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PubMed2002

[Diagnosis and treatment in general practice of lower respiratory tract infections in adults].

Lower respiratory tract infections are common in the community. It might be difficult to differentiate between acute bronchitis, exacerbation of chronic obstructive pulmonary disease, and pneumonia. There is no satisfactory way of defining pneumonia by clinical criteria alone. Measurement of C-reactive protein is useful, but the specificity of the test is low, and must be carefully evaluated in comparison with the duration of illness and the clinical picture. The antibiotic management of lower respiratory tract infections must suppress Streptococcus pneumoniae. We therefore recommend that the first drug of choice should be penicillin V.

Adult↗
PubMed1996

Ribavirin for respiratory syncytial virus lower respiratory tract infection. A systematic overview.

OBJECTIVE: To systematically review the evidence evaluating the efficacy of aerosolized ribavirin for the treatment of infants with respiratory syncytial virus lower respiratory tract infection. DESIGN: A computerized search of MEDLINE from 1975 to the present, a review of the reference lists of each retrieved article, and contact with experts. PATIENTS: infants with documented respiratory syncytial virus lower respiratory tract infection who were the subjects of 8 double-blind randomized placebo-controlled trials. METHODS: Two independent reviewers assessed study quality and extracted data on the study populations, the drug regimens, and clinically relevant outcome measurements. RESULTS: Ribavirin does not significantly reduce mortality rate (relative risk [RR] = 0.42, 95% confidence interval [CI] = 0.13, 1.44) or lower the probability of respiratory deterioration (RR = 0.42, 95% CI = 0.16, 1.34) when meta-analysis is used to pool the outcomes of 3 trials, although strong trends in the direction of benefit are present. No study found ribavirin to shorten length of hospitalization. Results on length of ventilation and oxygen supplementation are conflicting. CONCLUSIONS: Use of ribavirin in infants with respiratory syncytial virus lower respiratory tract infection is not supported by evidence of significant benefit. However, previous studies lack sufficient power to rule out a potential reduction in mortality rate or respiratory deterioration. A large randomized controlled trial of ribavirin for ventilated and other high-risk patients is needed.

Antiviral Agents↗
PubMed2000

[Viral infection related to the appearance of acute bacterial respiratory tract infections].

To investigate what viruses are related to acute bacterial respiratory tract infections, we prospectively evaluated 113 cases with respiratory tract infections (always accompanying by purulent sputum) experienced between July 1998 and March 2000. Acute viral infections were detected in 25 cases (22%); 10 cases of influenza A virus and 6 cases of respiratory syncytial (RS) virus. The epidemiology of the influenza A virus and RS virus was mainly identified as from December to February in both winter seasons. A bacteriological examination of sputum cultures isolated 12 cases of Streptococcus pneumoniae and 10 cases of Haemophilus influenzae during the same periods and mixed infections of both viruses and bacteria were recognised in 16 cases (14%). These results suggest a significantly high percentage of mixed infections of both viruses and bacteria. However, it was unknown whether the patients with acute bacterial respiratory infections had been infected with viruses prior to the bacterial infections. The frequency of appearance of respiratory tract infections tended to increase with the seasonale epidemiology of viral infections.

Acute Disease↗
PubMedDate not supplied

The role of viruses and Mycoplasma pneumoniae in lower respiratory tract infections in childhood.

Acute lower respiratory tract infections are one of the major causes of childhood morbidity and mortality in developing countries. This study was undertaken at Hacettepe University Children's Hospital to determine the role of viruses and Mycoplasma pneumoniae in respiratory tract infections in children. Eighty-three patients with lower respiratory tract infections were selected at random from among the children admitted to the hospital for evaluation of respiratory symptoms. Acute and convalescent serum samples were collected from all patients for the complement-fixation test and the following antigens were used: respiratory syncytial virus (RSV), adenovirus, parainfluenza virus Type 1, influenza viruses A and B, and Mycoplasma pneumoniae. The test was positive in 39 of 83 patients (47%), and RSV was the most frequent agent detected serologically (15.7%).

Acute Disease↗
PubMed1993

[Parenteral cephalosporins for the treatment of lower respiratory tract infections].

In most cases of respiratory tract infection, antibiotic therapy has to be initiated before the results of microbiological examination are available. The four most common pathogens of acute exacerbations of chronic bronchitis are pneumococci, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus. Pneumococci are the predominant pathogens of community-acquired pneumonia, followed by H. influenzae and staphylococci. Legionella, mycoplasma and chlamydia vary in frequency according to the population studied. Staphylococci, Pseudomonas, Enterobacter and Klebsiella spp. as well as H. influenzae are the major pathogens of secondary pneumonia. For reasons of cost and environmental problems, oral antibiotics ought to be used whenever possible considering the severity of the infection and patient circumstance. Parenteral antibiotics are indicated in severe infections in order to provide high therapeutic drug levels. Second generation cephalosporins are appropriate for initial therapy of lower respiratory tract infections. In case of severe infection, cephalosporins should be combined with an aminoglycoside, ureidopenicillin or quinolone. Cefuroxime has shown good clinical efficacy and tolerance in lower respiratory tract infections.

Bronchitis↗
PubMed1997

Recurrent respiratory tract infections in paediatric patients.

Paediatric respiratory tract infections are one of the most common reasons for physician visits and hospitalisation, and are associated with significant morbidity and mortality. The role of physicians and other healthcare professionals has expanded from merely treating disease to implementing measures aimed at health maintenance and disease prevention. Therefore, children with recurrent respiratory tract infections represent a great challenge for the paediatrician, from both therapeutic and preventive standpoints. The paediatrician must first determine whether these recurrent infections are because of host-derived factors or are the result of increased environmental exposure. Host-derived factors may be nonimmunological or related to host immunodeficiency. The leading cause of recurrent respiratory tract infections throughout the world is increased environmental exposure in children attending nursery school or daycare centres. Acute otitis media in children is of particular concern because of its high incidence, frequent recurrence, and serious long term sequelae, e.g. hearing loss. The socioeconomic impact of these recurrent infections is staggering, and there remains much scope for devising methods for their treatment and prevention. Recent approaches have included the encouragement of breastfeeding, the use of intravenous immunoglobulin and respiratory syncytical virus immune globulin, as well as methods of stimulating immunity, such as ribosomal immunotherapy.

Child Day Care Centers↗
PubMed2006

[Monitoring of neopterin and INF-gamma in children with recurrent respiratory tract infection].

The upper and lover respiratory tract infections are usually mild and self-limited. Owing to their frequency recurrent upper and lower respiratory tract infection in children and adults constitute a major global health problem. The goal of our study was to observe 30 children with recurrent respiratory tract infection, 17 boy and 13 girl, they were treated with Ribomunyl. The control group consisted of 15 children who received only basic therapy (10 boys and 5 girls). The age of the children ranged between 8 months and 6 years. The study was conducted by the simply randomization method. Clinical and laboratory examinations were evaluated before and after treatment. The concentration of INF-gamma was rather low in study group in comparison with control group before the beginning of the treatment, that indicates insufficient stimulation of T-lymphocytes in children with recurrent infection. INF-gamma lever significantly increased after treatment (Statistically significantly P<0.05) in study group in comparison with control group. Neopterin level unlike INF-gamma in study group was higher than in the control group, before and after treatment. This fact can be explained that neopterin as a slowly acting biologically active substance remains high during the presence of recurrent infections. Ribomunyl treatment significantly increased the level of neopterin. The efficacy of the product is primarily confirmed by significant reductions in the number of recurrent infections episodes and the use of antibacterials. Combined immunostimulating effect of Ribomunyl makes it possible to use Ribomunyl to create a longterm postvaccinal protection of the child.

Biomarkers↗
PubMed2002

Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients.

In human immunodeficiency virus (HIV)-infected patients, bacterial lower respiratory tract infections are the most frequent respiratory diseases. They are frequently the first clinical manifestation of HIV infection. The incidence and severity of bacterial lower respiratory tract infections increase with the degree of immunosuppression. At the acquired immune deficiency syndrome (AIDS) stage, the responsible bacteria and clinical presentation may be atypical. Bacterial pneumonia may be fatal, particularly in AIDS patients, and its occurrence is predictive of a reduced survival time. Pneumococcal vaccine is recommended in patients with a CD4 T-lymphocyte count of > 200 cells mm(-3) and cotrimoxazole (trimethoprim/sulfamethoxazole) in patients with a CD4 T-lymphocyte count of < 200 cells x mm(-3). Unfortunately, such prophylaxis remains insufficiently prescribed and its protective effect is limited. Highly active antiretroviral treatment has dramatically reduced the incidence of lower respiratory tract infection due to Pseudomonas aeruginosa and opportunistic bacteria. In contrast, successful highly active antiretroviral therapy slightly decreased the risk of bacterial pneumonia due to usual bacteria, even in patients on successful highly active antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Epidemiology of lower respiratory tract infections in children].

Lower respiratory tract infections--croup, tracheo-bronchitis, bronchiolitis and pneumonia--represent one of the major causes of pediatric consultation. They occur most frequently during the first years of life, are usually not recurrent and require hospitalization in less than 2% of the cases. They are associated in time with epidemics of respiratory virus and Mycoplasma pneumoniae infections, but the role of bacteria as primary infectious agents, or as causes of superinfection is significant.

Bacterial Infections↗
PubMed1987

[Incidence of deep respiratory tract infections].

The distribution of respiratory tract infections (RTI) among the general population is not uniform. The incidence in neonates and the elderly (older than 65) is 2 to 3 times higher than that in adults. Examinations to determine the responsible pathogen are conducted in less than 1% of cases of RTI. The overall incidence of Haemophilus influenzae and Streptococcus pneumoniae in hospitalized patients amounts to 13 to 27%. The incidences of Staphylococcus aureus, Klebsiella and Pseudomonas aeruginosa in intensive care units are approximately 20% each. The management of the disease should be based on an aetiological diagnosis, and must take the individual patient's condition into account. Examination of the sputum or bronchial rinsing fluid is still the most reliable form of diagnosis, however, a sufficient number of quantitative methods must be applied. In hospitalized--and especially intensive care--patients these methods are often successful in isolating H. influenzae and pneumococci which we cannot afford to ignore as pathogens.

Bacterial Infections↗
PubMed2006

Primary care challenges in the management of respiratory tract infections.

Community-acquired respiratory tract infections (RTIs), such as community-acquired pneumonia, acute exacerbations of chronic bronchitis, and acute rhinosinusitis, are among the most common reasons that adults seek care from their primary health care providers in the United States. High levels of pneumococcal resistance have developed, particularly to macrolides, since the 1990s. Empiric management of these infections, the difficulty in differentiating bacterial from nonbacterial infection, and a high level of patient expectation of antimicrobial therapy contribute to the overuse of antibiotics. The primary care clinician must judiciously weigh various factors in order to prescribe appropriate and effective treatment.

Adult↗
PubMed2003

Ribosomal immunotherapy for recurrent respiratory tract infections in children.

Recurrent respiratory tract infections are common in children. They reflect the immaturity of the immune system in its encounter with environmental antigens. Little or no specific protective immune response has yet been established. These infections represent an important public health problem in terms of both treatment (anti-inflammatory or antibacterial drugs for children) and economy. Immunotherapy has been proposed as a means of preventing these recurrent infections by providing children with small doses of inactive bacterial antigens liable to trigger specific and protective immune responses. Among such drugs, ribosomal preparations (to which this review is limited) appear to be not only well tolerated, but also ideally targeted to induce mucosal responses. One preparation of ribosomal mucosal vaccine is commercially available in several countries. Numerous clinical trials in the world have confirmed the positive role of this mucosal ribosomal bacterial vaccine in significantly reducing the number of infections, courses of antibacterials, and absenteeism. In vitro and ex vivo investigations have confirmed that such vaccines indeed trigger protective specific immune responses.

Bacterial Vaccines↗
PubMed2002

Legionella species infection in adult febrile respiratory tract infections in the community.

Legionella spp. (Lsp) are well recognized as etiologic factors in pneumonia but less so in respiratory tract infections (RTI) in the community. The objective of the present study was to characterize febrile RTI patients with a documented Legionella etiology, in terms of specific serogroups, clinical manifestations of the disease, disease course and the effect of antibiotic therapy. Ambulatory adults with febrile RTI (n = 250) were included in a prospective study in which the etiological causes of the infection were identified using sophisticated serological techniques. Paired sera were obtained for each of the patients and were tested for 41 different serotypes of Lsp using micro-immuno-fluorescence (MIF) serology. Only a significant change in IgG and/or IgM antibody titers was considered diagnostic. In 28 patients (11.2%) there was serological evidence of acute infection with 1 of the types of Lsp. The infections were manifested clinically as upper RTI in 9 patients and as lower RTI in the other 19 patients (community-acquired pneumonia in 2 of these). L. pneumophila serogroup 1 was identified in 3 patients, L. pneumophila serogroups higher than 1 were identified in 13 patients and L. non-pneumophila serogroups in 18 patients. The clinical and laboratory findings in patients with acute Lsp infection were not significantly different from those in patients without evidence of this infectious agent. The length and course of the disease were similar in the 12 patients treated with specific antibiotics for Lsp and in those who were not. We conclude that Lsp can be identified in a significant percentage of patients with acute febrile RTI. No specific clinical or laboratory features were observed for these patients and specific antibiotic therapy does not affect the course of the disease.

Adult↗
PubMed1993

Association of microbiologic flora with clinical, endoscopic, and pulmonary cytologic findings in foals with distal respiratory tract infection.

Undifferentiated distal respiratory tract disease (nasal discharge, cough, pneumonia) in foals (1 to 8 months old) is a burdensome economic problem on breeding farms; yet, the infective agents associated with these episodes have not been well described. Possible causes of these episodes of illness were investigated by culturing specimens of proximal and distal airways of clinically diseased foals (n = 101), prior to any treatment, for aerobic and anaerobic bacteria and viruses (rhinoviruses, equine arteritis virus, equine herpesvirus subtype 1 [EHV-1], influenza virus, and adenovirus). Pairs of sera (n = 47) were examined for antibodies to influenza A virus, equine subtypes 1 and 2, EHV-1, and adenovirus antigens, and sera obtained from foals during acute infection were examined for antibodies (by agar gel immunodiffusion [AGID]) to equi factor antigens of Rhodococcus equi. Viruses were not isolated from the proximal (swab) or distal (bronchial lavage) airway specimens in foals, and only 2 of 47 randomly selected foals seroconverted to EHV-1. Serotiters to the other viruses were low and frequently decreasing between samples, which was compatible with maternally derived antibody. Streptococcus zooepidemicus was the predominant isolate from bronchial lavage specimens (88/101 cases), accompanied by alpha-hemolytic streptococci (8 cases), Bordetella bronchiseptica (13 cases), Staphylococcus epidermidis (9 cases), and other organisms in lesser frequency. Only Str zooepidemicus was recovered significantly (P < 0.05) more often in cases than in controls. The AGID test was found useful to detect foals with presumed exposure to R equi, but positive tests results did not correspond well with bacterial culture results; positive AGID results were recorded in 34% of culture-negative foals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

[Clinical studies of cefpodoxime proxetil in respiratory tract infections].

Twelve patients with respiratory tract infections were treated with cefpodoxime proxetil (CS-807, CPDX-PR), a new cephem antibiotic. It was given orally at a dose of 200 mg 2 times a day for 4 approximately 15 days. Its clinical effects were evaluated as excellent in 1 case, good in 9 cases and poor in 2 cases. The efficacy rate was 83.3%. Its bacteriological effects were evaluated as eradication in 5 strains and decrement in 1 strain. The eradication rate was 83.3%. No adverse reactions and disorder of laboratory findings due to CPDX-PR were observed.

Administration, Oral↗
PubMed2001

Validation study of a diary for use in acute lower respiratory tract infection.

BACKGROUND: Despite lower respiratory tract infection (LRTi) being the most common illness treated by doctors, no validated outcome measure to assess symptom duration and severity has been developed for patient self-completion. METHODS: As part of a randomized control trial researching management of acute LRTi, an easy self-completion diary was formulated and validated against the 'measure yourself medical outcome profile 2' (MYMOP2), an instrument previously validated in general practice. RESULTS: Spearman rank correlations of the diary profile versus MYMOP2 profile at baseline (r = 0.62), day 11 (r = 0.81) and change in score over time (r = 0.51) indicate that our diary correlates significantly with MYMOP2. The standardized response mean of the diary profile (mean change/SD change) = 1.48, indicating sensitivity to change. CONCLUSION: This study shows that a simple symptom diary is internally reliable, valid and sensitive to change for acute LRTi. This instrument could be used as a routine measure of LRTi in further research in both primary and secondary care.

Humans↗