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PubMed1992

[Three cases of lower respiratory tract infection worsened after rhinovirus infection].

We experienced three cases of lower respiratory tract infections worsened after Rhinovirus infection. Case 1: A 42-year-old male with diffuse panbronchiolitis was admitted to our hospital with the complaint of dyspnea on November 21, 1988. Rhinovirus was isolated from nasal washing and P. aeruginosa was cultured from transtracheal aspiration (TTA). Case 2: A 67-year-old male, whose underlying disease was pulmonary asbestosis, was admitted to our hospital complaining of pyrexia on June 12, 1990. Rhinovirus was isolated from TTA and H. influenzae and others were cultured from TTA. Case 3: A 64-year-old male with pulmonary emphysema was admitted to our hospital with a complaint of dyspnea on August 11, 1989. On December 17, 1989 the patient developed rhinorrhea and complained of purulent sputum, pyrexia and dyspnea after five days. Rhinovirus was isolated from nasal washing and TTA and S. nonhaemolyticus and others were cultured from TTA. As indicated in this report, it is interesting to study the relationship between viral infection of the upper respiratory tract and bacterial infection of the lower respiratory tract.

Adult↗

PubMed2000

Epidemiology of acute viral respiratory tract infections in Korean children.

OBJECTIVE: Viruses are the most common causes of respiratory tract infection in children. We investigated the aetiologies and the epidemiological features of acute viral respiratory tract infections in Korean children. METHODS: We tried to isolate respiratory syncytial virus (RSV) and parainfluenza virus from January 1994, influenza virus from February 1995, and adenovirus from April 1996 through August 1998, and identified the isolated viruses by indirect immunofluorescence (IF) staining in the children hospitalized with acute respiratory tract infections (ARTI). RESULTS: Virus was identified in 360 of 1389 (25.9%) nasopharyngeal aspirates cultured. Of a total of 392 viruses, 164 (41.8%) RSV, 90 (23%) parainfluenza virus, 66 (16.8%) influenza A virus, 54 (13.8%) adenovirus, and 18 (4.6%) influenza B virus were cultured, including cases in mixed viral infections. The male to female ratio of the culture-positive patients was 2:1, and the proportions of the patients aged >6 months, 6-11 months, 1, 2, 3, 4, 5, 6-7, 8-9, and >10 years were 22.5, 29.5, 25.7, 9.5, 3.8, 3.8, 1.7, 1.7, 1.2, and 0.6%, respectively. The major clinical diagnosis was bronchiolitis for RSV, croup for parainfluenza virus, and pneumonia for adenovirus and influenza virus. Infections by RSV, parainfluenza virus, and influenza virus occurred in annual epidemics, and infections by adenovirus occurred annually with or without epidemics. There were somewhat larger epidemics by adenovirus and influenza virus in May to July 1996 and March to June 1997, respectively. CONCLUSIONS: Viral agents are one of the main aetiologies and the main causes of admission in Korean children with ARTI.

Adenoviridae↗

PubMed1983

Respiratory tract disease and obstructive azoospermia.

Male infertility may be linked to respiratory tract disease in conditions such as cystic fibrosis and Kartagener's syndrome. Young's syndrome constitutes another such link, in which bronchiectasis is found in association with obstructive azoospermia and normal testicular function. We have studied 34 infertile men with mechanical azoospermia and appropriate control subjects to assess the number of patients with respiratory tract disease and the type and frequency of such disorders. Nineteen patients (59%) had grossly abnormal sinus radiographs compared with six controls (18%) (p less than 0.01) and 19 (56%--NS) gave a history of sinusitis; of these, six (18%) had had sinus operations (p less than 0.01). Eleven patients (32%) had histories of repeated otitis media, of whom two had had mastoid operations. Twelve (35%) had chronic bronchitis, of whom three were non-smokers. Ten other patients had bronchiectasis (p less than 0.001) and three of these had had a lobectomy. The chest radiograph was abnormal in 18 patients (p less than 0.001), including all 10 with bronchiectasis. Two patients had severe airflow obstruction and 13 others had a mildly obstructive pattern. This controlled study confirms that a significant excess of sinorespiratory disease can be identified in young men with obstructive azoospermia. We have found no features in the history or in the results of examination or investigations to explain why some of these patients have respiratory tract disease while others do not.

Adult↗

PubMed1983

Pathogenesis of lower respiratory tract symptoms in experimental rhinovirus infection.

To investigate the pathogenesis of lower respiratory tract symptoms during rhinovirus infection, 19 healthy young adult volunteers were exposed to a currently unnumbered rhinovirus strain (HH). Spirometry and bronchoprovocation with histamine sulfate were performed prior to and on Days 4, 5, and 21 after exposure to the virus. Fiberoptic bronchoscopy for visualization and culture of the tracheobronchial mucosa was done on Day 4 or Day 5. Fourteen of 19 volunteers were infected with rhinovirus; 9 of the 14 had clinical illness. Rhinovirus was isolated from the bronchial brush specimens in 5 of the 13 infected volunteers bronchoscoped, all of whom had clinical illness. Rhinovirus was not isolated at bronchoscopy from any of the 5 infected volunteers without clinical illness (p = 0.025, Fisher's exact test). Spirometry and histamine bronchoprovocation were unchanged during experimental rhinovirus infection. Rhinovirus may invade the lower respiratory tract in symptomatic infections, and thereby cause lower respiratory tract symptoms.

Adult↗

PubMed1994

The role of MRSA (methicillin-resistant Staphylococcus aureus) adherence and colonization in the upper respiratory tract of geriatric patients in nosocomial pulmonary infections.

The mechanism of nosocomial respiratory infections caused by MRSA (methicillin-resistant Staphylococcus aureus) in geriatric patients was investigated. Seriously ill patients (SIP) undergoing naso-gastric tube feeding or intravenous hyperalimentation and moderately ill patients (MIP) who were orally fed, were examined for their colonization and infection by Staphylococcus aureus (S. aureus) in the respiratory tract. Colonization of MRSA in the upper respiratory tract in SIP was from six to ten times higher than that in MIP and was associated with a high incidence of MRSA pulmonary infections. In vitro S. aureus adherence to nasal or oropharyngeal cells demonstrated that bacteria binding to nasal cells was higher, which probably can be interpreted as an elevated occurrence of S. aureus colonization in the nasal cavity than in the throat. The binding activity of MRSA was not superior to that of MSSA (methicillin-sensitive S. aureus). Though MRSA binding to the nasal cells from SIP was not higher than those from MIP, MRSA colonization in the upper respiratory tract was more frequently seen in SIP (P < 0.01). A higher incidence of total infectious episodes (P < 0.02-0.001) and more frequent use of antibiotics (P < 0.02-0.001), which were potent against MSSA might be the basis for selection of MRSA in these patients. In fact, the rate of MRSA colonization on the skin (pressure sores) was also higher in SIP (P < 0.01). A low nutritional state in SIP (P < 0.01-0.02) might also be associated with MRSA colonization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

[Clinical study of aztreonam on respiratory tract infections caused by gram-negative pathogens].

Aztreonam (E-0734, AZT) was administered to pneumonia and chronic respiratory tract infections. The results were as follows: AZT was administered to 29 patients. Twenty-six cases were evaluable and 3 cases were excluded from evaluation of efficacy because 1 was Gram-positive infection, 2 were unclear symptom of infection. Pneumonia was 4 cases. Chronic respiratory tract infections were 22 cases. Clinical efficacy was judged as follows; excellent in 7 cases, good in 10 cases, fair in 5 cases and poor in 4 cases, then the efficacy rate was 65.4%. Efficacy rate in pneumonia, acute aggravation of diffuse panbronchiolitis and bronchiectasis with infection was 50%, 67% and 83%, respectively. Bacteriological response was judged on 21 cases with eradication rate was 66.7%. Bacteriological response classified by pathogen was as follows: All 6 isolates of H. influenzae, 2 in 6 isolates of P. aeruginosa, 4 in 5 isolates of H. parainfluenzae and all 3 isolates of K. pneumoniae were cleared. Total eradicated rate was 74.1%. Eruption was observed in 1 case as side effect. Abnormal laboratory findings were observed in 4 cases. Elevation of GOT and GPT was in 3 cases. Increase of eosinophil and basophil was in 1 case. AZT was considered to be a useful antibiotic for the treatment of respiratory tract infections, especially chronic respiratory tract infections, caused by Gram-negative pathogens.

Adult↗

PubMed2005

Thoracic vagal efferent nerve stimulation evokes substance P-induced early airway bronchonstriction and late proinflammatory and oxidative injury in the rat respiratory tract.

Electrical stimulation of efferent thoracic vagus nerve (TVN) evoked neurogenic inflammation in respiratory tract of atropine-treated rats by an undefined mechanism. We explored whether efferent TVN stimulation via substance P facilitates neurogenic inflammation via action of nuclear factor-kappaB (NF-kappaB) activation and reactive oxygen species (ROS) production. Our results showed that increased frequency of TVN stimulation concomitantly increased substance P-enhanced hypotension, and bronchoconstriction (increases in smooth muscle electromyographic activity and total pulmonary resistance). The enhanced SP release evoked the appearance of endothelial gap in silver-stained leaky venules, India-ink labeled extravasation, and accumulations of inflammatory cells in the respiratory tract, contributing to trachea plasma extravasation as well as increases in blood O (2)(-) and H(2)O(2) ROS amount. L-732138 (NK(1) receptor antagonist), SR-48968 (NK(2) receptor antagonist), dimethylthiourea (H(2)O(2) scavenger) or catechins (O (2)(-) and H(2)O(2) scavenger) pretreatment reduced efferent TVN stimulation-enhanced hypotension, bronchoconstriction, and plasma extravasation. Increased frequency of TVN stimulation significantly upregulated the expression of nuclear factor-kappaB (NF-kappaB) in nuclear protein and intercellular adhesion molecule-1 (ICAM-1) in total protein of the lower respiratory tract tissue. The upregulation of NF-kappaB and ICAM-1 was attenuated by NK receptor antagonist and antioxidants. In conclusion, TVN efferent stimulation increases substance P release to trigger NF-kappaB mediated ICAM-1 expression and O (2)(-) and H(2)O(2) ROS production in the respiratory tract.

Animals↗

PubMed1983

Endoscopy of lower respiratory tract scleroma.

Eleven cases of scleroma with lower respiratory tract affection were examined by the flexible and rigid bronchoscopes. The patterns of laryngeal, tracheal and bronchial scleroma as seen through the flexible scope are presented. In the larynx, diffuse and localized forms are found. The trachea was affected by granular or atrophic lesions. Stenosis of the main bronchi was seen in two patients. The present-day treatment of lower respiratory tract scleroma is discussed.

Adolescent↗

PubMedDate not supplied

[Anaerobic flora of the respiratory tract (author's transl)].

The general outlines for the microbiological study of respiratory tract anaerobic flora are indicated. To day research tend to assign to these bacteria a significant role in sustaining some diseases of lungs pleural space and upper respiratory tract; anaerobes are therefore a subject of outstanding interest for clinical microbiologists. Difficult arise in isolation and identification of respiratory tract anaerobes owing to normal presence of anaerobic flora in the mouth; the difficult can be overcomed by avoiding contamination with normal flora (lung puncture for instance) or by quantitative evaluations of bacteria in sputum.

Anaerobiosis↗

PubMed1992

Optimum use of selective plated media in primary processing of respiratory tract specimens from patients with cystic fibrosis.

A total of 258 respiratory tract specimens from patients with cystic fibrosis were inoculated onto nine different plated media, and the rates of recovery of potential pathogens were compared. Media included sheep blood agar, enriched chocolate agar, MacConkey agar for gram-negative bacilli, chocolate agar containing bacitracin for Haemophilus spp., bromcresol green agar for yeasts, cetrimide agar for Pseudomonas spp., sheep blood agar containing colistin and nalidixic acid for gram-positive cocci, mannitol salt agar for Staphylococcus aureus, and oxidation-fermentation agar containing 300 U of polymyxin B per ml and 2 U of bacitracin per ml (OF-PBL medium) for Pseudomonas cepacia. With two exceptions, all of these media proved useful in recovering potential pathogens from respiratory tract specimens from patients with cystic fibrosis. The two exceptions were cetrimide agar and colistin-nalidixic acid-supplemented sheep blood agar, which were found to be superfluous. In addition, the results of this study further delineated the prevalence of selected bacteria and fungi in respiratory tract secretions from patients with cystic fibrosis. In rank order of frequency of isolation, we recovered isolates of Pseudomonas aeruginosa, Haemophilus parainfluenzae, Candida albicans, S. aureus, Haemophilus influenzae, molds, members of the family Enterobacteriaceae, yeasts other than Candida albicans, miscellaneous gram-negative bacilli, beta-hemolytic streptococci, P. cepacia, and Streptococcus pneumoniae.

Agar↗

PubMed1998

Microbial factors leading to recurrent upper respiratory tract infections.

The treatment or prophylaxis of upper respiratory tract infections such as otitis media, sinusitis and tonsillitis with penicillins can generate bacterial resistance caused by production of beta-lactamase or changes in the penicillin-binding proteins. This resistance can spread in the community even to untreated individuals. The prevalence of resistant organisms tends to increase in the winter months. Beta-lactamase-producing bacteria may interfere with the eradication of penicillin-susceptible organisms and may account for substantial numbers of therapeutic failures among cases of otitis media, sinusitis and tonsillitis. The presence of normal flora that possess interfering capabilities against potential pathogens is beneficial to the host. Such flora may enhance recovery and prevent infections of the tonsils by group A beta-hemolytic streptococci. Therapeutic use of antimicrobial agents that preserve the normal flora but overcome penicillin-susceptible or -resistant pathogens may enhance recovery from upper respiratory tract infections.

Child↗

PubMed1998

Seasonal trends of viral respiratory tract infections in the tropics.

To evaluate the seasonal trends of viral respiratory tract infections in a tropical environment, a retrospective survey of laboratory virus isolation, serology and immunofluorescence microscopy in two large general hospitals in Singapore between September 1990 and September 1994 was carried out. Respiratory tract viral outbreaks, particularly among infants who required hospitalization, were found to be associated mainly with respiratory syncytial (RSV) infections (72%), influenza (11%) and parainfluenza viruses (11%). Consistent seasonal variations in viral infections were observed only with RSV (March-August) and influenza A virus (peaks in June, December-January). The RSV trends were associated with higher environmental temperature, lower relative humidity and higher maximal day-to-day temperature variation. Although the influenza A outbreaks were not associated with meteorological factors, influenza B isolates were positively associated with rainfall. These data support the existence of seasonal trends of viral respiratory tract infections in the tropics.

Adolescent↗

PubMed2004

Communicating about expected course and re-consultation for respiratory tract infections in children: an exploratory study.

Acute respiratory tract infection is the commonest reason for children consulting, and about one-fifth re-consult for the same illness episode. Fifty-nine audiotape recordings from nine general practitioners (GPs) consulting with children with acute respiratory tract infections were examined. Prognosis was mentioned in only 22 consultations, with GPs predicting a brief course in 11, a possibly longer than expected course in six, and with predicted duration not made explicit in five. Carers were invited to re-consult if they were 'unhappy' with the child's condition in 11 consultations, and specific triggers to re-consult were provided in 15. A patient information leaflet was given out only once. Providing carers with an evidence-based account of the likely clinical course and communicating specific triggers to re-consult may help them manage more of these illness episodes without re-consulting.

Acute Disease↗

PubMed1999

Parainfluenza virus infection among adults hospitalized for lower respiratory tract infection.

To better define the contribution of human parainfluenza viruses (HPIVs) to lower respiratory tract infection in adults, we tested acute- and convalescent-phase serum specimens from hospitalized adults participating in a population-based prospective study of lower respiratory tract infection during 1991-1992. We tested all available specimens from the epidemic seasons for each virus and approximately 300 randomly selected specimens from the corresponding off-seasons for antibodies to HPIV-1, HPIV-2, or HPIV-3. During the respective epidemic season, HPIV-1 infection was detected in 18 (2.5%) of 721 and HPIV-3 infection in 22 (3.1%) of 705 patients with lower respiratory tract infection. Only 2 (0.2%) of 1,057 patients tested positive for HPIV-2 infection. No HPIV-1 infections and only 2 (0.7% of 281 patients tested) HPIV-3 infections were detected during the off-seasons. HPIV-1 and HPIV-3 were among the four most frequently identified infections associated with lower respiratory tract infection during their respective outbreak seasons.

Adult↗

PubMedDate not supplied

Deposition pattern of droplets from medical nebulizers in the human respiratory tract.

Total and regional deposition data for aerosol particles in the human respiratory tract measured in normal mouth-breathing subjects are applied to aerosols from medical nebulizers. From deposition data as a function of particle size and respiratory parameters and from the droplet size distributions of various jet and ultrasonic nebulizers, integral mass depositions as a fraction of the aerosol entering the mouthpiece are determined for the total respiratory tract, the extrathoracic airways, the tracheobronchial tree and the alveolar region. Since the aim of inhalation therapy is the deposition of particles in that part of the respiratory tract which is to be treated, the results of this study may also be useful in finding out optimum conditions in cases of therapeutic applications.

Aerosols↗

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↗

PubMed2001

Immunoglobulin A (IgA) responses and IgE-associated inflammation along the respiratory tract after mucosal but not systemic immunization.

The purpose of the present study was to determine the extent of immunologic responses, particularly immunopathologic responses, within the upper and lower respiratory tracts after intranasal immunization using the mucosal adjuvant cholera toxin (CT). BALB/c mice were nasally immunized with influenza virus vaccine combined with CT. The inclusion of the mucosal adjuvant CT clearly enhanced generation of antibody responses in both the nasal passages and lungs. After nasal immunization, antigen-specific immunoglobulin A (IgA) antibody-forming cells dominated antibody responses throughout the respiratory tract. However, IgG responses were significant in lungs but not in nasal passages. Furthermore, parenteral immunization did not enhance humoral immunity in the upper respiratory tract even after a nasal challenge, whereas extrapulmonary lymphoid responses enhanced responses in the lung. After nasal immunization, inflammatory reactions, characterized by mononuclear cell infiltration, developed within the lungs of mice but not in nasal passages. Lowering dosages of CT reduced, but did not eliminate, these adverse reactions without compromising adjuvancy. Serum IgE responses were also enhanced in a dose-dependent manner by inclusion of CT. In summary, there are differences in the generation of humoral immunity between the upper respiratory tract and the lung. As the upper respiratory tract is in a separate compartment of the immune system from that stimulated by parenteral immunization, nasal immunization is an optimal approach to generate immunity throughout the respiratory tract. Despite the promise of nasal immunization, there is also the potential to develop adverse immunopathologic reactions characterized by pulmonary airway inflammation and IgE production.

Administration, Intranasal↗

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↗