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PubMed2006

[Managing lower respiratory tract infections in immunocompetent patients. Definitions, epidemiology, and diagnostic features].

Particular attention is given to lower respiratory tract infections because of their frequency and potential severity. These infections represent a major cause of death worldwide and pneumonia remains the first cause of death from infectious origin in France. Three nosological entities are usually described according to the anatomic localization of the infectious process: acute bronchitis, pneumonia, and bronchopneumonia (if the infection involves the bronchial tree and the lung parenchyma). If bronchial infection occurs within the context of a chronic respiratory tract disease, it is called acute decompensation of chronic lung disease (usually chronic obstructive pulmonary disease). The major diagnostic difficulties are to be able to confirm alveolar implication in the infectious process and to determine the pathogenic agent(s) responsible for the clinical pattern. This information is essential for subsequent care depends. Apart from clinical examination, essential in this context, only chest-X-rays can be of any help to confirm alveolar involvement in the disease process. On the contrary, the interest of systematic microbiological confirmation and its value according to various techniques and swab conditions may be questioned for the clinical diagnosis. Microbiological confirmation does not seem essential in every case. The feasibility and relevance of microbiological techniques must be determined before any decision is taken on documentation. The microbiological documentation value depends on its yield and sensitivity profile in identifying the pathogen.

France↗

PubMed1997

[Clinical and experimental study on fuganlin oral liquid in treating repeated respiratory tract infection].

OBJECTIVE: To assess the efficacy of Fuganlin (FGL) oral liquid, a pure Chinese medicinal recipe in treating the repeated infantile respiratory tract infection. METHODS: FGL was used for repeated infantile respiratory tract infections. The children who took the antipyretic oral liquid as the control. Before and after treatment, immune function and other test were determined in both groups. Wistar rats taking FGL for three months was also observed. RESULTS: The curative and marked effective rates of the treated group were 76.8%, and the curative and marked effective rates of the control group were 48.0%. There are significant differences between the two groups (P < 0.01). CONCLUSIONS: FGL could not only modulate immune function but also could serve as a tonic as well as symptomatic relief for fever, cough, asthma, anti-viral, anti-bacterial infection and anti-inflammatory function.

Analgesics, Non-Narcotic↗

PubMed2003

[Are new antibiotics in therapy of respiratory tract infections necessary?].

Increasing worldwide antibacterial resistance among respiratory pathogens, especially S. pneumoniae, are an emerging problem in the treatment of respiratory tract infections. In some areas penicillin-resistant S. pneumoniae increased to 80% and macrolide-resistance and MLSb-resistance are an evolving problem. In addition, increasing resistance to quinolones has been documented in Hong Kong and in Spain. One way to combat increasing resistance is the development of new antimicrobial drugs. However, the practice of just changing one drug for another without also altering poor prescribing habits merely results in different resistance issues. In the long-term, to prevent increasing resistance, clinicians must be aware of restrictive antibiotic prescription and adequate dosages.

Anti-Bacterial Agents↗

PubMed1998

Sequential switch therapy for lower respiratory tract infections: a European perspective.

Traditionally, serious lower respiratory tract infections (LRTIs) are treated in hospital and with parenteral antibiotics. During the past decade, there has been an impetus to reduce the overall cost of antimicrobial therapy. The availability of new oral antibiotics with superior pharmacokinetics profiles and safety has enabled clinicians increasingly to consider their use in managing serious infections effectively. This article reviews the current published literature regarding the practice of switch therapy for LRTIs, examining the evidence for efficacy, safety, appropriate timing of the switch, the economic benefits, and the suitability of various antibiotics. There is an emphasis on comparing current European and US experience and examining key strategies in implementing such programs and means of assessing their impact.

Administration, Oral↗

PubMedDate not supplied

[Branhamella catarrhalis respiratory tract infections].

Forty-six hospitalised patients with respiratory tract infections (RTI) in whom Branhamella catarrhalis had been isolated were evaluated. On average they were 70 years old, there were 39 males and 7 females, 89% of them were smokers. In 85% Branhamella catarrhalis caused exacerbation of chronic bronchitis and in 15% the pneumonia. Most cases of this infection were detected in December and January. In vitro 78% of strains formed beta lactamasis. All 46 isolations were sensitive to cyprofloxacin, 43 (93%) to the combination of amoxicillin with clavulanic acid, 41% (89.1%) to erithromycin, 44 (95.6%) to gentamycin and only 26 (56.5%) to trimetoprim-sulphametoxasol. In the therapy amoxicillin with clavulanic acid, macrolids and kinolons were successful while trimetroprim-sulphametoxasol was less effective.

Aged↗

PubMed2006

Clinical prediction tool to identify patients with Pseudomonas aeruginosa respiratory tract infections at greatest risk for multidrug resistance.

Despite the increasing prevalence of multiple-drug-resistant (MDR) Pseudomonas aeruginosa, the factors predictive of MDR have not been extensively explored. We sought to examine factors predictive of MDR among patients with P. aeruginosa respiratory tract infections and to develop a tool to estimate the probability of MDR among such high-risk patients. This was a single-site, case-control study of patients with P. aeruginosa respiratory tract infections. Multiple-drug resistance was defined as resistance to four or more antipseudomonal antimicrobial classes. Clinical data on demographics, antibiotic history, and microbiology were collected. Classification and regression tree analysis (CART) was used to identify the duration of antibiotic exposure associated with MDR P. aeruginosa. Log-binomial regression was used to model the probability of MDR P. aeruginosa. Among 351 P. aeruginosa-infected patients, the proportion of MDR P. aeruginosa was 35%. A significant relationship between prior antibiotic exposure and MDR P. aeruginosa was found for all of the antipseudomonal antibiotics studied, but the duration of prior exposure associated with MDR varied between antibiotic classes; the shortest prior exposure duration was observed for carbapenems and fluoroquinolones, and the longest duration was noted for cefepime and piperacillin-tazobactam. Within the final model, the predicted MDR P. aeruginosa likelihood was most dependent upon length of hospital stay, prior culture sample collection, and number of CART-derived prior antibiotic exposures. A history of a prolonged hospital stay and exposure to antipseudomonal antibiotics predicts multidrug resistance among patients with P. aeruginosa respiratory tract infections at our institution. Identifying these risk factors enabled us to develop a prediction tool to assess the risk of resistance and thus guide empirical antibiotic therapy.

Adult↗

PubMed2004

Short-duration therapy for respiratory tract infections.

Antimicrobial therapy for community-acquired respiratory tract infections (CARTIs) must be of sufficient duration to result in clinical cure and bacterial eradication. Elimination of the causative bacteria may prevent disease progression, relapse, or recurrence while minimizing the risk for emergence of resistant bacterial strains. Standard 10-day courses of antibiotic therapy often are not completed by patients. This may decrease the likelihood of bacterial eradication and contribute to increased selection of resistant organisms. The ideal antimicrobial agent for the treatment of CARTIs would have an appropriate pharmacokinetic/pharmacodynamic profile for short-course therapy (eg, 5 days) without loss of either clinical or bacteriologic efficacy. Short-course therapy for CARTIs (such as acute bacterial maxillary sinusitis, acute exacerbations of chronic bronchitis, community-acquired pneumonia) has been demonstrated to be effective with antibiotics from several different classes, including the ketolide antimicrobials.

Anti-Bacterial Agents↗

PubMed1999

[Forty-seven cases of lower respiratory tract infections due to E. ictaluri].

OBJECTIVE: To study the risk factors and treatment of lower respiratory tract infections due to E. ictaluri, and the cause of its improved detection by sputum culture in recent years. METHODS: To sum up the number of positive cultures and analyze the clinical features of the cases with positive sputum culture tested from 1959 to 1998. RESULTS: Before 1996, there were no positive cultures (0%) in 17,500 sputum samples using manual techniques, in 1997 and 1998 the aggregate positive rate was 2.3% (47/1,962), using SCEPTOR detecting instrument. On chi square testing of the two results derived from the two methods, P < 0.001. On drug sensitivity testing, E. ictaluri was sensitive to imipenem, cefotaxime and tobramycin. CONCLUSIONS: E. ictaluri is an uncommon opportunistic pathogen of lower respiratory tract infections. Lowered body resistance is a risk factor, and improved technology is the principal cause for detection of E. ictaluri infections.

Adolescent↗

PubMedDate not supplied

Malnutrition and acute respiratory tract infections in Filipino children.

The impact of malnutrition on morbidity and mortality associated with acute respiratory tract infection (ARI) was studied in Filipino children less than 5 years old. Malnutrition measured by weight-for-age Z-scores of less than -3 SD and less than -2 SD from the National Center for Health Statistics median reference population was associated with the following significant relative risks of morbidity: 1.24 (95% confidence interval [CI] = 1.14, 1.34) and 1.14 (95% CI = 1.08, 1.19), respectively, for ARI; and 1.9 (95% CI = 1.46, 2.39) and 1.2 (95% CI = 1.03, 1.47), respectively, for acute lower respiratory tract infection (ALRI). These risk ratios remained significant when adjusted for age, crowding, and parental smoking. Malnourished children with severe ALRI also had a mortality risk two to three times higher than that of healthy children. This risk remained significant even when adjusted for significant predictors of mortality, including clinical complications, concurrent measles, severe infections, and female gender; and for clinical factors, including extent of pneumonic infiltrates, dehydration, and hepatic enlargement. These findings underscore the importance of nutritional intervention in the control of morbidity and mortality among patients with ARI.

Acute Disease↗

PubMed1975

[Therapeutic effect of lividomycin on infections of the respiratory tract (author's transl)].

Therapeutic effect of lividomycin was observed in patients with infections of the respiratory tract (infections in association with bronchiectasis, mixed infections of cavities after negative conversion of tubercle bacilli, pneumonia, and so forth). Significant improvement of clinical symptoms was observed in 15 cases and no improvement in 4 cases. Lividomycin was administered at a dose of 1 g/day for 3 to 15 days. Staphylococcus aureus (9 cases), Klebsiella pneumoniae (1 case), alpha-hemolytic Streptococcus (3 cases), Aerococcus (4 cases) and Pseudomonas aeruginosa (1 case) were suggested to be causative organisms in the above-mentioned patients. (In one case, however, causative organism was not determined.) Lividomycin seemed to be effective in cases of infections with Staphylococcus aureus, alpha-hemolytic Streptococcus and Klebsiella pneumoniae, whereas not effective in a case of infection with Pseudomonas aeruginosa. In order to differentiate causative organisms from the organisms constantly existing on the upper respiratory tract, alkali treatment was employed as an aid for the determination of the causative organisms. However, further studies are desirable for the evaluation of this procedure.

Adult↗

PubMed1994

Characteristics related to the incidence and prevalence of acute respiratory tract infection in young children in Kenya.

Acute respiratory tract infection (ARI) in children is a prevalent condition that results in substantial morbidity and consumes large portions of health care resources in developing countries. We examined factors associated with the reported incidence and prevalence of ARI in a 3-year longitudinal study of 485 children < 5 years of age in rural Kenya. A large number of environmental factors, household and family characteristics, and child-specific factors were examined with use of multivariable methods. Few variables that may play a role in the incidence and prevalence of ARI (e.g., household tobacco use and weight z-score) were found to be related to such rates. Several factors related to ARI incidence and prevalence (e.g., mother's age, number of children, and community) were found to be associated with only mild ARI episodes. Evidence is presented to support the hypothesis that these factors are related to differential reporting of mild ARI episodes. The impact of such differential reporting on health care utilization and health education is discussed.

Child, Preschool↗

PubMed2005

Rationale and design of the prevention of respiratory infections and management in children (PRIMAKid) study: a randomized controlled trial on the effectiveness and costs of combined influenza and pneumococcal vaccination in pre-school children with recurrent respiratory tract infections.

Health and economic burden of recurrent respiratory tract infections (RTIs) in early childhood is considerable. A systematic review of licensed influenza and pneumococcal vaccines showed substantial efficacy in children, but the health-economic impact of such vaccines among pre-school children with recurrent RTIs is unknown. We therefore, designed a double-blind randomized controlled trial to determine the effectiveness and costs of a combined influenza and pneumococcal vaccination program among a primary care based cohort of children with recurrent episodes of RTI aged between 18 and 72 months. We will enroll 690 children over three consecutive years (2003--2005) who will be randomly allocated to receive vaccinations against influenza and pneumococcal disease, influenza alone or hepatitis B in a similar schedule. Follow up by parental diaries, tympanic temperature measurements, questionnaires and interviews is planned until May 2006. Primary outcome is number of febrile RTIs. Other outcomes include duration and severity of RTI episodes, medical consumption, safety and costs.

Child↗

PubMed1980

Feline respiratory tract disease in Louisiana.

An investigation of feline respiratory tract disease (FRD) was made involving 65 affected cats (group 1) and 65 control cats (group 2) matched for age, sex, and residence. Feline calicivirus strains (FCV), feline herpesvirus-1 (FHV-1), or both, were isolated from 59% of group 1 cats and from 7% of group 2 cats. Isolation of these viruses showed a significantly greater (P < 0.05) relative risk for group 1 cats. Virus isolations were three times more frequent from males than from females older than 1 year (both groups), but were equally distributed between males and females younger than 1 year. Bacteria and fungi had a secondary role in both FCV- and FHV-1 associated FRD. Intestinal infections of Ancylostoma spp, Dipylidium caninum, and Toxocara cati were diagnosed more frequently in group 1 cats than in control (group 2). Paragonimus kellicotti was diagnosed in 3 group 1 cats, Taenia taeniaeformis in 1 group 1 cat, Isospora rivolta in 1 group 1 cat, and Giardia cati in 1 control cat. The present study supports the current concept of a primary viral cause for development of FRD.

Age Factors↗

PubMed1992

The relationship of nasal disorders to lower respiratory tract symptoms and illness in a random sample of children.

We examined the relationship of nasal disorders, defined as frequent colds and sinus trouble, to lower respiratory tract symptoms in a random population of 718 children aged 4 to 11 years in East Boston, Massachusetts. Frequent colds were significantly associated with maternal smoking (odds ratio (OR) = 3.00; 95% confidence interval (CI) = 1.97, 4.58), and so was sinus trouble (OR = 4.73; 95% CI = 1.78, 12.51). After adjustment for maternal smoking, age and sex, frequent colds (OR = 2.88; 95% CI = 1.87, 4.42) and sinus trouble (OR = 4.95, 95% CI = 1.83, 13.39) remained significant predictors of lower respiratory tract symptoms in separate logistic regressions. If one restricted the cohort to the 513 children who also had personal smoking information and adjusted for this variable as well, the results for colds were unchanged (OR = 2.94; 95% CI = 1.78, 4.84) but the results for sinus trouble were now not statistically significant (OR = 2.30, 95% CI = 0.67, 7.94). We conclude that nasal disorders are associated with lower respiratory tract symptoms in children.

Child↗

PubMed1994

Significance of isolation of Moraxella catarrhalis in routine cultures from the respiratory tract in adults: antibody response studied in a whole cell EIA.

The significance of the isolation of Moraxella catarrhalis from sputum or nasopharynx was studied in patients treated at an infectious disease clinic. A whole-cell enzyme immunoassay was used to detect a specific antibody response to M. catarrhalis during infection. In all, 27 patients with respiratory tract infections and 4 with other infections were studied. Titre rises were recorded in 11/23 patients with lower respiratory tract infections, whereas patients with common cold or infections elsewhere all had negative serology. In patients with acute bronchitis, 7/10 patients responded with a significant titre rise. Patients with a low titre in their acute serum sample were those who responded with a titre increase during infection. The findings indicate that isolation of M. catarrhalis from sputa and nasopharyngeal samples in adults is of value for the etiological diagnosis of acute bronchitis and other lower respiratory tract infections, and is therefore important for the choice of drug for treatment, as many isolates are resistant to beta-lactam antibiotics.

Adolescent↗

PubMed1994

Ciliary beat frequency at six levels of the respiratory tract in cow, dog, guinea-pig, pig, rabbit and rat.

1. The ciliary beat frequency (CBF) of six animal species from six regions of the respiratory tract were measured: inferior turbinate, nasopharynx, the upper part of trachea from first to second cartilage, the lower part of trachea, main bronchus and subsegmental bronchi. Cow, pig, dog, rabbit, guinea-pig and rat were studied. 2. There were no significant differences in the CBF values between cow, pig and dog, and the ciliary activity was essentially the same (11.3-16.9 Hz) in all parts of the respiratory tract. 3. In the rat, the CBF was slower, especially in subsegmental bronchi (6.8 Hz). 4. In general, CBF was higher in upper than lower airways, with the exception of guinea-pig. 5. Signal quality was the highest in guinea-pig tissue, whereas rat tissue produced the signal with the widest variation in CBF and the highest proportion of distorted waveforms. 6. Therefore, for studying drug effects on ciliary activity, guinea-pig seems to be a more suitable animal than the more commonly used rabbit or rat. In drug comparisons, the same part of the respiratory tract and the same animal species should be used.

Analysis of Variance↗

PubMed1996

An analysis of decisions by European general practitioners to admit to hospital patients with lower respiratory tract infections. The European Study Group of Community Acquired Pneumonia (ESOCAP) of the European Respiratory Society.

BACKGROUND: The purpose of this study was to identify factors on which European general practitioners (GPs) base their decisions to admit to hospital patients with lower respiratory tract infections (LRTI). METHODS: A survey was carried out from December 1993 to January 1994 to identify factors that affect GPs' decisions to admit to hospital patients with LRTI by collecting data on 2056 patients from 605 GPs in France, Germany, Italy, Spain, and the UK. RESULTS: Only 93 (4.5%) of the patients included in the study were admitted to hospital. Univariate analysis showed that age > 60 years, institutionalisation of the patient, concomitant diseases, cardiac insufficiency, asthma, a diagnosis of pneumonia, and clinical signs such as chest pain, cyanosis, tachypnoea and hypotension significantly (odds ratio (OR) > 2.0, p < 0.002) influenced the decision to admit to hospital. No influence could be shown for sex, smoking habits, history of bronchiectasis or chronic bronchitis, the presence of fever, chills, myalgia, cough or purulent sputum, and the diagnoses of acute bronchitis, influenza or exacerbation of chronic bronchitis. In the multivariate analysis only the presence of chest pain (OR 2.3, 95% confidence interval (CI) 1.5 to 3.5), cyanosis (OR 4.1, 95% CI 2.4 to 7.1), dyspnoea (OR 4.9, 95% CI 3.1 to 7.9), and hypotension (OR 2.9, 95% CI 1.6 to 5.2), as well as a diagnosis of pneumonia (OR 6.6, 95% CI 4.3 to 10) (all p < 0.00001) remained as factors that significantly affected the decision to admit to hospital. CONCLUSIONS: Clinical signs of severe infection and a diagnosis of pneumonia are the main factors that induce GPs to admit patients with LRTI to hospital in Europe.

Europe↗

PubMed1975

Immunologic and virologic aspects of secretory immune system in human respiratory tract.

Many external mucosal surfaces in man are replete with immunoglobulin containing plasma cells and thymic dependent (T) lymphocytes. Immunization with viral vaccines administered via different routes have indicated that viral specific secretory immunoglobulins particularly of gamma A class are synthesized locally in the external mucosal surfaces. Local availability of viral antigens especially after local mucosal immunization appears to be the most effective means of inducing viral specific secretory antibody responses in the respiratory tract. Similarly, local induction of specific cellular immune responses in the respiratory tract and tonsilar lymphoid cells has been demonstrated after intranasal immunization with viral vaccines. Generally, the locally induced secretory antibody and cell-mediated immune responses in the respiratory tract appear to be independent of the immune response in the systemic sites, with little or no contribution from circulating immunoglobulins and T-cells. Information obtained after natural or vaccine induced infections with polio, influenza, measles, rubella and other viruses suggest that the outcome of a reinfection challenge in the respiratory and alimentary tracts is determined to a major extent by the presence and level of pre-existing secretory antibody. Although the precise role of locally induced cellular immunity in protection against viral infection remains to be determined, these observations suggest that the mechanism of immunologic defence in external surfaces may be mediated largely through specific secretory immunoglobulin and cellular immune response.

Agammaglobulinemia↗