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PubMed1979

Influence of a mycoplasma respiratory tract infection on sheep erythrocyte and complement receptor-bearing cell composition in the respiratory tract of swine.

Pulmonic and peripheral blood lymphocyte subpopulations in healthy and Mycoplasma suipneumoniae-infected pigs were compared. The T- and the B-lymphocyte populations were counted, the B cells by the complement receptor (zymosan-complement rosettes) technique and the T cells by the ED-rosette technique (sheep RBC-dextran rosettes). The T cells were found to predominate among pulmonic, as well as blood, lymphocytes. Pulmonic B-cell and blood T-cell percentages were increased after mycoplasma respiratory tract infection. However, blood B-cell and pulmonic T-cell percentages were not significantly affected. A significant (P less than 0.001) correlation between pulmonic and blood T-lymphocyte compositions was found; conversely, no correlation was observed between blood and pulmonic B-cell percentages. These data could imply that pulmonic B cells are predominantly involved in local immune reactions after a mycoplasma respiratory tract infection.

Animals↗
PubMed2001

Respiratory tract infections caused by respiratory syncytial virus in children. Diagnosis and treatment.

Respiratory syncytial virus (RSV) is the most common viral cause of lower respiratory tract infection in infancy and young children. No effective treatment for RSV lower respiratory tract infection (RSV-LRTI) exists. Ribavirine initially was reported to be an effective anti-viral drug for RSV-LRTI. However, subsequently performed trials could not reproduce these positive results and based on the current available evidence there is no place of ribavirin in the routine treatment of RSV-LRTI. The use of nebulised bronchodilator therapy in RSV-LRTI has been subject of many trials, with conflicting RESULTS. Although the individual patient may have some short term benefit of nebulised bronchodilators there does not seem to be a sufficient scientific base for the standard use of bronchodilator therapy in infants and children with RSV-LRTI. There is increasing evidence that RSV-LRTI is an immune-mediated disease and therefore corticosteroids may be an effective treatment. The results from efficacy trials have demonstrated that corticosteroids are not effective for patients with mild RSV infection. In contrast, there is some evidence suggesting that it may be beneficial in patients with more severe RSV-LRTI. Immunoprofylaxis with hyperimmune immunoglobulins and monoclonal antibody against the viral F-protein have been shown to be effective in the prevention of severe RSV-LRTI. From the results of the therapeutic efficacy trials, however, it is evident that immunoglobulins have no place in the treatment of RSV-LRTI. In conclusion, although RSV infections each year have a considerable socio-economic impact attempts to find an effective therapy have been quite unsuccessful so far.

Adrenal Cortex Hormones↗
PubMed2000

Therapy for respiratory tract infections caused by respiratory syncytial virus.

UNLABELLED: Respiratory syncytial virus (RSV) is the most common viral cause of lower respiratory tract infection (LRTI) in infancy and young children. No effective treatment for RSV lower respiratory tract infection (RSV-LRTI) exists. Ribavirin initially proved to be an effective anti-viral drug for RSV-LTRI. However, subsequently performed trials could not reproduce these positive results and, based on the current available evidence, there is no place for ribavirin in the routine treatment of RSV-LTRI. The use of nebulised bronchodilator therapy in RSV-LTRI has been subject of many trials, with conflicting results. Although the individual patient may have some short-term benefit from nebulised bronchodilators, there does not seem to be a sufficient scientific basis for the standard use of bronchodilator therapy in infants and children with RSV-LTRI. There is increasing evidence that RSV-LTRI is an immune-mediated disease and therefore corticosteroids may be an effective treatment. The results from efficacy trials have demonstrated that corticosteroids are not effective for patients with mild RSV infection. In contrast there are indications that it may be beneficial in patients with more severe RSV-LTRI. It has been demonstrated that in children with RSV infection the vitamin A concentration is inversely related to disease severity. The use of vitamin A in the treatment of patients with RSV-LTRI, however, proved not to be effective. Immunoprophylaxis with hyperimmune immunoglobulins and monoclonal antibody against the viral F-protein have been shown to be effective in the prevention of RSV-LRTI. From the results of the therapeutic efficacy trials, however, it can be discerned that immunoglobulins have no place in the treatment of RSV-LRTI. CONCLUSION: Although respiratory syncytial virus infections each year have a considerable socioeconomic impact, attempts to find an effective therapy have so far been quite unsuccessful. Anti-viral therapy with ribavirin has not been proven to be effective. Symptomatic therapy with bronchodilators may give only short-term relief of symptoms in some individual patients, but has no effect on hospitalisation rates, or duration of hospitalisation. The beneficial effect of corticosteroids in patients with mild respiratory syncytial virus infection is very disappointing, however, there are indications that there might be an effect in patients with more severe infection. So far no beneficial therapeutic effect has been demonstrated with immune globulins.

Adrenal Cortex Hormones↗
PubMed2002

Role of upper and lower respiratory tract immunity in resistance to Mycoplasma respiratory disease.

This study determined whether respiratory tract immunization protects against mycoplasma infection and compared preferential immunization of the upper respiratory tract (nasal) with upper and lower respiratory tract (nasal-pulmonary) immunization. Small volumes of inoculum preferentially deposited antigen and induced IgA responses in nasal passages. Larger inoculums deposited antigen in both the upper and lower respiratory tracts, generating corresponding IgA responses. Mice were given nasal or nasal-pulmonary immunizations with Mycoplasma pulmonis antigen alone or with cholera toxin (CT), and resistance to infection was determined. Generation of upper respiratory tract immunity reduced mycoplasma infection at this site, but CT was needed to elicit protective responses. In the lower respiratory tract, nasal-pulmonary immunization was most effective, but nasal immunization did confer some protection from pulmonary infection. In contrast, intraperitoneal immunization resulted in little protection. Thus, respiratory tract immunity plays a major role in resisting mycoplasma infection, and it should be considered during vaccine development.

Adjuvants, Immunologic↗
PubMed2005

[The activity of granulocytes in children with recurrent infections of respiratory tract].

Acute upper respiratory tract infection (URTI) is a common disease in young children. URTI contributes to approximately 20% of mortality in children younger than 5 years of age. Infections of the upper respiratory tract are the most common cause of viral morbidity in children. They represent the most frequent problem in general pediatric practice and are responsible for more than one third of school absences. On the other hand respiratory tract infections through MALT system play a positive role in maturation and development of immune system. Many different immunologic disturbances can occur during the development of respiratory infections. Disorders of granulocyte functions are the principal cause of inflammation in the upper respiratory tract. Chemiluminescence of granulocytes is a renowned method for the estimation their overall activity as measured by the production of reactive oxygen species. The goal of the study was to evaluate chemiluminescent activity of granulocytes from 41 children with recurrent infections of the respiratory tract compared to 30 healthy children. Chemiluminescent response to all the examined stimuli in children with recurrent infections was significantly lower compared to control. In the examined group of 41 children depressed response to at least 1 stimulus was detected in 32 (78%) cases. The use of both fMLP and opsonised zymosan allowed to detect defect of granulocyte function in 93,75% cases. This defect may be related to delayed maturation of the immune system in certain children or may be induced by intensive therapy with antibiotics.

Adolescent↗
PubMed1992

Cytologic evaluation of the respiratory tract.

Evaluation of respiratory tract disease is a challenge for several reasons: no serum biochemical or hematologic tests that localize injury to the respiratory system are available, imaging techniques do not usually lead to etiologic diagnoses, and excisional biopsies are often very difficult to obtain from respiratory lesions. For these reasons, specific diagnosis of respiratory tract disease often resides in cytologic evaluation. This article reviews the various cytologic collection techniques that yield high-quality specimens from the upper and lower respiratory tract. Cytologic features of the normal respiratory tract as well as common respiratory disorders are described and illustrated.

Animals↗
PubMed2002

Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity.

This study was designed to collect data on the prevalence of respiratory syncytial virus (RSV) infection in Italy in infants hospitalized for lower respiratory tract infections, and to evaluate which of the recognized risk factors might be associated with disease severity. Thirty-two centers throughout Italy participated in the study. Over a 6-month period (November 1,1999 to April 30, 2000), we evaluated all children < 2 years of age hospitalized for lower respiratory tract infections. All subjects were tested for RSV within 24 hr of hospitalization by using an immuno-enzymatic diagnostic test (Abbott Testpack, RSV). Logistic regression was used to identify the factors that might be associated with more severe disease or could increase the likelihood of RSV positivity in hospitalized infants. Out of a total of 1,232 children enrolled, 40.6% were found to be RSV-positive (RSV+). The peak of the RSV epidemic occurred in February, while the lowest prevalence of RSV positivity was seen in November (P < 0.05). A high proportion of study subjects had low birth weight and low gestational age. The clinical diagnosis at hospitalization was bronchiolitis in 66.7%, pneumonia in 15.3%, and wheezy bronchitis in 18.1%. In the bronchiolitis group, a higher prevalence of RSV+ was found in patients with gestational age or= 36 weeks (P < 0.04). No differences were found in the proportion of RSV+ patients in the three gestational age subgroups with pneumonia and wheezy bronchitis (P > 0.05, each comparison). Independent of the clinical diagnosis at admission, RSV infection was associated with more severe respiratory impairment. Environmental smoke exposure was higher in subjects with bronchiolitis than in those with wheezy bronchitis (P < 0.04), and RSV+ was positively related with the birth order (P < 0.05). The presence of older siblings and birth order plays an important role in RSV infection. The collected data show that, in Italy, RSV is an important cause of lower respiratory tract infection in infants. Gestational age, birth order, birth weight, and exposure to tobacco smoke affected the prevalence and severity of RSV-related lower respiratory tract disease.

Acute Disease↗
PubMed2000

[Serological screening examinations of atypical pathogens (Mycoplasma pneumoniae, Chlamydia pneumoniae) in respiratory tract infection].

Lower respiratory tract infections are a heterogeneous group of disorders induced by plenty of pathogens. Atypical bacteria play an important role in the respiratory tract pathology. In our study 90 patients with acute infection of the respiratory tract were examined in serological screening test for Mycoplasma pneumonia and Chlamydia pneumoniae. It was confirmed that in 21 patients with community acquired pneumonia Mycoplasma pneumonia antibodies were detected in 38% and Chlamydia pneumoniae in 10%. In our opinion this screening serological tests are useful for early diagnosis of atypical bacterial infections of the respiratory tract.

Acute Disease↗
PubMed2002

Stem cells of the respiratory tract.

Childhood respiratory diseases are accompanied by various forms of epithelial repair and remodelling. Respiratory stem cells are likely to be of great importance in these processes but their identification remains uncertain. By contrast, an enormous effort has been made to identify specific markers of stem cells of other organs; this has given rise to the new concept of plasticity. This proposes that stem cell differentiation is influenced by the niches in which the cells reside rather than their site of origin. Many studies provide evidence in support of this concept, including one demonstrating that respiratory epithelium can arise from bone marrow stem cells. Recent findings from human and animal studies suggest that Clara cell-specific protein-expressing cells with pre-Clara cell phenotypes may be candidate stem cells for the entire respiratory tract.

Adult↗
PubMed1993

Clinical requirements in the treatment of today's respiratory tract infections.

Respiratory tract infections (RTIs) are among the most frequent infections in man and lower tract infections account substantially for the overall mortality in hospitals. Regarding the etiology of pneumonias, one has to consider different pathogenic mechanisms, age of the patients, underlying diseases, concomitant medications, symptomatologies, seasonal influences, and clinical conditions, e.g. intensive care environment and mechanical ventilation. To optimize the rational management of respiratory infections, identification of the etiologic agent would be desirable. The decision of how to treat is often based on epidemiologic, clinical, and radiological assessments. Epidemiologic studies have shown a pronounced difference in the etiologic spectrum between community- and hospital-acquired RTIs. In community-acquired pneumonias, pneumococci, Haemophilus influenzae, Legionella, Mycoplasma and viruses predominate, whereas in nosocomially acquired pneumonias, Enterobacteriaceae, e.g. Klebsiella, Proteus, Enterobacter as well as Pseudomonas and staphylococci comprise the most frequent isolates. Empirical therapy has to cover all possible etiologic pathogens which most likely cause the infection. In addition, an adequate kinetic profile, e.g. once or twice daily dosing, sufficient pulmonary tissue or fluid penetration, and acceptable tolerance and costs are prerequisites for optimal therapy. Drugs of choice for the treatment of community-acquired pneumonia are aminobenzylpenicillins or macrolides. Oral cephalosporins exhibit excellent activity against many bacterial pathogens of typical community-acquired pneumonia, and are active against beta-lactamase-producing H. influenzae.

Drug Resistance, Microbial↗
PubMed1996

Comparison of bronchoalveolar lavage and catheter lavage to confirm ventilator-associated lower respiratory tract infection.

Lower respiratory tract infection (LRTI) is a well recognised complication of artificial ventilation in intensive care units (ICU). Ideally, specimens for microbiological analysis should be obtained during bronchoscopy, but this is not always possible. Therefore, the microbiological diagnosis of lower respiratory tract infection by broncho-alveolar lavage (BAL) obtained during bronchoscopy was compared with catheter lavage (CL) with a balloon-tipped catheter. Adult patients with clinical evidence of lower respiratory tract infection in an adult ICU were randomly assigned to undergo BAL followed by CL or vice versa. Forty ml of normal saline 0.9% were instilled and then aspirated with a flexible bronchoscope to obtain BAL. A similar volume was instilled and aspirated with a 12-gauge Foley balloon-tipped catheter to obtain a CL sample. The number of inflammatory cells, epithelial cells and organisms seen by microscopy were quantified. Culture results were semi-quantified and classified as negative, positive, equivocal or contaminated. Seventy-nine paired specimens were obtained from 66 patients, including specimens from 10 patients taken on two or more occasions. Only 20% of BAL and 16% of CL had one or more epithelial cells and bacteria were seen in 26 BAL and 21 CL specimens, respectively; 35% of BAL and CL specimens were positive and there was a discrepancy in the culture result in only two cases. Staphylococcus aureus was the pathogen isolated most frequently and polymicrobial lower respiratory infection was diagnosed on 10 occasions (15%). CL fluid is as reliable as BAL in diagnosing lower respiratory tract infection in ICU. This approach does not require bronchoscopic expertise and utilises convenient laboratory techniques.

Adolescent↗
PubMed1999

Delivery of peptide and non-peptide drugs through the respiratory tract.

The respiratory tract, and the nose in particular, offers opportunities for improved drug delivery. Many drugs are rapidly and efficiently absorbed from the nasal cavity and, as a result, the nasal route may be used in crisis treatments (for example, for pain and nausea). Polar drugs, such as peptides and proteins, are not well absorbed across the nasal mucosa, unless they are delivered with an absorption enhancing material. Agents, such as the polysaccharide chitosan, that are able to open tight junctions between cells can offer important opportunities. The nasal route can also be used for the delivery of vaccines. This review makes a comparison between nasal and pulmonary delivery.

Journal Article↗