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PubMed1994

[Three cases of Pasteurella multocida infection in the respiratory tract].

Pasteurella multocida (P. multocida) is well recognized as "normal flora" in the upper respiratory tract of cats, dogs and other animals. Recently, various infections due to P. multocida in human have been noted as pulmonary infections in the patients with chronic pulmonary diseases as well as skin abscesses or septicemia after an animal bite or scratch. We report here three cases of respiratory tract infections caused by P. multocida. The first two patients had acute exacerbation of bronchiectasis caused by P. multocida and the other patients with pulmonary emphysema developed pneumonia. These three patients improved by antibiotic therapy. In Japan, P. multocida respiratory tract infection is rare, but it may become more common in the future. Therefore, it seems to be important to take this pathogen into consideration in the management of chronic lung disease.

Adult↗
PubMed1998

Upper respiratory tract infections in family practice.

The causative pathogens in the majority of mild to moderate upper respiratory tract infections are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Bacterial infections of the respiratory tract are often treated empirically; however, the recent increase in serious infections caused by S. pneumoniae and rising antimicrobial resistance rates have prompted experts to reevaluate the therapeutic approaches to treatment of these infections. Although amoxicillin continues to be considered a first line therapy, some situations warrant alternative therapies. Antimicrobial therapy must provide effective coverage of the potential pathogens, yet issues of compliance must also be addressed to ensure clinical success. Ease of administration, taste and the potential for adverse events are important considerations for the pediatric population. Clinical trials support the use of alternative therapies in the treatment of patients with upper respiratory tract infections.

Anti-Bacterial Agents↗
PubMedDate not supplied

[The epidemiology of nasopharyngeal colonisation of Streptococcus pneumoniae in children with respiratory tract infection].

Nasopharyngeal swab specimens from 324 children with respiratory tract infections were evaluated to detect the rate of Streptococcus pneumoniae colonisation. S. pneumoniae was detected in 92 (28%) of the subjects. Forty three (46.7%) of the isolates were serotyped by the capsular swelling tests. The most common serotypes were 19F, 6B, 3 and 23F. The 7, 9 and 11 valent conjugate pneumococcal vaccines covered 35.8%, 40% and 46.7% of all the S. pneumoniae isolates, respectively. Thirty two (34.8%) isolates exhibited penicillin MIC values between 0.1 and 1 microg/ml, only 1 isolate had MIC > or = 2 microg/ml. Penicillin resistant pneumococcal colonisation was most frequently detected in children with viral upper respiratory tract infections (12.5%). Resistance rates of trimetoprim-sulfamethoxazole, erythromycin, chloramphenicol, clindamycin, ceftriaxone, rifampin were 31.5%, 9.8%, 6.5%, 4.3%, 1%, 0%, respectively. Being a children of a family with low income was the only risk factor for colonisation with S. pneumoniae, whereas having a sibling attending to a day care center, antibiotic use in the last three months and use of more than one antibiotic were significant risk factors for colonisation with penicillin resistant S. pneumoniae (p < 0.05).

Adolescent↗
PubMed1985

Acute and exacerbated chronic respiratory tract infections: treatment with a combination of cefuroxime and acetylcysteine.

Sixty-five patients, 25 with acute bronchopulmonary respiratory tract diseases and 40 with acute exacerbations of chronic respiratory tract infections, were treated by means of intramuscular injection of an extempore combination of 1 g of cefuroxime and 300 mg of acetylcysteine. Patients were divided into two groups according to the acute or chronic nature of their respiratory tract diseases. Positive clinical results were obtained in 62 of the 65 patients. Of a total of 52 pathogens isolated in pretreatment bacteriological tests on sputum cultures, only three were still detectable after treatment. Tolerance of the treatment was good in all patients, no side-effects of any kind being observed.

Acetylcysteine↗
PubMed1972

Immunoglobulin E in immunologic deficiency diseases. I. Relation of IgE and IgA to respiratory tract disease in isolated IgE deficiency, IgA deficiency, and ataxia telangiectasia.

Serum immunoglobulin E concentration was studied in normal children and adults, in 25 patients with isolated IgA deficiency, and in 44 patients with ataxia telangiectasia using a double antibody radioimmunoassay. The geometric mean IgE level of the normal adult population studied was 105 ng/ml, with a broad 95% interval (5-2045 ng/ml). Individuals with concentrations less than 15 ng/ml were considered to be IgE deficient. IgE deficiency, defined in this way, was observed in 7 of 73 normal adults and was not found to be associated with respiratory tract disease.80% (35 of 44) of patients with ataxia telangiectasia (AT) were IgE deficient, 66% were IgA deficient, and 57% had combined IgE and IgA deficiencies. Although 45% of the patients with AT had respiratory tract disease, there was no correlation found between IgE deficiency or combined IgE and IgA deficiency and respiratory tract disease in these patients.11 of 25 individuals with isolated IgA deficiency were also IgE deficient. All 11 patients with both IgA and IgE deficiency were uniformly asymptomatic. However, there was an extremely high incidence (71%) of respiratory tract disease in IgA-deficient individuals who were not IgE deficient. These data fail to support the concept of a protective role for IgE in respiratory tract immunity. The possible role of IgE in the pathogenesis of respiratory tract disease in IgA-deficient patients is discussed.

Adolescent↗
PubMed1997

[Serum levels of tumor necrosis factor alpha and soluble tumor necrosis factor-receptor I in asthmatic patients and patients with chronic respiratory tract infection].

In order to investigate the role of tumor necrosis factor alpha (TNF-alpha) in bronchial asthma or chronic respiratory infection, we measured serum levels of TNF-alpha and serum soluble tumor necrosis factor-receptor I (sTNF-RI) in asthmatic patients (n = 11) and patients (n = 10) with chronic respiratory infection by Pseudomonas aeruginosa. We also measured serum levels of eosinophil cationic protein (ECP) in the asthmatic patients. The serum levels of TNF-alpha in the asthmatic patients, patients with chronic respiratory tract infection and control group were 2.864 +/- 0.719 g/ml, 2.564-1.384 pg/ml and 0.681 +/- 0.453 pg/ml respectively. The levels of the former two groups were higher than those of the control group (p < 0.05). The serum levels of sTNF-RI in the asthmatic patients, the patients with chronic respiratory tract infection, and the control group was 758 +/- 268 pg/ml, 999 +/- 242 pg/ml and 909 +/- 268 pg/ml respectively. The levels of the former two groups did not differ significantly from those of the control group. There were significant correlations between TNF-alpha and sTNF-RI in the control group and in the patients with chronic respiratory tract infection, but there was no significant correlation in the asthmatic patients. In the asthmatic patients. TNF-alpha/s TNF-RI correlated with %best of PEF (r = 0.691, n = 9, p 0.0373). The serum levels of ECP correlated significantly with TNF-alpha, but not with sTNF-RI in the asthmatic patients. It is suggested that TNF-alpha plays a significant role in the pathogenesis of bronchial asthma and chronic respiratory tract infection as a factor causing inflammation and that the increase of TNF-alpha/sTNF-RI reflects the activation of eosinophil functions in an asthmatic attack.

Adult↗
PubMed1991

[Clinical evaluation of cefixime in pediatric respiratory tract infections].

Cefixime (CFIX) was evaluated clinically in pediatric respiratory tract infections, particularly those caused by Haemophilus influenzae: 1. The total number of children in this study treated with CFIX was 232, out of which 215 cases were evaluated for clinical efficacy and 224 cases were investigated for safety. A daily dosage of 3-6 mg/kg/day was given divided into 2 to 3 times daily for 3-15 days. 2. Causative organisms were identified in 146 cases, out of which 128 cases were found to be single microbial infections and 18 cases were mixed infections. In single microbial infections, clinical efficacy was 100% for those caused by H. influenzae/Haemophilus parainfluenzae, and was 95% for Streptococcus pyogenes with an overall efficacy of 96.9%. In mixed infections, the clinical efficacy was 100% for those caused by a combination of H. influenzae and Streptococcus pneumoniae, and the overall rate was 94.4%. An involvement of H. influenzae was observed in 108 cases with a clinical efficacy rate of 99.1%, and definite involvement of beta-lactamase secreting strains of H. influenzae was found in 32 cases with a clinical efficacy of 96.9%. 3. Bacteriological effect was studied for 164 strains identified in 146 cases, and eradication rates were 89.5% for H. influenzae, 100% for H. parainfluenzae and S. pyogenes, and 71.4% for S. pneumoniae. The overall eradication rate was 91.4%. Superinfection was observed in 21 cases. MICs against 78 strains of H. influenzae were in a range of less than or equal to 0.10 microgram/ml regardless of beta-lactamase production, and far superior to cefaclor and amoxicillin. MICs against S. pyogenes and S. pneumoniae were in ranges of less than or equal to 0.10 microgram/ml and 0.39 micrograms/ml, respectively. 4. Clinical efficacy was 93.0% in 215 cases (excellent: 136, good: 64, fairly good: 10, poor: 5). CFIX attained a high efficacy in the range of 89.4-95.7% in acute pharyngitis, acute tonsillitis, acute bronchitis and acute pneumonia. 5. Safety was monitored in 224 cases and there were only one case of loose stool and another of diarrhea as side effects. There were no abnormal findings in 31 cases of the laboratory test. In conclusion, it was confirmed that CFIX is excellent and safe in the treatment of the respiratory tract infections.

Age Factors↗
PubMedDate not supplied

Effects of the beige mutation on respiratory tract infection with Pseudomonas aeruginosa in mice.

The role of neutrophil proteinases in the pathogenesis of respiratory tract infections with Pseudomonas aeruginosa was evaluated by studying the course of murine respiratory tract infection with a clinical isolate of P. aeruginosa mucoid strain developed by the agarose beads method in C57BL/6J(bg/bg) mice (beige mice). Neutrophils of beige mice are known to have defects in elastase and cathepsin G, but to have normal ability to produce reactive oxygen species. Contrary to the reported high susceptibility of beige mice to bacterial infections, we found that intratracheal inoculation of approximately 10(5) colony-forming units (CFU) of P. aeruginosa enmeshed in agarose beads resulted in lower mortality (0/16 versus 16/16, p < .01), fewer CFU counts in the lungs on day 5 (p < .05), and fewer elastolytic lung tissue injuries in beige mice compared with C57BL/6(+/+) mice. In vitro bactericidal study, however, revealed that beige neutrophils killed fewer bacteria than those of C57BL/6(+/+) mice (p < .05). Neutrophil elastase activities in the supernatants of pulmonary lavaged fluids measured using methoxysuccinyl-alanyl-alanyl-prolyl-valine-4-methylcoumar-7-amide were lower (p < .05) in beige mice than those in the normal littermates, whereas neutrophil recruitment into the airways and production of superoxide anion measured as the superoxide dismutase inhibitable rate of cytochrome c reduction were not impaired. These results suggest that neutrophil proteinases play a key role in tissue injuries in the respiratory tract infection with P. aeruginosa.

Animals↗
PubMed1998

Do radiographic features of acute infection influence management of lower respiratory tract infections in the community?

Community-acquired lower respiratory tract infection (LRTI) is a common clinical problem, and a chest radiograph is the most common investigation. This study investigated why general practitioners (GPs) request radiographs and whether radiographic features of LRTI affect management. The 12 month study included GP-requested chest radiographs performed at the Manchester Royal Infirmary. The GPs of patients with radiographic evidence of LRTI were sent a questionnaire. Radiographs (n=2,538) were performed in patients aged >15 yrs. One hundred and eleven (4.4%) chest radiographs showed evidence of LRTI, and 97 (87%) were included in the analysis. Fifty-six (62%) had their radiograph requested at the second or third visit. Forty-five (58%) radiographs were performed to confirm infection. In 47 (48%) of cases the GP felt the radiograph had affected treatment. An effect on treatment was significantly more common in patients not receiving antibiotics prior to the radiograph. Twenty-nine (32%) of GPs felt a normal radiograph would have affected management, most often with respect to antibiotic prescriptions (17 (58%)). Where the radiologist's report suggested a repeat radiograph or hospital referral, this was significantly more likely to have occurred. The commonest reason for a radiograph in patients with suspected lower respiratory tract infection is to confirm the infection. In the opinion of the general practitioner the results of the radiograph do affect patient treatment. The wording of the radiologists report is associated with patient management.

Acute Disease↗
PubMed2006

Role of ribomunyl((r)) in the prevention of recurrent respiratory tract infections in adults : overview of clinical results.

Recurrent respiratory tract infections (RRTIs) in adults are the result of an imbalance between lung defense mechanisms, and bacterial burden. Antibacterial treatments can temporarily restore the equilibrium between host and bacterial load, but do not prevent recurrence of infection. An alternative approach to prevent recurrence of infection is treatment with an immunostimulant, which provides immune protection against repeated bacterial and viral infection. All immunostimulant products are bacterial in origin: lysates (first generation immunostimulants), or bacterial extracts, like bacterial ribosomes, or membrane proteoglycans. This review highlights the current state of knowledge regarding the use of immunostimulants in adults with RRTIs, taking the ribosomal immunostimulant Ribomunyl((R)) as an example. Many studies are available on the mechanism of action and clinical efficacy in prevention of RRTIs in adults treated with Ribomunyl((R)). The effect of this immunostimulant on anti-infectious responses is explained by a stimulation of both nonspecific (innate) and specific (adaptive) immunity. In order to obtain a global overview of the therapeutic efficacy of Ribomunyl((R)) the most pertinent trials were selected from the literature based on adequate patient numbers and good methodology. Results of double-blind placebo-controlled trials using Ribomunyl((R)) for the treatment of different upper or lower RRTIs have demonstrated a statistically significant reduction in the number of infectious episodes and as a consequence, a decrease in antibacterial consumption, after 3 and 6 months of treatment. The tolerance profile of Ribomunyl((R)) was good in all studies. Economic evaluations suggest that savings can be made in healthcare expenditure, in patients with recurrent episodes of infection. It is concluded that Ribomunyl((R)) is effective in preventing and reducing upper and lower respiratory tract infections in adults. The product may also have an impact on reducing the development of bacterial resistance, as a result of fewer courses of antibacterials required to treat patients with RRTIs.

Adjuvants, Immunologic↗
PubMed1999

The impact of antimicrobial resistance: changing epidemiology of community-acquired respiratory-tract infections.

Current surveillance data and mechanisms of resistance for the three most common bacteria infecting the respiratory tract are reviewed. Many pathogens, once susceptible to available antimicrobials, are now demonstrating high levels of resistance to commonly prescribed antimicrobial agents for the treatment of respiratory-tract infections. The three most common respiratory-tract pathogens, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, all exhibit high-level resistance to one or a number of agents, including penicillin, ampicillin, erythromycin, tetracycline, and first-generation cephalosporins. To determine the prevalence of resistance in these organisms, surveillance programs have begun tracking the emergence of antimicrobial resistance in the United States and worldwide. Data recovered from several national surveillance studies should help guide decisions about empirical therapeutic treatment.

Community-Acquired Infections↗
PubMed2002

Distinct mechanisms for cross-protection of the upper versus lower respiratory tract through intestinal priming.

A main feature of the common mucosal immune system is that lymphocytes primed in one mucosal inductive site may home to distant mucosal effector sites. However, the mechanisms responsible for such cross-protection remain elusive. To address these we have used a model of local mucosal infection of mice with reovirus. In immunocompetent mice local duodenal priming protected against subsequent respiratory challenge. In the upper respiratory tract this protection appeared to be mainly mediated by specific IgA- and IgG2a-producing B cells, whereas ex vivo active effector memory CTL were found in the lower respiratory tract. In accordance with these findings, clearance of reovirus from the lower respiratory tract, but not from the upper respiratory tract, of infected SCID mice upon transfer of gut-primed lymphocytes depended on the presence of T cells. Taken together this study reveals that intestinal priming leads to protection of both the upper and lower respiratory tracts, however through distinct mechanisms. We suggest that cross-protection in the common mucosal immune system is mediated by trafficking of B cells and effector memory CTL.

Administration, Intranasal↗
PubMed1984

[Clinical studies on cefoxitin in the treatment of respiratory tract infections].

The clinical effects of cefoxitin (CFX) were studied in 31 cases of respiratory tract infections. The results were as follows: As for the clinical effects, CFX was excellent in 5 cases, good in 13, fair in 8 and poor in 5 out of 31 patients; the efficacy rate was 58.1%. The efficacy rate was 57.1% in bronchopneumonia, 61.1% in pneumonia and 50.0% in acute exacerbation of chronic respiratory tract infections. The efficacy rate was 70.6% in the group of 4 g/day or less and 42.9% in the group of 6 g/day or more. The efficacy rate was 50.0% in 6 cases that had not been responded to other antibiotics previously. As for side effects, skin eruption was observed in only 1 patient. No abnormality was observed in laboratory tests due to CFX. In conclusion, CFX is a useful drug in the treatment of respiratory tract infections.

Adult↗
PubMed2004

Lower respiratory tract infections in cats: 21 cases (1995-2000).

Twenty-one lower respiratory tract infections diagnosed in cats at University of Sydney Veterinary Centre between 1995 and 2000 were identified retrospectively. Patient records were analysed to determine historical, clinical, clinicopathologic and radiographic features of lower respiratory tract infections. Response to therapy was also assessed. Infectious agents identified were Mycoplasma spp., Pasteurella spp., Bordetella bronchiseptica, Salmonella typhimurium, Pseudomonas sp., Mycobacterium thermoresistible, Cryptococcus neoformans, Toxoplasma gondii, Aelurostrongylus abstrusus and Eucoleus aerophilus. The study provides a detailed retrospective analysis of infectious lower respiratory tract disease in this population of cats.

Animals↗
PubMed1987

International experiences with ceftriaxone in the treatment of lower respiratory tract infections.

The clinical efficacy and tolerability of ceftriaxone in the treatment of pneumonia and other lower respiratory tract infections were evaluated in 827 patients (515 pneumonia, 312 other lower respiratory tract infections) reported in the international literature (daily dose: 1 of 2 g.i.v. or i.m. in most patients). Therapeutic success was achieved in 738 patients (89.2%). Microbiological results were evaluated in 295 patients. Eradication of the most common respiratory pathogens was achieved in 100% of cases and of Enterobacteriaceae in 85.7%-100%. Adverse effects occurred in 4.9% of patients. A large multicenter trial was carried out in Italy using a single daily dose of 1-2 g by i.v. or i.m. Six hundred ninety-six patients were admitted to the study (370 pneumonia, and 326 other lower respiratory tract infections). Therapeutic success was achieved in 668 cases (96%). Pathogens were eradicated in 88% of cases (184 pts evaluated). Side effects were observed in 4.6% of cases.

Bacteria↗
PubMed1992

Therapeutic considerations: lower respiratory tract infections in smokers.

Tobacco smoke can alter both the structural and the immunologic defenses of the lungs against infection. The gases from smoke can also inhibit repair of the damages they create. Smokers have been found to have increased bacterial adherence to the respiratory tract, decreased IgA and IgG, and a decrease in vital capacity two to three times greater than that of nonsmokers. These and other respiratory tract alterations put smokers at an added disadvantage when acute lower respiratory tract infections strike. A history of smoking influences the diagnosis of respiratory tract infections because smokers are more prone than nonsmokers to infection by certain organisms. The major causes and characteristics of lower respiratory tract infections, methods of outpatient diagnosis, and the pros and cons of various modes of therapy are discussed.

Bacterial Infections↗
PubMed2005

Open comparative, randomized controlled clinical study of a new immunostimulating bacterial lysate in the prophylaxis of upper respiratory tract infections.

One hundred and fourteen patients with a medical history of recurrent upper respiratory tract infections (at least four episodes in the year preceding this open comparative study) were randomly assigned to three groups of 38 patients each. The first group received, by sublingual route, Ismigen, a new immunostimulating lysate (Polivalent Mechanical Bacterial Lysate, PMBL) obtained by mechanical lysis of 48 billion bacteria commonly responsible for upper respiratory tract infections; the second group received an oral immunostimulating lysate (CLBL) obtained by chemical lysis of 36 billion bacteria. A third group served as control and did not receive any immunostimulating treatment (Control NT). One tablet a day of PMBL was given to the first group for the first ten days during three consecutive months; the patients of the second group received one capsule a day of CLBL with the same treatment schedule. At the end of the treatment period the patients of the 3 groups were followed up for 3 months. The primary end point was the number of acute upper respiratory tract infections (URTIs) that occurred during the three months of treatment and three months of follow-up. Secondary endpoints were: the number of patients free from disease, the duration of infectious episodes, the number of working days lost because of disease, the need for a concomitant antibiotic treatment, and the safety of the two treatments. During the treatment period the mean number (+/- SD) of URTIs per patient was 0.34 (0.48) in the PMBL group, 1.0 (0.83) and 1.23 (0.77) in the CLBL and Control NT groups, respectively. Results of PMBL treatment were significantly better (p < 0.05) than the results in the other two groups; CLBL was not significantly different from the control group. In the three months of follow-up, the mean number (+/- SD) of URTIs per patient was: 0.42 (0.55) in the PMBL group, 0.92 (0.67) in the CLBL group, and 1.55 (0.88) in the Control NT group. The PMBL group was significantly better than the other two (p < 0.05). During the 6-month study, significantly more patients of the PMBL group remained free from respiratory infections in comparison to the other two groups. As regards other secondary end points (duration of infectious episodes and number of working days lost), the mean values of the PMBL group were statistically significantly lower than those of the other two groups, in both the treatment and follow-up periods. No PMBL treated patient needed concomitant administration of an antibiotic, while 9 patients of the CLBL group received such treatment (p < 0.05). No patient reported adverse events.

Adjuvants, Immunologic↗