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PubMed2005

Major bacteria of community-acquired respiratory tract infections in Turkey.

To determine the bacterial etiology of lower respiratory tract infections (LRTIs) in Turkey, quantitative cultures of sputum were carried out. The major pathogens for LTRIs were found to be Haemophilus influenzae, followed by Streptococcus pneumoniae and Moraxella catarrhalis. Only 6.1% of the H. inlfuenzae and all strains of M. catarrhalis were beta-lactamase producers. An E-test showed that 31.2% of the S. pneumoniae strains had an intermediate resistance to penicillin, and the remaining strains were susceptible; no fully resistant strains were detected.

Community-Acquired Infections↗
PubMedDate not supplied

[Interobserver agreement in the radiological diagnosis of lower respiratory tract infections in children].

OBJECTIVE: To evaluate the inter-observer agreement of radiological diagnosis of lower respiratory tract infections in children. METHODS: Chest X-rays from 60 children younger than 5 years of age were evaluated by three physicians: a pediatric radiologist (PR), a pediatric pulmonologist (PP) and an experienced emergency pediatrician (EP). All children had sought an emergency room due to acute respiratory infections with apparent lower respiratory tract involvement. Observers were blinded to the original diagnostic conclusions, but clinical and laboratory data from the initial medical evaluation were provided with each film. Variables were grouped into five categories: a) film quality; b) site of abnormality; c) radiological patterns; d) other radiographic images; e) diagnosis. Inter-observer agreement was assessed using Kappa statistics, accepting prevalence-bias-adjusted values (PABAK). compare the prevalence of breastfeeding and exclusive breastfeeding during the first six months of life among pacifier and non-pacifier users. RESULTS: Kappa values for each of the three observer pairs (RP vs. PP, RP vs. EP, and PP vs. PE) were 0.41, 0.43, and 0.39, respectively. The overall inter-observer agreement was moderate (0.41). Agreement on other variables was as follows: regular for "film quality" (0.30); moderate for "site of abnormality" (0.48); fair for "radiological patterns" (0.29); moderate for "other radiographic images" (0,43); and moderate for "diagnosis" (0.33). The overall intra-observer agreement was "moderate" (0.54), which is below the agreement values reported by other studies on chest X-ray variability. CONCLUSIONS: Inter-observer variability is an intrinsic characteristic of the interpretation of chest X-rays, and the diagnosis of lower respiratory tract infections in children remains a challenge. Most of our results were similar to those previously reported.

Child, Preschool↗
PubMed1995

Upper respiratory tract infections in the immunocompromised host.

Infections of the upper respiratory tract are a major source of morbidity and mortality in the immunocompromised host. The risks and types of infections are dictated by the specific immune defects present in the patient. Infections may involve virtually any of the structures in the upper respiratory tract, including the oral cavity, pharynx, larynx, trachea, ear, and sinuses. Infections may be complicated by abscess formation or invasion of critical central nervous system or neck space structures. Physicians must maintain a high index of clinical suspicion for upper respiratory tract infections, especially because they may present in an atypical fashion or be caused by unusual organisms in immunocompromised patients. For many of these infections, prompt initiation of appropriate antimicrobial therapy may be life saving. Prophylactic use of antibiotics, antifungal drugs, or antiviral agents is indicated in specific groups of immunocompromised patients.

AIDS-Related Opportunistic Infections↗
PubMed1992

Etiology of acute severe lower respiratory tract infection in hospital-based patients.

Acute respiratory infections are common childhood illnesses. Most are mild and self-limiting. Five percent are lower respiratory tract diseases and are potentially serious. A prospective study was conducted to ascertain the etiology of community-acquired severe lower respiratory tract infections (LRTI) in hospital based patients. Mycoplasma was the most frequently identified agent (33%). This was followed by viruses (28%) and bacteria (15%). Twenty-four percent of children had no identified causative agent.

Acute Disease↗
PubMed2002

Diagnostic tools in respiratory tract infections: use and comparison with Finnish guidelines.

The objectives of this prospective epidemiological study were to describe the diagnosis and treatment of respiratory tract infections by Finnish general practitioners and to compare current practice with national evidence-based guidelines. All patients (n = 4386) seeking primary care for a respiratory tract infection for the first time in 30 health centres during 1 week in November 1998 participated in the study. The main outcome measures were the amounts and types of diagnostic tests used and antimicrobials prescribed. Tympanometry was used in 1% of patients with acute otitis media. Ultrasonography, sinus radiography or both were used in 80% of cases of sinusitis and antigen detection or culture for Streptococci in 57% of throat infections. In acute bronchitis, a chest radiograph was taken in 5% of cases and the CRP level determined in 8%. The corresponding figures for pneumonia were 49% and 39%. In pneumonia and throat infection, diagnostic testing was statistically significantly associated with the use of antimicrobials, but not in otitis, sinusitis or acute bronchitis. Diagnostic tests were underused in respiratory tract infections compared to evidence-based recommendations.

Adolescent↗
PubMed2006

Detection of human coronavirus NL63, human metapneumovirus and respiratory syncytial virus in children with respiratory tract infections in south-west Sweden.

Two recently detected viruses, human metapneumovirus (hMPV) and coronavirus NL63 (HCoV-NL63), have been associated with acute respiratory tract infections, particularly in young children. This study investigated the frequency of hMPV and HCoV-NL63 infections in Swedish children by screening 221 nasopharyngeal aspirates, collected between November 2003 and May 2005, from 212 children attending the paediatric department of a county hospital in Sweden or submitted from local general practitioners. The samples were originally submitted to be tested for respiratory syncytial virus (RSV), and were examined retrospectively for hMPV and HCoV-NL63 by RT-PCR. Of the 212 patients, 101 were positive for RSV (48%), 22 (10%) were positive for hMPV, and 12 (6%) were positive for HCoV-NL63. The frequency of HCoV-NL63 infection increased from 1% in 2003-2004 to 10% in 2004-2005. Sequence analysis of parts of the coronavirus genomes showed considerable similarity to the HCoV-NL63 prototype sequence. The study demonstrated that HCoV-NL63 and hMPV occur in south-west Sweden with essentially the same frequency, seasonal distribution and clinical characteristics as have been reported in other countries.

Acute Disease↗
PubMed1994

Management of upper respiratory tract infections in Dutch family practice.

BACKGROUND: Family physicians vary in their management of upper respiratory tract infections (URTIs), especially regarding prescription of antimicrobial drugs and patient referral. This study was designed to provide insight into this variation in the management of URTI. METHODS: A secondary data analysis of a nationwide study of morbidity and interventions regarding the management of cases of acute otitis media, otitis media with effusion, acute upper respiratory tract infections (acute URTIs), sinusitis, and acute tonsillitis was performed. One hundred sixty-one Dutch family physicians and 335,000 patients were included in the study. RESULTS: About 10% of all first contacts in this study were house calls, which are most often made to patients in the youngest and oldest age categories. In one third of all first contacts, an antimicrobial drug was prescribed, most frequently for sinusitis (72%) and acute tonsillitis (74%), much less frequently for otitis media and acute URTI. Doxycycline and amoxicillin were prescribed most frequently; two thirds of all antimicrobial prescriptions for the first contact were for one of these two drugs. In 1% of all first contacts and 6% of repeat contacts, patients with URTI were referred to a specialist. CONCLUSIONS: Compared with physicians in other countries, Dutch family physicians show a relatively restrictive and selective prescription behavior in dealing with URTI. This may be why the Netherlands has one of the lowest reported levels of antibiotic resistance. House calls are still important in Dutch family practice.

Adult↗
PubMed1998

Recurrent respiratory tract infections during the first 3 years of life and atopy at school age.

BACKGROUND: The hypothesis that infections reduce the risk of atopy was investigated by estimating the association between recurrent respiratory tract infections during the first 3 years of life and atopy at school age. METHODS: According to surveys in three different areas of Norway, children were classified into three groups: asthma, wheeze without asthma (wheeze), and no asthma/no wheeze. The skin prick test (SPT) was conducted on a stratified random sample of children (n = 502). The outcome was at least one positive SPT. The exposure variable was retrospective parental report of respiratory tract infections during the first 3 years of life. RESULTS: Infections were negatively associated with atopy, crude odds ratio (cOR) = 0.3, 95% confidence interval (95% CI) 0.1-0.7, in the asthma group. A similar association was present in children with wheeze cOR = 0.4 (95% CI 0.1-1.2). The number of siblings was not associated with atopy in any group. Infections remained negatively associated with atopy in children with asthma, aOR = 0.3 (95% CI 0.1-0.7), in a logistic regression model adjusting for confounding factors. A similar pattern was present in the wheeze group. CONCLUSIONS: Recurrent respiratory tract infections during the first 3 years of life are negatively associated with atopy at school age in children with asthma.

Adolescent↗
PubMed1997

Economic analysis of treatment with roxithromycin in comparison with erythromycin in patients with lower respiratory tract infections.

A number of new antibiotics have lately become available for treatment of lower respiratory tract infections in out-patients. The new drugs are generally more expensive than the older ones, which might be justified by better effects, improved safety, or by other advantages. In this study, a retrospective economic analysis has been made using data from a previous trial comparing a new macrolide, roxithromycin, with an older 1, erythromycin stearate in the treatment of lower respiratory tract infections. The trial was multicentre, double blind, randomized and comparative. There were no significant differences in efficacy between treatments, although the cure rate was higher for roxithromycin, 85% vs 79% for erythromycin. 20/39 of the erythromycin-treated patients reported adverse events, vs 7/40 roxithromycin-treated subjects, a highly significant difference. More detailed information was obtained by reviewing the medical records of the participants, and from questionnaires distributed to the 3 centres that had included patients in the trial. Additional visits were found necessary for 4 patients treated with erythromycin and for 1 using roxithromycin. Using the healing rates in the present investigation, and including costs for initial drug treatments, second consultations, and failed therapy, average cost-effectiveness (SEK/patient cured) was 409 for roxithromycin-treated patients, and 488 for erythromycin-treated. Roxithromycin should then be cheaper than erythromycin stearate. With the same healing rate, roxithromycin would be less cost-effective, but indirect costs and effects on quality of life are not then taken into account.

Anti-Bacterial Agents↗
PubMed2001

[Patient adherence in respiratory tract infections: ceftibuten versus other antibiotics (PARTICULAR study)].

The study was conducted to evaluate patient compliance to antibiotic therapy in respiratory tract infections. The main aim of the study was to establish whether dosing frequency (1 vs 2 or 3 times daily) and other factors influence compliance. Patients aged 18 and over attending selected primary health facilities in Lódź region were enrolled. Patients were randomly assigned to receive ceftibuten, 400 mg once daily or other antibiotic on physician's choice with 2 or 3 times daily dosing. On the 5th day during the home visit the questionnaire study was performed and the compliance was measured by a pill count. Four hundred and six patients (205 in ceftibuten and 201 in other antibiotics group, respectively) were fully evaluable. Overall compliance was 76.6% with 97.6% for ceftibuten, 66.0% for antibiotics with b.i.d. dosing and 23.5% for antibiotics with t.i.d. dosing. Using a logistic regression analysis with a stepwise variable selection, dosing frequency was found to be a major variable associated with patient compliance (p = 0.00000, odds ratio 0.09, 95% confidence interval 0.057-0.165). Non-compliance with antibiotics is a common phenomenon in respiratory tract infections therapy. Once-daily antibiotic dosing leads to the best possible compliance in such circumstances. Due to its once-daily dosing and rare side effects, ceftibuten ensures nearly perfect compliance in respiratory tract infections therapy.

Adolescent↗
PubMed1995

Comparison of nasal prongs and nasopharyngeal catheter for the delivery of oxygen in children with hypoxemia because of a lower respiratory tract infection.

OBJECTIVE: To determine the best method of oxygen delivery for children in developing countries who have hypoxemia caused by acute lower respiratory tract infection. METHODS: One hundred eighteen children between 7 days and 5 years of age with a lower respiratory tract infection and arterial hemoglobin oxygen saturation (Sao2) less than 90% were randomly selected to receive oxygen by nasopharyngeal (NP) catheter (n = 56) or nasal prongs (n = 62). A crossover study to determine the flow rate necessary to achieve an Sao2 of 95% was performed in 60 children. RESULTS: One hundred twelve children could be oxygenated by the allocated method; in six oxygenation was poor with either method. The mean duration of therapy was 87.5 hours for the prongs and 94.9 hours for the NP catheter (not significant). The median oxygen consumption was 2142 L for prongs and 1692 L for the NP catheter (not significant). In the crossover study the prongs needed, on average, 26% higher oxygen flow rates than the NP catheter to obtain an Sao2 of 95% (p = 0.003). Complete nasal obstruction was observed in 24 of the children (44%) in the NP catheter group and in 8 (13%) in the prongs group (p < 0.001). Eighteen children died, 11 with NP catheter and 7 with prongs (not significant). CONCLUSIONS: Because nasal prongs are less prone to complications, and oxygenation in children is equally effective, they are a more appropriate method than the NP catheter for oxygen delivery to children in developing countries with acute lower respiratory tract infections.

Catheterization, Peripheral↗
PubMed1997

[Serum levels of tumor necrosis factor alpha and soluble tumor necrosis factor-receptor I in asthmatic patients and patients with chronic respiratory tract infection].

In order to investigate the role of tumor necrosis factor alpha (TNF-alpha) in bronchial asthma or chronic respiratory infection, we measured serum levels of TNF-alpha and serum soluble tumor necrosis factor-receptor I (sTNF-RI) in asthmatic patients (n = 11) and patients (n = 10) with chronic respiratory infection by Pseudomonas aeruginosa. We also measured serum levels of eosinophil cationic protein (ECP) in the asthmatic patients. The serum levels of TNF-alpha in the asthmatic patients, patients with chronic respiratory tract infection and control group were 2.864 +/- 0.719 g/ml, 2.564-1.384 pg/ml and 0.681 +/- 0.453 pg/ml respectively. The levels of the former two groups were higher than those of the control group (p < 0.05). The serum levels of sTNF-RI in the asthmatic patients, the patients with chronic respiratory tract infection, and the control group was 758 +/- 268 pg/ml, 999 +/- 242 pg/ml and 909 +/- 268 pg/ml respectively. The levels of the former two groups did not differ significantly from those of the control group. There were significant correlations between TNF-alpha and sTNF-RI in the control group and in the patients with chronic respiratory tract infection, but there was no significant correlation in the asthmatic patients. In the asthmatic patients. TNF-alpha/s TNF-RI correlated with %best of PEF (r = 0.691, n = 9, p 0.0373). The serum levels of ECP correlated significantly with TNF-alpha, but not with sTNF-RI in the asthmatic patients. It is suggested that TNF-alpha plays a significant role in the pathogenesis of bronchial asthma and chronic respiratory tract infection as a factor causing inflammation and that the increase of TNF-alpha/sTNF-RI reflects the activation of eosinophil functions in an asthmatic attack.

Adult↗
PubMedDate not supplied

Bacterial colonization of the upper respiratory tract and its association with acute lower respiratory tract infections in Highland children of Papua New Guinea.

Acute lower respiratory tract infection (ALRI) is the major cause of death among children in Papua New Guinea. This longitudinal study reports the bacteriologic findings for children observed in their hamlets. A total of 1,449 nasal swab specimens from 158 children less than 5 years of age who were studied intensively for 18 months were examined. Non-serotypable strains of Haemophilus influenzae were isolated from 91% of specimens, and serotypable strains were isolated from 35% (8% H. influenzae type b) of specimens. All children had acquired Streptococcus pneumoniae by the age of 3 months. The most frequently occurring serotypes of S. pneumoniae were 6, 19, and 23. Children more frequently carried invasive pneumococci during an episode of ALRI than when they were healthy. Also, children more frequently carried serotypable strains of H. influenzae during the 2 weeks preceding an episode of ALRI than when they were healthy. Between-children analyses showed that children who were susceptible to attacks of ALRI and those who were not susceptible had similar rates of carriage of bacteria.

Age Factors↗
PubMed1999

Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study.

OBJECTIVES: To determine clinical correlates and outcome of hypoxaemia in children admitted to hospital with an acute lower respiratory tract infection. DESIGN: Prospective cohort study. SETTING: Paediatric wards of the Royal Victoria Hospital and the hospital of the Medical Research Council's hospital in Banjul, the Gambia. SUBJECTS: 1072 of 42 848 children, aged 2 to 33 months, who were enrolled in a randomised trial of a Haemophilus influenzae type b vaccine in the western region of the Gambia, and who were admitted with an acute lower respiratory tract infection to two of three hospitals. MAIN OUTCOME MEASURES: Prevalence of hypoxaemia, defined as an arterial oxygen saturation <90% recorded by pulse oximetry, and the relation between hypoxaemia and aetiological agents. RESULTS: 1072 children aged 2-33 months were enrolled. Sixty three (5.9%) had an arterial oxygen saturation <90%. A logistic regression model showed that cyanosis, a rapid respiratory rate, grunting, head nodding, an absence of a history of fever, and no spontaneous movement during examination were the best independent predictors of hypoxaemia. The presence of an inability to cry, head nodding, or a respiratory rate >/= 90 breaths/min formed the best predictors of hypoxaemia (sensitivity 70%, specificity 79%). Hypoxaemic children were five times more likely to die than non-hypoxaemic children. The presence of malaria parasitaemia had no effect on the prevalence of hypoxaemia or on its association with respiratory rate. CONCLUSION: In children with an acute lower respiratory tract infection, simple physical signs that require minimal expertise to recognise can be used to determine oxygen therapy and to aid in screening for referral. The association between hypoxaemia and death highlights the need for early recognition of the condition and the potential benefit of treatment.

Acute Disease↗
PubMed2002

Comparison of nebulized adrenaline versus salbutamol in wheeze associated respiratory tract infection in infants.

OBJECTIVE: (i) To assess the efficacy of bronchodilators in wheeze associated respiratory tract infection (WRTI); and (ii) To compare L-adrenaline with salbutamol in wheeze associated respiratory tract infection. DESIGN: Randomized controlled trial. METHOD: Ninety one children in age group of 2 months to 2 years with their 1st or 2nd episode of wheezing in association with fever and/or coryza were enrolled. Of these, 45 received L-adrenaline (0.1ml/kg/dose in 1 in 10,000 solution) (Group A) and 46 received salbutamol (0.1mg/kg/dose) (Group B). Three doses of each drug were given, nebulized with oxygen at 20 minutes intervals. Respiratory rate, RDAI score, clinical status and pulse oxymetry was recorded before intervention and 10 minutes after each dose. Patients who showed significant relief were discharged after an observation period of three hours while those who did not were admitted. RESULTS: Both L-adrenaline and salbutamol caused significant improvement in mean symptom score and oxygenation. However, the adrenaline group showed a significantly better improvement in the study parameters than the salbutamol group. More children in the adrenaline group could be sent home after the emergency treatment. CONCLUSION: Adrenergic agonists both specific and non specific are beneficial in WRTI. Adrenaline is more effective than salbutamol and is thus a better, inexpensive and relatively safe alternative.

Administration, Inhalation↗
PubMed1983

[Clinical evaluation of an ampicillin suppository (KS-R1) in respiratory tract infections in children].

Fundamental and clinical studies of ampicillin (ABPC) suppository (KS-R1) were performed in children with respiratory tract infections. Serum levels of ABPC after rectal administration of KS-R1 at a dose of 250 mg (11.4-17.7 mg/kg) in 3 children (3-5 years old) were 4.0-10.2 micrograms/ml (average 6.4 micrograms/ml) at 1/4 hour, 3.8-9.4 micrograms/ml (average 6.2 micrograms/ml) at 1/2 hour, 1.2-4.5 micrograms/ml (average 2.8 micrograms/ml) at 1 hour, 0.3-1.4 micrograms/ml (average 0.7 micrograms/ml) at 2 hours, and 0.3 microgram/ml in 1 case and unmeasurable amount in 2 cases at 4 hours. Urine concentrations of ABPC were 230-445 micrograms/ml (average 312 micrograms/ml) in 0-2 hours, 5.3-156 micrograms/ml (average 66.7 micrograms/ml) in 2-4 hours, and 1.3-13.4 micrograms/ml (average 6.1 micrograms/ml) in 4-6 hours, and the recovery rate into urine was 6.6-27.7% (average 15.6%) up to 6 hours. Clinical effects of KS-R1 on 16 childish patients with respiratory tract infections (acute purulent tonsillitis in 9 cases, acute bronchitis in 5 cases, acute bronchopneumonia in 1 case and acute purulent otitis media in 1 case) were excellent in 13 cases, good in 2 cases and poor in 1 case, and the effective rate was 93.8%. Bacteriologically, 5 strains of S. pyogenes, 4 strains of S. pneumoniae and 3 strains of H. influenzae were all eradicated with eradication rate of 100%. Side effect was weak diarrhea in 1 case, but this diarrhea immediately disappeared with discontinuation of treatment. There was no abnormality of clinical laboratory findings. It was concluded that KS-R1 is a useful drug for the treatment of respiratory tract infections in children.

Ampicillin↗
PubMed1996

Management of acute asthma attacks associated with respiratory tract infection: a postal survey of general practitioners in the U.K.

Asthma attacks in general practice are frequently associated with respiratory tract infection. The aim of this study was to examine how U.K. general practitioners (GPs) might use oral steroids and antibiotics in such situations. The timing of follow-up and use of self-management plans were also examined. A postal questionnaire was sent to all 205 GP principals in Bath Health District, U.K. in February and March 1993. Respondents were asked questions regarding the management of an adult and a child presenting with acute asthma associated with respiratory tract infection. Replies were received from 185 of 205 (90%) doctors approached. Antibiotics would have been prescribed by 119 of 179 (66%) doctors for the adult and 98 of 169 (58%) doctors for the child. The modal initial dosage of oral prednisolone was 40 mg for the adult and 30 mg for the child, and modal duration of oral steroid dosage was 5 days for both adult and child. Planned follow-up was mainly doctor initiated within 24 h of initial consultation. There was low reported use of self-management plans (49% for adults and 33% in children over 7 years of age). Antibiotic prescription appears to be common practice by GPs when faced with an acute asthma attack associated with respiratory tract infection. There may also be inadequate duration of oral steroid courses in adults. There is a need to examine further the proper role, if any, of antibiotics in such situations, to determine the optimum dose and course length of oral steroid therapy, and to continue validating the use of self-management plans in acute asthma management.

Acute Disease↗
PubMed2000

Increased burden of respiratory viral associated severe lower respiratory tract infections in children infected with human immunodeficiency virus type-1.

OBJECTIVES: To determine the burden of viral associated severe lower respiratory tract infections (SLRTI) in human immunodeficiency virus-infected (HIV+) and HIV-uninfected (HIV-) urban black South African children. METHODS: Children with SLRTI aged 2 to 60 months were enrolled between March 1997 and March 1998. Monoclonal antibody immunofluorescent testing was performed on nasopharyngeal aspirates to detect respiratory syncytial virus (RSV), influenza A and B, parainfluenza 1-3, and adenovirus-specific antigens. RESULTS: Of the 990 children studied, 44.6% were HIV+. The estimated burden of disease of viral associated SLRTI in children under 2 years was increased for RSV, influenza A/B viruses, parainfluenza 1-3 viruses, and adenovirus in children who were HIV+ compared with children who were HIV- (P <.001). Viral pathogens, however, were identified less frequently (15.7% vs 34.8%, P < 10(-5)) and bacterial pathogens more frequently (12.5% vs 5.8%, P <.0001) in children who were HIV+ than in children who were HIV- and had SLRTI. The seasonal peak for RSV in late summer-early autumn observed in children who were HIV- was less evident in children who were HIV+ (P =.02). Children who were HIV+ and had virus-associated SLRTI had a higher mortality rate (7. 5%) than did children who were HIV- (0%, P < 10(-3)). CONCLUSIONS: The contribution of viral associated SLRTI differs between HIV+ and HIV- children. In HIV+ children in South Africa, RSV isolation is not limited by season.

Adenovirus Infections, Human↗