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PubMed1981

Mechanisms of infection in the respiratory tract.

Related to its potential vulnerability the respiratory tract has a very complex and effective defence apparatus. The interaction between these defence mechanisms and certain characteristics of aetiological agents results in a pattern in which initial infections by these agents tend to occur at specific sites in the tract. Infections in which the primary portal of entry is in the upper respiratory tract include Bordetella bronchiseptica and Haemophilus spp in pigs; Pasteurella spp in cattle, sheep, pigs; Mycoplasma spp in cattle, sheep, pigs and poultry; equine herpesvirus 1 in horses; infectious bovine rhinotracheitis in cattle; parainfluenza 3 in cattle and sheep; infectious laryngo-tracheitis and infectious bronchitis in poultry; feline viral rhinotracheitis and calicivirus in cats; Aujeszky's disease virus and swine influenza in pigs; and equine influenza in horses. Infections in which the primary portal of entry is in the lower respiratory tract include Aspergillus fumigatus in poultry and mammals, respiratory syncytial virus in cattle, distemper virus in dogs and adenovirus in cattle and dogs. A fuller understanding of the interactions between an agent and the host at the point of entry would make it much easier to develop effective vaccines and therapeutic agents.

Animals↗
PubMed2004

Circovirus infection in a Gouldian finch (Chloebia gouldiae).

The bird examined was a 10-week-old female Gouldian finch (Chloebia gouldiae) from an aviary that had housed about 100 Gouldian finches, which had nasal discharge, dyspnoea, anorexia, depression and a very high mortality (50%) in both adult and young birds. Gross and histopathology revealed moderate to severe lymphoid depletion in the bursa of Fabricius and thymus, and sinusitis/rhinitis, tracheitis, bronchopneumonia, myocarditis, nephritis and splenitis. Circovirus infection was diagnosed in the Gouldian finch based on finding characteristic globular intracytoplasmic inclusion bodies containing 15 to 18 nm virus particles in the mononuclear cells of the bursa of Fabricius by transmission electron microscopy and by demonstrating circovirus DNA in the cytoplasm of mononuclear cells of the bursa of Fabricius by in situ hybridization using a circovirus-specific DNA probe. The Gouldian finch was also affected by concurrent bacterial and adenovirus infections. This is the first report of circovirus infection in a Gouldian finch.

Animals↗
PubMed2006

An outbreak of avian influenza subtype H9N8 among chickens in South Korea.

Low pathogenic avian influenza subtype H9N8 was diagnosed on a Korean native chicken farm in Gyeonggi province, South Korea, in late April 2004. Clinical signs included moderate respiratory distress, depression, mild diarrhoea, loss of appetite and a slightly elevated mortality (1.4% in 5 days). Pathologically, mucopurulent tracheitis and air sacculitis were prominently found with urate renal deposition. The isolated A/chicken/Kr/164/04 (H9N8) had an Ala-Ser-Gly-Arg (A/S/G/R) motif at the cleavage site of haemagglutinin, which has been commonly found in H9N2 isolated from Korean poultry. Phylogenetic analysis of the haemagglutinin and neuraminidase genes of the H9N8 avian influenza virus (AIV) isolate showed that reassortment had occurred. Its haemagglutinin gene was similar to that of Korean H9N2 AIVs, but its neuraminidase gene was closely related to that of A/WBF/Kr/KCA16/03 (H3N8) isolated from the faeces of wild birds in Korea. The pathogenicity of the isolate was tested on 6-week-old specific pathogen free chickens. The inoculated virus (H9N8) was recovered from most tested organs, including the trachea, lung, kidney, spleen, and caecal tonsil. This is the first report of an outbreak of low pathogenic avian influenza in chickens caused by AIV subtype H9N8.

Animals↗
PubMed2006

Do influenza and acute respiratory infective diseases weigh heavily on general practitioners' daily practice?

OBJECTIVE: Respiratory infections are a frequent causes of medical attendance. Influenza viruses increases this phenomena. The aim of this study was to prospectively identify GPs' increased work in terms of visits and time. METHODS: Over a period of five months 5 GPs recorded sex, age, number and place of visits, telephone consultations of the patients visited for acute respiratory disease (ARD)which included acute respiratory infections (ARI), influenza (FLU) and Influenza-like illness (ILI). Upper respiratory tract infections (URTI) were classified as sinusitis, rhinitis, otitis, tonsillitis, pharyngitis, laryngitis, Lower respiratory tract infections (LRTI) were classified as tracheitis, bronchitis, pneumonia, bronchopneumonia, acute episodes of chronic obstructive pulmonary disease (COPD) and asthma. FLU and ILI were considered two different entities on the basis of symptoms. RESULTS: Acute respiratory disease increase of 22 patients attending every GP's office monthly (from 176 to 198 total visits). 6,542 patients were observed. The incidence of ARD was 33.5% (2191: 1,091 female and 1,100 males). URTI affected 944 patients, LRTI 739, FLU 328 and ILI 180. The increase in home visits grew from 10 to 36. Each home visit took from 15 to 45 minutes. In a high number of cases (236), home visits were necessary for sick-leave certificates. FLU (54%) and LRTI (37.5%) required more attention, and they were the primary causes for visits. Telephone consultations took place for all ILI or FLU of minor severity and in young people. CONCLUSION: During the winter there is an increased work-load for GPs due to the diffusion of influenza virus and respiratory tract diseases. "Burn out syndrome" is increasing among the GPs. Territorial GPs' action is highly efficacious. Patients self-certification should be evaluated. Vaccine therapy could be more effective if done on a larger population. More research is needed.

Acute Disease↗
PubMed1982

Acute inhalation toxicity and sensory irritation of dimethylamine.

The sensory irritation potential of dimethylamine (DMA) inhalation on male Fischer-344 rats and male Swiss-Webster mice was evaluated by measuring the reflex decrease in respiratory rate. In addition, the six hour LC50 for rats exposed to dimethylamine was established. Groups of 3 or 4 rats and mice were exposed for 10 minutes to concentrations of DMA ranging from 49 to 1576 ppm during which time the respiratory rate was monitored and recorded. Sensory irritation concentration-response curves were obtained and RD50 values (concentration which elicits a 50% decrease in respiratory rate) were determined to be 573 and 511 ppm for rats and mice, respectively. In another set of experiments seven groups of male rats were exposed to concentrations of DMA ranging from 600 to 6119 ppm for six hours. Mortality counts were made during and for 48 hours post exposure. The sic hour LC50 was determined to be 4540 ppm. Histopathologic examination of the respiratory tract revealed concentration related changes ranging from ulceration and necrosis to rhinitis, tracheitis, and emphysema. Overall, DMA was found to be less potent as a sensory irritant than other airborne irritants.

Animals↗
PubMed1999

Antibiotic prescribing for Canadian preschool children: evidence of overprescribing for viral respiratory infections.

Antibiotic resistance is associated with prior receipt of antibiotics. An analysis of linked computerized databases for physician visits and antibiotic prescriptions was used to examine antibiotic prescribing for different respiratory infections in preschool children in Canada. In 1995, 64% of 61,165 children aged <5 years made 140,892 visits (mean, 3.6 visits per child) for respiratory infections; 74% of children who made visits received antibiotic prescriptions. Antibiotics were prescribed to 49% of children with upper respiratory tract infection, 18% with nasopharyngitis, 78% with pharyngitis or tonsillitis, 32% with serous otitis media, 80% with acute otitis media, 61% with sinusitis, 44% with acute laryngitis or tracheitis, and 24% with influenza. Acute otitis media accounted for 33% of all visits and 39% of all antibiotic prescriptions. The estimated Canadian-dollar cost of overprescribing was $423,693, or 49% of the total cost of antibiotics ($859,893) used in this group. This population-based study confirms antibiotic overprescribing in Canada.

Anti-Bacterial Agents↗
PubMed1975

Antiviral activity of adenine arabinoside and iododeoxyuridine in human fetal intestinal and tracheal organ cultures.

In vitro antiviral activities of two potentially clinically useful antiviral compounds, adenine arabinoside and iododeoxyuridine, were examined in human fetal intestinal and tracheal organ cultures infected with Herpesvirus hominis (types 1 and 2) or vaccinia virus. The two compounds were similarly active against the viruses in organ culture, and minimal inhibitory concentrations could be determined by titration of organ culture fluid harvests into tissue culture or directly in the organ cultures themselves. Minimal inhibitory concentrations were consistently lower in tracheal than in intestinal organ cultures and were consistently higher for H. hominis type 2 than for H. hominis type 1. Thus the organ cultures are promising systems in which to evaluate antiviral activity against those agents that replicate in vitro only in organ culture, and they may have particular application to the study of herpetic tracheitis and esophagitis.

Humans↗
PubMed1975

Influenza alone and in sequence with pneumonia due to Streptococcus pneumoniae in the squirrel monkey.

Squirrel monkeys (Saimiri sciureus) inoculated intratracheally with 10(4.2)-10(8.2) egg median infectious doses (EID50) of type A influenza virus (H3N2) responded with clinical illness including such signs as fever, sneezing or coughing, coryza, and increased respiratory rates. Necropsy studies performed six days after inoculation revealed bronchopneumonia in addition to a mild tracheitis. Squirrel monkeys given 10(5)-6 x 10(8) colony-forming units (cfu) of Streptococcus pneumoniae intratracheally died four to six days later after developing severe illness characterized by fever, bacteremia, lethargy, anorexia, coughing, labored breathing, and bronchopneumonia. Monkeys given 770 cfu of S. pneumoniae responded with less severe symptoms and survived. Four squirrel monkeys inoculated with 10(8.2) EID50 of virus and then 102 hr later with 770 cfu of S. pneumoniae developed severe disease; three of the four animals died within 40 hr. At necropsy these monkeys had more extensive and severe bronchopneumonia than was seen in monkeys infected with either organism alone.

Animals↗
PubMed1987

Sequential intravenous-oral amoxycillin/clavulanate (Augmentin) therapy in paediatric hospital practice.

The efficacy and safety of intravenous and sequential intravenous-oral clavulanate-potentiated amoxycillin therapy was evaluated in 71 hospitalized paediatric patients, one month to 16 years of age. The infections treated included peritonsillar abscess (2 patients), purulent tracheitis (1), acute epiglottitis (24), pneumonia (31), pansinusitis (4), mastoiditis (1), cellulitis (4), lymphadenitis (2) and pyelonephritis (2). The severity of disease was rated as moderate in 31 patients (44%), and as severe in 40 (56%). Bacterial pathogens could be cultured in 26 cases (37%). The response to therapy was prompt and followed by clinical cure in each patient. Adverse drug effects included phlebitis (in 6%), mild gastrointestinal complaints (6%), rash (4%) and transient neutropenia and elevation of transaminases (one case each). It is concluded that amoxycillin/clavulanate is effective and safe treatment for bacterial infections of the respiratory tract, urinary tract, skin or soft tissues in children.

Administration, Oral↗
PubMed1998

Adult acute upper respiratory tract infections in Sicily: pattern of antibiotic drug prescription in primary care.

We performed an observational study of the antibiotic-prescribing behaviour of Sicilian general practitioners (GPs) in managing acute upper respiratory tract infections (URTIs). Seventy-six GPs from 25 towns, representing a patient population of 96,630, participated in the study between September 1995 and May 1996. These physicians issued 2038 antibiotic treatment courses for acute upper respiratory tract infections: 792 for acute pharyngitis, 531 for acute tonsillitis, 304 for acute laryngitis and tracheitis, 268 for suppurative and non-suppurative acute otitis media, 124 for acute sinusitis and 19 for acute rhinitis. Forty-nine different antibiotics were prescribed. The most commonly used therapeutic groups were macrolides (38.6%), cephalosporins (27.1%), a combination of penicillins with beta-lactamase inhibitors (15.7%) and extended spectrum penicillins (13.5%). For each of the above diseases, except rhinitis, more than 30 different antibiotics were used. The choice of the route of administration appeared to be influenced by the age of the patients and, significantly, by a subjective clinical assessment of disease severity rather than by any consideration of epidemiological information or evidence from clinical trials. The rather marked variation in antibiotic-prescribing pattern for URTIs among Sicilian GPs reflects lack of availability or knowledge of any local or national guidelines.

Adolescent↗
PubMed1981

Clinical experience with high frequency jet ventilation.

High frequency jet ventilation (HFJV) has been used in recent years in some forms of respiratory failure, where the presence of barotrauma limited the application of high peak inspiratory pressure. In the present report, the authors describe the clinical experience with 17 patients, who could not be supported with conventional mechanical support and were placed on HFJV. Rates of 100 breath/min, inspiratory/expiratory ratio of 1:2 and cannula size of 1.06--1.62 mm (18--14) gauge were used. Driving pressure required to maintain a PaCO2 of 40--45 torr was 14--45 psig; however, except in 2 patients who developed hemorrhagic tracheitis with subtotal obstruction of both mainstem bronchi, a driving pressure higher than 27 psig was never required, even when PEEP up to 32 cm H2O was used. Of 17 patients treated, 8 survived. In all cases, alveolar ventilation could be maintained within the desired range with high frequency ventilation, even in those patients who eventually died; mechanical support never provided better oxygenation or alveolar ventilation than high frequency ventilation. Hemodynamic function was essentially unchanged with high frequency ventilation; indeed, in three cases, inotropic support with dopamine could be discontinued after initiation of high frequency ventilation.

Carbon Dioxide↗
PubMed2002

'Defatting' tracheotomy in morbidly obese patients.

OBJECTIVES/HYPOTHESIS: Standard-sized tracheostomy tubes often fit morbidly obese patients poorly because of increased submental and anterior cervical girth. The surgeon has two options to overcome this problem: Modify the tracheostomy tube to fit the patient or recontour the neck to accommodate a standard tube. The purpose of the study was to assess the safety and morbidity of the latter technique, the "defatting" tracheotomy. STUDY DESIGN: Retrospective cohort study of 23 patients treated between 1994 and 2001 with cervical lipectomy and tracheotomy. METHODS: Medical charts were reviewed for indications, demographics, body mass index, tracheotomy-related complications, and decannulation results. RESULTS: The average age of patients was 50 years (age range, 34-77 y). The mean preoperative body mass index was 55.9 (range, 39.2-73.5). Indications for the procedure were respiratory failure requiring chronic ventilation in 16 patients (70%) and obstructive sleep apnea in 7 (30%). Four patients died postoperatively from causes unrelated to tracheotomy. The mean follow-up time of survivors was 23 months. The overall tracheotomy-related complication rate was 43%. Four patients developed wound infections in the perioperative period, one patient developed a neck abscess, and one patient required neck exploration for control of hemorrhage. Four patients (22%) developed late complications including tracheitis (1), neck abscess (1), and stenosis of the tracheocutaneous tract (2). Eight patients (44%) ultimately had decannulation. CONCLUSIONS: Defatting tracheotomy is a safe technique that allows for the placement of a standard tracheostomy tube in morbidly obese patients. It is associated with a high rate of minor infectious complications. Even so, we think that cervical lipectomy with tracheostomy tube placement is the preferred surgical option for this patient population.

Adipose Tissue↗
PubMed1988

Croup syndrome: historical perspective.

The management of acute croup syndrome has undergone very interesting changes in the past century. Initially a number of conditions were thought to be synonymous with croup, but with identification of the bacterial and viral etiology these have been separated into different clinical entities: viral croup which is very common and frequently self-limited; bacterial tracheitis, a condition which is infrequently encountered and which may be a complication of viral croup; and epiglottitis or supraglottitis, a disease that has been identified as most frequently due to a specific organism, H. influenzae. The management of the child with airway obstruction has also changed. Before the past decade virtually all children with epiglottitis were treated with tracheotomy and currently very few children are thus treated. Intubation has been showed to be a safe procedure in these cases. There still exists some controversy regarding the treatment of the child with laryngotracheobronchitis. In the vast majority of cases medical management has been successful and in the remainder there is controversy regarding the use of intubation or tracheotomy.

Child↗
PubMed1989

Tracheostomy in the intensive care unit: a safe alternative to the operating room.

Severely injured patients frequently require endotracheal intubation, either by the nasotracheal (NT) or orotracheal (OT) route, for airway control and/or ventilatory support. If intubation is required for more than two to four weeks, an elective tracheostomy is usually indicated. Transferring these patients to the operating room is difficult, and it impairs their continued monitoring and care. Over a period of 48 months at our institution, 74 patients had tracheostomy done in the intensive care unit (ICU) by a surgical resident (PG2 level) assisted by a chief resident or attending faculty member. Local anesthesia was supplemented with intravenous sedatives, and operating room technique was used, with complete surgical instrument pack and adequate lighting. There were no deaths from the procedure. There were no complications specifically attributed to the performance of tracheostomy in the ICU, though one patient each suffered tracheitis, tracheostomy tube dislodgement, and tracheomalacia. Tracheostomy in the ICU avoids the risks of moving these patients with all their monitoring and infusion lines, and saves operating room time and charges. Trained surgical personnel using adequate instruments and lighting can safely perform a tracheostomy in the intensive care unit.

Combined Modality Therapy↗
PubMed1994

Upper airway obstruction from tonsillar infection in adults.

We report the case of a 23-year-old male who presented to the emergency department with severe upper airway obstruction resulting from infection of the palatine tonsils. Manifestations of tonsillar infection and airway obstruction included hoarseness and extreme difficulty breathing, severe sore throat and inability to swallow liquids or solids. Urgent otolaryngologic consultation was obtained, and the patient was taken directly to the operating suite for nasotracheal intubation with tracheostomy standby. The patient was maintained on broad-spectrum antibiotics and was discharged after a hospital course complicated by pulmonary oedema, tracheitis and difficulty weaning from the ventilator, requiring temporary tracheostomy. The Monospot test was negative for infection with the Epstein-Barr virus (EBV). We could find no previously reported cases of adults with severe palatine tonsillar-induced airway obstruction which was not due to infection with EBV (mononucleosis). The airway management of obstruction due to palatine tonsillar hypertrophy is discussed.

Adult↗
PubMed2003

Measles outbreak in Dublin, 2000.

BACKGROUND: An outbreak of measles occurred in Ireland between December 1999 and July 2000. The majority of cases were in north Dublin, the catchment area of The Children's University Hospital (TCUH). METHODS: Details of all of the 111 children attending the hospital with a diagnosis of measles between December 1999 and July 2000 were prospectively entered into a database. Charts were subsequently reviewed to extract epidemiologic and clinical details. National figures were obtained from the National Disease Surveillance Centre. RESULTS: In the study period 355 attended TCUH with a serologic or clinical diagnosis of measles, and 111 were admitted (47% female, 53% male). The main indications for admission were dehydration in 79%, pneumonia or pneumonitis in 47% and tracheitis in 32%. Thirteen children (11.7% of those admitted) required treatment in the intensive care unit, and in 7 of these mechanical ventilation was necessary. There were 3 deaths as a result of measles. Public health measures to curb spread of the disease included promotion of immunization for susceptible children nationally and recommending administration of measles-mumps-rubella vaccine (MMR) from the age of 6 months, in North Dublin. CONCLUSION: This outbreak of measles posed a major challenge to the hospital and the community for the first half of 2000. The national MMR immunization rate before the outbreak was gravely suboptimal at 79%, whereas the rate in North Dublin, the catchment area of TCUH, was <70%. Three children died as a result of a vaccine-preventable illness.

Age Distribution↗
PubMedDate not supplied

Preliminary experience with the use of oral linezolid in infants for the completion of antibiotic therapy in the outpatient setting after admission to the pediatric intensive care unit.

Advances in medical technology have led to improved survival after catastrophic illnesses. Many of the survivors require ongoing care including tracheostomy, mechanical ventilation, tube feedings, and indwelling venous catheters. Repeated hospitalizations may be necessary to treat infectious complications resulting from resistant organisms requiring intravenous antibiotic therapy. Because prolonged intravenous access may be difficult or even impossible in these patients, alternative means of therapy are necessary. Linezolid is the first of a new class of antimicrobial agents known as the oxazolidinones with activity against gram-positive bacteria similar to that of vancomycin and yet its oral bioavailability allows for enteral administration. We present our retrospective experience with oral linezolid in a cohort of pediatric intensive care unit patients. Primary infectious disease issues included endocarditis, tracheitis, pneumonia, or central line sepsis resulting from Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus, and Enterococcus. Treatment was initiated with vancomycin and changed to enteral linezolid (10 mg/kg every 12 hours). The duration of therapy with linezolid varied from 7 days to 6 weeks. All of the patients were discharged home to complete their course of enteral linezolid. No complications related to linezolid therapy were noted, and all of the patients completed their prescribed course of therapy without the need for rehospitalization. Our preliminary experience suggests that oral linezolid offers an effective alternative to intravenous vancomycin for the treatment of infections resulting from gram-positive bacteria and avoids the need for prolonged vascular access.

Acetamides↗
PubMed2004

Out-of-hospital cardiopulmonary arrest in children with croup.

Viral laryngotracheobronchitis is a ubiquitous infectious process that has not caused significant mortality in the past 20 years. Bacterial tracheitis and pneumonia can complicate viral laryngotracheobronchitis and markedly increase the risk of bad outcome. Even uncomplicated, properly managed, viral laryngotracheobronchitis can occasionally result in death, particularly in the infant age group.

Child, Preschool↗