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PubMed2006

Relationship between salivary IgA secretion and upper respiratory tract infection following a 160-km race.

AIM: The relationship between salivary IgA secretion rate and upper respiratory tract infection (URTI) was studied in 155 ultramarathoners (126 males, 29 females, mean age 46.5+/-0.7 y) who had qualified to run the 160-km 2003 Western States Endurance Run. METHODS: Subjects provided saliva samples during registration, held the morning before the race, and within 5-10 minutes postrace (mean race time, 26.2+/-0.3 h). Unstimulated saliva was collected by expectoration for 4 minutes into 15-mL plastic, sterilized vials. Runners finishing the race and providing pre- and postrace saliva samples (n=106) turned in a health log specifying URTI episodes and severity of symptoms for the 2-week period following the race. RESULTS: The total volume of saliva that the runners was able to expectorate during sample collection decreased 51% postrace compared to prerace values (P<0.001). Saliva protein concentration increased 20% (P<0.001) while the saliva protein IgA concentration decreased 10% (P<0.05). Salivary IgA secretion rate decreased 46% when comparing pre- to postrace values (P<0.001). Twenty-four percent of the runners finishing the race and providing salivary samples reported an URTI episode lasting 2 days or longer during the 2-week period following the race (mean number of days with symptoms was 5.4+/-0.6 days). The decrease in salivary IgA secretion rate (pre- to postrace) was 53% greater in the 25 runners reporting URTI (-355+/-45 microg/min) compared to the 81 runners not reporting URTI (-232+/-37 microg/min), (P=0.04). CONCLUSIONS: In summary, nearly 1 in 4 runners reported an URTI episode during the 2-week period following a 160-km race, and the decrease in salivary IgA secretion rate was significantly greater in these runners compared to those not reporting URTI.

Female↗
PubMed2003

Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection.

BACKGROUND: Diagnostic tests enabling general practitioners (GPs) to differentiate rapidly between pneumonia and other lower respiratory tract infections (LRTIs) are needed to prevent increase of bacterial resistance by unjustified antibiotic prescribing. AIMS: To assess the diagnostic value of symptoms, signs, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for pneumonia; to derive a prediction rule for the presence of pneumonia; and to identify a low-risk group of patients who do not require antibiotic treatment. DESIGN OF STUDY: Cross-sectional. SETTING: Fifteen GP surgeries in the southern part of The Netherlands. METHOD: Twenty-five GPs recorded clinical information and diagnosis in 246 adult patients presenting with LRTI. Venous blood samples for CRP and ESR were taken and chest radiographs (reference standard) were made. Odds ratios, describing the relationships between discrete diagnostic variables and reference standard (pneumonia or no pneumonia) were calculated. Receiver operating characteristic analysis of ESR, CRP, and final models for pneumonia was performed. Prediction rules for pneumonia were derived from multiple logistic regression analysis. RESULTS: Dry cough, diarrhoea, and a recorded temperature of > or = 38 degrees C were independent and statistically significant predictors of pneumonia, whereas abnormal pulmonary auscultation and clinical diagnosis of pneumonia by the GPs were not. ESR and CRP had higher diagnostic odds ratios than any of the symptoms and signs. Adding CRP to the final 'symptoms and signs' model significantly increased the probability of correct diagnosis. Applying a prediction rule for low-risk patients, including a CRP of < 20, 80 of the 193 antibiotic prescriptions could have been prevented with a maximum risk of 2.5% of missing a pneumonia case. CONCLUSION: Most symptoms and signs traditionally associated with pneumonia are not predictive of pneumonia in general practice. The prediction rule for low-risk patients presented here, including a CRP of < 20, can considerably reduce unjustified antibiotic prescribing.

Adolescent↗
PubMed2006

Use of a personal digital assistant for managing antibiotic prescribing for outpatient respiratory tract infections in rural communities.

OBJECTIVE: To assess the acceptability and usage of a standalone personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the diagnosis and management of acute respiratory tract infections (RTIs) in the outpatient setting. DESIGN: Observational study performed as part of a larger randomized trial in six rural communities in Utah and Idaho from January 2002 to March 2004. Ninety-nine primary care providers received a PDA-based CDSS for use at the point-of-care, and were asked to use the tool with at least 200 patients with suspected RTIs. MEASUREMENTS: Clinical data were collected electronically from the devices at periodic intervals. Providers also completed an exit questionnaire at the end of the study period. RESULTS: Providers logged 14,393 cases using the CDSS, the majority of which (n=7624; 53%) were from family practitioners. Overall adherence with CDSS recommendations for the five most common diagnoses (pharyngitis, otitis media, sinusitis, bronchitis, and upper respiratory tract infection) was 82%. When antibiotics were prescribed (53% of cases), adherence with the CDSS-recommended antibiotic was high (76%). By logistic regression analysis, the odds of adherence with CDSS recommendations increased significantly with each ten cases completed (P=0.001). Questionnaire respondents believed the CDSS was easy to use, and most (44/65; 68%) did not believe it increased their encounter time with patients, regardless of prior experience with PDAs. CONCLUSION: A standalone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practices and easily gather a rich set of clinical data.

Ambulatory Care↗
PubMed2003

Lower respiratory tract infections in patients during hospital stay after heart transplantation.

A retrospective analysis was performed on the records of 95 pts who underwent heart transplantation at Dept. Of Cardiac Surgery & Transplantation in 1999 and 2000 y. In 34 pts lower respiratory tract infections were observed. In all cases bacterial factor was detected in sputum or bronchoalveolar lavage. In study population we analysed influence of such factors as age of the patients, the intensity and duration of immunosuppression, pre-existing diseases and timing after transplantation on the incidence of infection. Most often, in 43 pts gram negative stains bacteria was detected. Pseudomonas aeruginosa (15 pts), Acinetobacter baumanii (7 pts) and Enterobacter cloacae (6 pts) were predominant. Gram positive stains bacteria was detected only in two cases (Streptococcus pneumoniae and Staphylococcus aureus). In 1 pt we observed lung tuberculosis and in 2 pts Pneumocystis carinii pneumonia. Older recipient age was the only risk factor leading to occurrence of respiratory tract infections in patients after heart transplantation.

Acute Disease↗
PubMedDate not supplied

Combined aztreonam and gentamicin therapy for pseudomonal lower respiratory tract infections.

A multicenter, open-label study was performed to assess the efficacy and safety of aztreonam plus gentamicin in the treatment of lower respiratory tract infections due to Pseudomonas aeruginosa. Patients with documented P aeruginosa infections were given aztreonam 2 g every 8 hours (q8h) plus gentamicin 3 to 5 mg/kg per day in three equal doses. Clindamycin, 600 mg q8h, was added to the regimen for patients with infections also involving gram-positive and/or anaerobic bacteria. Therapy was continued for at least 5 days or until obvious failure to respond to treatment. Of 64 patients with suspected P aeruginosa infections, 57 were eligible for clinical evaluation and 51 for microbiologic evaluation. At entry, impaired host defense was present in 35% of patients, and chronic obstructive pulmonary disease in 28%, in addition to other predisposing conditions such as emphysema, history of tuberculosis, and pneumothorax. The clinical response rate for the combination regimen was 48/57 (84%), which included 27 (47%) cures and 21 (37%) partial responses. The microbiologic response rate was 35/51 (69%), of which 25 (49%) outcomes were classified as eradication and 10 (20%) as eradication with relapse. Superinfection was observed in 3 (6%) patients. The combination of aztreonam and gentamicin was synergistic in the initial isolates obtained from 33 (72%) patients. A total of 16 patients died of pulmonary or other underlying disease, for a mortality rate of 28%. The monobactam-aminoglycoside combination was generally well tolerated. Two other patients were withdrawn because rashes emerged on treatment. This study demonstrates that aztreonam can be administered as one component of a synergistic monobactam-aminoglycoside therapy in the treatment of nosocomial lower respiratory tract infections involving P aeruginosa.

Adult↗
PubMed2004

Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study.

OBJECTIVE: To evaluate the effectiveness and safety of a preparation containing echinacea, propolis, and vitamin C in the prevention of respiratory tract infections in children during a 12-week winter period. DESIGN: Randomized, double-blind, placebo-controlled study. SUBJECTS: Four hundred thirty children, aged 1 to 5 years, were randomized to an herbal extract preparation (n = 215) or a placebo elixir (n = 215). INTERVENTION: Administration of an herbal preparation (Chizukit) containing 50 mg/mL of echinacea, 50 mg/mL of propolis, and 10 mg/mL of vitamin C, or placebo (5.0 mL and 7.5 mL twice daily for ages 1 to 3 years and 4 to 5 years, respectively) for 12 weeks. RESULTS: Significant mean +/- SD reductions of illnesses were seen in the Chizukit group in the number of illness episodes, 138 vs 308 (55% reduction); number of episodes per child, 0.9 +/- 1.1 vs 1.8 +/- 1.3 (50% reduction, P<.001); and number of days with fever per child, 2.1 +/- 2.9 vs 5.4 +/- 4.4) (62% reduction, P<.001). The total number of illness days and duration of individual episodes were also significantly lower in the Chizukit group. Adverse drug reactions were rare, mild, and transient. CONCLUSION: A preventive effect of a product containing echinacea, propolis, and vitamin C on the incidence of respiratory tract infections was observed.

Ascorbic Acid↗
PubMed1979

[Clinical effects of CS-1170 on respiratory tract infections. II: Mainly on the use of 2 g piggy bag alone (author's transl)].

The following results have been obtained in our trial of CS-1170, in 2 g piggy bag, on the respiratory tract infections: 1) CS-1170 was found to be effective in all the cases treated, including 6 cases in which CS-1170 was used alone. The cases treated with CS-1170 included those cases in which no other antibiotics had been used, as well as 5 cases in which other penicillins and cephalosporins were found to be ineffective or not adequately effective. The results indicate the usefulness of CS-1170 in the treatment of the respiratory tract infections. 2) Slight elevation of GOT and GPT was observed in one case as the side effect of CS-1170. No abnormality was found in other laboratory tests. The incidence of side effects of CS-1170 is believed to be not higher than those of other cephalosporins.

Adolescent↗
PubMed1994

Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections.

OBJECTIVE: To investigate the intrinsic effects of individually prescribed homoeopathic medicines. DESIGN: Randomised double blind placebo controlled study. SETTING: Paediatric outpatient department of university hospital. PATIENTS: 175 children with frequently recurring upper respiratory tract infections. Of the 170 children evaluable, 86 were randomised to homoeopathic medicines (47 boys, 39 girls; median age at start 4.2 years; median number of episodes in past year 4) and 84 to placebo (43 boys, 41 girls; median age at start 3.6 years; median number of episodes in past year 4). MAIN OUTCOME MEASURES: Mean score for daily symptoms, number of antibiotic courses, and number of adenoidectomies and tonsillectomies over one year of follow up. RESULTS: The mean daily symptom score was 2.61 in the placebo group and 2.21 in the treatment group (difference 0.41; 95% confidence interval -0.02 to 0.83). In both groups the use of antibiotics was greatly reduced compared with that in the year before entering the trial (from 73 to 33 in the treatment group and from 69 to 43 in the placebo group). The proportion of children in the treatment group having adenoidectomies was lower in the treatment group (16%, 8/50) than in the placebo group (21%, 9/42). The proportion having tonsillectomies was the same in both groups (5%). CONCLUSION: Individually prescribed homoeopathic medicines seem to add little to careful counselling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy.

Adenoidectomy↗
PubMed2006

IL-12 deficiency transiently improves viral clearance during the late phase of respiratory tract infection with influenza A virus in mice.

T helper 1-driven immune responses have been implicated in protective immunity against viral infections. Interleukin (IL)-12 is a heterodimeric proinflammatory cytokine formed by a p35 and a p40 subunit that can induce differentiation of naïve T cells towards a T helper 1-response. To determine the role of IL-12 in respiratory tract infection with influenza, p35 gene deficient (p35-/-) and normal wild type mice were intranasally infected with influenza A virus. IL-12 p35-/- mice displayed a transiently enhanced rather than an impaired viral clearance, as indicated by a 10-fold reduction in viral loads on day 8 after infection. Although interferon-gamma levels were significantly lower in the lungs of IL-12 p35-/- mice, their cellular immune responses were not altered, as reflected by similar T cell CD69 expression and influenza-specific T cell recruitment. Our data indicate that endogenous IL-12 impairs viral clearance during the late phase of influenza A virus infection in mice.

Animals↗
PubMed1993

The role of respiratory tract infections in asthma.

In this article the author presents the latest data on the role of bacterial and viral respiratory tract infections in the pathogenesis of bronchial asthma. The effect of microorganisms and their products on immunological and non-immunological mechanisms of cell mediator release, cytokine activity, bronchial hyperreactivity and acute and late asthmatic reactions are discussed. As this brief review shows, the role of respiratory infections in the development of different types of asthma is very important.

Animals↗
PubMed1992

Nosocomial respiratory tract infections in multiple trauma patients. Influence of level of consciousness with implications for therapy.

A prospective study of 161 multiple trauma patients was carried out to determine the incidence, the causative agents, and the outcome of nosocomial respiratory tract infections in this highly selected population. Thirty-eight (23.6 percent) patients developed a nosocomial pneumonia (NP). In addition, there were four superinfections in three patients, representing an incidence of 26 percent (42 of 161). Incidence of NP was significantly greater among comatose patients (42.2 vs 13.3 percent, p less than 0.05). Furthermore, purulent tracheobronchitis was diagnosed in six patients. The causative agent of NP was identified in 36 (85.7 percent) episodes by means of fiberoptic bronchoscopies with protected specimen brush sampling. Staphylococcus aureus (55.8 percent) was the predominant pathogen isolated in multiple trauma patients in coma (Glasgow coma score [GCS] below 9 during a period greater than 24 h), while aerobic Gram-negative bacilli were responsible for the majority of cases in the remaining population studied. The overall mortality rate was 19.8 percent, but only five deaths were related to NP. We conclude that nosocomial respiratory tract infections are a frequent problem in multiple trauma patients, especially in those with GCS below 9, although this complication is associated with a relatively low mortality. Among patients with GCS below 9, S aureus was a frequent finding; consequently, antimicrobial therapy in this population needs to be different than that for the remaining multiple trauma patients with NP.

Bacteria↗
PubMed1987

Direct and indirect pathogenicity of anaerobic bacteria in respiratory tract infections in children.

Bacteroides sp (Bacteroides melaninogenicus, Bacteroides oralis, and Bacteroides fragilis), peptostreptococci, and fusobacteria are important pathogens in respiratory tract infections (RTI). These organisms are often recovered mixed with other aerobic, facultative, and anaerobic bacteria. Evidence supporting their virulence is provided by studies showing their synergistic potentials in mixed infections and their increased virulence when encapsulated. A recent increase in numbers of beta-lactamase producing strains of anaerobic gram-negative bacteria in RTI has been associated with increased failure rates of penicillins in eradication of these infections. These infections include chronic otitis media, chronic sinusitis and mastoiditis, chronic recurrent tonsillitis, and lung abscesses. The pathogenicity of these organisms is apparent through their ability not only to survive penicillin therapy but also to protect penicillin susceptible pathogens from that drug. These direct and indirect virulence characteristics of anaerobic bacteria require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections. The synergy that exists between different aerobic and anaerobic organisms in the respiratory tract is due to several pathogenic mechanisms. These mechanisms include the production of a capsule, which protects organisms from phagocytosis, and the production of beta-lactamase, which inactivates penicillins and first-generation cephalosporins. Both of these mechanisms enhance infection and induce complications. However, more work is necessary to prevent encapsulation and the production of enzymes. Data, thus far, indicate that there are therapeutic modalities that can be used to prevent these occurrences and eliminate many mixed RTI.

Animals↗
PubMed1988

[Clinical studies on S 6472 granule preparation (sustained-release cefaclor) in chronic respiratory tract infections].

S 6472 granule preparation (sustained-release cefaclor) was orally administered to 15 patients with chronic respiratory tract infections (2 acutely exacerbated cases of chronic bronchitis, 13 cases of secondary infections consisting of 1 case of bronchial asthma, 2 cases of bronchial asthma/pulmonary emphysema, and 10 cases of bronchiectasis) at a daily dose of 750 mg divided into 2 doses administered after breakfast and dinner, for a duration of 14 days. The drug was ineffective in 3 of the 10 cases of bronchiectasis but was effective in the other 12 cases, with a rate of efficacy of 80%. There were no side effects of abnormal laboratory findings due to administration of this drug.

Administration, Oral↗
PubMed1979

Comparative trial of co-trimoxazole and tetracycline in the treatment of lower respiratory tract infection.

One hundred and twenty-six adult patients with acute lower respiratory infection were studied in a double-blind trial. One group was treated with co-trimoxazole (480 mg trimethoprim and 2400 mg sulphamethoxazole) per day and the other group with tetracycline 2 g per day. The results showed that co-trimoxazole was significantly more effective than tetracycline as judged by clinical improvement, and the reduction in sputum volume and purulence. No haematological abnormalities were observed, but the incidence of side-effects, though mostly mild, was higher in the group of patients on tetracycline than in the co-trimoxazole group. The results of this study strongly suggest that co-trimoxazole may be a useful and reliable drug in the treatment and control of acute lower respiratory tract infection in the developing countries.

Adolescent↗
PubMed2002

Duration of cough in acute upper respiratory tract infections.

OBJECTIVE: To determine the duration of cough in patients without pre-existing respiratory problems presenting to general practitioners with acute upper respiratory tract infections (URTIs). METHOD: Patients without chronic chest problems who presented to two general practices with an URTI during the winter of 1999 were surveyed to assess the duration of cough. RESULTS: One hundred and seventy-nine patients were recruited, of whom 131 could be followed until their cough ceased. Of these, 93% developed a cough, 78% coughed for at least one week, 58% for at least two weeks, 35% for three weeks, and one continued into the tenth week. CONCLUSION: The acute cough associated with an URTI often continues for several weeks. There may be benefits from educating the community and medical profession about this natural history.

Adolescent↗