Common Lower Respiratory Infection Research Articles

The global burden of respiratory infections in indigenous children and adults: A review.

This review article focuses on common lower respiratory infections (LRIs) in indigenous populations in both developed and developing countries, where data is available. Indigenous populations across the world share some commonalities including poorer health and socio-economic disadvantage compared with their non-indigenous counterparts. Generally, acute and chronic respiratory infections are more frequent and more severe in both indigenous children and adults, often resulting in substantial consequences including higher rates of bronchiectasis and poorer outcomes for patients with chronic obstructive pulmonary disease (COPD). Risk factors for the development of respiratory infections require recognition and action. These risk factors include but are not limited to socio-economic factors (e.g. education, household crowding and nutrition), environmental factors (e.g. smoke exposure and poor access to health care) and biological factors. Risk mitigation strategies should be delivered in a culturally appropriate manner and targeted to educate both individuals and communities at risk. Improving the morbidity and mortality of respiratory infections in indigenous people requires provision of best practice care and awareness of the scope of the problem by healthcare practitioners, governing bodies and policy makers.

Notch signaling pathway and bronchiolitis

Bronchiolitis is the most common lower respiratory tract infection in infancy and early childhood.The main pathogen is respiratory syncytial virus(RSV), which is one of the main factors in hospitalized infants, closely related to asthma.However, the detailed mechanism is not clarified, and there is no specific treatment.Recent studies have showed that Notch signaling pathway plays an important role in its pathogenesis.This review mainly summarizes the association between bronchiolitis immunological mechanisms and Notch siganling pathway. Key words: Bronchiolitis; Notch signaling pathway; Respiratory syncytial virus

Etiology and clinical features of viral bronchiolitis in infancy.

BackgroundBronchiolitis is a common lower respiratory tract infection in infancy. The aim of this review is to present the clinical profile of viral bronchiolitis, the different culprit viruses and the disease severity in relation to the viral etiology.Data sourcesDatabases including PubMed and Google Scholar were searched for articles about the clinical features of bronchiolitis and its viral etiology. The most relevant articles to the scope of this review were analyzed.ResultsCurrently there are two main definitions for bronchiolitis which are not identical, the European definition and the American one. The most common viral pathogen that causes bronchiolitis is respiratory syncytial virus which was identified in 1955; now many other viruses have been implicated in the etiology of bronchiolitis such as rhinovirus, adenovirus, metapneumovirus, and bocavirus. Several studies have attempted to investigate the correlation of bronchiolitis severity with the type of detected virus or viruses. However, the results were not consitent.ConclusionsFor the time being, the diagnosis of bronchiolitis remains clinical. The isolation of the responsible respiratory pathogens does not seem to confer to the prognosis of the disease severity.

Management of bronchiolitis in infants: key clinical questions

Abstract Bronchiolitis is the most common lower respiratory tract infection in infants. It is a seasonal illness and remains the leading cause of hospitalisation of infants worldwide. Respiratory syncytial virus (RSV) is responsible for approximately 70% of cases. Infants present with coryzal symptoms progressing to a cough and respiratory distress. A mild pyrexia and reduced feeding are common. Bronchiolitis is a clinical diagnosis and investigations are often of limited value. The management of bronchiolitis remains a contentious issue with a wide variation in practice. Recently here has been a significant shift in favour of minimally invasive, supportive therapy as the cornerstone of management. This typically involves minimal handling, nasopharyngeal suction, oxygen supplementation and optimising hydration. There is little evidence to support the use of pharmacological agents in managing of bronchiolitis. Palivizumab, a monoclonal antibody targeting RSV, can be administered to high risk patients in an attempt to reduce admission rates.

To study the efficacy of non-invasive ventilation in severe bronchiolitis

Objectives: Bronchiolitis is the most common lower respiratory tract infection in infancy and about 6-15% of patients of acute bronchiolitis require ventilatory support. Non Invasive Ventilation by increasing Mean Airway Pressure reduces airway resistance and recruits non-functional respiratory units to improve oxygenation. The objective of this study is to determine the effectiveness of Non Invasive Ventilation in patients of severe acute bronchiolitis. Methods: The present observational descriptive study was conducted in the department of Paediatrics, Dr. B.C. Roy Post Graduate Institute of Paediatric sciences, Kolkata, India. Those patients fulfilling the criteria for severe Acute Bronchiolitis according to Bronchiolitis Scoring System were included in this study. 76 patients were studied during the 1 year period from April 2014 to March 2015. Results: A success rate of 72.4% has been observed in this study. Mean duration of Non Invasive Ventilation in patients where it was successful was 32.5±15.3 hours. Abnormalities in pH and PCO2 improved over a period of 6 hours. Conclusion: Non Invasive Ventilation was found effective in 72.4% of patients of severe bronchiolitis. Abnormalities in pH & PCO2 were also improved over 6 hours. Thus, it is an effective, safe and cost effective modality of treatment of severe bronchiolitis.

Economic evaluation of nasogastric versus intravenous hydration in infants with bronchiolitis.

Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalisation. We aimed to assess whether intravenous hydration (IVH) was more cost-effective than nasogastric hydration (NGH) as a planned secondary economic analysis of a randomised trial involving 759 infants (aged 2-12 months) admitted to hospital with a clinical diagnosis of bronchiolitis and requiring non-oral hydration. No Australian cost data exist to aid clinicians in decision-making around interventions in bronchiolitis. Cost data collections included hospital and intervention-specific costs. The economic analysis was reduced to a cost-minimisation study, focusing on intervention-specific costs of IVH versus NGH, as length of stay was equal between groups. All analyses are reported as intention to treat. Intervention costs were greater for IVH than NGH ($113 vs $74; cost difference of $39 per child). The intervention-specific cost advantage to NGH was robust to inter-site variation in unit prices and treatment activity. Intervention-specific costs account for <10% of total costs of bronchiolitis admissions, with NGH having a small cost saving across all sites.

Minor injuries and ailments. 9: Bronchiolitis

Approximately one in three children in the UK develop bronchiolitis, a common lower respiratory tract infection that affects babies and young children before their first birthday and is most common in babies aged 3–6 months. This article will focus on managing and treating bronchiolitis in children at home; when parents should be advised to attend A&amp;E; and when to call an ambulance.

LO039: The effect of desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis

Introduction: Bronchiolitis is the most common lower respiratory tract infection among infants, characterized by wheeze and respiratory distress. Reliance on pulse oximetry has been associated with increased hospitalizations, prolonged hospital stay and escalation of care. The objectives were to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of emergency department discharge in infants with bronchiolitis who desaturate to &lt;90% for at least one minute during home oximetry monitoring versus those without desaturations. Methods: This is a prospective cohort study from 2008 to 2013 enrolling 118 otherwise healthy infant aged 6 weeks to 12 months discharged home from a tertiary care pediatric emergency department with a diagnosis of acute bronchiolitis. The primary outcome was unscheduled medical visits for bronchiolitis, a visit to any health care provider due to concerns about respiratory symptoms, within 72 hours of discharge in infants with and without desaturations. Secondary outcomes included examination of the severity and duration of the desaturations, delayed hospitalizations within 72 hours of discharge and the effect of activity on desaturations. Results: During a mean monitoring period of 19 hours, 75/118 (64%) infants had at least one desaturation event (median continuous duration 3.4 minutes). 59/118 infants (50%) had at least 3 desaturations, 12 (10%) desaturated for &gt;10% monitored time and 51(43%) had desaturations lasting ≥ 3 minutes continuously. 59/118 (50%) infants desaturated to ≤ 80% and 29 (24%) to ≤ 70% for ≥ 1 minute. A total 18/75 infants with desaturations (24.0%) had an unscheduled visit for bronchiolitis versus 11/43 of their non-desaturating counterparts (25.6%) [Difference - 1.6%; 95%CI -0.15 to ∞, p=0.66]. One of 75 desaturating infants (1.3%) and 2/43 (4.6%) of those without desaturations were hospitalized within 72 hours [Difference of -3.3%; 95% CI -0.04 to 0.10, p = 0.27]. Seventy seven percent of infants with desaturations experienced them during sleep or while feeding. Conclusion: The majority of infants with mild bronchiolitis experienced recurrent or sustained desaturations after discharge home. Children with and without desaturations had comparable rates of return for care, with no difference in unscheduled return medical visits and delayed hospitalizations.

Bronchiolitis – It Is Time for a Unique Definition

Bronchiolitis is the most common lower respiratory tract infections in infants. It is time to reach a unique clinical definition, encompassing the acute onset of respiratory distress with cough, tachypnoea, retraction and diffuse crackles on auscultation in infants aged less than 12 months.

Incidence, risk factors and hospital burden in children under five years of age hospitalised with respiratory syncytial virus infections.

Respiratory syncytial virus (RSV) infections are among the most common lower respiratory tract infections in infants, but few studies have determined the age-specific incidence of hospitalisation in defined populations. This study gathered Swedish data on RSV in Gothenburg and its 10 surrounding municipalities from 2004 to 2011. Information was obtained from hospital databases of all patients up to five years of age who had a discharge diagnosis of an RSV infection and had a positive antigen detection or polymerase chain reaction test. A total of 1764 children fulfilled the inclusion criteria and 238 of these were preterm. The incidence under one year of age was 17.4/1000/year, and in children aged one to four years it was 0.6/1000/year. RSV patients occupied a mean of 1141 hospital beds per year: 65 were treated in the intensive care unit, 27 needed ventilator support, 19 needed continuous positive airway pressure, 408 (23%) received antibiotics, 399 (23%) received steroids, and all but four patients received a bronchodilator. All children survived. The incidence of RSV infections was high, medication use was high, and complications were low. Preterm infants had a higher risk, but most infants needing hospitalisation for RSV are full term and have no known risk factors.

Acute bronchiolitis: A review

Acute bronchiolitis is the most common lower respiratory tract infection (LRTI) in infants and children less than two years of age. It is broadly defined as a clinical syndrome characterized by upper respiratory symptoms followed by lower respiratory infection and inflammation, resulting in wheeze and crackles. Supportive care with focus on oxygenation and hydration remains the main stay of therapy. Several recent evidence-based reviews reveal that bronchodilators or corticosteroids should not be routinely used in bronchiolitis. This review presents the current status of recent therapies such as nebulized hypertonic saline, lieliox, continuous positive airway pressure (CPAP), montelukast, surfactant, and inhaled furosemide. etc.

In vitro activity of levofloxacin against lower respiratory tract pathogens.

Background:Considerable morbidity and mortality are associated with lower respiratory tract infections (LRTIs) that put a considerable strain on the health budget. Selection of appropriate antibiotics as empirical therapy maximizes positive patient outcomes, and that depends on regular surveillance of infective agents and their antibiograms, which vary according to the geographical areas.Aim:The aim was to study the drug susceptibility pattern of the isolated pathogens of the respiratory tract infections.Settings and Design:Retrospective study for a period of 1-year 3 months from January 2013 to March 2014 at a Tertiary Care Hospital.Materials and Methods:Eleven hundred and eighty-four sputum samples from both outdoor and indoor patients with symptoms of LRTI were processed, and antibiotic sensitivity test was done to commonly used antibiotics. Descriptive statistics was used to analyze the data.Results:Among 502 quality sputum samples, 312 (62.15%) samples showed growth of pathogenic bacteria. The most common pathogens were Klebsiella spp. (38.14%), Moraxella spp. (16.02%), Streptococcus pneumoniae (14.10%), Pseudomonas spp. (9.93%), S. aureus (9.29%). It was found that the overall susceptibility pattern was <50% for amoxicillin, amoxicillin-clavulanic acid, cefuroxime, cotrimoxazole and erythromycin whereas for cefotaxime, cefixime, and cefoperazone-sulbactum it was 60.08%, 51.59%, 69.04%, respectively. The susceptibility to ciprofloxacin, ofloxacin, and levofloxacin were 66.67%, 70.19% and 83.33%, respectively.Conclusion:Klebsiella spp. was the most common LRTI pathogen. There was limited activity of amoxicillin, amoxicillin-clavulanic acid, cefuroxime, cotrimoxazole and erythromycin for the treatment of LRTI whereas levofloxacin, (being an oral drug with good compliance) had good activity against respiratory pathogens and could be used for empiric treatment in LRTI.

PO-1018 The Role Of Vitamin A In Post Bronchiolitis Wheezing In Infants 2 To 12 Months Old

Background Viral bronchiolitis is a common lower respiratory infection during infancy. 50% of infants with acute Bronchiolitis develop Post bronchiolitis wheezing (PBW) that may cause childhood asthma. Vitamin A deficiency impairs epithelial integrity, systemic immunity and increases the severity of childhood respiratory infections such as RSV. In this study the effect of vitamin A in improving PBW has been evaluated. Methods This was a double blind pilot trial on 84 patients aged 2 to 12 months old who were admitted in Emam Sajad Hospital in Yasuj (Iran) from October 2012 to October 2013. The patients were diagnosed by history, physical examination and chest x-ray by a paediatrician. The 84 individuals were put in case and control groups (42 in each group). The case group received 5000 IU/kg Vitamine A intramascularly, plus cold and wet oxygen, and beta 2 agonist (ventolin) by nebulizer, and the control group received the same except vitamin A.1,2 and 3 weeks after treatment the patients were examined by the same paediatrician and were compared based on severity of wheezing, and response to the treatment (decrease in wheezing, distress and cough). Findings The diferences of demographic data and severity of wheezing were not significant between the groups before treatment. There were significant differences in response to treatment between two study groups after 1, 2 and 3 weeks following treatment (p = 0.045, p = 0.001 and p = 0.001 respectively). No side effects were seen during and after the course of treatment. Conclusion Usual treatments together with Vitamin-e A have stronger effect on reducing post bronchiolitis wheezing, compared with usual treatments alone.

PO-0184 Seasonality Of Acute Bronchiolitis In Hospitalizated Infants Over A 4-year Period: Abstract PO-0184 Table 1

Background and aims Bronchiolitis is the most common lower respiratory infection in infants and a leading cause of hospitalizations in this age group. To describe the rhythm and seasonality of the yearly epidemics of bronchiolitis in hospitalised children. Methods Epidemiological analysis of patients who were admitted to our hospital with bronchiolitis, over an 4-year period, from 2008 to 2012. The epidemic onset and conclusion was established according to the first and last cases per months, respectively. Results Data was collected from 389 patients, mean age: 59 days (5–739), 59% male. The mean length of stay was 5,9 days (2–71). There was no risk factor in 87% (10% premature and 1,5% heart disease). The clinical score at hospitalisation was mild (4%), moderate (43%) and severe (2,8%). The RSV was positive 67%. Epidemics begin in October (50%) and November (25%); the highest peak was observed in January, February and December and its conclusion varies between March and July. There were no cases in August and September. Conclusion Bronchiolitis epidemics onset is in October and November and conclusion varies along time years in hospitalised infants. The most incidence months are January and February with no cases in August and September. It not seems that a late season is followed by an early season in a 2-year pattern as is described but they alternate between greater numbers of patients with other patients less.

Epidemiology, Clinical, and Laboratory Characteristics of Bronchiolitis in Hospitalized Children

Background: Bronchiolitis is the most common lower respiratory tract infection in infants, which is often due to respiratory syncytial virus. The treatment is supportive; therefore, epidemiology, clinical, laboratory, and radiologic findings can help to prevent inappropriate use of antibiotics. Objectives: The aim of this study was to evaluate the clinical, and laboratory characteristics of bronchiolitis in hospitalized children. Patients and Methods: In this cross-sectional study, we recruited 117 patients with the bronchiolitis who with one to 24 months old who were hospitalized in Ali-Ebne Abitaleb Hospital of Zahedan, Iran, from December 1, 2011 to December 1, 2013. The participants were included according to the clinical diagnostic criteria. We tried to select the patients from the same demographic characteristics and health condition. Based on exclusion criteria, 17 patients were excluded from the study. Demographic, radiologic, and laboratory data were recorded in separate data forms were analyzed by SPSS 21. Results: A total of 117 patients were recruited, 57% were male and 43% female. The most common age at disease onset was one to six months old. Winter was the most common season for bronchiolitis. The most common clinical signs were cough, wheezing, rhinorrhea, fever, and dyspnea, consecutively. In radiologic studies, hyperinflation was the most prevalent finding. Leukocytosis was seen in 67% of patients. Conclusions: We can prevent inappropriate use of antibiotics in bronchiolitis with early diagnosis and supportive measures. Moreover, we obtain symptoms of bronchiolitis in southeastern Iran.

Using hypertonic saline to manage bronchiolitis in infants.

Bronchiolitis is the most common lower respiratory tract infection in young children and the leading cause of infant hospitalizations. Treatment is centered on supportive measures. Recent studies suggest hypertonic saline is an effective treatment option in admitted infants, demonstrating promising reductions in length of stay and clinical severity scores.

A PATIENTS WITH LOWER RESPIRATORY TRACT INFECTION. A CONSILIUM

In primary care, the most common lower respiratory tract infections are acute bronchitis, acute exacerbation of chronic bronchitis / chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia. A general practitioner should make a decision about management of such patient considering clinical and laboratory data. Two cases of an acute exacerbation of COPD and community-acquired pneumonia were discussed in the article. Issues of optimal antibacterial therapy were reviewed. The main pathogens causing acute exacerbation of chronic bronchitis / COPD are S. pneumoniae, H. influenzae, M. catarrhalis, so preferable antibiotics in this case could be aminopenicillines, macrolides, newer fluoroquinolones. According to the results of PeGAS survey josamycin is a macrolide with the highest activity against S. pneumoniae.

Treatment options of acute viral bronchiolitis in two Iraqi pediatric hospitals with a recent montelukast treatment option.

Bronchiolitis is a virally induced acute bronchiolar inflammation. It is the most common lower respiratory tract infection in infants with ages less than 1 year.The most common virus responsible for bronchiolitis is respiratory syncytial virus (RSV). The mainstay of management is oxygen and fluid administration. Pharmacological interventions including corticosteroids and bronchodilators have not been shown to improve outcome.Is to evaluate the effect of montelukast and to verify the efficacy of bronchodilators and anti-inflammatory drugs among infants presenting with acute viral bronchiolitis in two Iraqi pediatric hospitals.This was a randomized, prospective study in two Iraqi pediatric hospitals. Sixty infants with age range (2-24months) with a first episode of acute bronchiolitis were randomlydivided into four treatment groups: oxygen plus intravenous fluid, montelukast pediatric chewable tablet, salbutamol given in combination as oral plus nebulized salbutamol, and dexamethasone IV injection. Control infants with non respiratory diseases were also studied for comparisons. The measured outcomes included: respiratory rate, heart rate, oxygen blood saturation, and times to resolution of illness, duration of oxygen &amp; intravenous fluid therapy,and length of hospital stay. These parameters were measured for each infants from hospital admission untildischarge.All groups were comparable at baseline. There are significant improvements in the respiratory rate, heart rate, blood oxygen saturation and rapid resolution of illnesses in the patients group that received oxygen plus IV fluid &amp;the patients group that received montelukast tablet compared to other treatment options.Length of hospital stays was shorter in these two treatment options compared to other treatment options.The results observed effect of montelukast &amp; oxygen plus intravenous fluid on the measured parameters compared to other treatments options in these two hospitals.

G162(P) What Predicts Duration of Hospital Stay For Bronchiolitis?

BackgroundBronchiolitis is a common lower respiratory tract infection of infancy. In theUK, 3% of all infants are hospitalised with bronchiolitis and this places a considerable burden on the NHS every...

Advancement of T helper17 cells in bronchiolitis

Bronchiolitis is a common lower respiratory infection disease in children younger than two years old.The main pathogen of bronchiolitis is respiratory syncytial virus,which is also associated with the asthma.By now,it is still unknown about the pathogenesis of bronchiolitis.Recent findings provide that T helper17(Th17) cells play an important role in bronchiolitis.This review summarizes the progresses of regulation of Th17 cells development,Th17 cells function,and the relationship between Th17 cells and bronchiolitis. Key words: Bronchiolitis; T helper17 cell ; Respiratory syncytial virus