Diagnosis Of Upper Respiratory Infection Research Articles

Using a gradient boosted model for case ascertainment from free-text veterinary records

Case ascertainment for prevalence and incidence studies from veterinary clinical data poses a major challenge because medical notes are not consistently structured or complete. Using natural language processing (NLP) and machine learning, this study aimed to obtain accurate case recognition for feline upper respiratory tract infections (primarily caused by viruses such as feline herpes virus (FHV-1) and feline calici virus (FCV), and bacteria such as Chlamydophila felis, Mycoplasma felis and Bordetella bronchiseptica using retrospective electronic veterinary records from the Royal Society for Prevention of Cruelty to Animals, Queensland (RSPCA Qld). Data cleaning and NLP on eight years of free-text veterinary records from RSPCA Queensland was carried out to derive text-based predictors. The NLP steps included sorting records by length of stay, vectorising, tokenising and spell checking against a bespoke veterinary database. A gradient boosted model (GBM) was trained to predict the probability of each animal having a diagnosis of upper respiratory infection. A manually annotated dataset was used for training the algorithm to learn dominant patterns between predictors (frequencies of n-grams) and responses (manual binary case classification). The GBM’s performance was tested against an out of sample validation dataset, and model agnostics were used to interrogate the model’s learning process. The GBM used patient-level frequencies of 1250 unique n-grams as predictor variables and was able to predict the probability of cases in the validation dataset with an accuracy of 0.95 (95% CI 0.92, 0.97) and F1 score of 0.96. Predictors that exerted the highest influence on the model included frequencies of “doxycycline”, “flu”, “sneezing”, “doxybrom” and “ocular”. The trained GBM was deployed on the full dataset spanning eight years, comprising 60,258 clinical entries. The prevalence in the full dataset was predicted to be 23.59%, which is in line with domain expertise from practicing veterinarians at the shelter. Case ascertainment is a crucial step for further epidemiological study of cat flu. Ultimately, this tool can be extended to other clinical procedures, conditions, and diseases such as intensive care treatment due to snake bites and tick paralysis, physical injuries such as orthopaedic fractures or chest injuries and labour-intensive infectious diseases like parvovirus, canine cough, and ringworm, all of which require prolonged quarantine and care.

Prevalence of Upper Respiratory Tract Infections Before, During, and After the COVID-19 Pandemic in Germany: A Cross-Sectional Study of 2 167 453 Outpatients.

Although the burden of the COVID-19 pandemic on global healthcare systems is declining, long-term sequelae such as long COVID syndrome and other disease dynamics not primarily associated with COVID-19 remain a challenge. Recent data suggest that the incidence of non-COVID upper respiratory tract infections (URTI) is increasing sharply in the post-pandemic period, but there is a lack of real-world data from Germany in this respect. This cross-sectional study evaluated the number of patients with a diagnosis of URTI from the Disease Analyzer database (IQVIA) between January 2019 and December 2022. The number of UTRI diagnoses per practice and the duration of sick leave per patient were compared over time. A total of 1 872 935 individuals (1 403 907 patients from general practices (GP) and 469 028 patients from pediatric offices) were included, 48% of whom were female. The number of URTI patients per practice was significantly higher in 2022 than in 2019 (732 vs 464, 58%, P < .001), and this was observed for both women (56%, P < .001) and men (60%, P < .001). The post-pandemic increase in the number of URTI diagnoses correlated with age and was highest in the age group between 18 and 30 years (22%, P < .001) and lowest in older patients >70 years (3%). In pediatric patients (<18 years), the increase was highest in the age group ≤5 years (89%). Both the number of patients per practice on sick leave due to URTI (184 vs 92) and the average duration of sick leave (+2 days) increased from 2019 to 2022. Our data suggest a dramatic increase in the incidence of URTI among all demographic subgroups in Germany between 2019 and 2022, which was associated with a tremendous impact on socioeconomic variables such as the frequency or duration of sick leave. These data could be of great importance in current pandemic management and the management of future pandemics.

Correlation of initial upper respiratory tract viral burden with progression to lower tract disease in adult allogeneic hematopoietic cell transplant recipients.

Some respiratory viruses have been evaluated for the association between viral burden and respiratory disease progression in hematopoietic cell transplant (HCT) recipients, and no significant association has been reported. To assess whether initial viral burden of respiratory viruses predicts risk of progression to lower respiratory tract infection (LRTI) among adult allogeneic HCT recipients who presented with upper respiratory tract infection (URTI) with 12 viruses in the PCR era. We reviewed adult allogeneic HCT recipients (4/2008-9/2018) who presented with their first symptomatic respiratory viral infection following transplantation at the Fred Hutchinson Cancer Center. Cox proportional hazards models were used to investigate whether viral burden as measured by initial Ct values at the diagnosis of URTI is associated with progression to LRTI within 90 days for each virus, treating death as a competing risk. Among 2,148 adult HCT recipients during the study periods, 1,102 episodes of URTI met the study inclusion criteria. Higher viral burden (lower Ct value) were associated with an increased risk of progression to LRTI for influenza after adjusting for immunodeficiency scoring index and initiation of antiviral therapy, respectively. The association between viral burden and progression to LRTI was not found for other viruses. Our findings suggest that routine reporting of viral burden in current molecular diagnostic platforms may be beneficial. Further studies are needed to investigate the impact of viral burden on LRTI in other populations including pediatric HCT recipients.

Antibiotic Prescribing Patterns in Paediatric Primary Care in Italy: Findings from 2012-2018.

Comprehensive data are needed to monitor antibiotic prescribing and inform stewardship. We aimed to evaluate the current antibiotic prescribing patterns, including treatment switching and prolongation, in the paediatric primary care setting in Italy. This database study assessed antibiotic prescriptions retrieved from Pedianet, a paediatric primary care database, from 1 January 2012 to 31 December 2018. Descriptive analyses were stratified by diagnosis class, calendar year, and children’s age. Generalized linear Poisson regression was used to assess variation in the prescriptions. In total, 505,927 antibiotic prescriptions were included. From 2012 to 2018, the number of antibiotics per child decreased significantly by 4% yearly from 0.79 in 2012 to 0.62 in 2018. Amoxicillin prescriptions decreased with increasing children’s age, while macrolides and third-generation cephalosporins had the opposite trend. Prescriptions were associated with a diagnosis of upper respiratory infection in 23% of cases, followed by pharyngitis (21%), bronchitis and bronchiolitis (12%), and acute otitis media (12%). Eight percent of treatment episodes were prolonged or switched class, mostly represented by co-amoxiclav, macrolides, and third-generation cephalosporins. Our findings report an overall decrease in antibiotic prescriptions, but pre-schoolers are still receiving more than one antibiotic yearly, and broad-spectrum antibiotics prescription rates remain the highest.

1441. Significant Decrease in the Incidence Rate of Common Outpatient Upper Respiratory Tract Infection Diagnoses per Clinic Visit in the First Respiratory Season of October 2020 to March 2021 During the Covid-19 Pandemic. A Report From an Outpatient Antimicrobial Stewardship Program at a community hospital in Brooklyn

BackgroundAs part of our outpatient Antimicrobial Stewardship Program, we do surveillance of diagnoses and antibiotic use for common upper respiratory tract infections such as acute upper respiratory tract infection, acute bronchitis, sinusitis, and pharyngitis. We sought to evaluate the impact of the Covid-19 pandemic on the incidence rate of upper respiratory tract infection diagnoses per clinic visit during October 2020 to March 2021 season compared to the three prior respiratory seasons. We also sought to reflect of impact of increase in televisits and overlapping symptoms of COVID 19 and upper respiratory tract infections.MethodsOur cohort study extending from October 2017 to March 2021. We collected number of diagnoses of upper respiratory infections and number of unique clinic visits during four consecutive respiratory seasons at our primary care sites via electronic health records.ResultsDuring the recent October 2020 to March 2021 respiratory season which coincided with the second NYC Covid-19 wave, we had 11569 unique clinic visits and 39 diagnoses of an upper respiratory tract infection - incident rate of 1.29. In the three prior respiratory seasons combined, we had 40939 unique clinic visits and 833 diagnoses of an upper respiratory tract infection – incident rate of 1.49. The incident rates showed a dramatic decline using the test based method and the chi square-statistic p< 0.0001 with an incident rate ratio using a poisson exact method of 6.0359. Statistical comparisons of the current season to each prior individual season yielded similar results. The percentage of Tele-visits during the current season was 19% compared to 0% in the 3 prior seasons.ConclusionDuring the first respiratory season from October 2020 to March 2021 in midst of the Covid-19 pandemic which also coincided with the second Covid-19 wave in New York, we saw a statistically significant decrease in incidence of common upper respiratory tract infection diagnoses per clinic visit compared to the three prior respiratory seasons. Overlapping signs and symptoms of upper respiratory tract infections and Covid-19 with the added percentage in Tele-visits did not cause an increase in incidence rates of upper respiratory tract infection diagnoses. Covid-19 related mitigation efforts may have played a role.Disclosures All Authors: No reported disclosures

Viral Upper Respiratory Infection

The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx, and is susceptible to a variety of pathogens including many viruses. Although other pathogens can also cause infections of the upper respiratory tract, we are focusing on viral illnesses for the purposes of this review. Upper respiratory tract infections (URIs) include sinusitis, nasopharyngitis (common cold), pharyngitis, epiglottitis, and tracheitis. URI’s are one of the most frequent causes for visits to see a physician in the United States. Despite the fact that many URIs are caused by viral pathogens, more than half of patients in both the clinic and the emergency department setting with a diagnosis of URI received antibiotics. URIs are generally mild, and self-limited illnesses; however, it is important to recognize clinical entities that may be severe and warrant more extensive diagnostic workup and treatment such as epiglottitis and tracheitis. This review covers the pathophysiology, diagnosis, treatment, disposition and outcome for multiple viral URIs seen commonly in the emergency department setting. This review contains 3 figures, 8 tables, and 87 references. Key words: Common cold, epiglottitis, nasopharyngitis, pharyngitis, sinusitis, tracheitis, upper respiratory tract infection

Viral Upper Respiratory Infection

The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx, and is susceptible to a variety of pathogens including many viruses. Although other pathogens can also cause infections of the upper respiratory tract, we are focusing on viral illnesses for the purposes of this review. Upper respiratory tract infections (URIs) include sinusitis, nasopharyngitis (common cold), pharyngitis, epiglottitis, and tracheitis. URI’s are one of the most frequent causes for visits to see a physician in the United States. Despite the fact that many URIs are caused by viral pathogens, more than half of patients in both the clinic and the emergency department setting with a diagnosis of URI received antibiotics. URIs are generally mild, and self-limited illnesses; however, it is important to recognize clinical entities that may be severe and warrant more extensive diagnostic workup and treatment such as epiglottitis and tracheitis. This review covers the pathophysiology, diagnosis, treatment, disposition and outcome for multiple viral URIs seen commonly in the emergency department setting. This review contains 3 figures, 8 tables, and 87 references. Key words: Common cold, epiglottitis, nasopharyngitis, pharyngitis, sinusitis, tracheitis, upper respiratory tract infection

2150. Detection and Characterization of Viral and Bacterial Pathogens in Tonsillar Tissues of Children Undergoing Tonsillectomy

BackgroundThe diagnosis of upper respiratory infections is commonly made using nucleic acid amplification technologies for viruses and bacteria. The impact of latency and colonization are not often appreciated. We aimed to detect viruses and bacteria present in tonsil and adenoid tissues from children during the absence of acute infection symptoms.MethodsRemnant tonsil and adenoid tissues were obtained from children undergoing tonsillectomy procedures. Nucleic acids of viruses and bacteria were detected using laboratory developed PCRs targeting Epstein–Barr virus (EBV), Adenoviruses (AdV), human herpes virus 6 (HHV6), human enteroviruses (HEV), Group A streptococcus (GAS), Kingella kingae (KKN), Staphylococcus aureus (SA), Streptococcus pneumoniae (SPN), Arcanobacterium haemolyticus (AHE), Fusobacterium necrophorum (FNE), Mycobacterium pneumoniae (MPN) and Neisseria meningitidis (NM). The genogroup of AdV and the type of HHV6 were determined as well. Demographics, clinical presentation and detection rates of these viruses and bacteria were analyzed.ResultsDuring the study period (April 2018 and March 2019), 239 samples were collected from patients <18 years with an average age of 5.1 years. More male subjects than female subjects were included (57.7% vs. 42.3%). Most of the patients underwent tonsillectomy due to adenotonsillar hypertrophy (93.3%). Thirty (12.5%) also had a history of tonsillitis, 224 (93.7%) sleep apnea, 36 (15.1%) otitis media, 35 (14.6%) Eustachian tube dysfunction and 46 (19.2%) had other conditions. The detection of the pathogens among each age group is presented in Table 1. The seasonal distributions of virus positivity are shown in Figure 1.ConclusionThe detection rates of each virus and bacterium in the tonsillar tissues from children absent of acute infection symptoms vary in each age group and fluctuate among seasons. In the molecular era when syndromic real-time multiplex PCR kits can provide sensitive and rapid results for a wide range of pathogens, it is important to understand the meaning of detection and differentiate between an infection and colonization or latency. Disclosures All authors: No reported disclosures.

Role of rapid diagnostics for viral respiratory infections in antibiotic prescribing decision in the emergency department.

To describe the frequency of antibiotic prescriptions in patients with known viral respiratory infections (VRIs) diagnosed by polymerase chain reaction (PCR) in 3 emergency departments (EDs) and to identify patient characteristics that influence the prescribing of antibiotics by ED physicians despite PCR confirmation of viral cause. Retrospective, observational analysis of patients with PCR-diagnosed VRI discharged from 3 acute-care hospital EDs within 1 health system. In total, 323 patients were discharged from the ED with a VRI diagnosis, of whom 68 were prescribed antibiotics (21.1%). These patients were older (median, 59.5 vs 43 years; P = .04), experienced symptoms longer (median, 4 vs 2 days; P = .002), were more likely to have received antibiotics in the preceding 7 days (27.9% vs 9.8%; P &lt; .001), and had higher proportions of abnormal chest X-rays (64.5% vs 28.4%; P &lt; .001). Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P &lt; .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P &lt; .001). Despite a diagnosis of VRI, one-fifth of ED patients were prescribed antibiotics. Patient characteristics including age, duration of symptoms, abnormal chest X-rays, and specific diagnosis may increase provider concern for concurrent bacterial infections. Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED.

The inappropriate use of antibiotics in hospitalized dengue virus-infected children with presumed concurrent bacterial infection in teaching and private hospitals in Bandung, Indonesia.

BackgroundDengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics.MethodsA retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients’ medical records admitted from January 1 to December 31, 2015.ResultsThere were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (p<0.0001 and p<0.05 respectively). The diagnosis of URTI in both teaching and private hospitals was merely based on clinical findings. Amoxicillin was given to 1 patient in the teaching hospitals; the 3rd generation of cephalosporins, mostly intravenous, were given in 247 (67%) cases in private hospitals. The diagnosis of typhoid fever in the teaching hospitals was based on culture in 1 (16.7%) and reactive IgM anti-Salmonella in 5 (83.3%) cases while in the private hospitals, they were based on reactive IgM anti-Salmonella in 13 (6.5%) cases, single Widal test in 61 (32.5%), and without laboratory confirmation in 114 (60.6%) cases. Most of the cases in both hospital settings were treated mostly with 3rd generation cephalosporin. The diagnosis of UTI was based on positive leucocyte esterase and nitrite in urine dipstick test in 7 (38.9%) and leucocyturia alone in 11 (61.1%) cases and was treated with 3rd generation in 15 (83.3%) cases, amoxicillin, chloramphenicol and clarithromycin, each in 1 (5.6%) case.ConclusionThe use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics.

Decreasing Low Acuity Pediatric Emergency Room Visits with Increased Clinic Access and Improved Parent Education.

The goal of this study was to decrease avoidable, low-acuity emergency department (ED) use among pediatric patients at Coastal Family Medicine. The rationale behind this focus was to improve continuity for our patients while decreasing the cost burden for low-acuity ED visits. The family medicine residency clinic pediatric panel has grown by 35% over the past 3 years, bringing this issue of same-day acute access in our clinic to the forefront. A survey was created to better understand the needs of our high users of the ED. The survey identified that patients believed the ED provided better same-day access than our clinic during the daytime hours, 8 am-5 pm, Monday-Friday. By using this data, along with a literature review and a community practice review, a business-hour walk-in clinic for ages 0 years to 18 years was started to improve access. Clinic posters, revised scripting for office staff, phone room staff, and our after-hour triage line as well as bookmarks advertising the walk-in clinic given during well-child checks were created to address parent education. Pediatric ED data generated through our electronic medical record as well as through Medicaid reimbursement data framed the scope of this issue as significant. This was used to monitor pediatric ED visits following interventions as well. Over the initial 3 months of interventions, pediatric ED use decreased by 62 visits compared with the prior year. The low-acuity diagnoses of upper respiratory infections decreased by 43.7% (71 to 40 visits) and fever decreased by 50.0% (14 to 7 visits) from the same 3 months the year prior. This decrease was sustained when examined during year 3. Over the next 12 months, there were 284 (29.8%) less visits to the ED with low-acuity diagnoses. This calculates to approximately $300,000 saved to the Medicaid system. During this time frame, our pediatric panel increased by 200 patients. Increasing access and improving patient education decreased low-acuity pediatric ED visits in our clinic. This combination of interventions worked well in our community and has been shown to help optimize the setting in which pediatric patients are seen.

Clinical characteristics of acute drug-induced dystonia in pediatric patients.

ObjectiveDystonia is a movement disorder in which muscles contract uncontrollably. Acute drug-induced dystonia (DID) can be diagnosed through detailed history taking and physical examination. This study aimed to identify the clinical characteristics of DID in children, which could help emergency physicians diagnose these conditions more efficiently.MethodsWe reviewed medical records of children aged below 18 years diagnosed with drug-related dystonia after discharge from the emergency department over 10 years. We collected the patients’ age, sex, suspected causative drugs, initial diagnosis of the prescribing physician, duration of drug-taking, diagnostic evaluations, treatment methods, and prognosis.ResultsSeventy-nine patients were enrolled. The mean age was 11.3±4.9 years (range, 4.0 months to 18.0 years), and 41 patients (51.9%) were boys. The most common cause of DID was gastrointestinal medications in 45 patients (57.0%), followed by antipsychotics in 23 patients (29.1%). Eleven (24.4%) out of 45 patients with DID due to gastrointestinal medications had the initial diagnosis of upper respiratory infection, and seven (30.4%) out of 23 patients with DID due to antipsychotics had the initial diagnosis of non-psychotic diseases. Younger children received more diagnostic procedures and were more frequently admitted. A benzodiazepine (67.1%) was the most common single drug for treatment.ConclusionPhysicians should not only acknowledge DID in order to reduce unnecessary workup and admission, but also know that antiemetics and antipsychotics are common causes of DID. Therefore, physicians should try to avoid multidrug prescriptions in children.

Evaluation of individual and area-level factors as modifiers of the association between warm-season temperature and pediatric asthma morbidity in Atlanta, GA

IntroductionPrevious studies have found associations between respiratory morbidity and high temperatures; however, few studies have explored associations in potentially sensitive sub-populations. MethodsWe evaluated individual and area-level factors as modifiers of the association between warm-season (May-Sept.) temperature and pediatric respiratory morbidity in Atlanta. Emergency department (ED) visit data were obtained for children, 5–18 years old, with primary diagnoses of asthma or respiratory disease (diagnoses of upper respiratory infections, bronchiolitis, pneumonia, chronic obstructive pulmonary disease, asthma, or wheeze) in 20-county Atlanta during 1993–2012. Daily maximum temperature (Tmax) was acquired from the automated surface observing station at Atlanta Hartsfield International Airport. Poisson generalized linear models were used to estimate rate ratios (RR) between daily Tmax and asthma or respiratory disease ED visits, controlling for time and meteorology. Tmax effects were estimated for single-day lags of 0–6 days, for 3-, 5-, and 7-day moving averages and modeled with cubic terms to allow for non-linear relationships. Effect modification by individual factors (sex, race, insurance status) and area-level socioeconomic status (SES; ZIP code levels of poverty, education, and the neighborhood deprivation index) was examined via stratification. ResultsEstimated RRs for Tmax and pediatric asthma ED visits were positive and significant for lag days 1–5, with the strongest single day association observed on lag day 2 (RR=1.06, 95% CI: 1.03, 1.09) for a change in Tmax from 27°C to 32°C (25th to 75th percentile). For the moving average exposure periods, associations increased as moving average periods increased. We observed stronger RRs between Tmax and asthma among males compared to females, non-white children compared to white children, children with private insurance compared to children with Medicaid, and among children living in high compared to low SES areas. Associations between Tmax and respiratory disease ED visits were weak and non-significant (p-value>0.05). ConclusionsResults suggest socio-demographic factors (race/ethnicity, insurance status, and area-level SES) may confer vulnerability to temperature-related pediatric asthma morbidity. Our findings of weaker associations among children with Medicaid compared to other health insurance types and among children living in low compared to high SES areas run counter to our belief that children from disadvantaged households or ZIP codes would be more vulnerable to the respiratory effects of temperature. The potential reasons for these unexpected results are explored in the discussion.

Docosahexaenoic Acid Alleviates Atopic Dermatitis in Mice by Generating T Regulatory Cells and M2 Macrophages

Han et al. (this issue) describe a novel mechanism by which docosahexaenoic acid (DHA) may suppress atopic dermatitis symptoms in mice. They find that DHA induces FoxP3 T regulatory cells in vivo, M2 macrophages drive transforming growth factor-β and IL-10 conversion of CD4 T cells to CD4 FoxP3 T regulatory cells in vitro, and DHA-treated M2 macrophages suppress atopic dermatitis in mice.

Antibiotic Prescriptions for Upper Respiratory Infection in the Emergency Department: A Population-Based Study

Study Objective. Antibiotics prescriptions for upper respiratory infections (URI) are not uncommon, but the benefits for these groups had seldom been evaluated. We aimed to utilize a sampled National Health Insurance (NHI) claims data containing one million beneficiaries to explore if the use of antibiotics could reduce the possibility of unscheduled returns. Methods. We identified patients presented to ambulatory clinics with the discharged diagnoses of URI. The prescriptions of antibiotics were identified. We further matched each patient in the antibiotic group to the patient in the control group by selected covariates using a standard propensity score greedy-matching algorithm. The risks of unscheduled revisits were compared between the two groups. Results. A total of 6915140 visits were identified between 2005 and 2010. The proportions of antibiotics prescriptions are similar among these years, ranging from 9.99% to 13.38 %. In the propensity score assignment, 9190 patients (4595 in each group) were further selected. The odds ratio of unscheduled revisits among antibiotics group and control group was 0.92 (95% CI, 0.70–1.22) with P value equal to 0.569. Conclusions. Overall, antibiotics prescriptions did not seem to decrease the unscheduled revisits in patients presented to the ED with URI. Emergency physicians should reduce the unnecessary prescriptions and save antibiotics to patients with real benefits.

Differences Between the Spectra of Respiratory Illnesses in Children Living in Urban and Rural Environments

A longitudinal study launched in 1994 within the framework of the Teplice Programme aimed at comparing the respiratory morbidity in children born (1994-1998) and living in the districts of Teplice (TE) and Prachatice (PRA) in the Czech Republic. Lists of all illnesses of 960 children from birth to 10 years of age were obtained from paediatric medical records. From 26,471 diagnoses (in ICD-10 codes), 34.7% were diagnoses of upper respiratory infections (URI, J00-02, J06), 11.3% of tonsillitis, 10.2% of influenza, 9.4% of bronchitis, 8.9% of laryngitis/tracheitis (J04), 2.7% of otitis media, and 0.5% of pneumonia. The more polluted district of Teplice was divided into two parts: the town itself (TE-town) and the rest of the district (TE-district). The cumulative incidence rates of the above respiratory illnesses per 100 children per 10 years were 2,212 in TE-town, 2,192 in PRA and 1,985 in TE-district. In the first two years of life, the children from TE-town had a significantly higher incidence of laryngitis/tracheitis, influenza, otitis media, and pneumonia and significantly lower incidence of bronchitis and tonsillitis than children living in PRA. The incidence rates of laryngitis/tracheitis and influenza in TE-town persisted as the highest among the three regions till the age of 10 years. The incidence rates of bronchitis (from the 1st to 5th year) and URI (from 4th to 10th year) were highest in children living in PRA. When compared to TE-town, children in TE-district had a higher incidence of upper respiratory infections (1-8 years) and lower incidence of bronchitis (6-8 years). Children in the district of Prachatice had a significantly higher prevalence of allergic rhinitis and a lower prevalence of wheezing than children in the district of Teplice. Thus, the three regions differed by the spectra of respiratory illnesses rather than by overall morbidity and, hypothetically, the effects of air pollution were obscurred by differences in the degree of urbanization.

Signs and Symptoms That Differentiate Acute Sinusitis From Viral Upper Respiratory Tract Infection

Differentiating acute bacterial sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with acute sinusitis based on clinical criteria likely have an uncomplicated URI. The objective of this study was to determine which signs and symptoms could be used to identify the subgroup of children who meet current clinical criteria for sinusitis but who nevertheless have a viral URI. We obtained sinus radiographs in consecutive children meeting a priori clinical criteria for acute sinusitis. We considered the subgroup of children with completely normal sinus radiographs to have an uncomplicated URI despite meeting the clinical diagnostic criteria for sinusitis. We examined the utility of signs and symptoms in identifying children with URI. Of 258 children enrolled, 54 (20.9%) children had completely normal radiographs. The absence of green nasal discharge, the absence of disturbed sleep and mild symptoms were associated with a diagnosis of URI. No physical exam findings were particularly helpful in distinguishing between children with normal versus abnormal radiographs. Among children meeting current criteria for the diagnosis of acute sinusitis, those with mild symptoms are significantly more likely to have a URI than those with severe symptoms. In addition to assessing overall severity of symptoms, practitioners should ask about sleep disturbance and green nasal discharge when assessing children with suspected sinusitis; their absence favors a diagnosis of URI.

Comparison of procalcitonin, CRP, ESR and Leukocytes as severity and prognostic biomarkers in respiratory tract infections in the very elderly

Objective.– To determine the value of procalcitonin (PCT) as a prognostic biomarker in elderly patients with respiratory infection comparing it with Curb-65 and acute phase reactants: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)and leukocytes. Methods.– Prospective observational study in elderly patients admitted to an Acute Geriatric Unit with the diagnosis of upper respiratory infection or pneumonia. We collected sociodemographic variables, clinical and geriatric assessment. Samples were taken to determine PCT, CRP and ESR at admission and 72hours after. Results.– We included 50 patients, 30 with pneumonia and 20 with respiratory infection, with an average age of 86 years, significant comorbidity (Charlson Index≥3 in more than 50%), cognitive impairment (70%) and poor functional status (Katz≥D 56%). Mortality during admission was high (37% in pneumonia and 25% in upper respiratory infection). At admission 60% of patients have elevated PCT (≥0.25ng/mL), 100% PCR, 84% ESR and 36% leukocytes. In all patients the PCT difference between admission and 72hours was marginal (P=0.059); in patients with respiratory infection decreased significantly at 72hours (P=0.046),while there wasnovariation inpatientswithpneumonia. Theother acutephase reactants, except leukocytes (P≤0.05) showedno significant differences during the first 72hours. Conclusions.– In elderly patients with suspected upper respiratory infection, decreased procalcitonin levels at 72hours indicates a good prognosis. In those with pneumonia study these evolutionary parameters at 72hours show no change, so control should be delayed.

Review of bacteraemia in elderly patients in a District General Hospital in the United Kingdom

Objective.– To determine the value of procalcitonin (PCT) as a prognostic biomarker in elderly patients with respiratory infection comparing it with Curb-65 and acute phase reactants: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)and leukocytes. Methods.– Prospective observational study in elderly patients admitted to an Acute Geriatric Unit with the diagnosis of upper respiratory infection or pneumonia. We collected sociodemographic variables, clinical and geriatric assessment. Samples were taken to determine PCT, CRP and ESR at admission and 72hours after. Results.– We included 50 patients, 30 with pneumonia and 20 with respiratory infection, with an average age of 86 years, significant comorbidity (Charlson Index≥3 in more than 50%), cognitive impairment (70%) and poor functional status (Katz≥D 56%). Mortality during admission was high (37% in pneumonia and 25% in upper respiratory infection). At admission 60% of patients have elevated PCT (≥0.25ng/mL), 100% PCR, 84% ESR and 36% leukocytes. In all patients the PCT difference between admission and 72hours was marginal (P=0.059); in patients with respiratory infection decreased significantly at 72hours (P=0.046),while there wasnovariation inpatientswithpneumonia. Theother acutephase reactants, except leukocytes (P≤0.05) showedno significant differences during the first 72hours. Conclusions.– In elderly patients with suspected upper respiratory infection, decreased procalcitonin levels at 72hours indicates a good prognosis. In those with pneumonia study these evolutionary parameters at 72hours show no change, so control should be delayed.

The Impact of Early Nutrition on Incidence of Allergic Manifestations and Common Respiratory Illnesses in Children

To investigate the incidence of allergic and respiratory diseases through age 3 years in children fed docosahexaenoic acid (DHA)- and arachidonic acid (ARA)-supplemented formula during infancy. Children who completed randomized, double-blind studies of DHA/ARA-supplemented (0.32%-0.36%/0.64%-0.72% of total fatty acids, respectively) versus nonsupplemented (control) formulas, fed during the first year of life, were eligible. Blinded study nurses reviewed medical charts for upper respiratory infection (URI), wheezing, asthma, bronchiolitis, bronchitis, allergic rhinitis, allergic conjunctivitis, otitis media, sinusitis, atopic dermatitis (AD), and urticaria. From the 2 original cohorts, 89/179 children participated; 38/89 were fed DHA/ARA formula. The DHA/ARA group had significantly lower odds for developing URI (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.08-0.58), wheezing/asthma (OR, 0.32; 95% CI, 0.11-0.97), wheezing/asthma/AD (OR, 0.25; 95% CI, 0.09-0.67), or any allergy (OR, 0.28; 95% CI, 0.10-0.72). The control group had significantly shorter time to first diagnosis of URI (P = .006), wheezing/asthma (P = .03), or any allergy (P = .006). DHA/ARA supplementation was associated with delayed onset and reduced incidence of URIs and common allergic diseases up to 3 years of age.