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PubMedDate not supplied

[Treatment of acute upper respiratory tract infections in children].

INTRODUCTION: Acute respiratory tract infections are the most common diseases of childhood. A preschool child suffers up to 5-7 infections of upper airways during a year. Upper airway infections make 80-90% of all respiratory infections. ETIOLOGY AND TREATMENT: In 75% of all cases respiratory infections are of viral etiology, 15% of bacterial and 10% are caused by mycoplasma, rickettsiae, fungi, parasites. The treatment of respiratory infections includes antimicrobial therapy (causal), relief of symptoms (symptomatic) and application of general principles of child treatment. The choice of antimicrobial drug is based on the evidence of agents and their sensitivity to antimicrobial drugs, age, patient's condition, previous treatment and possible allergic reactions to the drug. In cases where adequate specimen cannot be obtained for microbiologic tests, when these tests do not reveal the agent, or therapy must start before evidence of the agent is available, we must decide about the therapy, taking in consideration the most frequent agents, and those that would cause the most devastating clinical picture. This therapy can be modified later, according to the isolated agent and its sensitivity to the drug. Considering the incidence and importance of respiratory infections in morbidity and mortality of children, the aim of this article was to present guidelines in treatment of respiratory infections. The main point remains that the treatment should take into consideration the individual patient before all.

Acute Disease↗

PubMed1997

Impact of HIV on mortality from acute lower respiratory tract infection in rural Zambia.

AIMS: To establish the prevalence and clinical correlates of HIV among children with acute lower respiratory tract infection. METHODS: Children admitted to a rural Zambian hospital were studied over an eight month period. The diagnosis of acute lower respiratory tract infection was made clinically, according to World Health Organisation (WHO) criteria. Clinicians, who were unaware of the children's HIV status, prescribed antibiotic and supportive treatment according to WHO guidelines. HIV status was established using the polymerase chain reaction (Amplicor HIV1, Roche) applied to dried blood spots. RESULTS: Acute lower respiratory tract infection was diagnosed in 132 children (median age 8 months, range 1 month to 4 years). The WHO criteria for severe or very severe pneumonia were met by 96/132 patients (73%) and 21 patients (16%) died. HIV dried blood spot PCR was positive in 14 cases (11%), of whom four fulfilled the WHO clinical case definition for paediatric AIDS and five died. The group as a whole were malnourished, but the HIV positive children were more severely malnourished (mean z score for weight = -3.01) than the HIV negative children (mean z score = -1.73, p < 0.001). The relative risk of death was 2.6 in the HIV positive group but this was not significant (p = 0.079). CONCLUSIONS: An important minority of children with acute lower respiratory tract infection in rural Zambia will be infected with HIV. However, most HIV positive children presenting with respiratory infection will survive given simple antibiotic and supportive treatment.

AIDS-Related Opportunistic Infections↗

PubMed1992

Examination of the upper and lower respiratory tract relevant to purchase.

The intent and extent of the respiratory tract examination relevant to purchase are dictated by numerous factors, including historical information, signs suggestive of respiratory tract abnormalities, intended use of the horse, and economic considerations. Following a thorough and systematic examination of the horse at rest, evaluation during and following exercise may be warranted. The physical examination should include evaluation of regional symmetry of the head, neck, and thorax; evaluation of nasal airflow and patency; palpation of the nasal septum, larynx, and trachea; examination for surgical scars; and auscultation and percussion. Special examination techniques, including endoscopy, stress evaluation, and radiography, may be indicated. Much has been learned about the URT in recent years, particularly regarding endoscopy of the region and the interpretation of endoscopic findings. The reader is referred to a generous list of references to gain further detailed information regarding the endoscopic diagnosis of other URT conditions.

Animals↗

PubMed1987

Failure to transmit diethylnitrosamine tumorigenicity from transplacentally exposed F1 generation Syrian hamsters to the respiratory tract of F2 and F3 generations.

A multigeneration study with four successive generations of Syrian hamsters was conducted to determine whether a single s.c. injection of different doses of diethylnitrosamine (DEN) (1.25, 2.5, 5, 10, and 20 mg/kg body weight) on day 15 of pregnancy induces respiratory tract tumors not only in the treated P generation mothers and their F1 progeny but also in F2 and F3 generations. In this study, the P generation mothers only were given a single injection of DEN during the period of gestation. Fifty-six % of the 36 DEN-treated mothers and 52% of their F1 generation offspring (total, 233 animals) developed neoplasms in the respiratory tract. A single respiratory tract tumor was found in one DEN-unexposed F1 generation control hamster as well as in one F2 generation animal (total, 209 animals) descended from DEN-exposed P generation. Both tumors were considered to have arisen spontaneously. No respiratory tract tumors were observed in the F3 generation (total, 160 animals) descended from a DEN-exposed P generation. Thus our results indicate that the vertical transmission of the tumorigenic effect of DEN in Syrian hamsters is limited to one generation and does not persist in the F2 and F3 generations.

Animals↗

PubMed2005

[Excretion of beta-elemene from rat respiratory tracts].

AIM: To investigate the excretion of beta-elemene from the respiratory tracts in male Spraque-Dawley rats. METHODS: After a single administration of beta-elemene to rats at the dosage of 75 mg x kg(-1) (i.v. or i.p.), the exhaled gases were collected and concentrated at various time points. The residues were analyzed by gas chromatography. RESULTS: A minor amount of unchanged beta-elemene was excreted via rat respiratory tracts after iv and ip administration of a single dose. The cumulative excretion were 1.41% and 0.51% respectively. CONCLUSION: The results demonstrated that unchanged beta-elemene excretes from rat respiratory tracts, but may not be the main elimination pathway in rats.

Animals↗

PubMed1980

[Aetiology and importance of viral diseases of the respiratory tract (author's transl)].

After discussion of the epidemiological situation of acute respiratory diseases and their economic consequences, and after a survey of clinical signs and symptoms, a review is given of the most important viral agents causing such diseases. That are influenza, parainfluenza, respiratory syncytial, adeno, corona, REO, and rhino viruses, which are prevalent in the respiratory tract. Viruses predominantly localized outside of the respiratory tract as well as bacteria and bacteria-like microorganisms are only shortly mentioned. Most weight is given to virological problems (morphology, antigenic structure), to pathogenic property and importance of viruses causing acute respiratory diseases.

Adenoviruses, Human↗

PubMed1991

Exercise and the incidence of upper respiratory tract infections.

We examined illness patterns in a cohort of 530 male and female runners who completed a monthly log for 12 months. The average number of upper respiratory tract infections (URTIs) per person per year for the cohort was 1.2. An upper respiratory tract infection was indicated by the report of any of the following symptoms; runny nose, sore throat, or cough. Using a multiple logistic regression model, the following factors were found to be associated with having one or more URTIs in the follow-up period: living alone (odds ratio = 2.27, 95% CI = 1.01, 5.09), running mileage (486-865 miles, odds ratio = 2.00, 95% CI = 1.01, 2.78; 866-1388 miles, odds ratio = 3.50, 95% CI = 1.52, 4.44; greater than 1388 miles, odds ratio = 2.96, 95% CI = 1.30, 3.68), body mass index greater than the 75th percentile (odds ratio = 0.58, 95% CI = 0.35, 0.94), and male gender (odds ratio = 0.14, 95% CI = 0.03, 0.68). A significant interaction was found to exist between gender and alcohol use, with the association between alcohol use and upper respiratory tract infections being positive in males and negative in females. These results suggest that running dosage (mileage) is a significant risk factor for upper respiratory tract infections in this group of exercisers.

Adolescent↗

PubMed1994

[Clinical evaluation of combination therapy of sulbactam/cefoperazone and aminoglycoside in respiratory tract infections].

We compared clinical efficacy and safety of sulbactam/cefoperazone (SBT/CPZ) with those of SBT/CPZ combined with aminoglycoside (amikacin (AMK), tobramycin (TOB), etc.) in treatment of respiratory tract infections in patients with underlying respiratory diseases, with cancer, or with acute exacerbation of chronic respiratory infections. Clinical evaluations of monotherapy with SBT/CPZ in a total of 30 patients showed excellent results in 5, good results in 17. Clinical effects of combined therapy of SBT/CPZ plus different aminoglycosides in a total of 33 patients were excellent in 18, good in 5. The efficacy rates (excellent plus good) were 73.3% in the monotherapy and 69.7% in the combined therapy. AMK was used concomitantly with SBT/CPZ in 16 of 33 patients. Clinical effects of SBT/CPZ plus AMK were excellent in 10, good in 3, and the efficacy rate was 81.3%. Bacteriological effects were evaluable against 11 strains in the monotherapy group, and against 17 strains in the combined therapy group. The eradication rates were 54.5% in the monotherapy group, and 81.3% in the combination therapy group. Diarrhea was observed in a patient who received the monotherapy. Abnormal laboratory test results were observed on in 5 patients who received the monotherapy, and in 4 patients who received one of the combined therapies. All abnormalities disappeared after the completion or discontinuation of therapies. We considered SBT/CPZ combined with an aminoglycoside is a useful chemotherapy for respiratory tract infections in patients with underlying diseases and acute exacerbation of chronic respiratory tract infections.

Adult↗

PubMed2002

Management of respiratory syncytial virus with lower respiratory tract infection in infants and children.

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and children requiring pediatric hospitalizations. Infants with chronic lung, cardiac, or neuromuscular conditions are at increased risk for RSV infection. Early RSV is associated with subsequent diagnosis of reactive airway disease. The management of RSV with lower respiratory track infection in infants and children remains controversial. Bronchodilators may have some short-term benefit, but are not recommended as standard practice for infants and children. Antiviral therapy may be used for high-risk and severely ill patients. Corticosteroids may be effective in cases of moderate to severe RSV with lower respiratory track infection. Monoclonal antibodies have shown some promise in achieving passive immunity for those at greatest risk, including preterm infants younger than 1 year or infants younger than 2 years with chronic lung disease. Emergency management remains primarily supportive, with vigilant monitoring of oxygenation and hydration status. Interventions include supplemental oxygen therapy, ventilation, and fluid and nutrition therapy. Respiratory syncytial virus prophylaxis for high-risk patients includes intramuscular injections of palivizumab (Synagis) each month during RSV season, from November through April. Prevention strategies include washing hands, cleaning environment surfaces, and isolating infants and children with RSV in the emergency care area.

Adrenal Cortex Hormones↗

PubMed1985

Acute respiratory tract infections of children in hospital: a viral and Mycoplasma pneumoniae profile.

Respiratory specimens and blood were collected from all infants and children admitted with acute respiratory illness to a paediatric unit in Christchurch from May to November (late autumn, winter and spring) 1983, to define the viral aetiological agents involved. A virus or Mycoplasma pneumoniae was identified in 160 (50%) of 317 children studied by the rapid indirect immunofluorescence, virus culture and/or serological techniques. Aetiological agents were detected in 71% of children with bronchiolitis, 57% with pneumonia, 53% with bronchitis, 40% with laryngotracheitis (croup), and 45% with upper respiratory tract illness. Respiratory syncytial virus was the most frequently identified virus, confirming the importance of this virus as a cause of respiratory illness requiring hospitalisation of young children in Christchurch. An epidemic due to influenza A/Dunedin/7/83 (HINI) and A/New Caledonia/4/83 (HINI) viruses occurred during the study period.

Bronchiolitis, Viral↗

PubMed1985

Quantitative deposition of ultrafine stable particles in the human respiratory tract.

Theoretical models of particle deposition in the respiratory tract predict high fractional deposition for particles of less than 0.1 micron, but there are few confirming experimental data for those predictions. We have measured the deposition fraction of a nonhygroscopic aerosol in the human respiratory tract. The aerosol had a count mean diameter of 0.044 micron SD of 1.93, as measured with an electrical aerosol analyzer, and was produced from a 0.01% solution of bis(2-ethylhexyl) sebacate using a condensation generator. Subjects inhaled the aerosol using a controlled respiratory pattern of 1 liter tidal volume, 12/min. Deposition was calculated as the difference in concentration between inhaled and exhaled aerosol of five size fractions corrected for system deposition and dead-space constants. Three deposition studies were done on each of five normal male volunteers. Means (+/- SE) for the five size fractions were 0.024 micron, 0.71 +/- 0.06; 0.043 micron, 0.62 +/- 0.06; 0.075 micron, 0.53 +/- 0.05; 0.13 micron, 0.44 +/- 0.04; and 0.24 micron, 0.37 +/- 0.06. These data demonstrate that deposition of inhaled particles in the 0.024- to 0.24-micron size range is high and increases with decreasing size. These observations agree with and validate predictions of mathematical models.

Adult↗

PubMed2005

Use of antimicrobial agents for upper respiratory tract infections in Taiwanese children.

Upper respiratory tract infections (URTIs) are mostly caused by viruses. Antibiotic misuse for viral URTIs in children is a serious problem that not only results in selection of resistant strains of bacteria but also wastes millions of dollars each year in Taiwan. Antibiotic resistance among common respiratory bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis has become a major issue for public health. The common cold, acute pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, influenza and acute epiglottitis are the most frequently encountered acute URTIs in out-patient clinics. This article recommends the judicious use of antimicrobial agents for these seven common pediatric URTIs, based on local epidemiological data and the recommendations of the Infectious Disease Society of Taiwan and the American Academy of Pediatrics. With education and behavior modification, practitioners will help to reduce antibiotic overuse, and the goal of reducing antimicrobial resistance may be accomplished.

Acute Disease↗

PubMed1999

[Antibiotics in bacterial acute respiratory tract infection in children].

The data on changes in the susceptibility of the most frequent respiratory tract pathogens i.e. Pneumococcus spp. and Haemophilus influenzae within the last 15 years and Streptococcus spp., Staphylococcus spp. and Moraxella spp. at the present time as well as recommendations based on the original and some literature data on the choice of the antibacterial drugs for the initial treatment of bacterial complications of acute respiratory tract viral infections such as otitis, sinusitis and pharyngitis are presented. The necessity of decreasing the unjustified use of antibiotics in cases of uncomplicated acute respiratory tract viral infections is indicated.

Acute Disease↗

PubMedDate not supplied

Bacterial colonization of the upper respiratory tract of patients with primary lung cancer and nonmalignant lung disease.

We examined the bacterial colonization of the upper respiratory tract of 110 patients with primary lung cancer (PLC), 75 patients with nonmalignant lung diseases (NMLD) and 45 healthy volunteers (HV), comparing the sensitivity of expectorated sputum, and throat and nasal swabs. The frequency of bacterial colonization of the upper respiratory tract was significantly higher in the PLC patients (59.1%) than in NMLD patients (37.3%, p < 0.01) and HV (37.8%, p < 0.01). The frequency of gram-negative colonization was significantly higher in PLC patients than in the other subjects (p < 0.01). Expectorated sputum and nasal swab were the most sensitive for detection of whole bacteria and methicillin-resistant Staphylococcus aureus in the patients with PLC. Our results showed that PLC patients are significantly more frequently colonized by bacteria in their upper respiratory tracts and that a combination culture of expectorated sputum and nasal swab is suitable to estimate the bacterial colonization of the upper respiratory tract in the patients.

Adult↗

PubMed1989

Inhibitory substances produced by Streptococcus salivarius and colonization of the upper respiratory tract with group A streptococci.

It has been proposed that inhibitory substances produced by viridans streptococci colonizing the upper respiratory tract aid in eradication of established group A streptococcal colonization of that site. We studied the prevalence of inhibitory-substance producing strains of Streptococcus salivarius in throat cultures from three groups of children: 16 children with persistently positive throat cultures for group A streptococci despite receiving recommended therapeutic courses of antibiotics (group I), 26 children from whom group A streptococci were eradicated from the upper respiratory tract by antibiotic therapy (group II), and 18 children who never harboured group A streptococci in their upper respiratory tract during the study period (group III). An in vitro deferred antagonism method was employed to detect inhibitory substances; 5233 strains of S. salivarius were examined. Strains of S. salivarius producing inhibitory substances were isolated from 76-88% of the children in each group on at least one occasion. However, only a small percentage of subjects in each group harboured strains producing these substances in every throat culture. The mean total percentage of S. salivarius strains producing inhibitory substances was 21.8% in children in group I, 22.4% in children in group II, and 16.4% in children in group III; these percentages were not statistically different (P greater than 0.1). In this study, we could not confirm a significant role for inhibitory substances produced by S. salivarius in the eradication of group A streptococci from the upper respiratory tract of colonized individuals.

Adolescent↗

PubMed2001

Respiratory syncytial virus infection of the lower respiratory tract: radiological findings in 108 children.

For years the typical appearance of respiratory syncytial virus (RSV)-induced infection of the lower respiratory tract has been discussed. All available studies have led to different results. The aim of this study was to control these results, with 108 children. The age range was 1 day to 10 years (median 7 months). Within 72 h of admission, all children developed an RSV infection of the lower respiratory tract. Chest X-rays (pa-view) of 55 children under, and 53 children over, the age of 6 months (10/53>24 months) were evaluated. The diagnosis of RSV and the chest X-ray were mostly done on the same day. The major radiological findings of the two age-groups were compared by Wilcoxon's unpaired rank sum test. Major radiological findings were: normal chest X-ray (30%), central pneumonia (32%) or peribronchitis (26%). There was no statistical significance between the age-groups. Other findings were emphysema (11%), pleural effusion (6%), lobar- or broncho-pneumonia (each 6%), atelectasis (5%) or pneumothorax in one case. Therefore, the most common radiological findings in RSV-induced infection of the lower respiratory tract, supported by our results (RSV infection without bacterial superinfection) are central pneumonia, peribronchitis or normal chest X-ray. Thus an age-group separation into under or over 6 months is no longer necessary.

Bronchitis↗

PubMed1998

[The clinical diagnostic significance on detection of Mycoplasma pneumoniae antigen in upper respiratory tract epithelium].

OBJECTIVE: To investigate the early diagnosis of pulmonary mycoplasma pneumoniae (MP) infection by detection of MP antigen in upper respiratory tract epithelium. METHOD: A prospective study on respiratory MP infection was conducted in 110 patients with acute respiratory infection from February 1996 to November 1997 in our hospital. Upper respiratory tract epithelia were collected from gargle and MP antigen was detected by immunofluorescent assay (IFA). At the same time, serum samples were taken and immunoglobulin M (IgM) fractions of specific antibody to MP were assessed by the same method in 70 of 110 patients. Moreover, clinical features, cold agglutination test and chest X-ray were also collected for analysis. RESULT: The positive rates of MP antigens and IgM antibody were 17% and 20%, respectively, while the titer on cold agglutination test > 1:8 in only two patients. The clinical features in patients with positive MP antigen and/or IgM antibody were similar to that of pulmonary MP infection. CONCLUSION: Examination of MP antigen in upper respiratory tract epithelium collected from gargle combined with serum specific IgM antibody is a good method for the early diagnosis of pulmonary MP infection.

Adolescent↗

PubMed1982

Outcome of acute lower respiratory tract infection in infants: preliminary report of seven-year follow-up study.

Seven years after admission to hospital for acute lower respiratory tract infection in infancy 200 children and their matched controls were assessed for respiratory state and epidemiological characteristics. The index group comprised 100 cases where respiratory syncytial virus infection had been responsible for the index illness (group 1) and 100 cases in whom this organism had not been found (group 2). There were no differences between index and control groups in birth weight or gestational age but fewer index cases were breast fed. Social indices such as class distribution and family size were more favourable in controls, though housing standards and maternal smoking habits were similar in the two groups. The prevalence of subsequent respiratory symptoms--cough, wheeze, nasal discharge, and hearing difficulties--was greater in index cases as was absence from school and family doctor consultation for respiratory illness. Bronchitis and asthma were significantly more common in the index group. Impaired ventilatory function and bronchial hyperreactivity were found in index cases when compared with controls. No differences in clinical characteristics and outcome were found in the two groups of index cases. The question whether lung "damage" during lower respiratory tract infection predisposes to subsequent respiratory problems or whether certain infants are more vulnerable than others to respiratory illnesses (including lower respiratory tract infection) from the onset is unanswered.

Acute Disease↗