Bacteremia caused by viridans streptococci in 71 children.

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient''s illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient''s illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient''s illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.     

Characterization of the viral microbiome in patients with severe lower respiratory tract infections, using metagenomic sequencing

The human respiratory tract is heavily exposed to microorganisms. Viral respiratory tract pathogens, like RSV, influenza and rhinoviruses cause major morbidity and mortality from respiratory tract disease. Furthermore, as viruses have limited means of transmission, viruses that cause pathogenicity in other tissues may be transmitted through the respiratory tract. It is therefore important to chart the human virome in this compartment. We have studied nasopharyngeal aspirate samples submitted to the Karolinska University Laboratory, Stockholm, Sweden from March 2004 to May 2005 for diagnosis of respiratory tract infections. We have used a metagenomic sequencing strategy to characterize viruses, as this provides the most unbiased view of the samples. Virus enrichment followed by 454 sequencing resulted in totally 703,790 reads and 110,931 of these were found to be of viral origin by using an automated classification pipeline. The snapshot of the respiratory tract virome of these 210 patients revealed 39 species and many more strains of viruses. Most of the viral sequences were classified into one of three major families; Paramyxoviridae, Picornaviridae or Orthomyxoviridae. The study also identified one novel type of Rhinovirus C, and identified a number of previously undescribed viral genetic fragments of unknown origin.     

Respiratory disorders in Manitoba cattle farmers.

A group of 76 cattle farmers from southern Manitoba answered the National Heart, Lung, and Blood Institute questionnaire on respiratory symptoms and supplementary questions on farming and farming-related syndromes. Lung function was tested, serum was examined for precipitating antibodies, and skin testing with common allergens was performed. Analysis of the men''s answers revealed a high prevalence of chronic respiratory symptoms among the farmers in all categories of smoking history, and the presence of these symptoms was significantly associated with a history of symptoms related to handling mouldy hay or grain; 51% of the men had chronic symptoms and 55% had symptoms related to crop handling. In seven farmers (9%) the symptoms related to crop handling suggested an attack of farmer''s lung. One other farmer, with a history of illness after handling mouldy hay, had a reduced total lung capacity, and in 18 the ratio of the forced expiratory volume in the first second to the forced vital capacity was lower than predicted. Precipitating antibodies against Thermoactinomyces were absent in all farmers, but two farmers had antibodies against Aspergillus ruber. Immediate hypersensitivity was found in 16 (21%) of the farmers; sensitivity to Dermatophagoides farinae was commonest.     

Collaboration,not co-optation.

Studies of health effects of urea formaldehyde foam insulation (UFFI) were critically reviewed by means of accepted rules for evidence of causation. Three categories of health effects were examined: reported symptoms, primarily of the upper respiratory tract, lower respiratory tract disease and cancer. Most of the studies purporting to demonstrate health effects of UFFI failed to meet minimal methodologic criteria for evidence of causation. Evidence from the adequate studies provides little support for the hypothesis of a causative role of UFFI in health problems.     

Respiratory infections in the first year of life in children at risk of developing atopy.

Ninety-two infants, each of whom had one parent with asthma or hay fever, were followed up from birth to age of 1 year and 72 to the age of three years. During the first year of life respiratory symptoms, eczema, and respiratory viral infections were all reported. Within the first year 24 babies developed eczema; 28 had a wheal of 1 mm in diameter or more on prick skin testing with cutaneous allergens. Forty-three children had one or both of these characteristics and formed an atopic subgroup; by the same criteria, 49 children were non-atopic. The number of respiratory infections in the two groups was not significantly different; similar viruses were isolated from both groups. These viruses were associated with both upper and lower respiratory tract infections. Wheezing was a clinical feature in 12 children during lower respiratory tract infections. Of these babies six were atopic in the first year of life. Of the six non-atopic babies, one had eczema in the second year and five children developed raised total serum IgE values within the 3 years.     

Organophosphate Pesticide Poisoning

A total of 118 workers from a 120-person grape picking crew became ill in early September 1976. Of these (108 men and 10 women), 85 received medical attention and three of the 85 were admitted to hospital. The symptoms were typical for organophosphate poisoning. Average plasma and red cell cholinesterase values for the affected workers were depressed more than 60 percent. Most were treated with atropine and some were also treated with 2-PAM (pralidoxime). The exposure to residues of the organophosphate pesticides dialifor (Torak^®) and phosalone (Zolone^®) occurred in one grower''s vineyards near Madera, California.It appeared that workers had been allowed into recently-treated areas before the expiration of the required 30-day safety interval for dialifor, and that excessive skin exposure to residues of this pesticide had resulted. The clinical management of these cases and the occupational surveillance of the workplace became quite complex.The grower sustained significant losses of grapes during the period in which some of his vineyards were under quarantine and he had to pay substantial medical expenses as well as a fine for violating state regulations concerning the proper use of pesticides.Organophosphate pesticides decay more slowly under hot, dry weather conditions than they do when rainfall is frequent. California has imposed a number of specific safety intervals to be observed after the application of these pesticides to certain crops. If, in violation of these regulations, workers are permitted to enter fields too soon, poisoning can occur.     

Respiratory Disease in Young Adults: Influence of Early Childhood Lower Respiratory Tract Illness,Social Class,Air Pollution,and Smoking

The prevalence of cough during the day or night in winter has been studied in 3,899 20-year-olds. These were members of a cohort born in England, Scotland, and Wales in the last week of March 1946. The prevalence of cough and current smoking habits have been related to events recorded during infancy and childhood—that is, exposure to air pollution, social class of father, and lower respiratory tract illness under 2 years of age. At age 20, of these factors cigarette smoking was found to have the greatest effect on symptom prevalence, followed by a history of a lower respiratory tract illness under 2 years of age. Social class and air pollution had little effect.     

Morbidity in Canadian Indian and non-Indian children in the first year of life.

A cohort study of health status was undertaken to determine the patterns of morbidity in the first year of life for Indian and non-Indian infants living in southern Ontario. The annual incidence of office-reported health problems was 8.0 episodes for the 99 Indians and 4.5 for the 316 non-Indians studied. The risk of illness of most diagnostic categories was more than 1.5 times greater and the rate of hospital admission 4 times greater for the Indian infants. There was no difference between the two cohorts in the rates of visits to hospital emergency departments. The main cause of illness in both cohorts was respiratory tract infection; lower respiratory tract infections, particularly pneumonia, were a major health problem among the Indian infants. Only 36% of the Indian infants compared with 68% of the non-Indian infants attended five or more well-baby examinations. Part of the difference in morbidity between the Indian and non-Indian infants may be attributed to environmental factors, health care behaviour and geographic constraints.     

Outcome of acute lower respiratory tract infection in infants: preliminary report of seven-year follow-up study.

Seven years after admission to hospital for acute lower respiratory tract infection in infancy 200 children and their matched controls were assessed for respiratory state and epidemiological characteristics. The index group comprised 100 cases where respiratory syncytial virus infection had been responsible for the index illness (group 1) and 100 cases in whom this organism had not been found (group 2). There were no differences between index and control groups in birth weight or gestational age but fewer index cases were breast fed. Social indices such as class distribution and family size were more favourable in controls, though housing standards and maternal smoking habits were similar in the two groups. The prevalence of subsequent respiratory symptoms--cough, wheeze, nasal discharge, and hearing difficulties--was greater in index cases as was absence from school and family doctor consultation for respiratory illness. Bronchitis and asthma were significantly more common in the index group. Impaired ventilatory function and bronchial hyperreactivity were found in index cases when compared with controls. No differences in clinical characteristics and outcome were found in the two groups of index cases. The question whether lung "damage" during lower respiratory tract infection predisposes to subsequent respiratory problems or whether certain infants are more vulnerable than others to respiratory illnesses (including lower respiratory tract infection) from the onset is unanswered.     

Diseases of captive cheetahs (Acinonyx jubatus): Results of the cheetah research council pathology survey, 1989–1992

Knowledge of the diseases of cheetahs is essential to prevent and treat conditions that can modulate fertility and longevity. Toward this aim, a comprehensive pathology survey was conducted under a directive from the Cheetah Species Survival Plan. To date, 31 adult cheetahs and nine cubs from 16 zoological parks have been evaluated. Also, liver biopsies from 67 female cheetahs from 22 zoological parks were examined. Veno-occlusive disease (VOD) affected 82% of deceased cheetahs and 51% of live female cheetahs, and was the cause of death in nine cheetahs. Glomerulosclerosis and nephrosclerosis affected 84% and 39% of the population, respectively, and caused renal failure in eight cheetahs. The severity of VOD and glomerulosclerosis increased with age, and was not associated with infertility. Chronic gastritis was noted in 91% of the study population, and 95% of these cases also had spiral bacteria. Feline infectious peritonitis caused the death of two cheetahs. Male cheetahs had testicular degeneration, atrophy, and/or spermatogenic arrest, but these cheetahs also had severe systemic illness. Most females did not have reproductive tract lesions that would cause infertility, including those with parovarian cysts. Ovarian histology suggested that infertile cheetahs were not ovulating. Most cubs died from pneumonia or other systemic infections. The results of this study indicate that serious diseases are prevalent in the North American cheetahs, but these diseases do not appear to be the cause of infertility in the population. However, these diseases do limit the life span and well-being of cheetahs in captivity. Further research is needed to elucidate the causes of these diseases. © 1993 Wiley-Liss, Inc.     

Influence of passive smoking on admissions for respiratory illness in early childhood.

An association was sought between passive smoking and inpatient admissions for respiratory illness in 1058 children born between 1 June and 31 December 1981 and living in the neighborhoods of Nan-Jing Western Road and Yan-An Western Road in Jing-An District, Shanghai. The admission rate for first episodes of respiratory illness was positively correlated with the total daily cigarette consumption of family members during the children''s first 18 months of life. The relative risk of developing a first episode of respiratory illness was 1.80 for children living in families including people who smoked 10 or more cigarettes a day compared with those living in non-smoking families. Multiple logistic regression analysis showed that the effect of passive smoking on inpatient admission for respiratory illness was independent of the child''s birth weight, type of feeding, father''s education, size of the home, and chronic respiratory disease among adults in the family. The adjusted odds ratios compared with the non-smoking group were 1.17 in families smoking 1.9 cigarettes daily and 1.89 in families smoking 10 or more cigarettes daily. These data suggest that exposure to household cigarette smoke of children in early life increases the risk of severe respiratory illness.     

Early respiratory experience and subsequent cough and peak expiratory flow rate in 36 year old men and women.

Earlier work on the respiratory health of members of the Medical Research Council''s national survey of health and development (1946 birth cohort) was extended to age 36. At that age measures of peak expiratory flow rate and respiratory symptoms, elicited by the MRC chronic bronchitis questionnaire, were made in 3261 cohort members. In both men and women lower peak expiratory flow and higher respiratory morbidity were independently associated not only with current indices of poor social circumstances and cigarette smoking but also with poor home environment at age 2 years and lower respiratory tract illness before age 10. The findings provide additional evidence for a causal relation between childhood respiratory experience and adult respiratory disease.     

Breast feeding and lower respiratory tract illness in the first year of life. Group Health Medical Associates.

OBJECTIVE--To assess the relation between breast feeding and subsequent experience of lower respiratory tract illness. DESIGN--Prospective (from well child visits) and retrospective (from maternal recall) study of breast feeding and prospective assessment by paediatricians of lower respiratory tract illness in infants during first year of life. SETTING--Health maintenance organisation. PARTICIPANTS--Over 1000 infants who were healthy at birth and whose parents used the paediatricians of a local health maintenance organisation. MAIN OUTCOME MEASURES--Duration of breast feeding and type of lower respiratory tract illness (wheezing and non-wheezing) at different age intervals during the first year of life. RESULTS--Breast feeding was associated with a decreased incidence of wheezing illnesses only in the first four months of life. Interactions existed between breast feeding and sharing a room, being Mexican American, and being a boy. Multivariate techniques showed that after controlling for a variety of factors children who received minimal breast milk had a greater risk of early wheezing illnesses; the risk was further increased by simultaneous exposure to sharing a room. CONCLUSION--Breast feeding seems to protect against wheezing respiratory tract illnesses in the first four months of life, particularly when other risk factors are present.     

Serum 25-Hydroxyvitamin D and the Incidence of Acute Viral Respiratory Tract Infections in Healthy Adults

Background

Declining serum concentrations of 25-hydroxyvitamin D seen in the fall and winter as distance increases from the equator may be a factor in the seasonal increased prevalence of influenza and other viral infections. This study was done to determine if serum 25-hydroxyvitamin D concentrations correlated with the incidence of acute viral respiratory tract infections.

Methodology/Findings

In this prospective cohort study serial monthly concentrations of 25-hydroxyvitamin D were measured over the fall and winter 2009–2010 in 198 healthy adults, blinded to the nature of the substance being measured. The participants were evaluated for the development of any acute respiratory tract infections by investigators blinded to the 25-hydroxyvitamin D concentrations. The incidence of infection in participants with different concentrations of vitamin D was determined. One hundred ninety-five (98.5%) of the enrolled participants completed the study. Light skin pigmentation, lean body mass, and supplementation with vitamin D were found to correlate with higher concentrations of 25-hydroxyvitamin D. Concentrations of 38 ng/ml or more were associated with a significant (p<0.0001) two-fold reduction in the risk of developing acute respiratory tract infections and with a marked reduction in the percentages of days ill.

Conclusions/Significance

Maintenance of a 25-hydroxyvitamin D serum concentration of 38 ng/ml or higher should significantly reduce the incidence of acute viral respiratory tract infections and the burden of illness caused thereby, at least during the fall and winter in temperate zones. The findings of the present study provide direction for and call for future interventional studies examining the efficacy of vitamin D supplementation in reducing the incidence and severity of specific viral infections, including influenza, in the general population and in subpopulations with lower 25-hydroxyvitamin D concentrations, such as pregnant women, dark skinned individuals, and the obese.     

Management and outcome of winter upper respiratory tract infections in children aged 0-9 years.

Age-specific incidences for upper respiratory tract infections in children from a new-town population during 1975-7 were studied, and 965 consecutive upper respiratory tract infections in children aged under 10 during two winters were analysed in detail. Significantly different management plans made by seven doctors did not correlate with the clinical outcome as judged by complications, recall rates, and demand for treatment for similar episodes in the future. Two hundred and thirty-two children (24%) returned for another consultation for the same episode of upper respiratory tract infection. The main reason for these repeat consultations seemed to be that parental expectations about the natural history of the illness were not fulfilled. More realistic parental expectations might be set and safer clinical standards maintained if doctors warned parents about symptoms such as cough and occasional diarrhoea or vomiting that are commonly associated with upper respiratory tract infections in children.     

Risk factors for lower respiratory complications of rhinovirus infections in elderly people living in the community: prospective cohort study.

OBJECTIVE: To assess the role of rhinoviruses in elderly people living in the community. DESIGN: Prospective community based surveillance of elderly people, without intervention. Subjects were telephoned weekly to identify symptomatic upper respiratory tract infections. Symptoms and impact of illnesses were monitored, and specimens were collected for diagnostic serology and human rhinovirus polymerase chain reaction. SETTING: Leicestershire, England. SUBJECTS: 533 subjects aged 60 to 90. MAIN OUTCOME MEASURES: Symptoms, restriction of activity, medical consultations, and antibiotic use during 96 rhinovirus infections. Adjusted odds ratios for lower respiratory syndromes with respect to smoking and health status. RESULTS: A viral cause was established in 211 (43%) of 497 respiratory illnesses; rhinoviruses were identified in 121 (24%) and as single pathogens in 107. The median duration of the first or only rhinovirus infection in the 96 people with 107 rhinovirus infections was 16 days; 18 of the 96 patients were confined to bed and 25 were unable to cope with routine household activities. Overall, 60 patients with rhinovirus infections had lower respiratory tract syndromes; 41 patients consulted their doctor, 31 of them (76%) receiving antibiotics. One patient died. Logistic regression analysis showed that chronic medical conditions increased the estimated probability of lower respiratory rhinovirus illness by 40% (95% confidence interval 17% to 68%) and smoking by 47% (14% to 90%). There were almost six times as many symptomatic rhinovirus infections as influenza A and B infections. CONCLUSIONS: Rhinoviruses are an important cause of debility and lower respiratory illness among elderly people in the community. Chronic ill health and smoking increase the likelihood of lower respiratory complications from such infections. The overall burden of rhinovirus infections in elderly people may approach that of influenza.     

Perspective on the host response to human metapneumovirus infection: what can we learn from respiratory syncytial virus infections?

Human metapneumovirus (HMPV) is a recently discovered pathogen first identified in respiratory specimens from young children suffering from clinical respiratory syndromes ranging from mild to severe lower respiratory tract illness. HMPV has worldwide prevalence, and is a leading cause of respiratory tract infection in the first years of life, with a spectrum of disease similar to respiratory syncytial virus (RSV). The disease burden associated with HMPV infection has not been fully elucidated; however, studies indicate that HMPV may cause upper or lower respiratory tract illness in patients between ages 2 months and 87 years, may co-circulate with RSV, and HMPV infection may be associated with asthma exacerbation. The mechanisms and effector pathways contributing to immunity or disease pathogenesis following infection are not fully understood; however, given the clinical significance of HMPV, there is a need for a fundamental understanding of the immune and pathophysiological processes that occur following infection to provide the foundation necessary for the development of effective vaccine or therapeutic intervention strategies. This review provides a current perspective on the processes associated with HMPV infection, immunity, and disease pathogenesis.     

A、B、C三型流感病毒病毒学、流行病学、临床特征和流感疫苗

２０世纪人类遭受了４次流感大流行,数千万人失去了生命,流感病毒分Ａ、Ｂ、Ｃ三型,对其病毒学、流行病学和临床特征,以及流感病毒传统疫苗－－灭活疫苗和新型疫苗－－核酸疫苗的研究进展作了论述。     

Respiratory viruses and cot death.

Respiratory viruses and histological appearances of the lung were studied prospectively in an unselected series of 104 children who died between 1 week and 2 years of age. Thirty-one of the cases were cot deaths. Seven of these showed evidence of active virus infection in the lower respiratory tract. Similar evidence was found in two children who died from known causes and did not have a severe respiratory illness terminally. Although in some cases of cot death respiratory viruses may be responsible for a severe and rapidly overwhelming illness, the present results are compatible with an alternative hypothesis-namely, that minor respiratory illness may trigger sudden apnoea.