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Molecular genetic methods in the diagnosis of lower respiratory tract infections.

Molecular diagnostic techniques, such as PCR, have become useful tools for the rapid etiological diagnosis of lower respiratory tract infections. Nucleic acid amplification tests (NAATs) have been evaluated for detecting most respiratory pathogens, and commercial assays are available for some pathogens. However, standardized protocols are needed before these assays are introduced into routine diagnostic use. For pneumonia, NAATs offer advantages over conventional tests for the detection of Mycoplasma pneumoniae, Legionella spp. and Chlamydia pneumoniae. For pneumococcal pneumonia in adults, PCR adds little to existing diagnostic tests, and is unable to distinguish pneumococcal colonization from infection when testing respiratory samples. Although less sensitive than culture-based methods, several commercial molecular diagnostic assays have been developed for tuberculosis and are useful rapid tests for selected patients. PCR can now be considered the rapid diagnostic test of choice for pertussis and some respiratory virus infections. Further work is required to better characterize the role of molecular diagnostic tests for diagnosing lower respiratory tract infections, and to develop standard assays that can be readily adopted by routine diagnostic laboratories.

Bacterial Infections↗

Benzo[a]pyrene-induced respiratory tract cancer in hamsters fed a diet rich in beta-carotene. A histomorphological study.

The effect of a high dietary level of beta-carotene on the formation of preneoplastic and neoplastic respiratory tract lesions was studied in hamsters intratracheally treated with benzo[a]pyrene (B[a]P) attached to ferric oxide (Fe2O3) and suspended in saline. In addition to conventional histopathological examinations, the expression of cytokeratins and the glutathione S-transferase isoenzyme Pi (GST-Pi) was determined in tracheal epithelium using immunocytochemical techniques. B[a]P treatment increased the expression of cytokeratins in tracheal mucous and ciliated epithelial cells as detected by antibody RCK102 (cytokeratins 5 and 8), which normally recognizes basal cells only. The expression of cytokeratins in mucous and ciliated cells as detected by antibody RGE53 (cytokeratin 18) was decreased by B[a]P treatment. Furthermore, the expression of the cytokeratin detected by antibody RKSE60 (cytokeratin 10), characteristic of metaplastic squamous cells, and the expression of the GST-Pi, characteristic of metaplastic changes, was increased in trachael epithelium of hamsters treated with B[a]P. There was no evidence for dietary beta-carotene affecting the expression of cytokeratins or GST-Pi. The incidence of preneoplastic changes and tumors of the respiratory tract was not reduced by dietary beta-carotene. On the contrary, the tumor response of the respiratory epithelium was almost twice as high in hamsters fed the high beta-carotene diet than in hamsters on the low beta-carotene diet. However, this difference was not statistically significant (P = 0.15); hence, the present study did not produce evidence for a clear effect of beta-carotene on B[a]P-induced respiratory tract cancer in hamsters.

Animals↗

[Burns of the respiratory tract].

The authors observed 167 cases with thermal burns of the respiratory tract and body integument. According to the authors' data the mortality among these cases reaches 72.4%. The treatment of such patients should be a complex one. The authors prefer the microtracheostomy and consider this operation to be a compulsory one for the most of the burned with the second degree burns of the respiratory tract.

Body Surface Area↗

[Treatment of inflammatory diseases of the upper respiratory tract -- comparison of a homeopathic complex remedy with xylometazoline].

INTRODUCTION: The primary objective of treatment of inflammatory diseases of the upper respiratory tract (rhinitis, uncomplicated sinusitis) with local decongestants is to relieve obstruction and to improve associated symptoms. Restoration of unrestricted respiration and drainage of the nasal sinuses reduce the risk of further complications (i.e. chronicity). OBJECTIVE: To determine whether the therapeutic effects of the homeopathic complex remedy Euphorbium compositum nasal drops SN are comparable to those of xylometazoline with respect to efficacy and tolerability. METHODS: Open, multicenter, prospective, active-controlled cohort study in patients with inflammatory processes and diseases of the upper respiratory tract. The primary outcome was to demonstrate non-inferiority of the homeopathic complex remedy to xylometazoline. RESULTS: Clinically relevant reductions in the intensities of disease-specific symptoms were observed with both therapies. Non-inferiority of the homeopathic complex remedy to xylometazoline could be shown for all studied variables and in no case did the lower boundary of the 95% confidence interval cross the threshold of 0.5 score points. Tolerability was good with for both therapies. CONCLUSIONS: This cohort study indicates a comparable efficacy and tolerability profile of the homeopathic complex remedy Euphorbium compositum nasal drops SN and the reference substance xylometazoline in patients with inflammatory processes and diseases of the upper respiratory tract.

Adult↗

Spiramycin concentrations in the human respiratory tract: a review.

Spiramycin has exceptionally good distribution properties, especially in respiratory tract tissues and fluids. Three hours after a single oral dose of 3 g spiramycin, the serum concentration ranged from 1.6 to 2.8 mg/l and the reported half-life was approximately 8 h. Studies of lung tissue concentrations showed that high pulmonary levels were achieved after a loading dose of 3 g; the levels were higher after multiple doses and reached approximately 30 to 45 mg/kg in lung tissue and 6.5 to 36 mg/kg in bronchial mucosa; in bronchial secretions and in sputum the concentrations of spiramycin ranged from 1.5 to 7.3 mg/l (after 1 g, multiple doses). In upper respiratory tract tissues and fluids, high levels of spiramycin were reached as well: 8 to 13 mg/kg in sinus mucosa; 15 to 29.5 mg/kg in tonsils or adenoids.

Animals↗

Insensible water loss from the respiratory tract in patients with fever.

The evaporative water loss from the respiratory tract was studied in 29 patients suffering from elevated body temperature due to disease. The method used was based on a fast acting aspiration psychrometer and an ultrasonic sensing flowmeter. A heating device was connected to the system so that no condensation could occur before the gases reached the site where the water vapour content and the minute volume were registered. It was shown that the minute volume was significantly increased when the patients temperature rose above 39 degrees C. The increase was 1.0 1.m-2 (25%). Consequently, the evaporative water loss from the respiratory tract rose 4.6 g.h-1 for a person with a body temperature above 39 degrees C and 1.75 m2 body surface. However, in clinical practice when replacing the increased water loss during high fever, the dermal loss which can amount to 500-1 000 g.24 h-1 due to sweating is of greater importance than the respiratory extra loss of about 110 g.24 h-1.

Adult↗

ETB but not ETA receptor-mediated contractions to endothelin-1 attenuated by respiratory tract viral infection in mouse airways.

1. The current study investigated the effects of respiratory tract viral infection on the density of ETA and ETB receptors in murine tracheal smooth muscle and on the contractile response to endothelin-1 mediated by these receptors. 2. Quantitative autoradiographic studies using [125I]-endothelin-1 revealed that tracheal smooth muscle from control mice contained ETA and ETB receptors in the ratio of 42%:58% (+/- 4%, n = 10 mice), respectively. In contrast, tracheal smooth muscle obtained from mice 2 days post-inoculation with Influenza A/PR-8/34 virus contained 23 +/- 2% fewer receptors for [125I]-endothelin-1 (n = 10, P < 0.01). This reflected a selective reduction in ETB receptor density and a change in the ratio of ETA and ETB receptors to 77%:23% (+/- 5%, n = 10 mice), respectively. 3. The ETB receptor-selective agonist, sarafotoxin S6c, was a potent spasmogen of murine isolated tracheal smooth muscle and the EC50 for contraction was similar in preparations from control (3.6 nM [95% confidence limits, 2.7-4.8 nM], n = 16 preparations from 8 mice) and virus-inoculated mice (3.0 nM [2.4-3.7 nM], n = 16 preparations from 8 mice). However, the maximum contractions induced by sarafotoxin S6c (100 nM) in the preparations from virus-inoculated mice (37 +/- 5% Cmax, where 100% Cmax was the response to 10 microM carbachol) were significantly smaller than those from control mice (85 +/- 4% Cmax, P < 0.01). 4. Contractions induced by endothelin-1 in tracheal smooth muscle preparations obtained from virus inoculated mice (EC50 for contraction, 6.5 nM [95% confidence limits, 2.7-16 nM]; maximum contraction,112 +/- 5% Cm.; n = 4) were similar to those induced by endothelin-1 in control preparations (ECm9.3 nM (4.2-21); maximum contraction, 110 +/- 3% Cmax; n = 4). Endothelin-1-induced contractions in control preparations were only marginally inhibited by the ETA receptor-selective antagonist BQ-123 (in the presence of 3 micro M BQ-123; EC50 for contraction, 5.9 nM [4.1-8.5]; maximum contraction, 82 +/- 4%Cmax; n = 4). In contrast, 3 microM BQ-123 caused a 50 fold rightward shift (17-160, n =4) of the concentration-effect curve to endothlin-1 in preparations obtained from virus-inoculated mice (measured at the 30% Cmax level of contraction).5. Tracheal smooth muscle preparations exposed to 100 nM sarafotoxin S6c for 30 min (followed by a 30 min washout period) did not contract to subsequently administered sarafotoxin S6c (1-100 nM;n = 8), but contracted normally in response to endothelin-1 (EC50 6.5 nM (2.3-18); maximum contraction,109 +/- 2% Cmax; n = 4). Endothelin-l-induced contractions in these ETB receptor desensitized preparations were markedly inhibited by 3 microM BQ-123, irrespective of whether the preparations were obtained from control (63 fold shift (10-400) at the 30% Cma. level of contraction, n = 4) or virus inoculated mice (46 fold shift (18-120), n = 4).6. In summary, tracheal smooth muscle obtained from mice infected with a respiratory tract virus,Influenza A/PR-8/34 had a reduced density of ETB receptors and an attenuated ETB receptor-mediated contractile response to sarafotoxin S6c and endothelin-1. Virus-inoculation was also associated with a modest increase in tracheal smooth muscle ETA receptor density, although no significant change in ETA receptor-mediated contractile activity was seen. Thus, virus infection in murine airways produced profound alterations in endothelin receptor density, some of which were associated with changes in receptor-mediated contractile activity.

Animals↗

Cytological changes of the respiratory tract in young adults related to high levels of air pollution exposure.

Several histopathological and cytological studies have shown that lesions of the respiratory tract epithelium become increasingly severe with duration of exposure to high levels of urban air pollution as well as with ageing of studied population groups. In this study we investigated and compared findings of cytological abnormalities in sputa of young adults (21-25 years of age) exposed to high levels of air pollution since birth with those who were exposed in the last 2-3 years only. All subjects were non-smokers and were clinically healthy at the time of sampling. No significant differences in the incidence or severity of any of the cytological findings were found. The fact that even 10 times longer exposure to air pollution resulted in no major respiratory tract epithelial changes is, in our opinion, a result of the extremely efficient defence mechanisms and enormous regenerative potential of the respiratory tract of younger people.

Adult↗

Pneumococcal neuraminidases A and B both have essential roles during infection of the respiratory tract and sepsis.

We examined the role of the neuraminidases NanA and NanB in colonization and infection in the upper and lower respiratory tract by Streptococcus pneumoniae, as well as the role of these neuraminidases in the onset and development of septicemia following both intranasal and intravenous infection. We demonstrated for the first time using outbred MF1 mouse models of infection that both NanA and NanB were essential for the successful colonization and infection of the upper and lower respiratory tract, respectively, as well as pneumococcal survival in nonmucosal sites, such as the blood. Our studies have shown that in vivo a neuraminidase A mutant is cleared from the nasopharynx, trachea, and lungs within 12 h postinfection, while a neuraminidase B mutant persists but does not increase in either the nasopharynx, trachea, or lungs. We also demonstrated both neuraminidase mutants were unable to cause sepsis following intranasal infections. When administered intravenously, however, both mutants survived initially but were unable to persist in the blood beyond 48 h postinfection and were progressively cleared. The work presented here demonstrates the importance of pneumococcal neuraminidase A and for the first time neuraminidase B in the development of upper and lower respiratory tract infection and sepsis.

Animals↗

Comparative evaluation of cefpodoxime versus cefixime in children with lower respiratory tract infections.

OBJECTIVE: The emergence of penicillin and macrolide resistant strains, responsible for Acute Lower Respiratory Tract Infections in children has offered third generation cephalosporins the platform to perform. The aim of the present study was to evaluate two third generation oral cephalosporins for their empirical use in community acquired lower respiratory tract infections in pediatric patients. An assessment of the clinical cure and bacteriological eradication rates and an overall tolerability was made. METHODS: It was a prospective, open, comparative, multicentric study. 776 children (Mean age 10 years) with LRTIs were included and randomly allotted to two groups respectively. A total of 396 children were given cefpodoxime susp 5 mg/kg b.i.d. and 380 patients on cefixime 4 mg/kg b.i.d. for 10-14 days. RESULTS: At the end of therapy, the clinical success with cefpodoxime was 97% as against 86.8% with cefixime. Bacterial eradication was 93.4% with cefpodoxime and 82.9% with cefixime. CONCLUSION: Cefpodoxime has been found to be a well-tolerated and superior alternative to cefixime synergistically documenting the extended spectrum of activity.

Acute Disease↗

Procoagulant activity in respiratory tract secretions from horses with chronic pulmonary disease.

Cell-free supernatants (sol phases), obtained after centrifugation (50,000 x g for 45 minutes) of respiratory tract secretions from horses with chronic pulmonary disease, were assayed for procoagulant activity (PCA) in a one-stage clotting assay. Of the 103 specimens tested, 59% (61) contained PCA. Procoagulant activity was detected most often in respiratory tract secretions of severely affected horses and was correlated with the quantity of neutrophils in the respiratory tract secretions. In 12 of the 17 secretions tested, the clotting time was decreased in a dose-dependent manner. However, in the coagulation assay, some reversal of PCA or inhibition of coagulation was observed in 4 secretion specimens when greater volumes of sol phase were added. Procoagulant activity was characterized tentatively as tissue factor, because it was temperature stable and was inhibited by phospholipase C and by concanavalin A. Clotting was induced in factor VIII-deficient human plasma; however, with the exception of 1 respiratory secretion specimen, clotting was not enhanced in factor VII-deficient human plasma. Procoagulant activity is a useful indicator of airway inflammation.

Animals↗

Mechanisms of neutrophil-induced DNA damage in respiratory tract epithelial cells.

Reactive oxygen species (ROS) released by neutrophils have been suggested to play an important role in cancer development. Since the mechanisms underlying this effect in the respiratory tract are still unclear, we evaluated DNA damage induced by neutrophils in respiratory tract epithelial cells in vitro and in vivo. For in vitro studies, rat lung epithelial cells (RLE) were co-incubated with activated neutrophils, neutrophil-conditioned medium, or hydrogen peroxide. For in vivo studies, we considered the human nose as a target organ, comparing neutrophilic inflammation in the nasal lavage fluid with the oxidative DNA lesion 8-hydroxydeoxyguanosine (8-OHdG) in epithelial cells obtained by nasal brush. Our in vitro data show that human neutrophils are able to induce both 8-OHdG and strand breaks in DNA from RLE cells. Our data also suggest that DNA damage induced by neutrophils is inhibited when neutrophil-derived H2O2 is consumed by myeloperoxidase. In contrast, in the nose no association between neutrophil numbers and 8-OHdG was found. Therefore, it remains unclear whether neutrophils pose a direct genotoxic risk for the respiratory tract epithelium during inflammation, andmore in vivo studies are needed to elucidate the possible association between neutrophils and genotoxicity in the lung.

8-Hydroxy-2'-Deoxyguanosine↗

The current approach of the ICRP Task Group for modeling doses to respiratory tract tissues.

For radiation protection purposes, the International Commission on Radiological Protection (ICRP) Task Group proposes to apportion radiation risk within the respiratory tract according to the tumor mortality rates observed in the different anatomical regions. This approach requires that doses absorbed by extrathoracic tissues must be considered, in addition to those in the lung. For the extrathoracic region, the tissues at highest potential risk are the pharyngeal parts of the nasopharynx and oropharynx and a part of the larynx. In the lung, all tissues are potentially at risk, and it is necessary to consider doses absorbed by bronchial tissues, the lung parenchyma, and lymph nodes. This paper outlines the methods proposed by the Task Group to evaluate the heterogeneous doses absorbed by sensitive cells in these tissues from radioactive decays of alpha-emitters. The objective is to evaluate doses to broad regions of the respiratory tract, where the regions are defined to reflect substantial differences in potential risk when taking into account deposition and clearance behavior. The Task Group proposes to represent the respiratory tract by three generic regions: an extrathoracic region and two thoracic regions, one clearing fast and one slowly. The models of aerosol deposition and clearance applied for each region are outlined. To illustrate the use of the model, doses are evaluated for the key cases of short-lived radionuclides and long-lived insoluble alpha-emitters and are discussed with regard to current ICRP recommendations.

Aerosols↗

Cytology of the respiratory tract.

Information has been presented to assist veterinary practitioners in obtaining and interpreting cytology specimens from the respiratory tract. The various cytologic techniques are rapid, economical, and relatively noninvasive. Cytologic examination of the respiratory tract may provide a definitive diagnosis or information for improved case management until more complex diagnostic procedures are performed.

Animals↗

Safety and efficacy of Clarithromycin in the treatment of acute mild to moderate respiratory tract infections.

A total of 2,351 adult patients were recruited into a multi-centre open general practice study to investigate the safety and efficacy of Clarithromycin 250 mg b.d. for seven days in the management of acute mild to moderate respiratory tract infections. Overall a clinical success rate of 93.2% was seen with respect to assessment of the response of the respiratory tract infection to Clarithromycin therapy. Summary statistics are presented for each diagnosis recorded. A total of 110 (4.7%) adverse events were reported. Of these 71 (3%) were related to the gastrointestinal tract e.g. nausea, vomiting etc. The above results demonstrate that Clarithromycin in a dose of 250 mg b.d. is a well tolerated and effective therapy in the management of acute mild to moderate respiratory tract infections.

Adolescent↗

Nonvalue of sputum culture in the management of lower respiratory tract infections.

Establishment of the microbiological etiology of bacterial pneumonia by sputum culture is confounded by both lack of recovery of fastidious pathogens and contamination of specimens with oropharyngeal flora. We reviewed the clinical records from 249 patients over a 3-month period for evidence of pneumonia. Gram staining and cultures were performed on 381 specimens isolated from this population of patients. Recovery of respiratory tract pathogens was accomplished with 354 specimens from 226 patients; 27 specimens yielded normal flora in culture but were smear positive. An additional 256 specimens submitted to our microbiology laboratory did not meet smear criteria for purulence nor did they yield respiratory tract pathogens in culture. A total of 637 specimens submitted to the microbiology laboratory were evaluated for sputum purulence by the criteria of Bartlett. Of the total 354 specimens which were positive in culture for a pathogen, 182 (52%) were submitted from 150 patients with no objective evidence of pneumonia. The majority of specimens obtained from patients without pneumonia were nonpurulent. However, 71 of 182 culture-positive specimens obtained from 50 patients without pneumonia were purulent. Approximately half of these patients (31 of 50) had other pulmonary or upper respiratory tract pathology which could account for the sputum purulence. Among the 172 culture-positive specimens from 76 patients with pneumonia, only 100 (58%) were acceptable by smear criteria. An additional 23 patients provided expectorated purulent sputum from which no respiratory tract pathogen could be isolated. Of these 23, 7 had pneumonia. We conclude that sputum culture and Gram staining are neither specific nor sensitive as diagnostic tools. Objective criteria for purulence of Gram-stained specimens must be applied before their inoculation into culture media. Specimens should be sought only from patients with objective evidence of pneumonia.

Bacteria↗

[Clinical and bacteriological effects of cefetamet pivoxil against community-acquired respiratory tract infections].

We investigated clinical and bacteriological effects of cefetamet pivoxil (CEMT-PI) in community-acquired respiratory tract infections and obtained the following findings. 1. Of the 420 respiratory tract infection cases that were treated with CEMT-PI according to a same protocol at a total of 42 institutions in Tokyo, Kanagawa-ken, Saitama-ken and Chiba-ken from February to the beginning of April 1994, 359 cases in which clinical evaluations were considered possible were selected as the subjects of the clinical study. Regarding genders of patients, slightly more females (56.3%) than males were included. Diagnoses given to these patients included laryngopharygealitis (60.7%), tonsillitis (14.2%) and acute bronchitis (13.6). Outpatients accounted for 94.4% of the subjects. 2. For the bacteriological study, a written material describing the method of collecting specimens, storage and transport in detail was distributed to the above mentioned institutions. The isolation and identification of suspected causative bacteria, determination of minimum inhibitory concentrations (MIC) and investigation of beta-lactamase production were conducted all together. Suspected causative bacteria were detected from 238 (66.3%) out of the 359 cases. They included 85 strains of Haemophilus influenzae, 76 strains of Streptococcus pneumoniae, 20 strains of Streptococcus pyogenes and 17 strains of Moraxella subgenus Branhamella catarrhalis. 3. Clinical efficacy rates (the ratio of those excellent+good) among those who were treated with 1 CEMT-PI tablet (194 mg, titer) twice a day was 76.5% and among those who were given 2 tablets twice a day was 87.4%. The improvement rate of the latter was higher at a significant level of P < 0.05. 4. The clinical efficacies classified by suspected causative bacteria (single bacterium) were 93.3% against M.(B.) catarrhalis, 91.7% against beta-streptococci, 87.1% against H. influenzae and 78.4% against S. pneumoniae, etc. Though 7 (9.2%) of the 76 strains of S. pneumoniae were benzylpenicillin (PCG)-insensitive S. pneumoniae (PISP), the bacteriological efficacy was assessed either excellent or good in all of the 7 patients from whom PISP were detected. The clinical efficacy was assessed 100.0% in those from which a plural number of bacteria were detected. The 13 cases from which small numbers of Staphylococcus aureus was detected with other bacterium were also included in these cases.

Administration, Oral↗

[Acute respiratory tract infections due to a human metapneumovirus in children: descriptive study and comparison with respiratory syncytial virus infections].

BACKGROUND: A new paramyxovirus, the human metapneumovirus was recently isolated. We report the first French cases collected between 2000 and 2002. MATERIAL AND METHODS: Samples were obtained from nasopharyngeal aspirates from children hospitalised for acute respiratory tract infection in hospitals of Caen and Flers in Basse-Normandie. Human metapneumovirus was studied by polymerase chain reaction on negative samples for respiratory syncytial virus, influenza A and B virus, parainfluenza (1, 2 and 3) virus, adenovirus, coronavirus and rhinovirus. Comparison between metapneumovirus virus and respiratory syncytial virus infections was done after matching sex, age and infection month. RESULTS: Twenty-six human metapneumovirus infections were identified. A comparative study of a matched group of children infected by respiratory syncytial virus found no significative difference for hospitalisation motive, clinical criteria and treatment. CONCLUSION: The human metapneumovirus is responsible for typical acute bronchiolitis in children.

Acute Disease↗