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PubMed2006

Fungal respiratory disease.

PURPOSE OF REVIEW: Fungal respiratory disease is associated with a high mortality in immunocompromised patients. This review aims to describe the recent advances in the aetiology, clinical presentation, diagnosis and management of fungal respiratory disease. RECENT FINDINGS: Invasive aspergillosis is an uncommon complication of hematopoietic stem cell transplants and solid-organ transplants but continues to be associated with poor outcome. Isolation of Aspergillus spp. from respiratory samples preceded acute rejection in lung-transplantation recipients. Molecular typing suggested that there was a very weak correlation between the environmental and patient isolates of Aspergillus fumigatus in invasive pulmonary aspergillosis. Serological and molecular detection of Aspergillus antigens or fungal DNA may improve the diagnosis of pulmonary aspergillosis, but the sensitivity is variable and more studies are needed. Voriconazole and caspofungin are choice to Aspergillus and Candida infection, especially to azole-resistant Candida spp. Treatment combining amphotericin B preparations, early surgical resection of infected tissue and discontinuation of immunosuppressive treatment may improve prognosis of mucormycosis. SUMMARY: Invasive filamentaous fungal infections of lung remain important causes of death in immunocompromised patients. Development of new early diagnostic tools and well-designed multicenter evaluations of diagnostic methods and therapeutic regimens available at present are the important work in the next 2-3 years.

Antifungal Agents↗
PubMed2000

Risk factors for epidemic respiratory disease in Norwegian cattle herds.

An epidemic of acute respiratory disease associated with bovine respiratory syncytial virus (BRSV) occurred during the winter and spring of 1995 in two neighbouring veterinary districts in the south-eastern part of Norway. The objective of this study was to describe the time course of the outbreak associated with BRSV in the cattle herds, and to determine the association between selected herd factors and the risk of experiencing a herd outbreak of acute respiratory disease. Data from 431 cattle herds on the dates of disease occurrence, location of the farms, herd size, age profile and production type were collected retrospectively for 1995. The risk of acute respiratory disease occurring in a cattle herd was related to the herd size as well as the type of production, with an expressed interaction between these two variables. From the Cox proportional-hazards model, the risk of a herd outbreak in a mixed herd of 20 animals was estimated to be 1.7-times greater than in a dairy herd and 3.3-times greater than a beef herd (reference category) of a comparable size. On increasing the herd size to 50 animals, the risk increased 1.3-fold for a mixed herd, 3.3-fold for a dairy herd, and 2.1-fold for a beef herd, compared to the risk for a corresponding type of herd of 20 animals.

Age Factors↗
PubMed1979

[Indices of tuberculosis and nonspecific respiratory diseases a contribution to the surveillance of these diseases (author's transl)].

The epidemiology of tuberculosis and nonspecific respiratory diseases in GDR is reviewed. For tuberculosis an exact survey on its development in the course of the last 30 years is possible by reason of compulsory registration. The program of tuberculosis control has been pushed on consequently from the very beginning; all indices of tuberculosis epidemiology (annual infection rate, incidence and prevalence of morbidity, mortality) have favourably developed. Till 1982 tuberculosis is expected to be eliminated as a special problem of public health in GDR. The assessment and statistic evaluation of the nonspecific respiratory diseases is much more difficult. There is no compulsory registration or notification; acute respiratory diseases are very common; the chronic pulmonary diseases clinically and prognostically important are insufficiently defined and, therefore, patients can be delimited only badly from the by far greater number of persons with chronic cough and sputum defined on the base of epidemiological aspects. The informative significance of secondary statistics (temporary disabelement, dismissals from hospital, invalidity- social parameters) is analyzed regarding their value for an evaluation of these diseases. Acute respiratory diseases have serious consequences on the sickness absence rate due to the percentage of case and duration of absenteeism (20--35% of all cases) of the considerable portion of hospital dismissals. In periods of epidemics disablement is still by far higher.

Adolescent↗
PubMed1996

Effect of cooking fuels on respiratory diseases in preschool children in Lucknow, India.

The association between cooking fuels and the risk of respiratory disease in preschool children in Lucknow, India was studied. We interviewed mothers of 650 study children, randomly selected from among 28 urban poor neighborhoods. Children were eligible if they were less than five years of age, free of congenital heart disease, malignancy, and compromised immune status. Respiratory disease (defined as one or more of the following: runny nose, cough, sore throat, breathlessness, and noisy respiration) was assessed by observation. Exposures included the types of cooking fuels and duration of their use in the last week and other potential predictors of respiratory disease. Odds ratios (ORs) for disease were adjusted for covariables using multiple logistic regression. The point prevalence of respiratory disease was 14.5%. Cooking fuels used were wood (56.0%), kerosene (24.2%), coal (19.2%), gas (15.4%), and dung cakes (8.6%). Use of dung cakes, a sun-dried mixture of cow or buffalo dung and straw, as cooking fuel was associated with respiratory disease (adjusted OR = 2.69, 95% confidence interval [CI] = 1.37-5.31, P = 0.004), as was overcrowding in the bedroom (adjusted OR = 1.25 for each additional person, 95% CI = 1.11-1.41, P = 0.001). Age, weight, gender, family income, and household structure were not associated with disease. Use of dung cakes as cooking fuel and overcrowding in the bedroom increased the risk of respiratory disease. Interventions to modify oven design or install chimneys and, where feasible, to reduce the number of people sleeping together should be considered.

Child, Preschool↗
PubMed1996

Use of tilmicosin in a severe outbreak of respiratory disease in weaned beef calves.

Severe respiratory disease, associated with seroconversion to bovine respiratory syncitial virus (BRSV), caused the death of two cattle and necessitated antibiotic treatment of 70 calves (rectal temperature of 39.6 degrees C or greater) from a group of 96 (73%) during an 8-day period. Tilmicosin injection resulted in a reduction in median rectal temperature from 40.3 degrees C to 39.2 degrees C and 39.0 degrees C for the first and second days after treatment. The rectal temperature was 39.5 degrees C or lower in 72% (48 of 67) and 96% (64 of 67) of cattle 1 and 2 days after tilmicosin treatment, respectively. Ten cattle were re-treated with tilmicosin 6 to 16 days after the first treatment. Our study demonstrated that bovine respiratory syncytial virus infection could cause severe respiratory disease in a beef herd that had no previous history of BRSV-related disease. Secondary bacterial invasion after BRSV infection was controlled effectively by tilmicosin treatment but repeat antibiotic treatments were occasionally necessary due to bacterial re-infection of the respiratory tract.

Animals↗
PubMed1993

Respiratory illness and mortality in England and Wales. A study of the relationships between weekly data for the incidence of respiratory disease presenting to general practitioners, and registered deaths.

The possible relationship between the incidence of respiratory diseases as reported to general practitioners and numbers of registered deaths in England and Wales has been examined. Morbidity data from sentinel practices for the period 1986-1990 (population covered increased from 220,000 to 470,000) were used to calculate weekly rates of aggregated respiratory disease for persons of all ages and for elderly persons (aged 65 years and over). The elderly respiratory disease rates and numbers of deaths were aggregated into 4-week periods; secular and seasonal trends were removed from each series and the two sets of residuals were examined graphically and cross correlation coefficients calculated. There was a very strong positive association between the respiratory disease rate and number of deaths in the same 4-week period and there was also a significant but less pronounced association between respiratory disease in one 4-week period and deaths in the next. After prior separation of weeks according to temperature into four bands, weekly rates for respiratory disease were also strongly associated with the number of weekly deaths for each temperature band. The synchronisation of peaks and troughs in the two series throughout the year supports the hypothesis that a cause and effect relationship exists between respiratory disease in the elderly and number of deaths. Other climatic and meteorological variables besides temperature may play a part in determining the spread of a respiratory disease. There is a for further research to identify the micro-organisms responsible for acute respiratory infections in the elderly.

Acute Disease↗
PubMed1983

Impact of viral respiratory diseases on infants and young children in a rural and urban area of southern West Virginia.

Acute viral respiratory disease occurring in children residing in the community of Huntington, West Virginia (urban children) or in the hollows surrounding Huntington (rural children) was evaluated from September 1978 through March 1980. Cohorts of ambulatory children residing in each area were studied for the occurrence of mild to moderate respiratory disease. All children admitted to hospitals were evaluated for the occurrence of severe viral respiratory disease. Respiratory secretions were obtained from children for isolation of viruses. Epidemics of illnesses occurred simultaneously in the urban and rural groups of children. Among both the urban and rural ambulatory children, adenoviruses were the most common viruses isolated, and respiratory syncytial virus was the second most common viral pathogen isolated. Among the urban and rural hospitalized children, respiratory syncytial virus was the most common virus isolated. The distribution of the diagnoses, pneumonia, bronchiolitis, or croup, was similar among the urban and rural children who required hospitalization. The risk of hospitalization because of respiratory disease was found to be one in every 20 children during the first four years of life, and the estimated risk of hospitalization because of respiratory syncytial virus infection was one in 30. No differences were detected in the incidence of severe viral respiratory disease among children residing in urban or rural areas in southern West Virginia.

Child, Preschool↗
PubMedDate not supplied

Pulmonary function changes and clinical findings associated with chronic respiratory disease in calves.

Thirteen field cases of chronic respiratory disease in crossbred calves aged between 1 and 8 months were subjected to a standardized examination in which clinical criteria were scored and weighted to allow quantification. Predicted values for pulmonary function variables were generated using regression equations previously established in normal calves which related measured pulmonary function variables to thoracic perimeter. Subsequent pulmonary function testing of each calf was undertaken and values obtained compared with predicted values and correlated with clinical scores. Diagnosis was confirmed at post-mortem examination. Calves with chronic respiratory disease had significantly reduced inspiratory and expiratory times, tidal volume, dynamic compliance and PaO2, significantly increased respiratory frequency, airway resistance and PaCO2 and more negative transpulmonary pressure values when compared to predicted pulmonary function values for the same calves. PaO2 and PaCO2 were the only variables correlated with clinical scores, suggesting their value in the assessment of severe cases of calf respiratory disease.

Animals↗
PubMedDate not supplied

Screening for common respiratory diseases among Israeli adolescents.

BACKGROUND: Respiratory diseases are responsible for a significant proportion of serious morbidity among adolescents. There are few reports on the prevalence of common respiratory disorders in this population. The previous studies focused on specific diseases and screened relatively small samples. OBJECTIVE: To define the prevalence of different common respiratory disorders among 17-year-old Israeli conscripts. DESIGN: All 17-year-old Israeli nationals are obliged by law to appear at the Israel Defense Forces recruiting office for medical examination. Respiratory disease specialists evaluated and classified nominees with suspected respiratory disorders. RESULTS: A high prevalence of respiratory morbidity was found among 94,805 17-year-old conscripts (61.5% male, 39.5% female). The most prevalent diagnosis was asthma (in 8% of male and 6.8% of female subjects). Fifty-five per cent of the asthma patients suffered from moderate to severe disease. The prevalence of chronic obstructive pulmonary disease was 0.03% for the male and 0.01% for the female subjects. A difference in morbidity patterns between male and female adolescents was noted, particularly in the prevalence of chest deformation and spontaneous pneumothorax. CONCLUSIONS: The most prevalent respiratory disorder among 17-year-old Israeli conscripts was asthma. One-half of the asthma patients in this study suffered from moderate to severe disease. The prevalence of other respiratory disorders was much lower.

Adolescent↗
PubMed2003

Social position and mortality from respiratory diseases in males and females.

Although social differences in respiratory diseases are considerable, few studies have focused on this disease entity using mortality as an outcome. Does mortality from respiratory disease, including chronic obstructive pulmonary disease (COPD) differ with social position measured by education, income, housing and employment grade? The study population consisted of 26,392 males and females from pooling of two population studies in the Copenhagen area. Data was linked with information from social registers in Statistics Denmark. The relationship between socioeconomic factors and risk of death from respiratory disease and COPD was assessed with an average duration of follow-up of 12 yrs. Education was strongly associated with respiratory mortality in both sexes. The association was stronger in later birth cohorts comparing the highest level of education (>11 yrs) with the lowest (<8 yrs). Although smoking rates were inversely associated with the level of education, the social gradient was not affected by adjustment for smoking. In males, but not in females, there was an additional effect of other indicators of social position, i.e. employment grade (white collar versus blue collar), household income, housing conditions (less than one person per room versus more), and cohabitation (cohabiting versus living alone). Similar results were found for mortality from COPD. The results confirm the existence of a strong social gradient in respiratory mortality and chronic obstructive pulmonary disease, which is independent of smoking and is stronger in males. Social disadvantage is a potentially avoidable cause of death from respiratory disease and further research is needed to explain the excess risk in the socioeconomically disadvantaged.

Adult↗
PubMed2000

Respiratory diseases, diagnostics, and treatment of marsupials.

Primary respiratory disease is uncommon in marsupials, but generalized disease often involves the respiratory tract in these animals. Other disease entities may spread to involve the respiratory system secondarily. Treatment is challenging because most animals are severely compromised on presentation. Bacteria, viruses, parasites, fungi and yeasts, trauma, and neoplasia all can affect the respiratory systems of marsupials. Some of these conditions are only incidental findings, whereas others are pathogenic. Many therapies and diagnostic procedures are extrapolated from those in companion animal medicine and surgery. Despite the problems associated with the diagnosis and treatment of respiratory disease in marsupials, new therapeutic agents and diagnostic techniques are making these tasks easier and ultimately more successful.

Animals↗
PubMed2000

Update on gastroesophageal reflux and respiratory disease in children.

Pediatric respiratory diseases have been linked to gastroesophageal reflux disease (GERD), but evidence regarding the association and its potential mechanisms continues to accumulate, and important aspects remain to be determined. Evidence for the association in two common pediatric respiratory disorders - infantile apnea and asthma in older children - and difficult clinical issues associated with the diagnosis and treatment of these two disorders are reviewed. The provocative embryological and physiological connections between the upper gastrointestinal tract and the respiratory tract, and recent understanding of the compensatory anatomy and physiology that protect the normal individual from respiratory manifestations of GERD are also explored. Dysfunctions of these protections likely underlie the pathophysiology of these disorders.

Child↗
PubMed1993

A case-control study of malignant and non-malignant respiratory disease among employees of a fiberglass manufacturing facility. II. Exposure assessment.

A case-control study of malignant and non-malignant respiratory disease among employees of the Owens-Corning Fiberglas Corporation's Newark, Ohio plant was undertaken. The aim was to determine the extent to which exposures to substances in the Newark plant environment, to non-workplace factors, or to a combination may play a part in the risk of mortality from respiratory disease among workers in this plant. A historical environmental reconstruction of the plant was undertaken to characterise the exposure profile for workers in this plant from its beginnings in 1934 to the end of 1987. The exposure profile provided estimates of cumulative exposure to respirable fibres, fine fibres, asbestos, talc, formaldehyde, silica, and asphalt fumes. Employment histories from Owens-Corning Fiberglas provided information on employment characteristics (duration of employment, year of hire, age at first hire) and an interview survey obtained information on demographic characteristics (birthdate, race, education, marital state, parent's ethnic background, and place of birth), lifetime residence, occupational and smoking histories, hobbies, and personal and family medical history. Matched, unadjusted odds ratios (ORs) were used to assess the association between lung cancer or non-malignant respiratory disease and the cumulative exposure history, demographic characteristics, and employment variables. Only the smoking variables and employment characteristics (year of hire and age at first hire) were statistically significant for lung cancer. For non-malignant respiratory disease, only the smoking variables were statistically significant in the univariate analysis. Of the variables entered into a conditional logistic regression model for lung cancer, only smoking (smoked for six months or more v never smoked: OR = 26.17, 95% confidence interval (95% CI) 3.316-206.5) and age at first hire (35 and over v less than 35: OR = 0.244, 95% CI 0.083-0.717) were statistically significant. There were, however, increased ORs for year of employment (first hired before 1945 v first hire after 1945: OR = 1.944, 95% CI 0.850-4.445), talc (cumulative exposure >1000 fibres/ml days v never exposed: OR = 1.355, 95% CI 0.407-5.515), and asphalt fumes (cumulative exposure >0.01 mg/m(3) days v never exposed: OR 1.131, 95% CI 0.468-2.730). For non-malignant respiratory disease, only the smoking variable was significant in the conditional logistic regression analysis (OR = 2.637, 95% CI 1.146-6.069). There were raised ORs for the higher cumulative exposure categories for respirable fibres, asbestos, silica, and asphalt fumes. For both silica and asphalt fumes, ORs were more than double the reference groups for all exposure categories. A limited number of subjects were exposed to fine fibres. The scarcity of cases and controls limits the extent to which analyses for fine fibre may be carried out. Within those limitations, among those who had worked with fine fibre, the unadjusted, unmatched OR for lung cancer was (1.0 (95% CI 0.229-4.373) and for non-malignant respiratory disease, the OR was 1.5 (95% CI 0.336-6.702). The unadjusted OR for lung cancer for exposure to fine fibre was consistent with that for all respirable fibre and does not suggest an association. For non-malignant respiratory disease, the unadjusted OR for fine fibre was opposite in direction from that for all respirable fibres. Within the limitations of the available data on fibre, there is o suggestion that exposure to fine fibre has resulted in an increase in risk of lung cancer. The increased OR for non-malignant respiratory disease is inconclusive. The results of this population, in this place and time, neither respirable fibres nor any of the substances investigated as part of the plant environment are statistically significant factors for lung cancer risk although there are increased ORs for exposure to talc and asphalt fumes. Smoking is the most important factors in risk for lung cancer in this population. The situation is less clear for non-malignant respiratory disease. Unlike lung cancer, non-malignant respiratory represents a constellation of outcomes and not a single well defined end point. Although smoking was the only statistically significant factor for non-malignant respiratory disease in this analysis, the ORs for respirable fibres, asbestos, silica, and asphalt fumes were greater than unity for the highest exposure categories. Although the raised ORs for these substances may represent the results of a random process, they may be suggestive of an increased risk and require further investigation.

Adult↗
PubMedDate not supplied

Prevalence of Alcaligenes faecalis in North Carolina broiler flocks and its relationship to respiratory disease.

In order to assess the role of Alcaligenes faecalis in respiratory disease of broilers, a study was conducted to determine the prevalence of this bacterium in North Carolina broilers and to determine the relationship of A. faecalis infection to clinical disease. Our studies showed that A. faecalis is prevalent in North Carolina commercial broilers during the winter months. Bacteriological examination of turbinates and tracheas revealed that almost 40% of individual birds between 35 and 45 days of age yielded positive cultures; 62% of tested flocks were infected. When present, A. faecalis was usually the predominant bacterium isolated. Furthermore, because of a higher frequency of A. faecalis isolation in broiler flocks with respiratory disease (75% vs. 29% in flocks without respiratory diseases), these studies suggest a causal relationship between this bacterium and clinical respiratory disease.

Alcaligenes↗
PubMed1991

[Passive smoking and positive intracutaneous allergen tests in children with respiratory diseases].

In children with respiratory disease (bronchitis, pneumonia and bronchial asthma) skin hypersensitivity towards tobacco leaf crude extract has been tested and related to urinary cotinine level, the latter being most informative in assessing exposure to cigarette smoke. Besides routine intracutaneous tests a mixture of seven main brands of Bulgarian tobaccos (Burley, Virginia, Oriental etc.) has been applied as allergen. Urinary cotinine has been estimated by the method of BARLOW et al. [1]. Skin sensitization towards tobacco was positive in 2 (8%) of the children hospitalized for pneumonia and bronchitis and in 8 (47%) of children with bronchial asthma, followed up as outpatients. Cotinine concentrations were 66 mumol.l-1 and 107 mumol.l-1, respectively compared to 34 mumol.l-1 and 37 mumol.l-1 in healthy controls. Results outline the great importance of passive exposure to environmental tobacco smoke, an all the year round domestic pollutant in the home of smoking parents.

Adolescent↗
PubMed2000

Cost-effective antimicrobial drug selection for the management and control of respiratory disease in European cattle.

Respiratory disease in growing cattle has both animal welfare and economic implications, but the use of antimicrobial drugs to treat and control it is under public scrutiny owing to concerns that their use in food-producing animals may be detrimental to human health. This paper outlines criteria for the selection of appropriate and cost-effective drugs, based on good dinical practice and sound economic principles. It also suggests that these principles should be integrated into quality assurance schemes, and that the monitoring of antimicrobial resistance patterns among known bacterial respiratory pathogens should be improved.

Animals↗