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PubMed2004

The regulation of rhinovirus infection in vitro by IL-8, HuIFN-alpha, and TNF-alpha.

The influence of three important cytokines (IL-8, TNF-alpha, and HuIFN-alpha) on ongoing rhinovirus infections has been examined in vitro, individually or as combinations. TNF-alpha was able to transform traces of HRV infections into full-blown infections. Furthermore, TNF-alpha was able to down-regulate the antiviral action of HuIFN-alpha completely, even at levels of just a few pg/ml. This suggests that the induction of TNF-alpha by HRV may be part of the virus's strategy to minimize the interferon response which is part of the host's immune defence system. However, troxerutin (a flavonoid) was able to neutralize the downregulatory action of TNF-alpha on the HuIFN-alpha system at low levels and re-establish the antiviral activity ascribed to IFN-alpha. IL-8 exerted a minor influence on the interferon system, and had no influence on rhinovirus infections. The in vitro findings are supported, in part, by recent in vivo findings in a common cold pilot study.

Cell Line↗
PubMed1968

ECHO-11 as a respiratory virus: quantitation of infection in man.

Through a series of controlled experiments in volunteers, quantitative aspects of infection, illness, and immunity to ECHO-11 virus were studied. ECHO-11 is a transmissable viral infection in man and equally infectious to the upper respiratory and the intestinal tracts. The rate of infection was directly related to the dose of virus exposure, but any infectious dose of virus produced illness in only about one-third of the infected subjects. The infectious dose for man varied over a billionfold range. Larger challenge doses caused no difference in the local symptoms at the portal of entry or in the peak severity of illness, but symptoms were more diverse and prolonged after a higher dose. Persons with asymptomatic infections became just as heavily infected as ill persons. In respiratory secretions from natural infection, the titer of infectious virus was found to be about 10(2) median infective doses in tissue culture (TCID(50))/ml. At this level, up to 40% of exposed contacts could be infected per milliliter of secretion. The observed rate of spread was 24%. This low-dose inoculum caused illness in 12% of volunteers but failed to elicit a significant antibody response in 93% or immunity to reinfection and another illness upon rechallenge. Larger doses of virus produced a longer excretion of virus and a significant increase in serum-neutralizing antibody. Nasal antibody was infrequently found. The principal effect of antibody was to decrease virus excretion and to shorten illness; it reduced the rate but did not prevent infection. Attempts to produce an asymptomatic enteric infection which would induce immunity failed.The characteristics of respiratory transmission with mild disease, recurrent infection, and illness without a detectable antibody response or solid immunity to reinfection, satisfy the epidemiologic conditions to establish ECHO-11 virus as one of the causes of the common cold.

Adult↗
PubMed2000

Effect of treatment with zinc gluconate or zinc acetate on experimental and natural colds.

Two clinical trials were conducted, one involving 273 subjects with experimental rhinovirus colds and the other involving 281 subjects with natural colds. Symptomatic volunteers were randomized to receive oral lozenges containing zinc gluconate (13.3 mg), zinc acetate (5 or 11.5 mg), or placebo. The median duration of illness in zinc gluconate recipients was 2.5 days, contrasted with 3.5 days in the placebo recipients (P=.035), in the experimental colds study. Zinc gluconate had no effect on symptom severity and zinc acetate had no effect on either duration or severity. Neither formulation had an effect on the duration or severity of natural cold symptoms. Evaluation of blinding, taste, and adverse events revealed no significant differences among the 4 treatment arms. Zinc compounds appear to have little utility for common-cold treatment.

Adolescent↗
PubMed1995

Elevated levels of interleukins IL-1 beta, IL-6 and IL-8 in naturally acquired viral rhinitis.

We studied the cytokines IL(interleukin)-1 beta, IL-4, IL-6 and IL-8 in nasal lavage samples from 20 patients with naturally acquired viral rhinitis and 5 healthy controls without nasal complaints. IL-1 beta, IL-6 and IL-8 levels in lavage fluid from the viral rhinitis patients were significantly elevated when compared to control subjects. IL-4 was not measurable in any of the samples. The cytokine levels in secretions from the healthy controls remained stable intraindividually on 5 consecutive sampling days. We suggest that cytokines such as IL-1 beta, IL-6 and IL-8, but not IL-4, are involved in the pathophysiology of the common cold.

Adult↗
PubMed1986

Acute-phase decrease of T lymphocyte subsets in rhinovirus infection.

Populations of peripheral blood leukocytes were enumerated in 15 volunteers challenged by intranasal inoculation with rhinovirus serotype 25. The results demonstrated a significant decrease in total lymphocyte count among infected persons on the third day after challenge with the virus (P less than .01). The change in lymphocyte count was associated with a significant decrease in total T cells, as determined by monoclonal antibodies (both T11+ and T3+, P less than .02), but not in B cells (B7+). Among the subsets of T cells, T4+ (T helper/inducer) and T8+ (T suppressor/cytotoxic) lymphocytes both declined in number, but only the change in the T4+ subset was significant. For each of the lymphocyte populations that decreased significantly (T3+, T11+, and T4+) there was a strong correlation with increased severity of symptoms. Persons who had the greatest decrease in total lymphocyte count also shed virus most frequently. The number of nonlymphocyte leukocytes increased with the severity of the symptoms. These data show that T lymphocytes (particularly the T4+ population) are related to both the progression of infection and the symptoms of the rhinovirus common cold.

Adult↗
PubMed1988

Nasal-secretion leukocyte populations determined by flow cytometry during acute rhinovirus infection.

Leukocyte populations in the secretions of volunteers challenged by intranasal inoculation with rhinovirus serotype 25 were evaluated by means of flow cytometry. With the light-scatter properties of peripheral blood leukocytes as the standard of reference, significant increases (P less than .05) of both lymphocytes and phagocytes (polymorphonuclear leukocytes plus monocytes) were detected in the nasal secretions of persons infected by the viral challenge. There was a direct correlation of nasopharyngeal symptom severity with both the percentage of lymphocytes (P less than .05) and the percentage of phagocytes (P less than .001). Monoclonal antibodies for specific cell-membrane antigens identified the lymphocytes and phagocytes as leukocytes and also demonstrated the presence of a population of monocytic cells during the phase of maximal symptoms. The panel of monoclonals chosen did not unequivocally identify a lymphocyte population except in the presence of nosebleed. However, the results show that flow cytometry can be used to investigate nasal-secretion cell populations during the rhinovirus common cold.

Adult↗
PubMed2001

A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults.

PURPOSE: We performed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of 0.12% zinc sulfate nasal spray for reducing the duration and severity of acute upper respiratory infections. SUBJECTS AND METHODS: Patients with acute onset of upper respiratory illness of less than 24 hours' duration were eligible for the study. A nasopharyngeal swab was obtained at the time of enrollment for viral culture. Participants were randomly assigned to receive either 0.12% zinc sulfate or isotonic placebo spray. The medication was administered as two inhalations in each nostril four times a day. Each patient completed a diary card twice a day to record oral temperature, symptoms, and adverse effects. Symptoms were scored as absent (0), mild (1), moderate (2), or severe (3). RESULTS: One hundred eighty-five subjects volunteered to participate, and 160 met the criteria for enrollment. The median duration of all symptoms was 7 days in both groups (P = 0.45), and the median duration of nasal symptoms was 6 days in both groups (P= 0.12). After adjustment for baseline differences in severity, patients receiving zinc had a significant reduction in the total symptom score (P= 0.02) and the nasal symptom score (P= 0.02) on day 1, but not on any of the other days. Adverse effects were mild and had no significant association with the use of zinc. A respiratory virus was identified in 9 of the 160 participants; 6 of these were rhinovirus. CONCLUSION: A low concentration of zinc sulfate nasal spray had no effect on the duration of the common cold.

Acute Disease↗
PubMed2000

Antibiotic prescribing for patients with colds, upper respiratory tract infections, and bronchitis: A national study of hospital-based emergency departments.

STUDY OBJECTIVE: Antibiotics are often used to treat viral upper respiratory tract infections, even though they are usually ineffective. However, frequent inappropriate antibiotic use contributes to the emergence of drug-resistant bacterial pathogens. This study used a national database to evaluate antibiotic use in treating upper respiratory tract infections in emergency departments. METHODS: Data were obtained from the 1996 National Hospital Ambulatory Medical Care Survey. Antibiotic prescribing rates were examined for colds, upper respiratory tract infections, and acute bronchitis. Patients with comorbid conditions or secondary diagnoses, such as chronic obstructive pulmonary disease, pneumonia, sinusitis, and HIV, were excluded. Bivariate and multivariate analyses were used to assess predictors of antibiotic use. RESULTS: Overall, there were an estimated 2.7 million ED visits for colds, upper respiratory tract infections, and bronchitis by children and adults in 1996. Antibiotics were prescribed for 24.2% (95% CI 18.9, 29.5) of patients with common colds and upper respiratory tract infections and for 42.2% (95% CI 35.2, 49.2) of patients with bronchitis. There were no significant associations between antibiotic use and patient race, sex, Hispanic ethnicity, geographic location, or source of payment. Antibiotics were prescribed less often by interns or residents than by staff or other physicians (odds ratio 0.43; 95% CI 0.19, 0.98), and patients younger than 18 years were less likely to receive antibiotics than adults (odds ratio 0.32; 95% CI 0.20, 0.52). Smokers were 4.3 (95% CI 2.2, 8.3) times more likely to receive antibiotics than nonsmokers. CONCLUSION: Antibiotics are commonly prescribed for ED patients with upper respiratory tract infections even though they are usually ineffective in otherwise healthy adults. Efforts should be made to reduce inappropriate antibiotic use for the sake of containing costs, preventing side effects, and limiting the spread of antibiotic resistance.

Adolescent↗
PubMed1953

Attitudes toward specific therapies.

Attitudes of the physician and attitudes of the patient may affect the rational use of specific therapies. An example is the use of penicillin for the common cold. A survey showed that 25 per cent of physicians and 16 per cent to 22 per cent of three other groups polled had received penicillin for a cold, although there is no rational basis for such therapy. Evaluation of both the physicians' and patients' attitudes toward specific therapies might lead to a more rational treatment of the patient as a total personality.

Common Cold↗
PubMed1988

Combined cold urticaria and cholinergic urticaria--clinical characterization and laboratory findings.

Thirteen patients with both cold and cholinergic urticaria are reported. There was considerable variability, particularly in the cold urticaria which was of the common cold contact type in seven patients, of the generalized cold induced cholinergic type in two and in four patients the lesions induced by direct contact with ice were morphologically like cholinergic urticaria, but appeared despite prior application of an acetyl choline antagonist. The natural history, laboratory findings and the effects of therapy are discussed.

Adolescent↗
PubMed2005

Factors predicting early diagnosis of foreign body aspiration in children.

OBJECTIVES: To analyze the clinical spectrum of tracheobronchial foreign bodies in children and explore the clinical features which could facilitate early diagnosis. METHODS: We retrospectively studied pediatric patients who had aspirated foreign bodies over the past 5 years from July 1998 to July 2003 in a tertiary children hospital in northern Taiwan. Patients were divided into 2 groups according to the elapsed time from aspiration to definite diagnosis as early (< or =24 hours after aspiration) and late diagnosis (>24 hours after aspiration). The 2 groups were compared for clinical features, radiological findings, and the influence of morbidity and mortality of early- and late-diagnosed foreign body aspiration (FBA). RESULTS: A total of 53 patients (27 boys, 26 girls) were recruited with a median age of 25.4 +/- 21.3 months. FBA was suspected by the parents in 59% of patients. Sudden onset of cough (72%), dyspnea (64%), and wheeze (60%) were the predominant symptoms and signs. Nuts and peanut (59%) were the most common foreign bodies aspirated. Obstructive emphysema (53%) and normal chest radiograph (34%) were the most frequent radiological findings. Parenchymal consolidation with pneumonia was predominant in the group of late diagnosis (P < 0.05). Bronchial asthma (n = 9), pneumonia (n = 8), and common cold (n = 5) were the most common mistaken diagnoses. Witnessing of choking episode was the most important historical event to pinpoint an early diagnosis of FBA in children (P = 0.002). CONCLUSIONS: In children with an unequivocal choking event while eating even with normal physical and radiographic findings, FBA requires to be excluded by thorough investigations in such instances. Similarly, in toddlers with unexplained persistent cough with refractory parenchymal infiltrates, unrecognized FBA should also be considered. A witnessed choking event is the most important historical information to make an early diagnosis of FBA.

Bronchi↗
PubMed1991

The relationship of IgE, skin-test, eosinophilia, eosinophil cationic protein and tumor necrosis factor production in allergic rhinitis.

One hundred and twelve patients with allergic rhinitis (AR) were selected for this study. Sixty-one percent of the patients had elevated levels of total serum IgE (> 210 IU/ml) whereas 55% of them had eosinophilia. Skin-test reactivities to house dust mite and fungi allergens were positive in 86% of the patients, but this was correlated neither to levels of eosinophils and specific IgE to Dermatophagoides ptronyssinus (Dpt) and D. farinae (Df), nor with the levels of total IgE except in the skin-test highest-reactive group; they had significantly higher IgE level than the normal controls. Radioallergosorbent test (RAST) was 66% in those patients with high IgE levels and the major allergens were further identified by Quidel Allergen Screen assay as Dpt and Df. Serum ECP level was correlated with high, but not low, blood eosinophil numbers in patients with AR. Tumor necrosis factor (TNF) production from peripheral blood mononuclear cells culture by phytohemagglutinin (PHA) stimulation was suppressed in patients with AR with eosinophilia when compared with that of the normal controls. The symptom-triggering factors in patients with AR were primarily cold air, temperature change and the common cold. This suggests that factors other than the specific IgE response to house dust mite, skin-test reactivity and eosinophilia may also be important in the development of AR.

Adolescent↗
PubMed2005

From asthma to Alzheimer's: Cochrane vitamin reviews cover an array of topics.

In the current issue of the Cochrane Library (Issue 3, 2004), there are more than 25 systematic reviews addressing the use of vitamins in the prevention or treatment of disease. Vitamins have been a mainstay of health since their discovery in the early 1900s, so a question arises as to when using vitamins is considered complementary as opposed to conventional medical practice. Complementary or alternative vitamin use encompasses those uses that are outside of accepted medical practice. The use of vitamin C to prevent scurvy is accepted medical practice. The use of vitamin C as a therapeutic adjunct to asthma is not. This paper summarizes 15 Cochrane systematic reviews on the complementary use of vitamins for an array of conditions including the common cold, Alzheimer's disease, asthma, chemotherapy-induced mucositis, and depression.

Alzheimer Disease↗
PubMed1994

Systematic reviews. Some examples.

Reviewing the literature is a scientific inquiry that needs a clear design to preclude bias. It is a real enterprise if one aims at completeness of the literature on a certain subject. Going through refereed English language journals is not enough. On line databases are helpful, but mainly as a starting point. This article gives examples of systematic reviews on vitamin C and the common cold, pyridoxine against the premenstrual syndrome, homeopathy, and physiotherapy.

Ascorbic Acid↗
PubMedDate not supplied

Nasopharyngeal reservoir of bacterial otitis media and sinusitis pathogens in adults during wellness and viral respiratory illness.

BACKGROUND: The carriage rate of pathogenic bacteria in the nasopharynx (NP) was determined using three separate techniques for obtaining samples. METHODS: The NP of 99 healthy adults was sampled with (1) nasal swab, (2) oral swab, and (3) nasal aspiration; 49 adults with common cold were sampled with an oral swab and nasal aspiration. Three selective agars were used to detect Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. RESULTS: Seventy-three percent of healthy adults and 74% of cold sufferers had at least one pathogen detected in the NP. Detection rates were 65% (oral NP swab), 38% (catheter aspiration), and 28% (nasal swab; p < 0.001). Carriage rates for S. pneumoniae, M. catarrhalis, and H. influenzae were 45, 33, and 30%, respectively. Both a nasal and an oral sample were required for optimal detection. CONCLUSION: Bacterial pathogens were present in the NP of three-quarters of adults during wellness and during colds.

Adult↗
PubMed1997

Frequency and natural history of rhinovirus infections in adults during autumn.

Human rhinovirus (HRV) accounts for a significant portion of common-cold illness, with the peak incidence being in the early fall. Three hundred forty-six adults who had self-diagnosed colds of 48 h or less were enrolled in a study during September and October 1994 to determine the frequency and clinical course of HRV infections. Nasal wash specimens for viral culture and reverse transcription-PCR (RT-PCR) for HRV RNA and human coronavirus OC43 and 229E RNA detection were collected on enrollment, and participants recorded their symptoms twice daily for 14 days. Middle ear pressure (MEP) was measured with a digital tympanometer on days 1 and 7. Picornaviruses (224 HRV and 7 enterovirus isolates) were detected by culture in 67% (231 of 346) of the subjects. Among 114 samples negative by culture, HRV was detected by RT-PCR in 52 (46%) for an overall picornavirus infection rate of 82% (283 of 346 subjects). Among the remaining 62 negative samples, human coronavirus RNA was detected by RT-PCR in 5 patients, so that 288 (83%) of patients had documented viral infection. The first symptom noticed most often was sore throat (40%) in HRV culture- or PCR-positive patients and stuffy nose in HRV-negative patients (27%). No differences in symptom scores over time or in the presence of individual symptoms were noted between groups. The median duration of the cold episodes was 11 days in HRV culture-positive patients, 9.5 days in HRV RT-PCR-positive patients, and 11.5 days in HRV-negative patients. On enrollment, abnormal MEPs (< or = -100 or > or = +100 mm of H2O) were found for 21% of HRV culture-positive patients, 14% of HRV RT-PCR-positive patients, and 10% of HRV-negative patients. No important differences in the clinical course of HRV culture-positive, HRV culture-negative and RT-PCR-positive, or HRV-negative colds were found. These results represent the highest frequency of virologically confirmed natural colds to date and document the importance of rhinoviruses as the cause of colds during fall months.

Adolescent↗
PubMed1979

Self care for colds: a cost-effective alternative to upper respiratory infection management.

A Cold Self-Care (CSC) Center was established in a prepaid ambulatory care setting serving 21,500 subscribers and their dependents. After CSC establishment, a decrease in visits to practitioners for common colds was demonstrated. The operating cost ratio of an outpatient visit as compared to a CSC visit was 14.7/1. Savings over a two-year period are estimated at over $46,000, representing an average estimated ratio of $.09 cost per dollar saved per member per year.

Activities of Daily Living↗
PubMed1998

Association between interleukin-8 concentration in nasal secretions and severity of symptoms of experimental rhinovirus colds.

The purpose of this study was to examine the association between experimental rhinovirus infection and the elaboration of interleukin-8 (IL-8) into nasal secretions of volunteers and to determine the effect of pentoxifylline on IL-8 elaboration and rhinovirus-associated common cold symptoms. Fifty-four subjects with experimental rhinovirus infections and 20 sham-inoculated subjects were studied. Pentoxifylline had no effect on rhinovirus-induced symptoms or nasal-secretion IL-8 concentrations. IL-8 concentrations were significantly greater in nasal secretions from infected symptomatic subjects than in those from infected asymptomatic or sham-challenged subjects on days 2-4 after virus challenge. In infected subjects, there was significant rank correlation between nasal obstruction severity, rhinorrhea severity, and nasal-wash albumin concentrations and the change in IL-8 concentration from baseline on days 2-4 after virus challenge.

Adolescent↗