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PubMed1994

Stomatococcus mucilaginosus lower respiratory tract infection in a patient with AIDS.

We describe a case of recurrent Stomatococcus mucilaginosus lower respiratory tract infection in a patient with AIDS. Apart from S. mucilaginosus no other pathogens were found to account for infection. There was a rapid response to rifampicin, the organism being resistant to penicillin, co-trimoxazole and ciprofloxacin. Infections caused by this organism are increasingly described, but there are few reports of lower respiratory tract infection.

AIDS-Related Opportunistic Infections↗

PubMed1976

Sarcoidosis of the upper respiratory tract and its association with lupus pernio.

In a series of 34 patients with sarcoidosis affecting the upper respiratory tract and nose, 26 had lupus pernio (LP) and 17 had sarcoidosis of the upper respiratory tract (SURT). In nine patients these features coexisted. A patient presenting with SURT carried a 50% risk of developing LP although one feature could be present without the other. Both were disorders of women of the child-bearing years of life. SURT, like LP, was an indicator of chronic fibrotic sarcoidosis, developing insidiously and progressing indolently over the years. It was complicated by ulceration, septal perforation, and LP. Three patients had nasal septal perforations, in two instances following submucous resection. This operation is contraindicated in patients with active sarcoidosis, particularly when granulomas are found on nasal biopsy. The Kveim-Siltzbach skin test was positive in all patients with SURT, making it invaluable in the differential diagnosis of granuloma of the nasal cavity.

Adolescent↗

PubMed2001

Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods.

The need to decrease excess antibiotic use in ambulatory practice has been fueled by the epidemic increase in antibiotic-resistant Streptococcus pneumoniae. The majority of antibiotics prescribed to adults in ambulatory practice in the United States are for acute sinusitis, acute pharyngitis, acute bronchitis, and nonspecific upper respiratory tract infections (including the common cold). For each of these conditions-especially colds, nonspecific upper respiratory tract infections, and acute bronchitis (for which routine antibiotic treatment is not recommended)-a large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients. Because decreasing community use of antibiotics is an important strategy for combating the increase in community-acquired antibiotic-resistant infections, the Centers for Disease Control and Prevention convened a panel of physicians representing the disciplines of internal medicine, family medicine, emergency medicine, and infectious diseases to develop a series of "Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults." These principles provide evidence-based recommendations for evaluation and treatment of adults with acute respiratory illnesses.This paper describes the background and specific aims of and methods used to develop these principles. The goal of the principles is to provide clinicians with practical strategies for limiting antibiotic use to the patients who are most likely to benefit from it. These principles should be used in conjunction with effective patient educational campaigns and enhancements to the health care delivery system that facilitate nonantibiotic treatment of the conditions in question.

Acute Disease↗

PubMed1995

[Clinical evaluation of cefpodoxime proxetil, a new oral cephem, in the treatment of respiratory tract infections with the special reference to community-acquired Streptococcus Pneumoniae infections].

The clinical usefulness of cefpodoxime proxetil (CPDX-PR) was investigated in the treatment of pneumonia and chronic airway infections occurring in patients first visiting our outpatient clinic or those being treated at the outpatient clinic. CPDX-PR was orally administered twice a day after meals at a dose of 100-200 mg for acute respiratory tract infections and at a dose of 200 mg for chronic respiratory tract infections. Excellent, good, fair, and poor responses were observed in 20, 33, 10, and 3 of 66 patients (4 with acute bronchitis, 27 with pneumonia, and 35 with acute exacerbation of chronic airway infection), respectively, demonstrating an 80.3% efficacy rate (53/66). Causative organisms, including Streptococcus pneumoniae, were all eradicated from the patients whose causative organisms were examined over time, although 2 of the patients were superinfected with Pseudomonas aeruginosa. There were no serious adverse reactions or abnormal changes in laboratory test results. It was concluded that CPDX-PR could be used as a first-choice drug for the treatment of respiratory tract infections at an outpatient clinic, and that this drug should acquire greater importance in particular consideration of recent increases in infections with S. pneumoniae.

Adult↗

PubMed2006

Full breastfeeding duration and associated decrease in respiratory tract infection in US children.

OBJECTIVE: The American Academy of Pediatrics recommends exclusive breastfeeding for an infant's first 6 months of life. When compared with exclusive breastfeeding for 4 months, greater protection against gastrointestinal infection, but not respiratory tract infection, has been demonstrated for the 6-month duration. The objective of this study was to ascertain if full breastfeeding of > or = 6 months compared with 4 to < 6 months in the United States provides greater protection against respiratory tract infection. METHODS: Secondary analysis of data from the National Health and Nutrition Examination Survey III, a nationally representative cross-sectional home survey conducted from 1988 to 1994, was performed. Data from 2277 children aged 6 to < 24 months, who were divided into 5 groups according to breastfeeding status, were compared. Children who required neonatal intensive care were excluded. SUDAAN software was used to account for the complex sampling design. Logistic regression adjusted for confounding factors. Outcome measures included adjusted odds of acquiring pneumonia, > or = 3 episodes of cold/influenza, > or = 3 episodes of otitis media (OM), or wheezing in the past year or acquiring first OM at < 12 months of age. RESULTS: In unadjusted analyses, infants who were fully breastfed for 4 to < 6 months (n = 223) were at greater risk for pneumonia than those who were fully breastfed for > or = 6 months (n = 136) (6.5% vs 1.6%). There were not statistically significant differences in > or = 3 episodes of cold/influenza (45% vs 41%), wheezing (23% vs 24%), > or = 3 episodes of OM (27% vs 20%), or first OM at < 12 months of age (49% vs 47%). Adjusting for demographic variables, childcare, and smoke exposure revealed statistically significant increased risk for both pneumonia (odds ratio [OR]: 4.27; 95% confidence interval [CI]: 1.27-14.35) and > or = 3 episodes of OM (OR: 1.95; 95% CI: 1.06-3.59) in those who were fully breastfed for 4 to < 6 months compared with > or = 6 months. CONCLUSIONS: This nationally representative study documents increased risk of respiratory tract infection including pneumonia and recurrent OM in children who were fully breastfed for 4 vs 6 months. These findings support current recommendations that infants receive only breast milk for the first 6 months of life.

Birth Weight↗

PubMed1985

[Fibroscopy in assessing the effectiveness of radiation therapy in cancer of the upper respiratory tracts and in lymphosarcoma of the tonsillar ring].

Proceeding from 2626 fibroscopic examinations of the upper respiratory tract during radiotherapy of 492 cancer patients, the most appropriate time of control endoscopic examinations have been defined, endoscopic criteria for the evaluation of the efficacy of therapy of primary tumors of different parts of the upper respiratory tract have been determined. The evaluation of the efficacy of therapy by the common otorhinolaryngological method was compared with that of the fibroscopic method of examination. The efficacy of radiotherapy by changing endoscopic pictures is most vividly expressed in laryngeal cancer after delivering the dose of 30-40 Gy (49-66 units of TDF), in laryngeal and nasopharyngeal cancer 50 Gy (82 units of TDF) and in lymphosarcoma of the throat ring 20 Gy (33 units of TDF). In the use of the speculum and fibroscopic methods difficulties in the organ inspection and differentiation of changes were noted in 31.7 and 16.1% of the cases including 64.3 and 11.9% in laryngopharyngeal cancer and 80.9 and 1.8% in nasopharyngeal cancer. Tumor regression in concomitant involvement of the tonsils by lymphosarcoma develops not uniformly. A positive time course is first of all noted in lymphadenoid masses: in the palatine and lingual tonsils and then in the pharyngeal, tubal and laryngeal tonsils. Complete tumor regression after irradiation at a dose of 20 Gy (33 units of TDF) is noted in 50% of lymphosarcoma patients. In 13.2% of cases doses of 50 Gy (82 units of TDF) and 60 Gy (99 units of TDF) are required for complete regression of lymphosarcoma of the throat ring.

Evaluation Studies as Topic↗

PubMed1982

Catecholamine- and acetylcholinesterase-containing nerves in human lower respiratory tract.

The innervation of human lower respiratory tract was studied with special emphasis on airways with sodium-potassium glyoxylic acid (SPG) and acetylcholinesterase (AChE) methods to demonstrate catecholamine-containing and acetylcholinesterase-containing nerve fibers. AChE-method revealed a rich network of cholinesterase positive nerves both inside the bronchial glands where they run around and between the acini, and the airway smooth muscle from secondary bronchi to terminal bronchioli. No AChE-positive fibers were found in connection with the blood vessels or within the epithelium of bronchi or bonchioli. The AChE-positive nerve fibers in bronchial smooth muscle greatly outnumbered those containing catecholamine. The SPG-method revealed the presence of adrenergic nerves from the level of secondary bronchi to that of terminal bronchioli. These nerve fibers were most abundant in bronchial glands, where their amount was equal and distribution similar to those of AChE-containing nerve fibers. Outside the glands adrenergic fibers were constantly seen in connection with the bronchial blood vessels in connective tissues surrounding bronchi. A few nerve fibers were also present in airway smooth muscle from the secondary bronchi to terminal bronchioli.

Acetylcholinesterase↗

PubMedDate not supplied

Recurrent lower respiratory tract infections in children.

Recurrent lower respiratory tract infections in children are caused by a deficiency in the host defense or an underlying pulmonary disorder which may result from structural or functional alterations. Aspiration syndromes, congenital defects, airway clearance disorders and immune deficiency are the main categories. Careful evaluation with good history and examination provide important leads to limit the radiological and laboratory work up to the most relevant investigations. Some of the structural abnormalities are amenable to cure; however, secondary events need careful management of the underlying lung disorder to give the best quality of life to these children.

Child↗

PubMed1995

DNA strand breakage and base modification induced by hydrogen peroxide treatment of human respiratory tract epithelial cells.

Treatment of human respiratory tract epithelial cells with H2O2 led to concentration-dependent DNA strand breakage that was highly-correlated with multiple chemical modifications of all four DNA bases, suggesting that damage is due to hydroxyl radical, OH. However, the major base damage occurred to adenine. Hence, conclusions made about the occurrence and the extent of oxidative DNA damage on the basis only of changes in 8-hydroxyguanine should be approached with caution.

Bronchi↗

PubMed1978

Demonstration of cellular and humoral immunity to transplantable carcinomas derived from the respiratory tract of rats.

Previous studies with respiratory tract tumors in mice have suggested that such tumors are not immunogenic or are only weakly so. To determine whether this is a general characteristic of neoplasias found in the airways of rodents, we investigated seven transplantable carcinomas in rats, six of which originated from tracheal epithelium and one of which orginated from the distal lung. These carcinomas were all of the squamous type and were induced by three different carcinogenic polycyclic hydrocarbons. All of the tumors were shown to be immunogenic, capable of mobilizing cellular and humoral immune responses in isogenic hosts upon immunization. This was demonstrated by induction of transplantation resistance, by Winn's neutralization test, and by the detection of antibodies in the sera of tumor-immune hosts by two independent methods (antibody-dependent cytotoxicity and antibody-binding test). The degree of immunogenicity varied among the tumor lines. The most metastatic tumor was clearly the least immunogenic. The relationship between carcinogenic insult and immunogenicity, as well as the possible nature of the tumor-associated antigens involved, is discussed.

Animals↗

PubMed1970

Influence of immunization procedures on upper respiratory tract immunity in cattle.

Aspects of respiratory tract immunity have been investigated in the bovine species. Using Past. hemolytica type I as the antigen for this model the relationship of nasal and serum antibody production to the route of vaccination and type of vaccine was investigated in a series of 15 dairy calves from two to four months of age. Experimental results indicated that an aerosol vaccination with live Past. hemolytica resulted in a significant nasal antibody response while parenterally vaccinated gave calves with equivalent serum titers had no significant nasal antibody response.

Aerosols↗

PubMed2001

Community-acquired lower respiratory tract infections: etiology and treatment.

The current therapy for community-acquired lower respiratory tract infections is often empiric, usually involving administration of a beta-lactam or macrolide. However, the increasing prevalence of antibiotic resistance in frequently isolated respiratory tract pathogens has complicated the antimicrobial selection process. This review will discuss the incidence of various respiratory pathogens, as well as update the clinician on the various antimicrobial alternatives available, with particular emphasis on the role of the newer fluoroquinolones in the treatment of acute exacerbations of chronic bronchitis and community-acquired pneumonia.

Anti-Bacterial Agents↗

PubMed2003

Respiratory tract infections in general practice: considerable differences in prescribing habits between general practitioners in Denmark and Spain.

OBJECTIVE: The prevalence of antibiotic resistance in a country reflects the local consumption of antibiotics. The majority of antibiotics are prescribed in general practice and most prescriptions are attributable to treatment of respiratory tract infections (RTIs). The aim of this study was to compare general practitioners' (GPs') prescribing of antibiotics for respiratory tract infections in a country with a high prevalence of antibiotic resistance (Spain) with a country with a low prevalence of antibiotic resistance (Denmark). METHODS: A group of GPs in Copenhagen and Barcelona registered all contacts ( n=2833) with patients with RTIs during a 3-week period between 1 November 2001 and 31 January 2002. RESULTS: Overall, Spanish GPs treated a higher proportion of patients than Danish GPs. After adjusting for unequal distribution of age and sex, we found that Spanish GPs prescribed significantly more antibiotics to patients with focus of infection in tonsils and bronchi/lungs. Narrow-spectrum penicillin was the most used antibiotic in Denmark, representing 58% of all prescriptions issued, followed by macrolide and broad-spectrum penicillin. In Spain, prescriptions were distributed among a great number of compounds, with broad-spectrum penicillins and combinations of amoxicillin plus beta-lactamase inhibitors most frequently used. CONCLUSION: The substantial difference in the way GPs manage respiratory tract infections in Denmark and Spain cannot be explained by different patterns of RTIs in general practice. The discrepancies indicate variations in national recommendations, different treatment traditions or different impact of pharmaceutical marketing.

Adolescent↗

PubMed2004

Effect of daily cod liver oil and a multivitamin-mineral supplement with selenium on upper respiratory tract pediatric visits by young, inner-city, Latino children: randomized pediatric sites.

We studied the effect of daily supplementation with lemon-flavored cod liver oil and a children's multivitamin-mineral supplement containing selenium on the number of pediatric visits by young, inner-city, Latino children from late autumn of 2002 through early spring of 2003. Two private pediatric offices with similar demographics, located 1.1 miles apart in upper Manhattan, New York City, were randomized to a supplementation site and a medical records control site. Ninety-four children (47 at each site), 6 months to 5 years of age, were enrolled. The mean age of the supplementation group was 2.03 years (SD, +/- 1.04 years); that of the control group was 2.08 years (SD, +/- 1.10 years). Children > or = 1 year of age in the supplementation group received 1 teaspoon of lemon-flavored cod liver oil per day and one half-tablet of a children's multivitamin-mineral; the starting dose was halved for children < 1 year of age. The supplements were given from enrollment through May 1, 2003. The primary outcome measure was the number of upper respiratory tract pediatric visits during the follow-up/supplementation period. The supplementation group had a statistically significant decrease in the mean number of upper respiratory tract visits over time (p = .042; r = 0.893; y = 0.602 - 0.002x); the medical records control group had no change in this parameter (p = .999; r = 0.0006; y = 0.259 + 1.43 x 10(-6)x). The supplements were well tolerated; per parental report, 70% of children completed the 5- to 6-month course of cod liver oil. Use of these nutritional supplements was acceptable to the inner-city Latino families and their young children, and was associated with a decrease in upper respiratory tract pediatric visits over time; this approach therefore deserves further research and attention.

Child, Preschool↗

PubMed1991

Contaminated commercial charcoal as a source of fungi in the respiratory tract.

OBJECTIVE: To investigate the possibility that contaminated commercial activated charcoal may serve as a source for fungal colonization or infection of the lower respiratory tract. DESIGN: The clinical course of a patient who aspirated commercial activated charcoal was reviewed. Fungal cultures were performed for 2 samples of an activated charcoal in sorbitol product from separate lots produced by a single manufacturer. Details of the manufacturing process were obtained from a representative of the manufacturer. SETTING: An intensive care unit in a large community teaching hospital. PATIENTS: A single patient with steroid-treated lung disease who developed a fatal pulmonary illness after aspirating a commercial activated charcoal product. RESULTS: After aspirating the charcoal product, the patient developed respiratory tract colonization and possible infection with Aspergillus niger, Paecilomyces variotii, and Penicillium species. Similar fungal species were isolated from cultures of samples obtained from two separate lots of the same commercial activated charcoal product. Several opportunities for contamination during the manufacturing process were identified. CONCLUSIONS: Physicians caring for immunocompromised patients should be aware that commercial activated charcoal products can be a source of fungal respiratory tract colonization that may mimic or cause pneumonia.

Adenocarcinoma↗

PubMed1981

[Clinical studies of dibekacin intravenous challenge on respiratory tract infections (author's transl)].

Dibekacin was used for the treatment of 5 patients with bacterial respiratory tract infections (4 cases of Ps. aeruginosa and 1 case of S. marcescens) intravenously. Serum levels of DKB was observed by the method of enzyme immunoassay (EIA) and bioassay and no differentiation was observed between EIA and bioassay. Four cases of Ps. aeruginosa and 1 case of S. marcescens were all disappeared in 5 or 7 days of administration. No side effects were observed. The results obtained in this study indicate that DKB intravenous challenge might become one of the important method on respiratory tract infections.

Adolescent↗

PubMedDate not supplied

Moraxella catarrhalis in upper respiratory tract of healthy Yemeni children/adults and paediatric patients: detection and significance.

A highly variable carriage rate of Moraxella catarrhalis has been reported in the literature. In order to assess the reasons for this variability, detection rates of this organism from various sites of the upper respiratory tract of children and adults were studied. Throat swabs, oral swabs and nasal swabs from 131 children, 96 adults and 64 paediatric patients with upper respiratory tract infections were cultured on a selective medium. Detection rates of 31.4% in children less than three years of age, 38.5% in children between 4 and 12 years, 11.7% in adults and 21.9% in patients were found, respectively. The reasons for high variability in the carriage rates were many including the number and site of specimen collection, media used for isolation and identification criteria. All isolates were sensitive to amoxycillin-clavulanic acid and co-trimoxazole. A significantly higher share of M. catarrhalis isolates from patients were beta-lactamase producers (12/14, 85.7%) as compared to normal healthy subjects (41.9%), suggesting a cautious approach in the use of beta-lactam antibiotic in respiratory tract infections.

Administration, Oral↗

PubMed1994

[Clinical usefulness of the combined empirical therapy with flomoxef and fosfomycin for intractable respiratory tract infections. With a background of increasing MRSA incidence].

We conducted a multicenter trial to determine the clinical usefulness of the combined therapy with flomoxef (FMOX) and fosfomycin (FOM) (FF therapy) as an empirical therapy in the treatment of intractable respiratory tract infections, because FF therapy has clinically been proved to be very useful for the treatment of severe infections including MRSA infections. The overall efficacy rate of FF therapy was 69.2%. The efficacy rate for "pneumonia/lung abscess," which occupy the largest portions of respiratory tract infections, was 70.0%, showing a statistically significant difference from the efficacy rate for FMOX alone (56.7%) found in a previous study (P = 0.09 by chi-squared test). Although MRSA was eradicated in only 3 cases (37.5%) including superinfection cases, of 8 patients, from whom MRSA had been isolated as causative organisms, none of our patients were superinfected with MRSA. Thus it has been concluded that FF therapy is clinically very useful when used as an empirical therapy in the treatment of respiratory tract infections.

Aged↗