruginosa-specific IgA titers in patients with chronic lower respiratory tract infections by ELISA. Sonicated P. aeruginosa strain BB5746 was used as the coating antigen. Optical density was significantly elevated in sera from patients in whom P. aeruginosa was consistently isolated from sputum cultures, when they were respondent to the antigen, indicating that bacteria-specific IgA is not localized in the respiratory tract surface, but is circulating in the blood stream of these patients. The other two groups, chronic bronchitis patients from whom bacteria other than P. aeruginosa were occasionally isolated from sputum culture, and IgA nephropathy patients, had no detectable specific IgA in their sera as is the case in normal adults. Our results indicate that bacteria-specific serum IgA levels appeared to correlate with duration from the time of bacterial colonization with P. aeruginosa and the degree of bronchial and alveolar destruction seen on chest X-rays. In addition, detection of increased serum P. aeruginosa-specific IgA seems to contribute to the recognition of persistent bacterial colonization of the respiratory tract.

Adult↗

PubMed1986

Use of bacterial antigen detection in the diagnosis of pediatric lower respiratory tract infections.

Two immunochemical methods were used to identify Haemophilus influenzae and Streptococcus pneumoniae capsular antigens in the urine and serum of 162 children with acute lower respiratory tract infection. These methods were compared with standard bacterial blood culture. Viral and mycoplasma cultures of respiratory secretions were obtained simultaneously to determine the frequency of antigenuria at the time of nonbacterial acute lower respiratory tract infection. Urine from groups of well children and children with acute otitis media was tested for capsular antigens to determine the incidence of antigenuria. Antigenuria was found in 24% of children 2 months to 18 years of age with acute lower respiratory tract infection compared with a 2% incidence of bacteremia. Antigenuria was found in 4% of asymptomatic children and 16% of children with acute otitis media. One third of children with symptoms of acute lower respiratory tract infection and viral isolates from the oropharynx had bacterial antigenuria. The sixfold increase in frequency of bacterial antigenuria in children at the time of lower respiratory symptoms suggests that bacterial acute lower respiratory tract infection may be more common than identified by traditional culture techniques. Because bacterial antigen may come from other sites such as the middle ear, further studies are needed to determine the role of antigen detection in the diagnosis of pediatric acute lower respiratory tract infection.

Acute Disease↗

PubMed2001

Family doctors' attitudes towards patient self-management of upper respiratory tract infections.

OBJECTIVES: To determine the clinical attitudes and behaviour of family doctors in Hong Kong towards patient self-management of upper respiratory tract infections, and factors which may influence this practice. DESIGN: Questionnaire survey conducted between February 1999 and April 1999. SETTING: Hong Kong College of Family Physicians. PARTICIPANTS: Members of the Hong Kong College of Family Physicians. RESULTS: A total of 730 family doctors completed a postal questionnaire on self-management of upper respiratory tract infection, giving an overall response rate of 71.9%. The majority (95.2%) of respondents agreed that patients should be advised on self-management. More than two thirds (69.7%) of respondents also considered patients should be advised on self-medications for upper respiratory tract infection. Nearly two thirds and one third of respondents stated they would advise more than 60% of patients on self-management and self-medication, respectively. A close association was noted between the doctor's view on the usefulness of antibiotics for upper respiratory tract infection and patient advice regarding self-management and self-medication strategies. CONCLUSION: Doctors with certain characteristics are more likely to advise patients with upper respiratory tract infection on self-management and self-medication for upper respiratory tract infection.

Adult↗

PubMed2002

Management of suspected acute viral upper respiratory tract infection in children with intranasal sodium cromoglicate: a randomised controlled trial.

BACKGROUND: Upper respiratory tract infection in children is one of the most frequent reasons for visiting a family doctor, and antibiotics are often prescribed inappropriately. Sodium cromoglicate inhibits the ICAM-1 molecule, which is the receptor for human rhinoviruses. We aimed to investigate whether intranasal cromoglicate shortens duration of infection of the upper respiratory tract. METHODS: We randomly assigned 290 children diagnosed with suspected acute viral upper respiratory tract infection by their family doctor (137 boys, 153 girls; mean age 5.2 years [SD 3.39]) either intranasal 4% sodium cromoglicate spray or intranasal normal saline spray. Follow-up was by daily symptom diary for 2 weeks and by telephone. Canadian Acute Respiratory Illness and Flu Scale (CARIFS) score was the primary outcome measure. FINDINGS: 195 patients returned symptom diaries, and 20 of these could not be included in the main analysis. 246 patients completed the telephone interview at week 1. There was no difference in recovery rate over the first week between the two groups, with the estimated difference in slope of log (CARIFS) being -0.01 (95% CI -0.05 to 0.03). There were no differences between the two groups in side-effects or re-consultation rates. 43 (17%) of 246 children with suspected acute viral upper respiratory tract infection went back to see their family doctor, and 220 (89%) of 246 were managed without prescription of antibiotics. INTERPRETATION: Intranasal sodium cromoglicate is not a useful additional treatment for this infection. Our results further clarify the role of prescribed drugs for children with these frequent illnesses.

Acute Disease↗

PubMed2002

Determination of antimicrobial activity of Cefaclor on common respiratory tract pathogens in Pakistan.

OBJECTIVE: To determine the antimicrobial activity of Cefaclor against common respiratory tract pathogens isolated from patients in Pakistan. SETTING: Department of Microbiology, Liaquat National Postgraduate Medical Centre, Karachi. METHOD: A laboratory analysis was done on 466 isolates of respiratory tract pathogens collected from 13 laboratories from all over Pakistan. Antibiotic sensitivity test was done by Kirby Bauer disc diffusion method and MIC of Cefaclor was determined by 'E' test. RESULT: Of the 163 Streptococcus pneumoniae, 87 Moraxella catarrhalis and 216 Haemophilus influenzae > 95% isolates were susceptible to Cefaclor. The MIC 90 of all these pathogens were < 2 ug. CONCLUSION: Resistance of respiratory tract pathogens to the 2nd generation Cephalosporin, Cefaclor is very low. MIC 90 of Cefaclor against all three common respiratory tract pathogens is < 2 ug, which indicates that Cefaclor would be effective in more than 90% of cases infected with these bacteria.

Cefaclor↗

PubMed2005

Anesthetic management of the child with an upper respiratory tract infection.

PURPOSE OF REVIEW: The decision to proceed with anesthesia for the child with an upper respiratory tract infection is often difficult. Whereas most studies suggest that children who present for elective procedures with an upper respiratory tract infection are at increased risk of perioperative adverse events, these events are typically easy to recognize and treat. This review will discuss the current literature regarding outcome in children who present for elective surgery with an upper respiratory tract infection and suggests approaches to optimize their perioperative management. RECENT FINDINGS: Although the literature regarding this important topic has been slow to evolve, recent large-scale outcome studies have identified a number of factors that increase the risk of perioperative adverse events among children with upper respiratory tract infections. The significance of these findings will be discussed. SUMMARY: An understanding of the risk factors associated with administering anesthesia to the child with an upper respiratory tract infection is important in identifying elements of the preoperative assessment that merit attention and in optimizing the anesthetic plan as a means to limit any perioperative complications.

Journal Article↗

PubMed1993

Microbiologic changes during antimicrobial treatment and rate of relapse of distal respiratory tract infections in foals.

Despite the high incidence of distal respiratory tract infection of undetermined cause on farms, to our knowledge, the microbiologic effects of conventional antimicrobial treatment for this condition have not been studied. We evaluated the possible pathogenic role of bacterial isolates from the distal airways of foals with clinical respiratory tract disease, by correlating changes in their numbers (increase or decrease) with clinical, endoscopic, and pulmonary cytologic signs of disease resolution during treatment with antimicrobial drugs. We also determined qualitative changes in in vitro antimicrobial susceptibility of bacterial isolates after 7 days of treatment and relapse rate of foals. Significant (P < 0.05) decrease in the numbers of an isolate in the airways was considered strong evidence of a pathogenic role in this disease syndrome. Foals with endoscopically confirmed distal respiratory tract infection (DRTI; n = 65) were selected at random for treatment (n = 56) or nontreatment (n = 9), and bronchial lavage specimens were cultured and evaluated cytologically before and after 7 days of treatment with trimethoprim-sulfamethoxazole (TMS) and a beta-lactam drug (penicillin, ampicillin, or sulbactam-ampicillin), the standard treatment in all foals. The effect of treatment was to abruptly reduce the clinical (nasal discharge, cough, adventitious lung sounds) and cytologic signs of airway infection. Severity of disease in nontreated foals, however, did not change or did worsen over time. Reduction in the frequency and numbers of Streptococcus zooepidemicus isolated during treatment supported a causal role for this organism in the clinical syndrome observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1983

Treatment of lower respiratory tract infections with cefoperazone.

Fifteen patients with documented bacterial lower respiratory tract infections were treated with cefoperazone (2 gm every 12 hours, administered parenterally) as the single antibiotic therapy. Pulmonary infections included pneumonia (10), anaerobic lung abscess (2), bronchitis (2), and exacerbation of bronchiectasis (1); most of the patients had concomitant illnesses that compromised their host-immune status. Bacteria recovered from respiratory tract cultures included aerobic gram-negative bacilli (17), anaerobes (6), and aerobic gram-positive cocci (3). After therapy, lasting 5 to 28 days, nine patients had complete resolution of their infection, and the remaining six patients had significant clinical improvement. Diarrhea was the adverse reaction most commonly noted; others included an unusual reaction resembling serum sickness, and, in one patient treated for 24 days, hypotension and a subsequent decrease in renal function. Drug-related abnormalities in blood and serum values were few and mild. Cefoperazone was found to be effective in the treatment of lower respiratory tract infections.

Adult↗

PubMed1995

Serum antibody response to proteins of Moraxella (Branhamella) catarrhalis in patients with lower respiratory tract infection.

We searched for antibodies against Moraxella (Branhamella) catarrhalis proteins in the sera of patients with lower respiratory tract infection. Sera from 48 patients with M. catarrhalis and 39 patients without M. catarrhalis in their lower respiratory tract specimens were studied by a gel electrophoresis-immunoperoxidase technique; sera from 23 healthy adult blood donors were also included. Immunoglobulin G (IgG) antibodies against a 28-kDa protein were found significantly more frequently in patients with M. catarrhalis in lower respiratory tract specimens (71%) than in patients without M. catarrhalis in lower respiratory tract specimens (28%) or healthy adult blood donors (22%). Seroconversion, from the acute to the convalescent stages, occurred in at least eight patients with M. catarrhalis and in one patient without detectable M. catarrhalis. IgG antibodies against other M. catarrhalis proteins were found in most sera, including those obtained from blood donors. By adsorption experiments the 28-kDa protein was demonstrated to be surface exposed. IgM antibodies against an 85-kDa protein were found in serum from one patient from whom M. catarrhalis and Streptococcus pneumoniae were isolated from the lower respiratory tract, while IgA antibodies against M. catarrhalis proteins could not be detected in any serum specimen.

Acute Disease↗

PubMedDate not supplied

Respiratory tract cell-mediated immunity.

Cell mediated immunity in the respiratory tract, operating somewhat independently of systemic cell mediated immunity CMI, has been recognized only rather recently. Local CMI has been shown to be more consistently and more potently stimulated following local administration of immunogen. In addition, in the few studies that have been done relative to protection, local immunization has resulted in greater resistance to organisms usually considered protected against by CMI. Thus, like the humoral immune system, CMI appears to operate locally in the respiratory tract, at least partially independent of systemic CMI. This paper deals with the evidence relative to local CMI, as well as a discussion of the role of the pulmonary macrophage, the mechanisms whereby local CMI may operate in protection, and the evidence for the presence of T-cell memory in the respiratory tract.

Aerosols↗

PubMed1990

[IgG subclasses in healthy children and in children with frequent respiratory tract infections].

A group of 130 children presenting with frequent respiratory tract infections was examined for serum levels of IgG-subclasses IgG1, IgG2, IgG3 and IgG4 using radial immunodiffusion according to Mancini. Additionally a control group of 175 children not prone to infections was investigated. Both, low and high levels compared to controls were observed for IgG3 and IgG4. 11.5% of the children with frequent airway infections had IgG3 values below 2 SD below the mean for age compared to 2.8% in the control group (p less than 0.01). Likewise a low IgG4 level was observed more frequently in children prone to airway infections (9.8% versus 2.8% in control; p less than 0.05). IgG4 was undetectable (level less than 3.4 mg/dl) in 5 of the 175 control children. Despite an accumulation of low or undetectable IgG3 or IgG4 levels in children with frequent respiratory tract infections, no correlation between low IgG subclass-levels and the degree of the individual disease could be detected. Based on this lack of a simple causal relationship between frequent respiratory tract infections and the finding of low or undetectable IgG-subclass levels, an immunoglobulin replacement therapy has to be considered with reserve.

Adolescent↗

PubMed2006

Primary care challenges in the management of respiratory tract infections.

Community-acquired respiratory tract infections (RTIs), such as community-acquired pneumonia, acute exacerbations of chronic bronchitis, and acute rhinosinusitis, are among the most common reasons that adults seek care from their primary health care providers in the United States. High levels of pneumococcal resistance have developed, particularly to macrolides, since the 1990s. Empiric management of these infections, the difficulty in differentiating bacterial from nonbacterial infection, and a high level of patient expectation of antimicrobial therapy contribute to the overuse of antibiotics. The primary care clinician must judiciously weigh various factors in order to prescribe appropriate and effective treatment.

Adult↗