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PubMed2001

Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods.

The need to decrease excess antibiotic use in ambulatory practice has been fueled by the epidemic increase in antibiotic-resistant Streptococcus pneumoniae. The majority of antibiotics prescribed to adults in ambulatory practice in the United States are for acute sinusitis, acute pharyngitis, acute bronchitis, and nonspecific upper respiratory tract infections (including the common cold). For each of these conditions-especially colds, nonspecific upper respiratory tract infections, and acute bronchitis (for which routine antibiotic treatment is not recommended)-a large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients. Because decreasing community use of antibiotics is an important strategy for combating the increase in community-acquired antibiotic-resistant infections, the Centers for Disease Control and Prevention convened a panel of physicians representing the disciplines of internal medicine, family medicine, emergency medicine, and infectious diseases to develop a series of "Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults." These principles provide evidence-based recommendations for evaluation and treatment of adults with acute respiratory illnesses.This paper describes the background and specific aims of and methods used to develop these principles. The goal of the principles is to provide clinicians with practical strategies for limiting antibiotic use to the patients who are most likely to benefit from it. These principles should be used in conjunction with effective patient educational campaigns and enhancements to the health care delivery system that facilitate nonantibiotic treatment of the conditions in question.

Acute Disease↗
PubMed1998

Prevalence and severity of symptoms of asthma, allergic rhino-conjunctivitis and atopic eczema in secondary school children in Ibadan, Nigeria.

This study was part of the effort of the International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee to evaluate the epidemiology of asthma and allergic diseases around the world. Three thousand and fifty eight randomly selected children aged 13-14 years were studied, using a standard questionnaire developed and field tested by the ISAAC Steering Committee, to establish the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema. Of the 3,058 children, there were 1,659 (54.3%) females and 1,399 (45.7%) males (F:M ratio 1.2:1). The cumulative prevalence rates of wheezing, rhinitis other than common cold, and symptoms of eczema were 16.4%, 54.1% and 26.1%, respectively while within the immediate 12-month period, the rates were 10.7%, 45.2% and 22.4%, respectively. However, rhinitis associated with itchy eyes (allergic rhinoconjunctivitis) was reported by 39.2% of the school children. The prevalence of doctor-diagnosed asthma was 18.4%. Multiple logistic regression analysis showed that a higher prevalence of wheezing and rhinitis was associated with itchy eyes. The prevalence of severe symptoms of asthma, allergic rhinitis and eczema were higher when compared with a similar study in Kenya. However, the prevalence of symptoms of asthma was lower and that of allergic rhinoconjunctivitis higher in our series. There is a need for further studies to investigate the risk factors which might be responsible for the apparently different patterns in these two African countries.

Adolescent↗
PubMedDate not supplied

Acute community acquired bacterial sinusitis: To treat or not to treat.

The paranasal sinuses, normally sterile, are prone to bacterial invasion as a complication of viral illnesses such as the common cold. Using computed tomograms, abnormalities of the sinuses can be seen in 90% of healthy adults with upper respiratory tract infections; only 2% of these patients will develop bacterial sinusitis. Possible rationales for antibiotic treatment of sinusitis include the normal sterility of the sinuses, the clinical morbidity associated with sinusitis, the possibility of serious intracranial and periorbital complications in untreated cases, and the possible progression of acute infections to chronic sinus disease. Evidence from the literature supports antibiotic treatment of sinusitis to eradicate infection and to reduce symptoms. There is insufficient literature evidence to prove that antibiotic treatment reduces serious complications or reduces progression to chronic sinus disease. Treatment should include an antimicrobial with a spectrum likely to cover the important pathogens, including those with high levels of resistance.

Acute Disease↗
PubMed1999

Spontaneous intracerebral hemorrhage in children.

We reviewed our experience in 42 children younger than 16 years with spontaneous intracerebral hemorrhage (ICH) treated between January 1989 and December 1997. Glasgow coma scale (GCS) on admission was 15 in 21 (50%) patients. The most frequent presenting symptoms were headache in 28 (67%) patients, followed by loss of consciousness in 22 (52%) patients and vomiting in 21 (50%) patients. Three cases were diagnosed initially as meningitis and two cases as common cold. The locations of ICH were lobar (26 patients) and cerebellar (7). Cerebral angiographies were performed on 28 patients, and were diagnostic in 19 (68%). Magnetic resonance imaging (MRI) scans revealed two cases of cavernous angiomas, which were confirmed by the pathologic studies of surgical specimens. Laboratory examinations detected two cases of acute leukemia. Four categories of the causes of ICH were determined in 23 (55%) patients. The leading cause of bleeding was arteriovenous malformations (AVMs). The in-hospital survival rate of all patients in this study was 79%. Patients with GCS 3-5 on admission and ICH located at brain stem, cerebellum, and multiple subcortical areas had higher mortality rates. On the follow-up (mean 42 months), seventy percent of our cases had made a good recovery, 21% a fair recovery, 3% a poor recovery, and 6% had died. Children with ICH recover motor function more rapidly than adults. However, visual deficits always persist at our long-term follow-up examinations. A physician should keep in mind the diagnosis of ICH in children, even though the presenting symptoms may be non-specific and the incidence of ICH is very low in children.

Adolescent↗
PubMed1999

[Guillain-Barré syndrome with cerebellar symptoms and elevated serum anti-GD1b IgG antibody].

We reported a 46-year-old woman with Guillain-Barré syndrome (GBS) after suffering from common cold. She also had cerebellar symptoms; ataxic speech, poor finger-nose and heel-knee tests, dysmetria, dysdiadochokinesis, poor one foot standing, positive Mann's test, ataxic gait, and poor tandem gait without Romberg's sign, and sensory disturbance. We ruled out other diseases with cerebellar symptoms; for example, Wernicke encephalopathy, multiple sclerosis, cerebellar vascular disease and encephalitis in the brain stem and cerebellum. Anti-GD1bIgG antibody was elevated in her serum in the acute phase. She was treated with immuno-adsorption therapy (TR-350) in the acute phase. The antibody titer decreased with clinical improvement after immuno-adsorption therapy. The involvement of the anti-GD1bIgG antibody in the pathogenetic mechanism of peripheral neuropathy and cerebellar symptoms was suggested.

Autoantibodies↗
PubMed1999

[A case of acute renal failure with rhabdomyolysis caused by the interaction of theophylline and clarithromycin].

Theophylline toxicity has been recognized since its introduction into clinical medicine. Clarithromycin is a new oral macrolide antibiotic with excellent antibacterial activity and rare adverse effect. Patients with upper respiratory infection are often treated with theophylline and clarithromycin concurrently. We report a case of acute renal failure due to acute rhabdomyolysis caused by the interaction of theophylline and clarithromycin. A 72-year-old man visited our hospital because of coughing and a sore throat continuing for 1 week. He was diagnosed as having the common cold with a bronchial asthmatic symptom and was prescribed 200 mg/day of sustained-release theophylline for the treatment of asthma for 7 days. One week later, he visited our hospital again. Radiographic study of the chest revealed mild interstitial pneumonia and 200 mg/day of sustained-release theophylline and 400 mg/day of clarithromycin were administrated concomitantly. Five days after the second visit, the patient was admitted to our hospital because of generalized twitching, muscular weakness, high fever and serious general condition. He experienced generalized muscular twitching and tremor. Blood urea nitrogen was 106.1 mg/dl, serum creatinine was 7.4 mg/dl, serum creatinine kinase (CK) was 36,000 IU/l (normal 15-130 IU/l), CK isozyme revealed the following ratio: BB 0%, MB 1% and MM 99%. He was diagnosed as having acute renal failure with rhabdomyolysis caused by the interaction of theophylline and clarithromycin. Hemodialysis therapy was started. After 5 weeks, his serum creatinine was markedly decreased. It is well-known that clarithromycin enhances the serum concentration of theophylline by inhibition of the cytochrome P450-dependent pathway in hepatocytes. Theophylline toxicity may be enhanced when clarithromycin is administrated concomitantly, especially to elderly patients with dehydration.

Acute Kidney Injury↗
PubMed1999

[A case of non-herpetic acute encephalitis presenting high intensity lesion at unilateral temparal cortex on MR FLAIR image].

We reported a case of non-herpetic acute encephalitis with unilateral temporal cortex lesion revealed by MR imaging and SPECT study. The patient was an eighteen years old woman who developed tonic-clonic seizure after common cold symptom. She was healthy before this episode. Neurological abnormality was only a single convulsion at onset and there was no other abnormal physical and neurological signs except for low grade fever. Electroencephalogram showed spike and slow wave complex of 2 Hz focused on a right posteriotemporal point (T 6) and an MR FLAIR (fluid-attenuated inversion recovery) image revealed a high signal intensity area at right temporal cortex. There was a decrease of cerebral blood flow in the same portion on SPECT study. This lesion was obscure on T1 and T2 MR images. Cerebrospinal fluid showed pleocytosis with normal glucose level and protein concentration. Bacterial and fungal cultures of CSF were negative and a detection of tubercule bacillus by PCR hybridization method was also negative. Although CSF findings suggested viral infection of CNS, virological study could not demonstrate infections of herpes simplex virus type 1, type 2, varicella-zoster virus, cytomegalovirus, measles virus, mumps virus, Japanese encephalitis virus, and influenza virus type A and B. After infusion of acyclovir and antibiotics, the patient was discharged from our hospital without sequelae of encephalitis. EEG was normal at this point and a high intensity area of MR FLAIR image disappeared two months later. SPECT findings were normalized six months later. The encephalitis presenting unilateral temporal cortex lesion without the infection of herpes simplex virus is thought to be very rare. Our case was distinguished from non-herpetic acute limbic encephalitis by an extent of the lesion and clinical manifestations. MR FLAIR image was useful for the detection of the lesion in this case.

Acute Disease↗
PubMed1999

[Family doctor: acrobat or drugstore clerk?].

In four cases there existed a discrepancy between the patient's request and the views of the GP who went by the guidelines of the Dutch College of General Practitioners. The requests concerned were those of a woman aged 56 who wanted a serum cholesterol determination and a youth aged 17 with a sprained ankle who asked for an X-ray--they were not satisfied until their wishes had been fulfilled--and those of a man aged 43 with recurrent low back pain who wanted to be referred to physical therapy and a woman aged 39 with a common cold who wanted a prescription for an antibiotic--they were only satisfied after a favourable development. The general practitioner has to choose whether to fulfill the patient's wishes or try to explain that the advice--based on medical evidence--is preferable. Good patient information is necessary for a better understanding of each other's points of view and, moreover, gives the doctor more satisfaction in his or her work.

Adolescent↗
PubMed1999

Upper respiratory symptoms in elderly patients. Hypertension complicates treatment decisions.

Approximately 6% of elderly patients present to primary care offices with hypertension and upper respiratory infection. Elderly people develop an acquired immunity to many rhinoviruses, making them less susceptible than younger people to the common cold. But because of the decreased vigor of their immune systems, they are less able to fight infection, particularly secondary bacterial infections. Upper respiratory infections require close monitoring in elderly patients to detect secondary infections and other complications. Most published research on respiratory symptom treatment is not limited to elderly subjects.

Aged↗
PubMed1999

[Rhythmic involuntary movement of the neck in a patient with brainstem encephalitis].

A 36-year-old Japanese woman was admitted to our hospital, because of facial palsy, ophthalmoplegia, cerebellar ataxia, and rhythmic myoclonus of the neck. About a few weeks before admission, she developed symptoms of common cold and general fatigue. Her laboratory data were unremarkable, and her CSF was normal. Serum levels of antibodies to gangliosides were within normal limits. Her MRIs of the brain and neck were normal. Both somatosensory evoked cortical potential study and auditory evoked brainstem response study were normal. She was diagnosed as postinfectious brainstem encephalitis, and the administration of corticosteroid was started. After the treatment, her symptoms improved. To our knowledge, it is rare to see myoclonus to the neck without palatal tremor in patients with brainstem encephalitis.

Adult↗
PubMed1999

DM program cuts back pain costs by educating, supporting primary care physicians.

Right behind the common cold, low back pain is the second leading reason why people go to the doctor's office. But nine times out of 10, the pain will resolve on its own. Discover how a combination of practice guidelines and a special spine clinic to address unresolved back pain work to create better clinical and financial outcomes for one major health plan.

Cost Control↗
PubMed1999

[Subjective statements regarding use of selected drug groups--initial results of the 1998 Federal Health Survey].

This publication presents data concerning the daily frequency of usage for 34 selected drug-groups. The results are based on standardized medical interviews done with a representative sample of the German resident population aged 18 to 79 years during the German National Health Interview and Examination Survey 1998. Nearly 52% of the interviewed men and women report the daily use of drugs at least from one of the above mentioned 34 groups during the last year before the interview. In both sexes the prevalence of drug-usage rises steadily with age. Women are more often drug-users than men with approximately doubled daily drug-usage in some medication groups. With worsening of the health status the sex-specific differences of drug-usage diminish. For females aged 18 to 45 years the rank-order of drug-usage is as follows: oral contraceptives (33.0%), thyroid drugs (11.5%), vitamins (7.6%). For males of the same age group the rank order in the 'new Bundesländer' is as follows: antihypertensives (4.7%), drugs against common cold and grippe (3.8%) and vitamins (3.8%). In the 'old Bundesländer' the rank-order for males is the following: vitamins (5.0%), antihypertensives (2.1%) and thyroid drugs (1.9%). For those study participants older than 45 years, drug groups for therapy of cardiovascular diseases become prominent and are the most often used medications with daily use. This could be observed for males and females. The results give a first impression concerning the drug-usage pattern in an adult resident population in Germany. The discussion of the results has to consider, that the answers given in the interviews strongly depend on the memory of the study participants and their lay-understanding of the different groups of the questionnaire. Further it has to be considered that the 34 drug-groups did not cover the whole medication pattern.

Adolescent↗
PubMedDate not supplied

[The reactogenicity and safety of a multicomponent vaccine (VP-4) in the prevention of acute respiratory diseases in preschoolers].

The reactogenicity and safety of poly-component vaccine (VP-4), prepared from the antigens of opportunistic bacteria, in the prophylaxis of acute respiratory diseases (ARD) in children aged 2.6-6 years. The vaccine was administered intranasally in 3 administrations and orally in 6-8 administrations at intervals of 3-4 days for a period of 24 +/- 4 days. The prophylaxis of ARD with the use of VP-4 was carried out in 168 children in 4 children's preschool institutions. The control group was made up of 120 children, attending the same institutions. The study revealed that VP-4 had low reactogenicity and induced short-time systemic and local reactions (common cold, cough). The administration of VP-4 at a period of the epidemic rise on influenza and ARD morbidity did not lead to an increase in the frequency and duration of ARD in the vaccinees, as well as to the exacerbation of chronic infection and the allergization of the body.

Acute Disease↗
PubMed2000

[Small adenocarcinoma of the lung under long-term observation].

A 68-year-old man presented with symptoms of common cold at our hospital on March 8, 1995. Ground glass opacity (GGO) was detected in the right S 4 a by high resolution computed tomography (HRCT) during a routine examination. Except for mild traction of the nearest pleura, the lesion itself demonstrated little change on HRCT images for 2 years. HRCT images disclosed slight enlargement of the lesion over a long-term period of follow-up observation. Exactly 25 months after the first examination, HRCT scans demonstrated an area of centralized dense concentration. Right middle lobectomy was performed 30 months after the lesion was first detected. Pathologic findings from the resected specimen revealed Noguchi's small adenocarcinoma of the lung (type B classification: localized bronchioloalveolar carcinoma with collapse of alveolar structure). The lesion was scanned 8 times with HRCT during the follow-up period. The change to GGO with centralized density and spicula was observed in detail, and thought to be evidence of a progression from type A to type B. We concluded that a set of fixed settings should be utilized for repeated HRCT examinations of small peripheral lesions exhibiting GGO.

Adenocarcinoma↗
PubMed1998

[Study on the epidemiological characteristics and strategy of surveillance in low endemic areas of malaria in Hubei].

Due to good programs on case finding and control, malaria has decreased to a low level in China. Hence, the existing surveillance program of undertaking blood smear from cases with fever finds very few positives in the millions of examinees. Previously, all blood slides were collected from clinically diagnosed cases of malaria (group 1), suspected malaria cases (group 2), fever of unknown reasons (group 3) or common cold (group 4) in low or moderate malaria endemic areas in Hubei Province. In low prevalence areas, the positive rates on slides were 0.6/10,000 and 0.1/10,000 in group 3 and group 4 while 95.38% of the confirmed malaria cases were from those having clinical malaria or suspected malaria. It is suggested that group 3 and group 4 be dropped from low prevalence areas to encourage greater efficiency in case detection in the clinical and the suspected malaria groups.

Animals↗
PubMed2000

[A case report of Bickerstaff's brainstem encephalitis with positive anti GQ 1 b, GT 1 a, GM 1 ganglioside antibodies].

Patient was an 18-year-old female student. After she had symptoms of common cold for 3 days, she developed somnolence, diplopia, dysarthria, urinary disturbance and ataxia. On admission neurological examination revealed coma with mydriasis, ophthalmoplegia, ptosis and weakness of the upper limbs. Light reflex, corneal reflex and oculocephalic test were all negative. Deep tendon reflexes were brisk and extensor toe signs were positive bilaterally. She did not have nuchal rigidity. Laboratory test revealed normal cerebrospinal fluid with negative myelin basic protein. Brain MRI, brainstem evoked potentials presented no abnormality. EMG revealed normal conduction velocity and no conduction block. EEG had diffuse theta and delta slowing. Culture of the stool represented no Campylobacter jejuni. At the fifth day of admission consciousness level improved, and other neurological findings disappeared in about 6 weeks. She had anti GQ 1 b, GT 1 a(IgG, IgM) and anti GM 1(IgM) antibodies in the serum. We made a diagnosis of Bickerstaff's brainstem encephalitis from these neurological symptoms and clinical course. The main lesion was present in the brainstem from midbrain to medulla oblongata in the midline. High titer of anti GT 1a antibody may be related to the ophthalmoplegia as noted in Miller Fisher syndrome. As a result of EMG and stool culture, it denied the complication of Guillain-Barré syndrome. We had no proof of the reason of the presentation of anti GM 1 antibody.

Adolescent↗
PubMed2000

Nasal congestion: a review of its etiology, evaluation, and treatment.

The most common clinical syndromes that cause nasal congestion are allergic rhinitis, vasomotor rhinitis, chronic sinusitis, and upper respiratory viral infections (common colds). Nasal congestion, in turn, can lead to sequelae such as sinusitis, otitis media, and the onset or worsening of mild to severe sleep disturbances, including obstructive sleep apnea. There is a host of conservative treatments, including decongestant pharmacotherapy, antiallergy measures, and nasal dilation devices. Several surgical procedures are also available. This article reviews the current guidelines for the workup and diagnosis of nasal congestion and briefly describes the many and varied approaches to treatment.

Administration, Topical↗
PubMed2000

[A case of hypersensitivity pneumonitis caused by Strophariaceae].

A 38-year-old woman was admitted to the Iiyama Red Cross Hospital with a non-productive cough. She had been working with Strophariaceae cultures for 4 years, and in January 1999 a cough had developed. On admission, hypoxemia was noted. The serum level of lactate dehydrogenase was slightly elevated. Chest radiography and CT scanning showed diffuse ground glass opacity and small centrilobular nodules in both lower lobes. In the bronchoalveolar lavage fluid, the total cell count was normal, the CD4/CD8 ratio was reduced, and the lymphocyte fraction was very high. A transbronchial lung biopsy revealed alveolitis with lymphocytic infiltration and organizing changes like Masson bodies. The lymphocyte stimulation test was positive for Strophariaceae. Hypersensitivity pneumonitis caused by Strophariaceae was diagnosed. Prednisolone was administered because of persistent symptoms and prolonged abnormal chest radiography findings. These abnormalities disappeared 2 weeks after prednisolone treatment was initiated. There is one previous report of hypersensitivity pneumonitis caused by Strophariaceae. The symptoms are coughing and sputum production as in the common cold. The occupational history must be carefully considered in making a diagnosis.

Adult↗