Microbial interactions during upper respiratory tract infections

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus often colonize the nasopharynx. Children are susceptible to bacterial infections during or soon after upper respiratory tract infection (URI). We describe colonization with these 4 bacteria species alone or in combination during URI. Data were from a prospective cohort of healthy children 6 to 36 months of age followed up for 1 year. Analyses of 968 swabs from 212 children indicated that S. pneumoniae colonization is negatively associated with colonization by H. influenzae. Competitive interactions shifted when H. influenzae and M. catarrhalis colonized together. In this situation, the likelihood of colonization with all 3 species is higher. Negative associations were identified between S. pneumoniae and S. aureus and between H. influenzae and S. aureus. Polymicrobial interactions differed by number and species of bacteria present. Antimicrobial therapy and vaccination strategies targeting specific bacterial species may alter the flora in unforeseen ways.     

Cod liver oil, young children, and upper respiratory tract infections

Cod liver oil contains long-chain omega-3 fatty acids, as well as vitamins D and A. It was a traditional source of vitamin D in the United States and was used to prevent and treat rickets. In our clinical research, we used liquid cod liver oil of adequate purity and acceptable taste for infants and young children, as well as a children's multivitamin/mineral supplement with selenium and other trace metals. In a cluster-randomized study of pediatric visits for upper respiratory illness during the winter and early spring, these nutritional supplements decreased mean visits/subject/month by 36%-58%. Cod liver oil is culturally valued and has been used as a folk remedy by many low-income minorities in the United States. Nutritional supplements cannot be purchased with SNAP benefits (formerly called food stamps). Inclusion of cod liver oil in state Medicaid formularies would make it available to low-income children, whose families may not be able to pay for it out-of-pocket.     

Optimal induction of upper respiratory tract immunity to reovirus 1/L by combined upper and lower respiratory tract inoculation

There has been an increasing interest in developing vaccines which are both easy to administer and which elicit functionally protective immune responses at mucosal and/or systemic sites. Intranasally administered vaccines meet the criteria of ease of administration and are thought to stimulate respiratory-mucosal immunity via interaction with nasal associated lymphoid tissues (NALT). The aim of this study was to gain a better understanding of how best to stimulate respiratory-mucosal immunity using a murine model of respiratory reovirus infection. Either a predominantly upper respiratory tract infection or a combination upper and lower respiratory tract infection was established by administering the same virus dose in either a small or large inoculum volume. These studies demonstrate that stimulation of NALT alone by an upper respiratory tract infection does not induce an optimal primary antibody response even in the nasal cavity. Effective immunity of both the upper and lower respiratory tract was obtained when a combination upper and lower respiratory tract infection was established. These results have important clinical implications since they suggest that effective respiratory mucosal immunity will be best achieved by the combined stimulation of both the upper and lower respiratory tract and will likely require both intranasal as well as inhaled aerosol delivery of antigen to the lower respiratory tract in humans.     

Stress,breakfast cereal consumption and objective signs of upper respiratory tract illnesses

Recent research has shown that both negative life events and breakfast cereal consumption are associated with the incidence and severity of subjective symptoms of upper respiratory tract illnesses (URTIs) Two studies were conducted to examine whether objective markers of illness were also associated with stress and breakfast cereal consumption. The results from the first study showed that regular breakfast cereal consumption was associated with lower sub-lingual temperatures in volunteers with URTIs. Stress had no effect on temperature. In the second study nasal secretion weight was lower in regular breakfast cereal consumers but was not influenced by stress. These studies suggest that breakfast cereal consumption is associated with reduced illness severity and that this does not reflect stress levels. Further research is now required to determine whether such results are directly due to cereal consumption or reflect correlated attributes, such as other aspects of the diet.     

Clinical judgment predicts culture results in upper respiratory tract infections

BACKGROUND: We wanted to describe the natural history, familial transmission, microbiology, and accuracy of clinical judgment of potential pathogens of respiratory tract infections in a community family practice. METHODS: The study was a prospective case series in which consecutive patients requesting treatment for respiratory tract infections were evaluated after nurse triage during 3 fall-spring months in a solo family practice in suburban Cleveland, Ohio. According to the physician's usual practice, patients were classified into high-, medium-, and low-risk groups for bacterial illness based on their clinical signs and symptoms. Cultures were performed and sensitivities were determined for pathogens from the infected throat, nasopharynx, conjunctiva, or other sites. Patient symptoms and well-being were scored at the initial visit and at 3, 7 and 14 days later. RESULTS: There were 111 illness episodes in 86 patients; 94% had cultures taken, of which 38% grew a potentially pathogenic bacteria, most commonly group A streptococci, Branhamella catarrhalis or Staphylococcus aureus. The physician's judgment of bacterial infection was associated (P < .001) with having a positive culture (sensitivity 53%, specificity 78%, positive and negative predictive values 60% and 73%, respectively). A positive culture was associated with 2 of 16 signs or symptoms: purulent discharge from any site or a red swollen eye. There was no association of treatment status with clinical outcomes during 2 weeks of follow-up observation. CONCLUSION: Infection with a potentially pathogenic bacteria is difficult to determine solely by clinical signs and symptoms, but clinical judgment is associated with positive culture results. The effect of selective treatment of upper respiratory tract infection based on clinical signs and symptoms and patient and family culture results remains to be determined, but using clinical judgment could result in more selective antibiotic use than found in current practice patterns.     

Antibiotic use in upper respiratory tract infections in New Zealand

Upper respiratory tract infections (URTIs) are a common reasonfor presentation to general practitioners. The current studyused computerised consultation records of 100 222 patients from17 general practices in New Zealand for the 12-month period1 July 1991–30 June 1992. URTIs were noted in 8.9% ofall consultations: 44.1% of cases were children aged less than10 years. Females presented more frequently than males for allages above five years. Fifteen different antibiotics were prescribedfor URTIs, but in 22.5% of cases no antibiotic was prescribed.There was no statistically significant difference in the likelihoodof a successful outcome with or without antibiotic therapy (²= 0.76, P > 0.05). The treatment failure profile of someantibiotics highlights the need for more prescriber education,especially as the range of medications available for generalpractitioner prescribing increases.     

社会获得性呼吸道感染社会获得性呼吸道感染病原学变迁

1　社会获得性呼吸道感染 (CAP)病原的变迁我在 1 95 0年任住院医生时 ,新入院的呼吸道感染病人的 2 5 %为典型肺炎 ,即胸片示大叶性肺炎 ,当时基本上均为肺炎双球菌肺炎 (即目前的肺炎链球菌肺炎 ) ,约 1 5 %为化脓性肺炎或肺脓肿 ,大多为金黄色葡萄球菌 (金葡菌 )引起 ,约 3 5 %为各类型的肺结核 ,约 1 5 %为非典型肺炎即胸片示肺内未构成叶、段实变的小片阴影 ,多由病毒、支原体、衣原体等引起 ,还有约 1 0 %为寄生虫引起 ,包括阿米巴肝脓肿并胸腔感染、肺脓肿 ,胸片示肺多发性结节状病变 ,有疫水接触史的血吸虫 ,咳果酱痰 ,有到过疫区…     

反复上呼吸道感染患儿危险因素分析

目的探讨反复上呼吸道感染患儿高危因素,以期为降低患儿反复上呼吸道感染提供参考。方法选取227例3⁶岁反复上呼吸道感染患儿资料(感染组)及277名儿童保健科进行健康体检的正常儿童(对照组),调查人口学特征、父母育儿方式、父母文化程度、儿童营养状况、儿童生活环境等因素,检测全血微量元素含量,分析引起反复上呼吸道感染的危险因素。结果非条件logistic回归分析显示,户外活动每天<2h、年抗菌药物使用次数≥3次、父母有过敏史、家庭成员吸烟、母亲文化程度高中以上是患儿反复发生上呼吸道感染的独立危险因素(P<0.05),其中母亲文化程度高为保护因素;两组锌、铁、钙、铜、镁含量比较差异有统计学意义(P<0.05)。结论多种危险因素引起小儿反复上呼吸道感染发生,母亲文化程度高有利于降低小儿反复上呼吸道感染的发生。     

Echinacea purpurea is ineffective for upper respiratory tract infections in children

QuestionHow safe and effective is Echinacea purpurea at reducing the duration and severity of upper respiratory tract infections in children?Study designMulticentre randomised controlled trial.Main resultsThere was no significant difference in duration or severity of symptoms with Echinacea purpurea compared with placebo in children with upper respiratory tract infection (median duration of symptoms (95% CI): 9 days (8 to 10 days) with Echinacea vs. 9 days (8 to 10 days) with placebo; P=0.89; median severity of symptoms (95% CI): 33 (29 to 40) with Echinacea vs. 33 (30 to 38) with placebo; P=0.69). Rash occurred in significantly more children receiving Echinacea compared with placebo (reports of rash: 24 with Echinacea v 10 with placebo; P=0.008).Authors’ conclusionsEchinacea purpurea is ineffective for treating upper respiratory tract infections in children aged 2 to 11 years.     

反复呼吸道感染患儿细胞及体液免疫功能分析

目的分析反复呼吸道感染患儿细胞及体液免疫功能。方法选择2010年10月至2012年9月确诊为反复呼吸道感染患儿60例,按照年龄将其分为：A1组年龄＜3岁,B1组3～6岁;同时选择健康儿童60例作为对照组：A2组年龄＜3岁,B2组3～6岁。采用流式细胞术检测所有入组儿童外周血T淋巴细胞总数（ CD3＋）及其亚群（ CD3＋CD4＋、CD3＋CD8＋）的绝对计数;速率散射比浊法测定其血清免疫球蛋白G、A、M（ IgG、IgA、IgM）含量。结果 A1、B1组CD3＋、CD3＋CD4＋细胞绝对计数及IgG含量均较相应正常对照组A2、B2组降低,差异均有统计学意义（A1与A2组比较t值分别为0．003、0．033、0．017;B1与B2组比较t值分别为0．041、0．045、0．012,均P＜0．05）。在＜3岁儿童中,反复呼吸道感染患儿的IgA含量较正常同龄儿童偏低,差异有统计学意义（t＝0．035,P＜0．05）。结论反复呼吸道感染患儿CD3＋T淋巴细胞总数绝对计数的降低,尤其是CD3＋CD4＋T辅助细胞的减少,使其对T、B淋巴细胞增殖分化的调控作用削弱,浆细胞产生Ig过程障碍是导致儿童反复呼吸道感染的重要原因。     

流感季节上呼吸道感染与冠心病发生的相关性

目的 探讨流感高发季节上呼吸道感染与冠心病患者心血管病的相关性,为其临床防治提供参考依据.方法 共纳入85例入住医院心内科的冠心病患者作为病例组,同时随机选取90例无心血管疾病的人群作为对照组,详细记录其相关信息,应用多因素回归分析进行多因素分析.结果 病例组患者男性、体重指数≥25、高血压病史、糖尿病史、吸烟史、血清高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、甘油三酯(TG)、总胆固醇(TC)及流感分别为63.5％、61.2％、33.0％、31.8％、34.1％、(0.9±0.3)mmol/L、(5.2±3.0)mmol/L、(1.6±0.4)mmol/L、(4.6±0.6)mmol/L、63.5％水平,明显高于对照组的47.8％、28.9％、11.1％、11.1％、18.9％、(1.3±0.5)mmol/L、(3.4±2.3) mmol/L、(2.2±0.3)mmol/L、(5.5±0.7)mmol/L、47.8％,两组差异有统计学意义(P＜0.05);对上述相关因素进一步行多因素分析,结果显示高血压病史、糖尿病史、LDL-C、TG及流感是冠心病发生的独立危险因素(P＜0.05);不同季节冠心病的发生分析结果显示,2-4月、8-11月作为流感的高发季节,流感患者发生冠心病的风险最高,且冠心病发病率随着季节的变化而变化,相关性分析示:相关性系数0.77(P＜0.01).结论 流感高发季节上呼吸道感染是冠心病患者心血管病发生的独立危险因素,冠心病的发生与流感的发生存在密切的相关性,流感季节对患者行早期的预防治疗有重要的意义.     

唇裂患儿术前上呼吸道感染的原因及对策

目的 探讨唇裂患儿术前上呼吸道感染的相关原因,并提出相应的预防对策,以供临床参考.方法 选取2008年1月-2011年12月进行唇裂手术的患儿131例,选用经过岗前培训的专门调查人员对唇裂患儿术前上呼吸道感染的原因进行调查.结果 131例被调查唇裂患儿中手术前发生上呼吸道感染58例,术前上呼吸道感染率为44.27％,与术前上呼吸道未感染患儿平均住院时间相比,术前上呼吸道感染患儿平均住院时间明显较长,差异有统计学意义(P＜0.05);在影响58例术前上呼吸道感染的医院相关因素中,环境改变造成患儿上呼吸道感染率最高,为48.28％,其次为饮食变化的因素,为29.31％;在影响58例术前上呼吸道感染的患儿因素中,免疫力低下造成患儿上呼吸道感染率最高,为51.72％,其次为患儿鼻腔相对短小、鼻道狭窄因素,为31.03％.结论 加强患儿及其家属的心理护理,提高患儿住院环境质量,增强患儿饮食,合理应用抗菌药物,均有利于患儿术前上呼吸道感染的降低,促进患儿手术的顺利进行及术后的康复.     

鞍山城区肥胖患儿与上呼吸道感染的相关性调查分析

目的对鞍山城区肥胖患儿与上呼吸道感染之间的相关性进行调查,为幼儿保健及上呼吸道感染患儿的治疗提供参考资料。方法收集鞍山城区部分医院、妇幼保健院(所)年龄为3⁶岁的幼儿体检资料及病历,按照数字随机表法选择其中的1 180名幼儿作为调查对象,分析幼儿肥胖程度与上呼吸道感染之间的相关性。结果1 180名幼儿中发生上呼吸道感染216例,感染率为18.31%;216例上呼吸道感染患儿的平均体质量指数、血锌、血铁、血钙、血镁、血铅的含量分别为(22.46±3.52)kg/m2、(7.46±2.43)μmol/L、(8.10±2.98)μmol/L、(1.72±0.26)μmol/L、(1.09±0.16)mmol/L、(89.45±11.53)μmol/L,与对照组(18.72±3.61)kg/m2、(12.45±3.12)μmol/L、(14.26±3.26)μmol/L、(2.16±0.49)μmol/L、(1.89±0.31)mmol/L、(24.76±7.56)μmol/L比较,差异均有统计学意义(P<0.05);按照体质量指数将幼儿分成4组,其中以体质量指数≥25kg/m2组幼儿上呼吸道感染发生率最高为40.19%,体质量指数(176岁的幼儿体检资料及病历,按照数字随机表法选择其中的1 180名幼儿作为调查对象,分析幼儿肥胖程度与上呼吸道感染之间的相关性。结果1 180名幼儿中发生上呼吸道感染216例,感染率为18.31%;216例上呼吸道感染患儿的平均体质量指数、血锌、血铁、血钙、血镁、血铅的含量分别为(22.46±3.52)kg/m2、(7.46±2.43)μmol/L、(8.10±2.98)μmol/L、(1.72±0.26)μmol/L、(1.09±0.16)mmol/L、(89.45±11.53)μmol/L,与对照组(18.72±3.61)kg/m2、(12.45±3.12)μmol/L、(14.26±3.26)μmol/L、(2.16±0.49)μmol/L、(1.89±0.31)mmol/L、(24.76±7.56)μmol/L比较,差异均有统计学意义(P<0.05);按照体质量指数将幼儿分成4组,其中以体质量指数≥25kg/m2组幼儿上呼吸道感染发生率最高为40.19%,体质量指数(17¹5)kg/m2组幼儿上呼吸道感染发生率最低为5.07%,组间比较差异均有统计学意义(P<0.05)。结论肥胖幼儿的血微量元素与正常体质量指数幼儿存在显著性差异,幼儿体质量指数越大,其发生上呼吸道感染的概率也越大,控制幼儿体质量指数,利于幼儿的正常生长发育。     

Antibiotics for upper respiratory tract infections. Follow-up utilization and antibiotic use.

OBJECTIVES: To examine the effects of antibiotic prescribing during an initial visit for viral respiratory tract infections on future care seeking and the cost of care. MATERIALS AND METHODS: Retrospective analysis of recorded visits for viral respiratory tract infections (N = 49,862) between January 1, 1995, and December 31, 1997, to practices in a large network of affiliated practices that use the same electronic medical record. RESULTS: Patients receiving antibiotics at the initial visit were less likely to return for a second visit, but this difference was small (15.4% vs 17.4%, P < .001). When returning for the second visit, those who received an antibiotic on the initial visit were prescribed more expensive antibiotics than those who had not received an antibiotic on the initial consultation. Overall, cost from initial antibiotic use outweighed any benefit from reduced utilization in adults and children. CONCLUSIONS: Antibiotic prescribing at an initial contact for a viral respiratory tract illness may reduce the likelihood that an individual will return for a subsequent visit, but adds substantial costs to care for the initial antibiotic and for more expensive antibiotics used on subsequent visits.     

WBC、CRP、PCT 在上呼吸道感染中的检测意义

目的 探讨白细胞计数（ WBC）、C－反应蛋白（ CRP）、钙素原（ PCT）三者联合在患儿上呼吸道细菌性感染早期诊断中的意义。方法 回顾性分析2010年3月至2013年2月在浙江省玉环县人民医院儿科接受住院治疗的上呼吸道感染患儿100例的临床资料,并选取80例正常体检儿童作为对照组。比较两组受试者的一般信息、WBC、CRP、血沉（ ESR ）和白介素－6（ IL-6）、PCT等血液指标。对WBC、CRP、PCT以及三者联合对细菌性感染的诊断价值分别行ROC曲线分析。结果 观察组患儿的CRP、IL-6、WBC和PCT水平均显著高于对照组（t值分别为12．43、4．58、8．68和2．02,均P＜0．05）;CRP、WBC、PCT三者联合检测对于感染的曲线下面积为0．947,敏感性为91．30％,特异性为90．44％,均显著高于三者单独检测对于感染的诊断意义。结论 WBC、CRP、PCT三者联合检测对于患儿上呼吸道细菌性感染早期诊断有着积极的意义。