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PubMed2006

An investigation into the role of Chlamydophila spp. in bovine upper respiratory tract disease.

An outbreak of upper respiratory tract disease was investigated in a group of 17 housed home-bred calves on a mixed dairy, beef and sheep farm in Devon. Conjunctival swabs were collected and tested for Chlamydophila spp. DNA using a PCR test that detects Chlamydophila abortus and Chlamydophila psittaci. Six of the calves tested gave a positive result. Further epidemiological observations and laboratory testing indicated that the adult dairy cows, from which the affected calves originated, were the most likely source of infection.

Animals↗

PubMed2002

Viral etiology of frequently recurring respiratory tract infections in children.

The viral etiology of frequently recurring respiratory tract infection (FRRI) in children aged <2 years was studied. Altogether, 329 children were followed from 2 to 24 months of age in the Finnish Otitis Media Cohort Study. Children with FRRI were defined as having > or =9 episodes of upper respiratory tract infection (URI) and/or > or =4 episodes of acute otitis media during follow-up. Nasopharyngeal aspirates, middle ear fluid specimens, and serum samples were analyzed for 8 common respiratory viruses. Of 1358 URI episodes, 642 (47%) occurred in the 78 children with FRRI. At least 1 virus was associated with 62% of these episodes, whereas the corresponding figure for children without FRRIs was 54%. The frequency of different viruses was similar in both groups, but the relative proportion of rhinovirus infections was slightly higher among children with FRRI. In conclusion, a specific viral etiology does not explain the excess of URI episodes in children with FRRI.

Child, Preschool↗

PubMed2001

Prevalence of Chlamydia pneumoniae in acute respiratory tract infection and detection of anti-Chlamydia pneumoniae-specific IgE in Japanese children with reactive airway disease.

We examined the prevalence of Chlamydia pneumoniae in acute respiratory tract infection and association of C. pneumoniae infection and reactive airway disease in Japanese children. Four hundred eleven children with acute respiratory tract infection were enrolled in this study, and C. pneumoniae was isolated from 58 (14.1%) patients by culture. Evidence of infection with C. pneumoniae was detected in 58 children with pneumonia (34.5%), bronchitis (41.4%) and upper respiratory tract infection (24.1%). Twenty-nine (50.0%) out of 58 patients were younger than 5 years old and 18 (31.0%) had wheezing at first visit. A logistic test for anti-C. pneumoniae-specific IgE showed the deference in the fluorescence unit between the patients with C. pneumoniae infection with and without wheezing was statistically significant (Po = 0.02748, to = 2.31891). In conclusion, C. pneumoniae seems to be an important respiratory tract pathogen among young Japanese children, and our results support the association of C. pneumoniae infection and reactive airway disease.

Acute Disease↗

PubMed1997

Empiric therapy in lower respiratory tract infection--an ongoing challenge.

Lower respiratory tract infections are a common cause of morbidity and mortality. The pattern of pneumonia is altering, owing to changes in a number of influencing factors. These include patient characteristics, such as an aging population, increased immunosuppression and chronic disease, and changes in medical practice. There is also an increasing level of resistance to antimicrobial agents by organisms such as Streptococcus pneumoniae and Haemophilus influenzae, the pathogens most commonly associated with community-acquired pneumonia. In the management of pneumonia, it is important to be able to differentiate between atypical and typical pneumonia in the clinical setting and to grade the severity of the infection. Currently, there are no internationally agreed treatment recommendations for pneumonia. The role of antimicrobial agents in acute exacerbations of chronic bronchitis is still a controversial issue.

Humans↗

PubMed1986

[Serum and sputum levels of cefotetan used in respiratory tract infections].

In 5 patients with respiratory tract infections, concentrations of cefotetan (CTT) in serum and sputum after 1 hour intravenous administration of 2 g of CTT to each patient were investigated, and following results were obtained. Serum levels of CTT The mean peak level of CTT was 232.0 +/- 16.2 micrograms/ml immediately after the 1 hour drip infusion, then declined gradually and was 48.0 +/- 8.8 micrograms/ml after 6 hours. Sputum levels of CTT Mean sputum levels of CTT were 2.15 +/- 0.19 micrograms/ml from 2 to 4 hours after the administration and 2.19 +/- 0.18 micrograms/ml from 4 to 6 hours. Clinical evaluation of CTT Clinical effects were excellent in 1 case, good in 3 cases and poor in 1 case. No side effects were observed.

Adult↗

PubMed1993

Relevance of antibiotic tissue penetration in treating respiratory tract infections.

The majority of bacterial respiratory tract infections are caused by streptococci, Haemophilus spp. and Moraxella catarrhalis. These pathogens are located extracellularly. In logical consequence, the bactericidal action of the antimicrobial is required in these loci. To define the reasonable dosing regimen for effective eradication without creating unnecessary toxic potential we need to know (1) the distribution principles and kinetics, and (2) the correct correlation between concentration profiles in extracellular fluid (ECF) and blood. According to the permeability of the vascular capillaries unbound drug concentrations in plasma and ECF are in a dynamic equilibrium. Thus, for the beta-lactam antibiotics therapeutic efficacy is predictable by maintaining the free drug concentration above the bacterial minimum inhibitory concentration. Tissue homogenate data can only be useful if correctly interpreted by correcting for the partitioning between the tissue components.

Animals↗

PubMed1986

[Clinical evaluation of cefoperazone in lower respiratory tract infections].

Clinical evaluation and kinetics in serum of cefoperazone (CPZ) in patients with lower respiratory tract infections have been conducted as a multicenter trial participated by 20 institutions in Kyushu area during a period of 8 months from October 1984 to May 1985. Mean serum CPZ levels up to 4 hours following the end of intravenous infusion of either 1 or 2 g CPZ remained higher than the MIC80 of CPZ against major causative organisms of lower respiratory tract infections such as H. influenzae, P. aeruginosa, K. pneumoniae, and S. pneumoniae. Serum half-lives of CPZ following intravenous infusion were prolonged in the elderly and in patients who showed moderate liver or kidney dysfunction, but did not exceed twofold of normal value. Clinical efficacy rates of CPZ were 82.9% (34/41) against pneumonia, 80% (4/5) against lung abscess, 88.9% (32/36) against acute exacerbation of chronic bronchitis, 66.7% (2/3) against panbronchiolitis, 100% (1/1) against acute bronchitis, and 85.7% (12/14), 64.3% (9/14) and 70.0% (7/10) against infections concurrent to chronic respiratory diseases, pulmonary emphysema and bronchiectasis, respectively. The overall efficacy rate was 81.5% (101/124). Bacteriological eradication rates against P. aeruginosa, H. influenzae and S. pneumoniae were 60% (6/10), 88.9% (8/9) and 100% (3/3), respectively. The overall eradication rate including polymicrobial infection was 67.5% (27/40). The clinical efficacy rate of CPZ in patients with underlying diseases such as lung cancer, pulmonary tuberculosis, and pneumoconiosis, etc. was not significantly different from the efficacy rate in patients without these underlying diseases. Of 20 patients who failed to respond to previous antibiotic treatments, 13 were effectively treated by CPZ. Adverse reactions occurred in 6.7% (11/164) of the patients, and consisted primarily of rash, fever, diarrhea and loose stool. Laboratory abnormalities were seen in 5 patients during the study. These included elevations of S-GOT and S-GPT, eosinophilia and neutropenia. CPZ is a very useful drug in the treatment of lower respiratory tract infections because of its excellent clinical efficacy and rare incidence of abnormal accumulations in sera following the recommended 2-4 g/day administration even in the elderly.

Adult↗

PubMed2000

Upper respiratory tract infections in adolescents.

While upper respiratory tract infections (URTIs) cause much infectious morbidity in infants and young children, adolescents are not immune to infections. Adolescents experience two to four episodes of viral nasopharyngitis annually. In addition to group A streptococcus (GAS), pharyngitis may occur with other streptococci, Arcanobacterium haemolyticum, Epstein-Barr virus, Neisseria gonorrhoeae, and other pathogens. Uvulits, typically in association with GAS, occurs occasionally. Peritonsillar abscess is the most common deep neck space infection seen in adolescents, but retropharyngeal and parapharyngeal abscesses also occur, causing major morbidity. Adolescents experience fewer cases of otitis media than younger children. Rhinosinusitis occurs commonly in adolescents, occasionally leading to chronic sinusitis and serious sequelae such as osteomyelitis. This article reviews the major URTIs likely to be encountered by physicians caring for adolescents. For each entity there is a brief description of the epidemiology, morbidity, microbiology, clinical and laboratory features, treatment, and prevention.

Abscess↗

PubMed1983

Tissue damage and nutritional factors in experimental respiratory tract (Co-)carcinogenesis.

Cofactors involved in respiratory tract carcinogenesis were studied in Syrian golden hamsters or in rats using benzo(a)pyrene as the carcinogenic agent. These factors included severe tissue damage induced by electro-coagulation, glass fibers administered by intratracheal instillation, acetaldehyde as irritant vapor, food restriction, and nutrients such as vitamin A and saturated and unsaturated fats. In addition, the effects of a combined exposure to four different major gaseous cigarette smoke components--methyl nitrate, isoprene, methyl chloride and acetaldehyde--and to one solid cigarette smoke component--norharman--were examined in short- and long-term inhalation studies. An interesting finding was the carcinogenicity of acetaldehyde, of which the possible mechanism is briefly discussed. Another conspicuous observation was the substantial increase in number and size of lipid droplets in alveolar fibroblasts of hamsters fed a high vitamin A diet.

Acetaldehyde↗

PubMed1989

Cefixime versus amoxicillin/clavulanic acid in lower respiratory tract infections.

Sixty patients with lower respiratory tract infections, mainly acute bronchitis were treated for 14 days with either cefixime 200 mg twice daily (plus placebo once daily) or amoxicillin/clavulanic acid 500 mg/125 mg thrice daily in a double-blind manner. The sputum cultures indicated that all isolated pathogens (notably Hemophilus species, S. pneumoniae and B. catarrhalis, including the beta-lactamase producing species) were sensitive to cefixime, with the exception of Pseudomonas species. The bacteriological eradication rates were 54% and 52% for cefixime and amoxicillin/clavulanic acid, respectively. The positive clinical response (cured or improved) was 71% for the cefixime treated group and 74% in the amoxicillin/clavulanic acid group. There were no side effects and no significant adverse laboratory changes in both groups. The results indicate that cefixime twice daily is comparable in safety and efficacy with amoxicillin/clavulanic acid, thrice daily in acute bronchitis.

Adult↗

PubMed2004

Cough induced by airway vibration as a model of airway hyperreactivity in patients with acute upper respiratory tract infection.

Patients with acute upper respiratory tract infection (URTI) have been shown to be hyperreactive to inhaled tussigens such as citric acid and capsaicin, and the authors propose that this may be due to an increased sensitivity of airway receptors that mediate cough. In recent studies we have demonstrated that cough may be induced by vibration of the airway at the level of the throat or chest in patients with URTI but that the same stimuli induce little or no cough in healthy subjects. The difference between the patients with URTI and healthy subjects in their response to airway vibration may be explained on the basis of hyperreactivity of airway sensory receptors. We propose that the model of cough induced by airway vibration may be useful for studies on the pathophysiology and pharmacology of airway hyperreactivity in acute cough. The airway vibration model of cough may have some advantages over inhaled tussigens as the stimulus is easily controlled and the method is safe for use in children.

Acute Disease↗

PubMed1995

Antibiotic use in upper respiratory tract infections in New Zealand.

Upper respiratory tract infections (URTIs) are a common reason for presentation to general practitioners. The current study used computerised consultation records of 100,222 patients from 17 general practices in New Zealand for the 12-month period 1 July 1991-30 June 1992. URTIs were noted in 8.9% of all consultations: 44.1% of cases were children aged less than 10 years. Females presented more frequently than males for all ages above five years. Fifteen different antibiotics were prescribed for URTIs, but in 22.5% of cases no antibiotic was prescribed. There was no statistically significant difference in the likelihood of a successful outcome with or without antibiotic therapy (chi 2 = 0.76, P > 0.05). The treatment failure profile of some antibiotics highlights the need for more prescriber education, especially as the range of medications available for general practitioner prescribing increases.

Adolescent↗

PubMed1993

Ecology of Haemophilus influenzae and Haemophilus parainfluenzae in sputum and saliva and effects of antibiotics on their distribution in patients with lower respiratory tract infections.

Nine patients with lower respiratory tract infections were used to study in detail the effect of ampicillin or erythromycin on the colonization patterns of Haemophilus influenzae and Haemophilus parainfluenzae in sputum and saliva. H. influenzae was isolated from purulent sputum of eight patients before the start of treatment. Ampicillin was more effective than erythromycin at clearing H. influenzae from sputum and in decreasing purulence. By careful characterization of multiple strains, the changes in biotype distribution and antibiotic susceptibility patterns were shown. Five biotypes of H. influenzae were associated with chest infection, with type II predominating. Mixed biotype infections occurred in five patients. Most saliva contained multiple biotypes of H. parainfluenzae. Neither antibiotic selected resistant haemophili in saliva or sputum. After treatment with ampicillin, the mucoid sputum was colonized with ampicillin-susceptible H. parainfluenzae biotypes previously found in saliva. We postulate that as inflammation decreases at the bronchial mucosa, the ampicillin concentration drops, allowing ampicillin-susceptible oral H. parainfluenzae isolates to seed the residual mucoid sputum.

Ampicillin↗

PubMed1993

Sarcomatoid neoplasms of the respiratory tract.

Sarcomatoid carcinomas (SCAs) of the respiratory tract are uncommon neoplasms of adults, most of whom are men in late middle-age who have a long history of tobacco usage. These tumors may be observed in the paranasal sinuses, nose, naso-oropharynx, larynx, trachea, central bronchi, or peripheral lung parenchyma. They may assume a polypoid configuration, with projection into luminal spaces, or show an infiltrative growth pattern like that of typical high-grade carcinoma. Histologically, both biphasic and monophasic variants of SCAs are recognized. The former include tumors with foci of overt carcinoma admixed with areas of divergent differentiation into "committed" mesenchymal tissues, such lesions have usually been termed "carcinosarcomas" in the past. On the other hand, monophasic SCAs lack obviously epithelial foci on light microscopy. Ultrastructural and immunohistological studies support the notion that SCA represents a continuum that embraces carcinosarcomas and spindle-cell carcinomas, all of which are basically epithelial neoplasms. Tumor behavior is site-dependent; SCAs of the nose, sinuses, pharynx, and lungs usually pursue an aggressive course, whereas histologically similar lesions in the larynx are usually found at an earlier stage and, therefore, are associated with a better prognosis.

Carcinosarcoma↗

PubMed1977

Penetration of inhaled pollen into the respiratory tract.

The pathophysiologic mechanisms of pollen-induced asthma have heretofore remained unclear, because pollen particles have generally been considered too large to penetrate into the lower respiratory tract. Such grains are therefore believed to be unable to induce an immunologic response in the lower respiratory tract. Nevertheless, experimental curves of particle penetration into the respiratory tract indicate that a small percentage of large-sized particles may penetrate into the peripheral areas of the lungs. Under the conditions of our study, a radioisotopic method using labeled pollen grains was not effective in detecting the very small number of grains expected to be found in the lung. We used another simpler and more effective method derived from techniques used by palynologists in the detection of pollen grains in sediments. According to our results, which showed pollen grains normally present in tracheobronchial secretions and in lung parenchyma, we can safely assume that inhaled pollen does penetrate into the distal lower respiratory tract. At present, we do not know the precise number of pollen grains necessary to trigger a response, and we do not know the behavior of these grains with regard to the mucous membranes of the small bronchi and the alveoli. It is important to determine whether these grains have an effect on these areas and whether a direct mechanism is involved in the genesis of pollen-induced asthma.

Aged↗

PubMed1984

Use of clindamycin in lower respiratory tract infections.

The majority of lower respiratory tract infections (LRTI) are treated "blindly" because the establishment of an aetiological diagnosis is not possible in most cases. The rational choice of therapy mainly rests upon the knowledge of the microbiological epidemiology of LRTI, and on the possible host-parasite relationship. In community-acquired pneumonia, there is general concensus that penicillin maintains its position as the first drug of choice, and that therapy can be changed to erythromycin or tetracycline in cases of therapeutic failure. Treatment of nosocomial pneumonia, and LRTI in immunocompromised patients, calls for antibiotics with a broader antimicrobial spectrum. Clindamycin has an antimicrobial spectrum which makes this antibiotic a possible alternative in community-acquired pneumonia, and its efficacy in pneumococcal pneumonia has been documented. However, as first choice therapy it should be reserved for cases of penicillin allergy, or cases of strongly suspected staphylococcal pneumonia. In aspiration pneumonia--nearly always caused by anaerobic bacteria--penicillin has long been the preferred therapy, even in cases with Bacteroides fragilis. However, recent publications have clearly documented that in primary lung abscess, clindamycin is superior to penicillin. These results are especially important since metronidazole has been shown to be less effective in such cases.

Anti-Bacterial Agents↗

PubMed1977

[Vibravenös in infections of the biliary and respiratory tracts (author's transl)].

The clinical results of a European Vibravenös multicentre trial are reported as far as 227 patients with infections of the biliary tract and 185 patients with infections of the respiratory tract--mainly pneumonia--are concerned. In 203 of the 227 cases with biliary tract infections (=90%) and in 142 of the 185 cases with respiratory tract infections (=77%) the overall clinical result was good or very good. Toleration of Vibravenös was usually very good, only 4 patients had to be withdrawn from the trial because of side effects: in 3 cases an allergic skin reaction or pruritus occurred and in 1 patient local phlebitis developed at the injection site. Bacteriological tests performed on 71 patients showed that after broad usage doxycycline has an excellent antibacterial activity.

Adult↗

PubMed2001

Airflow limitation during respiratory syncytial virus lower respiratory tract infection predicts recurrent wheezing.

BACKGROUND: Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is frequently followed by recurrent wheezing. Thus far no clinical risk factors have been identified to predict which infants will have wheezing episodes subsequent to RSV LRTI. OBJECTIVE: To determine clinical predictors for airway morbidity after RSV LRTI. METHODS: In a 1-year follow-up study we investigated the predictive value of auscultatory findings characteristic of airflow limitation (wheezing) during RSV LRTI for subsequent airway morbidity. Clinical characteristics, including the presence or absence of signs of airflow limitation, of hospitalized infants with RSV LRTI were prospectively recorded during 2 winter epidemics. During a 1-year follow-up period parents of 130 infants recorded daily airway symptoms. OUTCOME MEASURE: Recurrent wheezing defined as > or = 2 episodes of wheezing. RESULTS: Signs of airflow limitation during RSV LRTI were absent in 47 (36%) infants and present in 83 (64%) infants. Recurrent wheezing was recorded in 10 (21%) infants without signs of airflow limitation and in 51 (61%) with signs of airflow limitation during initial RSV LRTI (relative risk, 0.29, P < 0.001). In a multiple logistic regression model, airflow limitation during initial RSV LRTI proved independent from other clinical parameters, including age, parental history of asthma and smoke exposure. CONCLUSIONS: A sign of airflow limitation during RSV LRTI is the first useful clinical predictor for subsequent recurrent wheezing.

Auscultation↗