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PubMed2002

Influence of mild infections on iron status parameters in women of reproductive age.

OBJECTIVE: To investigate the effects of mild infections on iron status parameters. DESIGN: A prospective observational study. SETTING: A population of female nurse students in Norway. SUBJECTS: 33 women with self-reported episodes of infection and 33 women without infections but with comparable s-ferritin at baseline. MAIN OUTCOME MEASURES: Change from baseline in haemoglobin, s-iron, TIBC, transferrin saturation, s-ferritin, e-protoporphyrin and s-transferrin receptor on days 3, 7, 14, 21, 28 and 56 after onset of illness, compared to changes in non-infected subjects tested in parallel. RESULTS: In febrile illness, such as influenza, there was a significant rise in s-ferritin that could take more than a month to normalise. S-ferritin increased significantly when CRP rose above 20 mg/L, but a normal CRP could not preclude falsely high s-ferritin values due to infection. S-iron and transferrin saturation fell below normal range in a substantial proportion of cases in the symptomatic stage, even in infections without a febrile response, such as the common cold, but was normalised within a week after onset of infection. CONCLUSION: For more than a month after febrile illness such as influenza, s-ferritin is not a reliable measure for ruling out iron deficiency in women of reproductive age.

Adult↗
PubMed2004

Recurrent antibiotic use in a small child and the effects on the family.

OBJECTIVE: To determine the typical characteristics of small children on recurrent therapy with antibiotics (RTA) and the effects RTA have on the families. DESIGN: Stratified randomised cluster sampling. SETTING: An unselected population-based questionnaire study in Finland. SUBJECTS: Parents (n = 1443) expecting their first child were followed prospectively from the mother's early pregnancy until the child was 18 months of age. MAIN OUTCOME MEASURES: The outcome measure was the number of courses of antibiotic therapy (options: 011-51 > or = 6) during the child's first 18 months of life. Six or more courses were considered RTA. Associated variables were child- and family-related factors during the child's first 18 months of life. RESULTS: Children on RTA were taken to see a physician more often than other children when they had fever or a common cold. RTA was significantly associated with the child's day care outside the home, allergy and need for a special diet. The father's severe stress was associated with the child's RTA. Breastfeeding lasting more than 3 months was found to have a protective effect against RTA. CONCLUSION: The threshold for seeking medical help was low in the families of children on RTA, which is best avoided by breastfeeding and day care at home. Health care staff should not forget to support families, especially the fathers, with children experiencing recurrent infections.

Anti-Bacterial Agents↗
PubMed2006

Primary care management of respiratory tract infections in Dutch preschool children.

OBJECTIVE: To determine age-specific antibiotic prescription and referral rates in preschool children diagnosed with acute respiratory tract infection (RTI) in primary care. DESIGN: Retrospective cohort study. SETTING: Research database of the Netherlands University Medical Center Utrecht Primary Care Network. SUBJECTS: All children aged 0-5 years within the database were included, covering 1998 to 2002 (18,801 child-years). MAIN OUTCOME MEASURES: Antibiotic prescription and referral rates were determined as percentage of children with at least one prescription or referral within a year, as total number of prescriptions per 1000 child-years, and as percentage of all RTI episodes. RESULTS: Antibiotics, mostly beta-lactam (80%) and macrolides (16%), were prescribed in 35% of RTI episodes. Annually 13% of the children received at least one antibiotic following an RTI. Antibiotics were prescribed in more than half of episodes of LRTI, sinusitis, AOM, and acute tonsillitis, and in 12-15% of episodes of asthma exacerbation, acute laryngitis, influenza acute, and acute upper respiratory infection (including common cold and pharyngitis). Almost 98% of RTIs were managed in primary care. On average 1% of the children were referred to a paediatrician or ENT specialist following RTI per year, especially after AOM (59% of referrals). Compared with older children, those under two years of age were more often treated with antibiotics (relative risk [RR] 1.4, 95% CI 1.3-1.6) and referred (RR 2.3; 95% CI 1.8-3.0). CONCLUSION: In the Netherlands most episodes of RTIs in preschool children were managed in primary care and this often involves prescription of antibiotics. Children younger than two years of age receive more often antibiotics for RTI and are also referred more, especially for AOM.

Acute Disease↗
PubMed2005

Milk consumption does not lead to mucus production or occurrence of asthma.

There is a belief among some members of the public that the consumption of milk and dairy products increases the production of mucus in the respiratory system. Therefore, some who believe in this effect renounce drinking milk. According to Australian studies, subjects perceived some parameters of mucus production to change after consumption of milk and soy-based beverages, but these effects were not specific to cows' milk because the soy-based milk drink with similar sensory characteristics produced the same changes. In individuals inoculated with the common cold virus, milk intake was not associated with increased nasal secretions, symptoms of cough, nose symptoms or congestion. Nevertheless, individuals who believe in the mucus and milk theory report more respiratory symptoms after drinking milk. In some types of alternative medicine, people with bronchial asthma, a chronic inflammatory disease of the lower respiratory tract, are advised not to eat so-called mucus-forming foods, especially all kinds of dairy products. According to different investigations the consumption of milk does not seem to exacerbate the symptoms of asthma and a relationship between milk consumption and the occurrence of asthma cannot be established. However, there are a few cases documented in which people with a cow's milk allergy presented with asthma-like symptoms.

Animals↗
PubMed1997

A memoir of olfaction.

Osphreiology, though beginning with Aristotle, and the title of a classical monograph from 1819 by Cloquet, has, like the human sense of smell itself, played a relatively modest role, compared to other sensory functions. The anatomical and physiological connections of the nose to the brain proved to be more complex than those of sight, hearing and even touch, and were therefore poorly understood before the second half of the 19th century. Moreover, the close association between smell and taste gave rise to much controversy regarding the respective roles of the first and the fifth cranial nerves. Next, came the unfolding of the evolutionary influence of cerebral structure and function--viz Broca's "limbic" concept, and the "olfactory desert" in the brains of "anosmatic" animals, Jackson's "uncinate" seizures featuring olfactory hallucinations brought the hippocampal formation into focus. Finally, there were the clinical manifestations of hyposmia and hyperosmia, from "coryza", the common cold, to injury or neoplasms causing hyposmia, as well as some endocrine alterations causing hyperosmia. (And let us not forget Charles Huysman's "Against the Grain" and Marcel Proust's evocative fragrant madeleine.).

Cranial Nerves↗
PubMedDate not supplied

Towards a coronavirus-based HIV multigene vaccine.

Human immunodeficiency virus (HIV) infection represents one of the major health threats in the developing world. The costly treatment of infected individuals with multiple highly efficient anti-HIV drugs is only affordable in industrialized countries. Thus, an efficient vaccination strategy is required to prevent the further spread of the infection. The molecular biology of coronaviruses and particular features of the human coronavirus 229E (HCoV 229E) indicate that HCoV 229E-based vaccine vectors can become a new class of highly efficient vaccines. First, the receptor of HCoV 229E, human aminopeptidase N (hAPN or CD13) is expressed mainly on human dendritic cells (DCs) and macrophages indicating that targeting of HCoV 229E-based vectors to professional antigen presenting cells can be achieved by receptor-mediated transduction. Second, HCoV 229E structural genes can be replaced by multiple transcriptional units encoding various antigens. These virus-like particles (VLPs) containing HCoV 229E-based vector RNA have the ability to transduce human DCs and to mediate heterologous gene expression in these cells. Finally, coronavirus infections are associated with mainly respiratory and enteric diseases, and natural transmission of coronaviruses occurs via mucosal surfaces. In humans, HCoV 229E causes common cold by infecting the upper respiratory tract. HCoV 229E infections are mainly encountered in children and re-infection occurs frequently in adults. It is thus most likely that pre-existing immunity against HCoV 229E will not significantly impact on the vaccination efficiency if HCoV 229E-based vectors are used in humans.

AIDS Vaccines↗
PubMed2000

Rhinoviruses infect the lower airways.

Rhinoviruses are the major cause of the common cold and a trigger of acute asthma exacerbations. Whether these exacerbations result from direct infection of the lower airway or from indirect mechanisms consequent on infection of the upper airway alone is currently unknown. Lower respiratory infection was investigated in vitro by exposing primary human bronchial epithelial cells to rhinoviruses and in vivo after experimental upper respiratory infection of human volunteers. Bronchial infection was confirmed by both approaches. Furthermore, rhinoviruses induced production of interleukin-6, -8, and -16 and RANTES and were cytotoxic to cultured respiratory epithelium. This evidence strongly supports a direct lower respiratory epithelial reaction as the initial event in the induction of rhinovirus-mediated asthma exacerbations. The frequency of infection and the nature of the inflammatory response observed are similar to those of the upper respiratory tract, suggesting that rhinovirus infections may be one of the most important causes of lower in addition to upper respiratory disease.

Bronchi↗
PubMed2001

Patients' interviews and misuse of antibiotics.

To better evaluate patient contribution in antibiotic use, we questioned 5379 subjects from 9 countries. Antibiotics are perceived as strong, efficient drugs, but they are believed to undermine immunity. Interviewees believe that most respiratory infections, except the common cold, require antibiotic therapy, and 11% of them had to exaggerate their symptoms to get an antibiotic prescription from their physician. About 1 patient in 4 saved part of the antibiotic course for future use. Sixty-nine percent of the patients claimed to have taken the course until the end (United Kingdom, 90%; Thailand, 53%), and 75% claimed that they actually took all the daily doses. In all countries, it was possible to get antibiotics from a pharmacist without a medical prescription. This study shows that patients exert pressure on their doctors to get antibiotics and should allow a design for precise educational action aimed at the public for better control of antibiotic use in the community.

Adult↗
PubMed2003

An outbreak of coronavirus OC43 respiratory infection in Normandy, France.

The 2 groups of human coronaviruses (HCoVs) represented by the prototype strains HCoV 229E and HCoV OC43 are mostly known as viruses responsible for common cold syndrome. HCoVs are difficult to detect, and epidemiological data are rare. From October 2000 through April 2001, we tested 1803 respiratory samples for HCoV by reverse-transcriptase polymerase chain reaction. From 8 February through 27 March 2001, HCoV OC43 was detected in samples obtained from 30 (6%) of 501 patients. The other viruses detected were respiratory syncytial virus (6.1%), parainfluenza virus 3 (1%), influenza virus A (7.8%), influenza virus B (7.2%), rhinovirus (6.4%), enterovirus (1%), and adenovirus (2%). Infection with HCoV OC43 was detected in patients of all age groups. The following clinical symptoms were noted: fever (in 59.8% of patients), general symptoms (in 30%), digestive problems (in 56.8%), rhinitis (in 36.6%), pharyngitis (in 30%), laryngitis (in 3.3%), otitis (in 13.3%), bronchitis (in 16.6%), bronchiolitis (in 10%), and pneumonia (in 6.6%). This study shows that an outbreak of HCoV OC43 respiratory infection was responsible for the lower respiratory tract symptoms observed in nearly one-third of patients identified by active surveillance for coronavirus infection.

Adolescent↗
PubMed2003

Rhinovirus induction of the CXC chemokine epithelial-neutrophil activating peptide-78 in bronchial epithelium.

Epithelial-neutrophil activating peptide-78 (ENA-78) induces neutrophil migration, an early response to viral infection. Rhinovirus serotype 16 (RV16) was used to infect primary bronchial epithelial cells and a cell line (BEAS-2B). Release of ENA-78 protein was measured by enzyme-linked immunosorbent assay, ENA-78 mRNA production was quantified by reverse-transcription polymerase chain reaction, and ENA-78 promoter activity was assessed by use of a promoter construct. After infection with RV16, ENA-78 protein and mRNA increased significantly, and RV16 induced 3-fold increases in ENA-78 gene transcription. Nasal ENA-78 measured in patients with asthma with and without RV infection was more elevated in patients with RV infection present. Our study demonstrates that ENA-78 is produced in bronchial epithelial cells in response to RV16 infection. With other chemokines, it may be an important initiator of neutrophil airway inflammation during RV common colds and thus may play a role in the development of virus-associated airway pathologies.

Adult↗
PubMed2004

Frequent detection of human coronaviruses in clinical specimens from patients with respiratory tract infection by use of a novel real-time reverse-transcriptase polymerase chain reaction.

During the past years, human coronaviruses (HCoVs) have been increasingly identified as pathogens associated with more-severe respiratory tract infection (RTI). Diagnostic tests for HCoVs are not frequently used in the routine setting. It is likely that, as a result, the precise role that HCoVs play in RTIs is greatly underestimated. We describe a rapid, sensitive, and highly specific quantitative real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for the detection of HCoV that can easily be implemented in the routine diagnostic setting. HCoV was detected in 28 (11%) of the 261 clinical specimens obtained from patients presenting with symptoms of RTI ranging from common cold to severe pneumonia. Only 1 (0.4%) of the 243 control specimens obtained from patients without symptoms of RTI showed the presence of HCoV. We conclude that HCoVs can be frequently detected in patients presenting with RTI. Real-time RT-PCR provides a tool for large-scale epidemiological studies to further clarify the role that coronavirus infection plays in RTI in humans.

Base Sequence↗
PubMed2001

Zinc potentiates the antiviral action of human IFN-alpha tenfold.

During the last decade, various zinc salts have been used against the common cold syndrome, which is known to be initiated by respiratory viruses, particularly rhinoviruses. Using rhinovirus as the challenge virus, we investigated whether zinc salts (Zn) could potentiate the antiviral action of native human leukocyte interferon (HuIFN-alpha) and rHuIFN-gamma. We found that HuIFN-alpha was potentiated tenfold at rather low levels of IFN activity (0.6-0.8 U/ml), resulting in 100% protection. Zn alone gave only marginal protection, if any. In contrast to HuIFN-alpha, rHuIFN-gamma directly increased the cytopathic effect of rhinovirus at low levels (<2 U/ml) but protected the cells at higher IFN levels (5-20 U/ml). No potentiation was seen with Zn. HuIFN-beta protected against rhinovirus at the same doses as used with HuIFN-alpha, but in contrast to HuIFN-alpha, no potentiation was noted.

Antiviral Agents↗
PubMed2003

Absence of the Kilifi mutation in the rhinovirus-binding domain of ICAM-1 in a Caucasian population.

Human rhinoviruses (HRV), responsible for approximately 60% of the common colds, are divided into two groups, according to their receptor specificity. The major group of HRVs gains access to human cells by binding to the intercellular adhesion molecule-1 (ICAM-1), whereas HRVs of the minor group use members of the low-density lipoprotein receptor (LDLR) family for cell entry. Previous studies confirmed that the HRV-binding region of ICAM-1 is located in the amino-terminal immunoglobulin-like (Ig) domain 1, which is encoded by exon 2 of the ICAM-1 gene. An A --> T transversion in codon 29 of ICAM-1 exon 2 causes a lysine to methionine substitution (K29M), and was found at a high frequency (33.2%) in Kilifi (Kenya), as well as in other African populations. In this study we examined whether polymorphisms in exon 2 of ICAM-1 could be detected in a Caucasian population, assuming that these could be of importance in HRV binding. DNA from 100 healthy, unrelated, Belgian volunteers was obtained through a noninvasive swish-and-spit method. Using a primer set in the adjacent intron sequences, the full-length ICAM-1 exon 2 was amplified by polymerase chain reaction (PCR), followed by direct sequencing of the PCR product. No polymorphisms could be demonstrated in exon 2 of the ICAM-1 gene among all 100 tested individuals. The rhinovirus-binding Ig domain 1 of ICAM-1 seems to be a highly conserved region in the Caucasian population.

Base Sequence↗
PubMed1999

The American coneflower: a prophylactic role involving nonspecific immunity.

OBJECTIVE: In humans, considerable circumstantial evidence exists that indicates soluble root extracts of the American coneflower, genus Echinacea, may act to ameliorate virus-mediated afflictions, such as the common cold, influenza, and even AIDS and virus-based tumors. This study was designed to quantify, in normal mice, Echinacea-mediated, quantitative, dynamic changes, with time on both mature and precursor cells, of all the hemopoietic and immune-cell lineages in the spleen and bone marrow. DESIGN: A specific, commercially prepared potent extract of Echinacea root was provided daily in the diet for either 1 week or 2 weeks with the aim of establishing a possible mechanism of action for this herb. RESULTS: The data revealed that natural-killer (NK) cells and monocytes, both mediators of nonspecific immunity and well-demonstrated killers of virus-containing cells, were numerically and significantly increased in both the bone marrow and the spleen as early as 1 week after beginning treatment with the dietary herb. In contrast to our observations with NK cells and monocytes, the sizes of all other hemopoietic and immune cell populations in these two organs remained at control levels even after 2 weeks of daily dietary Echinacea. CONCLUSIONS: The work has demonstrated the specific nature of Echinacea-derived phytochemicals in acting as stimulants of those cells responsible for nonspecific immunity, as the first line of defense against virus-infected/transformed cells. The observations that these cells were elevated in the bone marrow indicates that at least one mechanism of action of this herb, is to stimulate new cell production in situ. The significant elevation of these two fundamental immune-cell populations, in normal animals, suggests a prophylactic role for this herb.

Animals↗
PubMed2000

Treatment with propylthiouracil is associated with appearance of antineutrophil cytoplasmic antibodies in some patients with Graves' disease.

The use of propylthiouracil (PTU) for the treatment of Graves' disease is associated with few adverse effects such as skin eruptions, liver dysfunction, and agranulocytosis. Furthermore, recent studies described the development of antineutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis and vasculitis in patients treated with PTU. Here we investigated whether PTU therapy per se is associated with the appearance of ANCA in patients with Graves' disease. We analyzed 119 serum samples from 117 patients with Graves' disease treated with either PTU (n = 56), or methimazole (MMI) (n = 21), as well as untreated patients (n = 42). Myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA were tested by enzyme-linked immunosorbent assay (ELISA) kits. MPO-ANCA was negative in all patients treated with MMI therapy and untreated patients. However, MPO-ANCA was detected in 21 (37.5%) of 56 patients treated with PTU therapy. Furthermore, two patients who were negative for MPO-ANCA became positive after PTU therapy. The proportion of patients positive for MPO-ANCA increased with the prolongation of PTU therapy, but did not correlate with age, gender, and positive antithyroperoxidase (TPO) antibody. Among 21 MPO-ANCA positive patients, 12 had no symptoms, but 9 patients complained of myalgia, arthralgia, or common cold like symptoms after the appearance of MPO-ANCA. Three patients developed agranulocytosis or granulocytopenia, but none showed abnormal urinary findings. Our results suggest that PTU per se is associated with the production of MPO-ANCA in patients with Graves' disease.

Adult↗
PubMed2005

Occupational and environmental factors and idiopathic pulmonary fibrosis in Japan.

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease of unknown etiology. Environmental factors, especially occupational agents, may be of great importance in the manifestation of IPF. We examined the relationship between occupational and environmental factors and IPF in Japan. A multicenter hospital-based case-control study was performed in 2001. Included were 102 cases aged 40 years or over who were within 2 years of having been diagnosed in accordance with the most recent criteria. Controls, aged 40 years or over, were 55 hospitalized patients diagnosed as having acute bacterial pneumonia and four outpatients with common colds. Data on occupational and environmental factors were obtained from a questionnaire. Multiple logistic regression analysis was used to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of IPF for single factors with adjustment for age, sex and region. Compared with controls, cases were more likely to have been managers, officials or production workers and less likely to have been protective service or materials handling workers. Clerical and related work was significantly related to a decreased risk of IPF after further adjustment for pack-years of smoking (OR = 0.42; 95% CI = 0.18-0.95). Exposure to metal dust was significantly associated with an increased risk of IPF (OR = 9.55; 95% CI = 1.68-181.12). From 20.0 to 39.9 pack-years of smoking was significantly associated with an increased risk of IPF (OR = 3.23; 95% CI = 1.01-10.84). Our results appear to confirm data from previous epidemiologic studies. Metal dust exposure may be a particularly important risk factor for IPF.

Adult↗
PubMed1991

Fever: management and self-medication. Results from a Norwegian population study.

A representative sample of the Norwegian population was interviewed in 1988 as part of a monthly national opinion poll to investigate lay management and self-medication of fever. Six hundred and nineteen women and 592 men over the age of 15 were interviewed in their homes. Approximately one-fifth reported inappropriate measuring of body temperature. A variety of management and self-medication was found. In cases of common cold or influenza with fever, 35% would use antipyretics. Forty per cent would start to use antipyretics at a temperature below 39.0 degrees C. Forty-four per cent did not know any antipyretic brand names at all. The results indicate a need for more definite and consistent information to make fever management and self-medication more rational. Such information should be discussed and given by general practitioners, nurses at child welfare centers and pharmacists.

Adult↗
PubMed2003

Is it possible to diagnose acute otitis media accurately in primary health care?

BACKGROUND: Acute otitis media causes human suffering and enormous costs to society. Symptoms of acute otitis media overlap those of the common cold, and diagnostic methods confirming the diagnosis are used only occasionally. Uncertainty in diagnostics may lead either to overdiagnosis and unnecessary treatment or to underdiagnosis and an increase in complications. OBJECTIVE: Our aim was to evaluate the inter-rater agreement in diagnosis of acute otitis media for children in primary health care. METHODS: The GP on duty and the otorhinolaryngology resident at a primary health care clinic examined the same 50 children with caregiver-suspected acute otitis media. The otorhinolaryngologist photographed the tympanic membranes. Afterwards, two experienced clinicians evaluated the photographs with and without tympanograms. Diagnostic rates and diagnostic methods between clinicians were compared. RESULTS: The otorhinolaryngologist diagnosed acute otitis media in 44% and the GP in 64%. The GP based the diagnoses on symptoms and on the colour of the tympanic membrane, whereas the otorhinolaryngologist paid more attention to the movement and position of the tympanic membrane. CONCLUSION: The use of a pneumatic otoscope and tympanometry reduces the number of acute otitis media diagnoses by >30%, suggesting that acute otitis media may be misdiagnosed often. Between clinicians, there was a substantial discrepancy in diagnoses of acute otitis media.

Acute Disease↗