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At least 19 recordsLinked to original sources
PubMed1996

[Respiratory infections--pathogenesis of acute and chronic infections].

Respiratory infections in Japan have rapidly changed, because pathogenesis has also changed by the increase of compromised hosts and aged people with the development of chemotherapeutic agents and another medical progresses. Various respiratory infections have been accumulated in our clinical department and clinical investigations were done for these diseases during almost 20 years. Firstly, pneumonias in adult T cell leukemia have been very severe and these diseases have occurred with load from pathogenic orophayngeal bacteria to lower respiratory airway. With another clinical studies, these pathogenesis which firstly pathogenic bacteria attach to orophayngeal epithelial cells and would move to lower respiratory airway to infect were given very clear evidences especially for Branhamella and Pneumococcus infections with chronic respiratory infections. The exact clearance of pathogenic orophayngeal bacteria using povidon iode solution was very useful for prevention of these acute or chronic respiratory infections. Although acute bronchitis is very popular, the secondary bacterial pathogens remained to be unknown, in the world. We showed that H. influenzae, S.pneumoniae and B.catarrhalis were common major pathogens as the secondary invading bacteria of acute bronchitis in Japan, Thailand and Bangladesh. Recently, the pathogenesis of severe chronic respiratory infections such as diffuse panbronchiolitis is focused after the development of erythromycin therapy. We gave some evidences of macrolides effectiveness which these drugs inhibited IL-8 production. We described the importance of inflammatory cell classification in sputa or bronchial secretions for deep understanding of inflammatory situation in broncho-bronchiolar airway.(ABSTRACT TRUNCATED)

Acute Disease↗
PubMedDate not supplied

Practical approach to recurrent respiratory infections.

Respiratory diseases are a major cause of morbidity and mortality in developing countries. Recurrent respiratory infections in children pose a great challenge to the pediatrician where he has to exercise his clinical acumen and methodical approach for correct diagnosis and treatment. It is a fact that children should suffer 7 to 8 upper respiratory infections per year until they are 5 years of age when their immune status reaches adult level. In this situation, it is essential to find out whether the frequencies are abnormal. Whenever a child has the following problems, then only it needs to be investigated.--(a) repeated bacterial pneumonias; (b) a child less than 3 months old having repeated respiratory infections; (c) a child of 9 months old without a history of exposure infections; (d) infections complicating into bronchiectasis and; (e) in a child where there is no history of allergy or asthma. Once the problem is established as a true recurrent respiratory infection, the clinician should pose questions--whether it is chronic, acute or recurrent, to find out the site of pathology, seriousness of the problem, response to previous medications, to establish the possible diagnosis which fall into six categories--congenital anamolies, aspiration syndrome, genital disorders, immunological diseases, immune deficiency disorders and allergic diseases. The author discusses quoting some examples for various categories avoiding non pulmonary causes for recurrent respiratory infections in children.

Acute Disease↗
PubMed2004

Manipulation of immunity to and pathology of respiratory infections.

Respiratory infections are the third leading cause of death worldwide and are a priority for vaccine development. Immune defence mechanisms are critical in recovery from most respiratory infections but the role of the immune system in causing bystander lung injury is not as well understood, and will be the focus of this review. Immune-mediated injury results from physical occlusion of the airways or the ensuing 'cytokine storm', which may spill over into the systemic circulation and cause devastating consequences. Respiratory pathogens employ numerous strategies to avoid detection by the immune system. One of these, the alteration of key surface determinants, makes the design of rational vaccines problematic. In the following review the immune compartments responsible for clinical lung disease are discussed, and current and novel strategies to reduce their potency are overviewed.

Anti-Infective Agents↗
PubMed1988

[Antibiotics during pregnancy and breast feeding: consequences for the treatment of respiratory infections].

Respiratory infections are the second most frequent cause for antibiotic prescriptions during pregnancy, after genito-urinary infections. Overall, antibiotics are relatively innocuous. The following should be avoided: the tetracyclines, cotrimoxazole, chloramphenicol, metronidazole and the quinolones. Aminoglycosides should be administered controlling the plasma level. The beta-lactones (principally the penicillins) and the macrolides sold in France, are without any danger. Nevertheless, the rise in distribution volume and the overall physiological changes which accompany the developing pregnancy, particularly in the third trimester lead to a diminution in the serum concentration of these antibiotics and imply an adaptation, often a doubling, of the therapeutic dose administered. From the epidemiological data concerning the organisms involved in the respiratory infections, nearly the totality of extra-hospital infections may be cured by macrolides or penicillins (ampicillin). During more serious infections (nosocomial, or the immuno-depressed) the maternal prognosis should take precedence, adjusting the antibiotic to the organism, before the toxic risk to the child. All the antibiotics are excreted in the mother milk, but in very small quantities; they are generally destroyed in the digestive tract of the child so that the risk of any secondary effect during lactation is minimal.

Anti-Bacterial Agents↗
PubMed2001

Immunological investigations in children with recurrent respiratory infections.

Respiratory tract infections are common diseases in childhood. Most children with recurrent respiratory infections do not have an immunodeficiency. If they do, this is often due to an antibody deficiency. An important point in the investigation of a child with recurrent respiratory infections is to assess whether the child is thriving. If not, an underlying disease should be sought. Immunological investigations are useful if other, more frequent, underlying diseases have been ruled out. Early immunological screening is mandatory if there is a family history of immunodeficiency. In this review, a protocol is described which identifies children with severe antibody deficiency by simple screening tests before recurrent infections have caused irrepairable damage to the lungs. More elaborate tests are used to detect milder antibody deficiencies. These are reserved for those children in whom symptoms persist.

Child↗
PubMed2001

Management of community acquired respiratory infections.

Respiratory tract infections (RTIs) are the most common diagnosis in children visiting outpatient departments in both developing and developed countries. The impact of these infections is enormous in terms of total morbidity and mortality. Management of these infections requires a meticulous evaluation and a comprehensive but rational use of supportive, symptomatic and specific therapy. Antibiotics are widely prescribed for the treatment of community acquired respiratory infections to compensate uncertainties of diagnosis and prognosis; unnecessary anti-microbial drug therapy is expensive and resistance by respiratory pathogens is increasing at an exponential rate at a time when new anti-viral as well as anti-bacterial agents are being introduced into the therapeutic armamentarium. Major dilemmas persist regarding symptomatic therapy and the indications of antimicrobial agents. A comprehensive but brief review along with latest protocols and advancements is the management of community acquired respiratory infections in children in cited.

Adolescent↗
PubMed2000

[Complications of percutaneous endoscopic gastrostomy in the elderly: local skin infection and respiratory infection].

We investigated post-operative management of acute complications of percutaneous endoscopic gastrostomy (PEG) which often caused respiratory infections and local skin infections. The subjects were a total of 341 patients (male 131, female 210, and the mean age was 80.3), they were classified into six groups by method of feeding and use of antibiotics. Patients were divided into three groups based on the time that feeding was started. In Group I, enteral feeding was not started within the first five days. In Group II, sterilized enteral feeding (lactated Ringer's solution for intravenous infusion) using sterilized intravenous infusion kit started within 24 hours after the procedure, and in Group III, feeding of the usual enteral formula started within 24 hours after the procedure. And as for the using of antibiotics, they were also divided into two groups, antibiotics administered[AB (+)] and no antibiotics administered[AB (-)]. Thus, the patients were divided into six groups according to the time of starting nutrition and the use of antibiotics. The rates of incidence of acute respiratory infections and local skin infections in the six groups were compared by the chi-square test and differences in the rates of incidence of complication were also compared between two PEG methods; the Pull/Push method and the Introducer method. The frequency of local skin infection in Group III was significantly higher than in Group I and Group II. As for the PEG methods, the frequency of local skin infection in the Pull/Push method was significantly higher than Introducer methods. Acute respiratory infections occurred significantly less in the AB (+) group than in the AB (-) group. Postoperative administration of antibiotics would seem to be appropriate for prophylaxis of respiratory infection in elderly patients after PEG. On the other hand, local skin infections are not related to administration of antibiotics, and are highly related to the method of feeding. We concluded that nutrition of sterilized enteral feeding immediately after operation using a sterilized intravenous infusion kit and administration of antibiotics are advisable to prevent major complications in elderly patients.

Aged↗
PubMed1996

[Empirical antimicrobial therapy of respiratory infections].

Respiratory infections cause a significant morbidity and mortality. Ideally, the treatment should be directed against the identified pathogen and its sensitivity to antibiotics. In many situations, however, the pathogen is unknown and the infections are treated empirically. Author briefly reviews the current empirical therapeutical recommendations based on the age of patient, comorbidity and the type of infection (acute bronchitis, exacerbations of chronic bronchitis, community acquired pneumonia, nosocomial pneumonia and pneumonia in immunocompromised patients.

Anti-Bacterial Agents↗
PubMed2004

Activation of cytokines and NF-kappa B in corneal epithelial cells infected by respiratory syncytial virus: potential relevance in ocular inflammation and respiratory infection.

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection, claiming millions of lives annually. The virus infects various cells of the respiratory tract as well as resident inflammatory cells such as macrophages. Infection activates a variety of cellular factors such as cytokines and the pro-inflammatory transcription factor, NF-kappa B, all of which are important players in the respiratory disease. However, the exact natural route of RSV infection and its etiology remain relatively unknown. In this paper, we test the hypothesis that human corneal epithelial cells, which constitute the outermost layer of the cornea, can be infected with RSV, and that the infection leads to the activation of proinflammatory macromolecules. RESULTS: Corneal swabs obtained from pediatric patients with acute respiratory disease were found to contain RSV at a high frequency (43 positive out of 72 samples, i.e., 60%). Primary corneal epithelial cells in tissue culture supported robust infection and productive growth of RSV. Infection resulted in the activation of TNF-alpha, IL-6 and sixteen chemokines as well as NF-kappa B. Three proinflammatory CXC chemokines (MIG, I-TAC, IP-10) underwent the greatest activation. CONCLUSIONS: The ocular epithelium is readily infected by RSV. The pro-inflammatory cytokines are likely to play critical roles in the etiology of inflammation and conjunctivitis commonly seen in pediatric patients with respiratory infections. RSV-eye interactions have important implications in RSV transmission, immunopathology of RSV disease, and in the management of conjunctivitis.

Child↗
PubMed2002

Emergency department management of acute respiratory infections.

Respiratory tract infections are one of the most common problems prompting visits to the emergency department. Although many are the result of self-limited viral illnesses, these infections may result in substantial morbidity and, rarely, mortality. Prompt recognition and appropriate treatment can reduce morbidity and largely prevent mortality. Careful selection of antimicrobial agents is essential to maximize benefit and prevent overuse, which contributes to the emergence of antibiotic resistance.

Acute Disease↗
PubMed2001

Host defense in respiratory infections.

Respiratory defenses against infection involve a diverse and complex system. Mechanical barriers limit exposure of the respiratory tract to potential pathogenic organisms, whereas the mucociliary apparatus and cough reflexes work to expel any microbes that may bypass the initial defenses. When microorganisms have gained entry to the lower respiratory tract, the alveolar macrophage and recruited phagocytes may eliminate the culprits before active infection can be established. Only after the failure of the innate immune defenses is a specific immune response mounted. Examination of clinical defects in host defense allows one to understand the importance of the multitude of components of the lung's immune defense system.

Antibody Formation↗
PubMed1980

Office treatment of infection. 1. Respiratory infections.

Viral infections of the respiratory tract are more common but less easily treated than bacterial infections. Knowledge of the current patterns of susceptibility of the most common bacterial agents helps in selecting therapy. Many infections can be treated in the office empirically, provided adequate follow-up is assured.

Adult↗
PubMed1997

Respiratory syncytial virus (RSV) immune globulin intravenous therapy for RSV lower respiratory tract infection in infants and young children at high risk for severe RSV infections: Respiratory Syncytial Virus Immune Globulin Study Group.

OBJECTIVES: To evaluate the efficacy of high-titer intravenous respiratory syncytial virus immune globulin (RSVIG) in the treatment of children at high risk for severe RSV infection who were hospitalized with proven RSV. METHODS: Infants and young children younger than 2 years with bronchopulmonary dysplasia, chronic lung disease, congenital heart disease, or prematurity (<32 weeks' gestational age), hospitalized with a history of lower respiratory tract infection (LRI) of less than 4 days, were enrolled in this study. Patients were randomized in a blinded fashion to receive either 1500 mg/kg RSVIG or placebo in equal volumes. They were evaluated daily for safety and respiratory scores and for RSV nasal shedding. RESULTS: One hundred seven high-risk children were randomized--54 in the RSVIG group and 53 in the placebo group. Of these children, 51 in each group were considered evaluable. Children with pulmonary disease, congenital heart disease, or prematurity were equally distributed between the two treatment groups. However, two important differences were found in baseline variables between the two groups: there were more patients in the placebo group who had histories of previous LRI and there was a trend toward more severe disease at study entry in the RSVIG group. This was manifested by a higher entry respiratory score in the RSVIG group than in the placebo group (3.4 +/- 0.2 vs 3.1 +/- .01). A higher proportion of children in the RSVIG group (47%) than in the placebo group (28%) required intensive care at entry and mechanical ventilation at study entry (31% RSVIG-treated vs 18% placebo-treated patients). No significant difference was found between groups in the mean unadjusted duration of hospitalization (RSVIG group, 9.10 +/- 1.18 days; control group, 8.17 +/- 1.08 days). When the mean was adjusted for entry respiratory score, likewise, no difference was observed between each group (8.41 +/- 0.97 vs 8.89 +/- .99 days). The lack of efficacy observed in the study primary endpoint was observed in all diagnostic groups. No differences between the RSVIG and placebo groups were observed in the following secondary endpoints: duration of intensive care unit stay, duration of intensive care unit stay for RSV, mechanical ventilation, or supplemental oxygen. No significant differences in adverse events were reported in the RSVIG group (16 children) when compared with the control group (10 children). CONCLUSION: RSVIG treatment was safe but not efficacious in the treatment of children with bronchopulmonary dysplasia, congenital heart disease, or premature gestation who were hospitalized with RSV LRI.

Bronchiolitis↗
PubMed2006

[Simultaneous detection by multiplex PCR of atypical bacterial pathogens involved in infections of respiratory tract. Is it useful for the microbiological diagnosis of respiratory infections].

The aim was to evaluate the "strategical place" of the new commercial test Chlamylege (Argene-Biosoft-France) which allows the simultaneous detection in respiratory samples of Chlamydophila pneumoniae, Mycoplasma pneumoniae and most Legionella species using a PCR multiplex. 41 patients with an atypical pneumonia were included, all standard procedures of diagnosis were done and in addition the chamylege test. A pathogen was identified in 12 patients, an other microorganisms than the 3 targeted by our study was found in 8 patients. 4 positive PCR were obtained, 3 with M. pneumoniae and 1 with Legionella pneumophila 1. That means that for 29 patients no aetiology was found. Among them 23 clearly improved under antibiotic treatment. Though that PCR multiplex is an attractive test, easy to perform, sensitive, specific and convenient, we need further studies to approach the place of this PCR test in the diagnosis of multifaceted atypical pneumonia. We also need to know if the cost associated with the microbiological diagnosis (culture, serology, immunofluorescence, urinary antigen test, PCR...) for atypical pneumonia worth value? An algorithm as to be drawn to determine the value of intensive microbiological investigation. An other point to discuss, may be this kind of rapid and multiplex PCR technique could lead to spare the use of some antibiotics.

Atypical Bacterial Forms↗
PubMed2001

Oral bacteria and respiratory infection: effects on respiratory pathogen adhesion and epithelial cell proinflammatory cytokine production.

Several microbiologic and epidemiologic studies have suggested an association between dental plaque, poor oral health, and respiratory diseases such as nosocomial pneumonia and chronic obstructive pulmonary disease (COPD). A number of hypotheses are suggested to help explain how oral bacteria may participate in the pathogenesis of respiratory infection. Resident bacteria in oral secretions are likely aspirated along with respiratory pathogens and may affect the adhesion of the later organisms to the respiratory epithelium. Preliminary studies performed in our laboratory suggest that oral bacteria may modulate the adhesion of respiratory pathogens to epithelial cell lines. In addition, oral bacterial products or cytokines in oral/pharyngeal aspirates may stimulate cytokine production from respiratory epithelial cells, resulting in recruitment of inflammatory cells. The resulting inflamed epithelium may be more susceptible to respiratory infection. Further preliminary data are presented that some species of oral bacteria may induce the release of proinflammatory cytokines from epithelial cell lines to an extent similar to that seen for respiratory pathogens.

Aggregatibacter actinomycetemcomitans↗
PubMedDate not supplied

[Community-acquired respiratory infections].

BACKGROUND: Respiratory infections are the most frequent reason for primary health care consultation. Although generally not severe, they are responsible for a large number of days of laboral and scholar absenteeism and an excessive use of antibiotics. METHODS: The clinical and epidemiologic data of extrahospitalary infections in primary health care centers throughout Spain were collected according to the one day cut off system repeated trimestrally over one year. RESULTS: Data of 3,732 days of consultation were collected in which a total of 144,608 patients were attended. Of these, 20,614 had respiratory infections and 11,684 extrarespiratory infections. The most frequent processes were pharyngitis (33.7%), common cold (31.7%) followed by bronchitis (18.7%), otitis (11%), influenza (4.6%), laryngitis (4%), sinusitis (3.6%) and pneumonia (1.8%). Antibiotic treatment was prescribed in 13,488 patients (65%). The type of antibiotic was analyzed in the 11,977 patients treated for only one infection. Penicillins were the antibiotics most used followed by cephalosporins. The antibiotic prescribed was considered adequate in 70% of the 8,484 patients treated for potentially bacterial infection. A total of 3,493 patients had infection considered to be of viral etiology. CONCLUSIONS: Twenty-two percent of the patients attending a primary health care center presented infection and of these two out of three cases had respiratory infection. Pharyngitis and common cold were the most frequent processes observed. Two thirds of the patients consulting for respiratory infection received antibiotic treatment, with 29.2% being diagnosed with infections considered to be of viral etiology. The empiric treatment chosen for the two thirds of the potentially bacterial infections was considered as adequate.

Adolescent↗