Episodes Of Upper Respiratory Tract Infection Research Articles

Xylitol for the prevention of acute otitis media episodes in children aged 1–5 years: a randomised controlled trial

ObjectiveTo investigate the regular use of xylitol, compared with sorbitol, to prevent acute otitis media (AOM), upper respiratory tract infections (URTIs) and dental caries.DesignBlinded randomised controlled trial with a 6-month...

The Efficacy of Palmitoylethanolamide (Levagen+) on the Incidence and Symptoms of Upper Respiratory Tract Infection-A Double Blind, Randomised, Placebo-Controlled Trial.

Upper respiratory tract infections (URTIs) are caused by bacteria or viruses, with the most common causes being the common cold and influenza. The high occurrence of URTI means therapies that are effective with minimal side effects are in constant demand. Palmitoylethanolamide (PEA) is a signaling lipid previously shown to be effective in improving the incidence of URTIs. The aim of this study was to assess the effectiveness of PEA (Levagen+) on URTI incidence, duration, and severity. Participants (n = 426) consumed either 300 mg of Levagen+ or a placebo (maltodextrin) twice daily for 12 weeks. Participants completed the Wisconsin Upper Respiratory Symptom Survey 24 questionnaire daily upon the commencement of symptoms until symptoms subsided. The Levagen+ group reported fewer URTI episodes (39 vs. 64) compared to the placebo group. The Levagen+ group reported a significant reduction in the median severity score of URTI symptoms for scratchy throat (3 vs. 7) and cough (2 vs. 7) compared to the placebo group. The results of this study show Levagen+ to be safe and effective in reducing the incidence and symptoms associated with URTIs.

Environmental factors related to differences in the microbiota in the upper respiratory tract in young children: Focusing on the impact of early nursery attendance.

Microbial colonization of the upper respiratory tract (URT) during the first years of life differs significantly according to environmental factors. We investigated the association between early nursery attendance, URT infection (URTI) and drugs used for its treatment and the differences in the URT microbiota. This prospective study included 33 young children (11 and 22 with and without nursery attendance during their infancy, respectively). URT secretions were collected from the nasopharynx of these children at 2, 4, 6, 12, 18 and 24 months old. Clinical information after the latest sampling, including histories of URTI and the uses of antibiotics or cold medicines, was collected from all children. URT bacteria were identified by a clone library analysis of the 16S rRNA gene. In the diversity of URT microbiota using the Shannon index, we did not detect any associations between variations in the URT microbiota and environmental factors (nursery attendance, development of URTIs, or the uses of antibiotics or cold medicines). However, in a clustering analysis, the proportion of the samples classified as Corynebacterium propinquum-dominant cluster was significantly lower in children ≥6 months old with nursery attendance than in those without nursery attendance. In addition, the URT microbiota was significantly different between samples from children ≥6 months old with and without a history of ≥3 URTI episodes after the first sampling. Furthermore, the URT microbiota was also significantly different between samples from these children with and without antibiotic use between the previous and present samplings. Early nursery attendance and its related factors, including the frequency of URTI and antibiotic treatment, may be associated with the differences in the URT flora in young children.

Probiotics for preventing acute upper respiratory tract infections.

Probiotics are live micro-organisms that may give a beneficial physiological effect when administered in adequate amounts. Some trials show that probiotic strains can prevent respiratory infections. Even though our previously published review showed the benefits of probiotics for acute upper respiratory tract infections (URTIs), several new studies have been published. This is an update of a review first published in 2011 and updated in 2015. To assess the effectiveness and safety of probiotics (any specified strain or dose), compared with placebo or no treatment, in the prevention of acute URTIs in people of all ages, at risk of acute URTIs. We searched CENTRAL (2022, Issue 6), MEDLINE (1950 to May week 2, 2022), Embase (1974 to 10 May 2022), Web of Science (1900 to 10 May 2022), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to 10 May 2022), the Chinese Medicine Popular Science Literature Database (from 2000 to 10 May 2022), and the Master's Degree Dissertation of Beijing Union Medical College Database (from 1981 to 10 May 2022). We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for completed and ongoing trials on 10 May 2022. We included individual randomised controlled trials (RCTs) and cluster-RCTs comparing probiotics with placebo or no treatment to prevent acute URTIs. The participants were children, adults, or the elderly in the community, care facilities, schools, or hospitals. Our main outcomes were the number of participants diagnosed with URTIs (at least one event and at least three events), the incidence rate (number of cases/person year) of acute URTIs, and the mean duration of an episode of URTIs. Our secondary outcomes were the number of participants who were absent from childcare centre, school, or work due to acute URTIs; the number of participants who used prescribed antibiotics for acute URTIs; and the number of participants who experienced at least one adverse event from probiotics. We excluded studies if they did not specify acute respiratory infections as 'upper'; studies with more than 50% of participants vaccinated against influenza or other acute URTIs within the last 12 months; and studies with significantly different proportions of vaccinated participants between the probiotics arm and the placebo or no treatment arm. Two review authors independently assessed the eligibility of trials and extracted data using standard Cochrane methodological procedures. We analysed both intention-to-treat and per-protocol data and used a random-effects model. We expressed results as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, both with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. We included 23 individual RCTs and one cluster-RCT. As one of the individual RCTs did not report outcomes in a usable way, we could only meta-analyse data from 23 trials, involving a total of 6950 participants including children (aged from one month to 11 years old), adults (mean age 37.3), and older people (mean age 84.6 years). One trial reported 22.5% flu-vaccine participants within the last 12 months, and 25.4% flu-vaccine participants during the intervention. Probiotics were more likely to be given with milk-based food in children; administered in powder form in adults; and given with milk-based food or in capsules in the elderly. Most of the studies used one or two strains (e.g. Lactobacillus plantarum HEAL9, Lactobacillus paracasei (8700:2 or N1115)) and 109 or 1011 colony-forming units (CFU)/day of probiotics for more than three months. We found that probiotics may reduce the number of participants diagnosed with URTIs (at least one event) (RR 0.76, 95% CI 0.67 to 0.87; P < 0.001; 16 studies, 4798 participants; low-certainty evidence); likely reduce the number of participants diagnosed with URTIs (at least three events) (RR 0.59, 95% CI 0.38 to 0.91; P = 0.02; 4 studies, 763 participants; moderate-certainty evidence); may reduce the incidence rate (number of cases/person year) of URTIs (rate ratio 0.82, 95% CI 0.73 to 0.92, P = 0.001; 12 studies, 4364 participants; low-certainty evidence); may reduce the mean duration of an episode of acute URTIs (MD -1.22 days, 95% CI -2.12 to -0.33; P = 0.007; 6 studies, 2406 participants; low-certainty evidence); likely reduce the number of participants who used prescribed antibiotics for acute URTIs (RR 0.58, 95% CI 0.42 to 0.81; P = 0.001; 6 studies, 1548 participants; moderate-certainty evidence); and may not increase the number of participants who experienced at least one adverse event (RR 1.02, 95% CI 0.90 to 1.15; P = 0.79; 8 studies, 2456 participants; low-certainty evidence). Evidence showing a decrease in the number of people absent from childcare centre, school, or work due to acute URTIs with probiotics is very uncertain (RR 0.14, 95% CI 0.03 to 0.59; 1 study, 80 participants; very low-certainty evidence). Adverse events from probiotics were minor, and most commonly gastrointestinal symptoms, such as vomiting, flatulence, diarrhoea, and bowel pain. AUTHORS' CONCLUSIONS: Overall, we found that probiotics were better than placebo or no treatment in preventing acute URTIs.

After-hours consultations and antibiotic prescribing for self-limiting upper respiratory tract infections in primary-care practices.

To determine the association between after-hours consultations and the likelihood of antibiotic prescribing for self-limiting upper respiratory tract infections (URTIs) in primary care practices. A cross-sectional analysis using Australian national primary-care practice data (MedicineInsight) between February 1, 2016 and January 31, 2019. Nationwide primary-care practices across Australia. Adult and pediatric patients who visited primary care practices for first-time URTIs. We estimated the proportion of first-time URTI episodes for which antibiotic prescribing occurred on the same day (immediate prescribing) using diagnoses and prescription records in the electronic primary-care database. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the likelihood of antibiotic prescribing by the time of primary care visits were calculated using generalized estimating equations. Among 357,287 URTI episodes, antibiotics were prescribed in 172,605 episodes (48.3%). After adjusting for patients' demographics, practice characteristics, and seasons, we detected a higher likelihood of antibiotic prescribing on weekends compared to weekdays (OR, 1.42; 95% CI, 1.39-1.45) and on national public holidays compared to nonholidays (OR, 1.23; 95% CI, 1.17-1.29). When we controlled for patient presentation and diagnosis, the association between antibiotic prescribing and after-hours consultations remained significant: weekend versus weekdays (OR, 1.37; 95% CI, 1.33-1.41) and holidays versus nonholidays (OR, 1.10; 95% CI, 1.03-1.18). Primary-care consultations on weekends and public holidays were associated with a higher likelihood of immediate antibiotic prescribing for self-limiting URTIs in primary care. This finding might be attributed to lower resourcing in after-hours health care.

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.

Factors influencing surgeon decision-making by measuring waiting time for pediatric ventilation tube insertions.

The surgeon and physician's decision-making may be influenced by many factors. The clinical practice guideline suggested that watchful waiting for 3 months should be the initial management for pediatric otitis media with effusion. The waiting time of ventilation tube insertion for pediatric patients is a proper measurement for physician decision-making. This study investigated factors influencing the waiting time for pediatric ventilation tube insertion and to explore factors influencing physician decision-making. Information associated with all patients under 18 years of age who received ventilation tube insertions from July 1, 2000 to December 31, 2009 were retrieved and analyzed from a nationwide, population-based administrative database. The waiting time before ventilation tube insertions from the time of diagnosis of otitis media with effusion was recorded. Certain factors that would influence the waiting time were identified. At the same time, how these factors influenced clinical decision-making were also identified. The waiting time decreased as patient age increased (p < 0.001), and increased as the recent frequency of upper respiratory tract infection diagnosis increased (p < 0.001). Patients who received simultaneously bilateral ventilation tube insertions had shorter waiting time than those who had unilateral surgery (p < 0.01) and patients who had undergone ventilation tube insertions in a tertiary referral center generally had longer waiting times (p < 0.001). The waiting time of ventilation tube insertions for pediatric otitis media with effusion can be influenced by many factors. Patients with older age and undergone simultaneously bilateral ventilation tube insertion had shorter waiting time. Patients who had more upper respiratory tract infection episodes and who received ventilation tube insertions in a tertiary referral center setting were subject to longer waiting times.

Lacticaseibacillus rhamnosus GG DSM 33156 effects on pathogen defence in the upper respiratory tract: a randomised, double-blind, placebo-controlled paediatric trial.

Acute upper respiratory tract infections (URTIs) are caused by numerous viruses and bacteria. URTIs can be a cause of morbidity and are among the most common reasons for visiting healthcare practitioners and prescribing antibiotics to children in addition to causing absenteeism from school and work. Oral intake of Lacticaseibacillus rhamnosus GG DSM 33156 has shown beneficial health effects in several clinical trials, primarily relating to immune function and gastrointestinal health in children and adults. It has also been suggested that oral intake of L. rhamnosus GG DSM 33156 can reduce the incidence rate and alleviate symptoms of URTIs in children. We here report the results of a randomised, double-blind, placebo-controlled trial of 619 children aged 2-6 years conducted at a single centre in Scotland. The children, who were in day care or primary school, were followed over a 16-week intervention period with 309 randomised in the active group and 310 in the placebo group. The parents or guardians reported a daily healthcare status and any presumed episodes of URTI, which were subsequently confirmed by a general practitioner. The investigational product was well tolerated in the trial. Although a general trend towards a beneficial effect was observed, this trial did not demonstrate that L. rhamnosus GG DSM 33156 significantly reduced the incidence of URTIs, diagnosed by a general practitioner according to prespecified criteria (primary endpoint). Moreover, none of the secondary efficacy endpoints were met. Applying a Ward's hierarchical clustering, two separate clusters, focussing on four quality of life-related endpoints, were identified. Cluster 1 was associated with more severe URTI characteristics than cluster 2. Cluster 2 was significantly enriched with children who consumed the product, indicating that the symptoms children experience during an URTI are alleviated by the intake of L. rhamnosus GG DSM 33156. The study is registered at ClinicalTrials.gov ID: NCT03636191.

Prevalence and risk factors for Subclinical Rheumatic Heart Disease among primary school children in Dar es Salaam, Tanzania: a community based cross-sectional study

BackgroundRheumatic heart disease (RHD) is the most common acquired heart disease occurring in children and adolescents. RHD is associated with significant morbidity and mortality particularly in low and middle- income countries (LMICs) where the burden is estimated to be higher compared to high income countries. Subclinical RHD is the presence of valvular lesion diagnosed by echocardiography in a person with no clinical manifestation of RHD. This study aimed at determining the prevalence, types and factors associated with subclinical RHD among primary school children in Dar Es Salaam, Tanzania.MethodsA descriptive community-based cross-sectional study was conducted in primary school children from February to May 2019. A standardized structured questionnaire was used to collect demographic characteristics, history of upper respiratory tract infections (URTIs), anthropometric measurements, and chest auscultation findings. Moreover echocardiographic screening was done to all children recruited into the study. World Heart Federation echocardiographic classification was used to define the types and prevalence of subclinical RHD.ResultsA total of 949 primary school children were enrolled with females being predominant (57.1%). The prevalence of subclinical RHD was 34 per 1000. All the participants had mitral valve disease only whereby 17 had definite disease and 15 had a borderline disease. The associated factors for subclinical RHD were older age of more than 9 years (OR 10.8, 95% CI 1.4–82.2, P = 0.02) having three or more episodes of URTI in previous six months (OR 21, 95% CI 9.6–46, P = 0.00) and poor hygiene (OR 3, 95% CI 1.3–6.8, P = 0.009).ConclusionSubclinical RHD as detected by echocardiographic screening is prevalent in primary school children, uniformly affects the mitral valve, and is associated with potentially modifiable risk factors. Children with a history of more than three episodes of URTI in six months represents a high-risk population that should be targeted for RHD screening.

PROPHYLACTIC EFFECT OF A PROBIOTIC INTERVENTION IN CHILDREN PRONE TO ACUTE UPPER RESPIRATORY TRACT INFECTIONS: A RANDOMIZED CONTROLLED TRIAL

Relevance. Upper respiratory tract infections (URTIs) are common in children and often progress with secondary complications such as otitis media, bronchitis, or pneumonia, especially in children with recurrent URTIs. Probiotics displayed immunomodulatory effects in children and adults, supporting immune functions to prevent winter diseases or common colds.&#x0D; Objectives. We assessed the effectiveness of a 6-week prophylaxis with probiotics (Lactobacillus helveticus Rosell®-52, Bifidobacterium infantis Rosell®-33 and Bifidobacterium bifidum Rosell®-71) for preventing primary infections and/or secondary complications in URTI-prone children.&#x0D; Methods. URTI-prone children were randomly divided into the probiotics (3×109 CFU/day; 6 weeks) or control arm (no preventive intervention). The number of URTIs, duration and related complications were monitored for 6 months. Resistance index, number of medical visits, and antibiotics prescriptions were also recorded.&#x0D; Results. After 2 months, probiotics reduced the number of URTIs (-2.34±0.13 vs -0.24±0.14; P&lt;0.0001) and duration in (-1.13 ±0.18 vs -0.18±0.18 days; P=0.0011), and the number of secondary complications (-53% vs -5.8%; RR 0.5313 95% CI [0.3534, 0.7986] P= 0.0058). Probiotic lowered resistance index (P&lt;0.0001), number of medical consultations with specialized physicians (P=0.0033) and antibiotics prescriptions (P&lt;0.0001).&#x0D; Conclusions. Overall, a 6-week prophylaxis with combined probiotic (Lactobacillus helveticus Rosell®-52, Bifidobacterium infantis Rosell®-33 and Bifidobacterium bifidum Rosell®-71) in URTI-prone children exerted a significant and clinically important health benefit, decreasing the number and duration of URTI episodes and secondary complications and reducing the resistance index to a near-normal value. Furthermore, potential societal benefits of reducing health care use and inadequate antibiotic prescriptions in children favours the use of this probiotic product as a preventive strategy against URTIs and their consequences in frequently sick children.&#x0D; This trial was retrospectively registered on ClinicalTrials.gov (NCT04525040).

Vitamin D and upper respiratory tract infections in young active males exposed to cold environments.

Performing indoor and outdoor work in cold environments may result in various adverse effects on human health and may lead to increased risk of respiratory infection. The aim of this study was to determine the relation of vitamin D status to secretory immunoglobulin A concentration, leucocyte counts, cytokine concentrations and incidence of upper respiratory tract infection (URTI) episodes in young active men during an autumn-winter period. The effect of work in a cold microclimate was studied among 23 young active male ice hockey players during a 19-week study period. Blood and saliva samples were collected 7 times during the study period. Incidence of URTI was evaluated using WURSS 21. White blood cell, neutrophil, lymphocyte, monocyte, eosinophil and basophil counts, concentrations of 25(OH)D, C-reactive protein, cortisol, IL-1ra, IL-10, IL-1β and immunoglobulins A, M and G, were determined in the blood. Secretory immunoglobulin A, A1 and A2 and cortisol were analysed in saliva. Spearman's correlations were used to evaluate relationships between initial or final 25(OH)D concentration and URTI incidence, as well as the immune and endocrine markers. Differences in URTI episodes, immune and endocrine parameters between sufficient ( ≥20 ng·ml -1) and deficient (<20 ng ·ml -1) vitamin D status groups were compared with the Mann-Whitney test. There were no statistically significant correlations between mucosal and blood markers or URTI incidence and initial and final 25(OH)D concentrations. Immune, endocrine and URTI variables did not differ between deficient and sufficient vitamin D status groups. 25(OH)D concentration has no impact on mucosal and systemic immunity, nor on URTI episodes.

Oscillococcinum® for upper respiratory tract infections and exacerbations in COPD: an observational, prospective study (OXITUNIS).

BackgroundUpper respiratory tract infections (URTIs) are a major cause of exacerbations in patients with chronic obstructive pulmonary disease (COPD). We assessed the effectiveness of Oscillococcinum® in the protection from URTIs in patients with COPD who had been vaccinated against influenza infection over the 2018–2019 winter season.MethodsPatients (n=106; mean ± standard deviation age: 66.0 ± 10.3 years; 89.6% men) were randomized into two groups: group V received influenza vaccination only and group OV received influenza vaccination plus Oscillococcinum® (one oral dose per week from inclusion in the study until the end of follow-up, with a maximum of 6 months follow-up over the winter season). The primary endpoint was the incidence rate of URTIs (number of URTIs/1000 patient-treatment exposure days) during follow-up compared between the two groups.ResultsThere was no significant difference in any of the demographic characteristics, baseline COPD, or clinical data between the two treatment groups (OV and V). The URTI incidence rate was significantly higher in group V than in group OV (2.9 versus 1.2 episodes/1000 treatment days, difference OV–V = −1.7; p=0.0312). There was a significant delay in occurrence of an URTI episode in the OV group versus the V group (mean ± standard error: 48.7 ± 3.0 versus 67.0 ± 2.8 days, respectively; p=0.0158). Limitations to this study include its small population size and the self-recording by patients of the number and duration of URTIs and exacerbations.ConclusionOscillococcinum may decrease the incidence rate and delay the appearance of URTIs in patients with COPD.

Early Childhood Caries Experience Associated with Upper Respiratory Infection in US Children: Findings from a Retrospective Cohort Study.

Both Early Childhood Caries (ECC) and Upper Respiratory Infection (URI) are infectious diseases. The oral cavity is considered a potential reservoir of respiratory pathogens due to the anatomical proximity between the oral cavity and respiratory system, which implies a potential association between ECC and URI. Hence, this study aimed to evaluate the association between ECC experience and URI incidence in preschool children. This retrospective cohort study collected data via electronic health records. The exposure was ECC before 3 years of age. The dependent variable was the incidence of URI between 4-6 years of age. To analyze the factors associated with the time-to-event of URI, we used log-rank tests and Cox regression models to compare the survival of URI between the ECC and Caries-Free (CF) groups, adjusting factors including demographic-socioeconomic characteristics and medical conditions. To analyze factors associated with the number of URI episodes, we used negative binomial regression models adjusting for factors mentioned above. A total of 497 US preschool children were included, with 117 ECC and 380 CF children. More children with ECC (58.1%) developed URI than the CF group (47.6%) during the follow-up period (4-6 years of age) (p=0.04). The ECC children were at 1.6 times higher risk to develop URI than the CF children even after accounting for other URI risk factors (Hazard Ratio 1.57 (1.13, 2.10), p=0.007). Our study suggests a potential association between ECC and URI, with an inference that early life ECC experience could be used as a predictor for developing URI in preschool age. The causal relationship between ECC and URI incidence in young children needs to be investigated through future studies.

Effect of processed aloe vera gel on immunogenicity in inactivated quadrivalent influenza vaccine and upper respiratory tract infection in healthy adults: A randomized double-blind placebo-controlled trial

BackgroundAloe vera is a functional food with various pharmacological functions, including an immune-modulating effect. Until now, A. vera has never been studied as an adjuvant in influenza vaccine, and its effects on upper respiratory tract infection (URI) are unknown. PurposeThe objective of our study was to investigate the effect of processed A. vera gel (PAG) on immunogenicity of quadrivalent inactivated influenza vaccine and URI in healthy adults. Study designA randomized, double-blind, placebo-controlled clinical trial was performed. MethodsThis study was conducted in 100 healthy adults at a single center from September 2017 to May 2018. Subjects were randomly divided into a PAG group (n = 50) and a placebo group (n = 50). The enrolled subjects were instructed to ingest the study drug for 8 weeks. The participants received a single dose of quadrivalent inactivated influenza vaccine after taking the study drug for the first 4 weeks of the study. The primary endpoint was seroprotection rate against at least one viral strain at 4 weeks post-vaccination. Other outcomes were seroprotection rate at 24 weeks post-vaccination, seroconversion rate, geometric mean fold increase (GMFI) at 4 and 24 weeks post-vaccination, seroprotection rate ratio and geometric mean titer ratio (GMTR) at 4 weeks post-vaccination between PAG and placebo groups, and incidence, severity, and duration of URI. ResultsThe European Committee for proprietary medicinal products (CPMP) evaluation criteria were met at least one in the PAG and placebo groups for all strains. However, there was no significant difference in the seroprotection rate at 4 weeks post-vaccination against all strains in both PAG and placebo groups. Among secondary endpoints, the GMFI at 4 weeks post-vaccination for the A/H3N2 was significantly higher in the PAG than in placebo group. The GMTR as adjuvant effect was 1.382 (95% CI, 1.014-1.1883). Kaplan–Meier curve analysis showed a reduction in incidence of URI (p = 0.035), and a generalized estimating equation model identified a decrease in repeated URI events (odds ratio 0.57; 95% CI, 0.39-0.83; p = 0.003) in the PAG group. ConclusionsOral intake of PAG did not show a significant increase in seroprotection rate from an immunogenicity perspective. However, it reduced the number of URI episodes. A well-designed further study is needed on the effect of PAG's antibody response against A/H3N2 in the future.

Does Lactoplantibacillus plantarum DR7 Reduce Days of Upper Respiratory Tract Infections and Fever? A Post‐Hoc Analysis of a Randomized, Placebo‐Controlled Trial

Objectives and Hypothesis Upper respiratory tract infections (URTIs) are amongst most common causes of doctor visits, days of work leave and school leave. Lactoplantibacillus plantarum DR7 (KCTC 13909BP) is a probiotic strain previously shown to modulate the tryptophan-serotonin-kynurenine pathway in human hosts. Previous results indicated a positive effect of a 3-month intervention with L. plantarum DR7 (109cfu/day) on individual nasal, pharyngeal and flu-like symptoms in a randomized, double-blinded trial against placebo in 109 adult subjects. We hypothesized that this probiotic could achieve a significant reduction of patient-days of URTI and fever. Also, we wanted to assess whether clinical or demographic traits may influence this effect. Methods Study outcomes were total patient-days of URTI and patient-days of fever during the 3-month intervention. Patient-days of URTI were estimated from symptoms questionnaire using two alternative definitions: i) duration of the longest-lasting symptom, and ii) average duration of symptoms. Patient-days of fever were taken directly from the questionnaire. Pairwise correlations between study outcomes and clinical and demographic parameters (age, sex, body mass index, smoker status, urban vs rural living, income above or below national average, and URTI episodes in the 4 weeks prior to study enrolment) were assessed by Spearman test. Differences in patient-days between groups were assessed by Chi-square (unadjusted) or Mantel-Haenszel tests (adjusted). Significance thresholds were multiplicity-corrected by Bonferroni-Holm method. All procedures on study subjects had been approved by the Internal Review Board of Universiti Sains Malaysia and adhered to the Helsinki Declaration. Summary of Results Of all clinical and demographic parameters analyzed, only recent URTI significantly correlated to study outcomes once corrected for multiplicity (rho=0.27-0.30, all p≤0.005). Compared to subjects without recent URTI (n=71), those with recent URTI (n=38) had increased patient-days of URTI (both definitions) and patient-days of fever (all p<0.001). History of recent URTI was numerically higher in probiotic than placebo group (43% vs 27%, Chi-square p=0.078). Probiotic intervention (n=56) resulted in significantly fewer patient-days of URTI compared to placebo (n=53) according to both definitions, as well as fewer patient-days of fever (all p<0.05 unadjusted, p<0.001 adjusted for recent URTI history; see Table 1). Conclusion Compared to placebo, intervention with L. plantarum DR7 significantly reduced patient-days with URTI by 20%, and patient-days with fever by 27%. Patient history of recent URTI significantly increased the risk of URTI during the intervention, and significance of probiotic efficacy was improved upon accounting for said parameter.

Effects of yeast β-glucans for the prevention and treatment of upper respiratory tract infection in healthy subjects: a systematic review and meta-analysis.

Yeast β-glucans are known for their immune-modulating effects; however, their effects on human upper respiratory tract infections (URTIs) remain unclear. The aim of the present study was to use a systematic review and meta-analysis approach to investigate the effects of yeast β-glucans for the prevention and treatment of URTIs in healthy subjects. Databases including Pubmed, Web of Science, EMBASE and the Cochrane Library were searched and 13 RCTs investigating the effects of yeast β-glucans on the incidence, duration, and severity of URTIs in healthy subjects were included. The results showed that compared to the placebo group, yeast β-glucan could significantly reduce the incidence of URTIs (OR = 0.345, 95% CI = 0.192 to 0.620, p < 0.001), decrease the average number of URTI episodes (SMD =  - 0.315, 95% CI =  - 0.500 to  - 0.130, p < 0.05), and decrease the duration of URTIs (SMD =  - 0.312, 95% CI =  - 0.561 to  - 0.064, p < 0.001). Improved severity of symptoms was found in yeast β-glucan group compared to the placebo group in the majority of included studies. In addition, yeast β-glucan was well tolerated and safe in general. These findings suggest a positive effect of yeast β-glucans on human URTIs. However, due to the high heterogeneity and small number of included studies, more high-quality research and clinical trials are warranted.

IFN-\u03bb4 genetic variants influence clinical malaria episodes in a cohort of Kenyan children

BackgroundInterferon (IFN)- λ4, a type III IFN, production is controlled by a dinucleotide frameshift variant (rs368234815-dG/TT) within the first exon of the IFNL4 gene. Carriers of the IFNL4-dG allele but not the IFNL4-TT allele are able to produce the IFN-λ4 protein. Patients with hepatitis C virus that do not produce the IFN-λ4 protein have higher rates of viral clearance suggesting a potential inhibitory role of IFN-λ4 in liver-tropic infections.MethodsIn this study, it was investigated whether children infected with Plasmodium falciparum, which has a well-characterized liver stage infection, would be more susceptible to clinical malaria relative to their IFNL4-rs368234815 allele. A cohort of 122 children from a malaria holoendemic region of Kenya was analysed. Episodes of clinical malaria and upper respiratory tract infections (URTIs) were determined using information collected from birth to 2 years of age. The dinucleotide frameshift variant IFNL4-rs368234815-dG/TT was genotyped using a TaqMan assay.ResultsIn this cohort, 33% of the study participants had the dG/dG genotype, 45% had the dG/TT genotype, and 22% had TT/TT genotype. The number and time to first episode of clinical malaria and URTIs with respect to the IFNL4-rs368234815 allele was evaluated. It was found that children that carried the IFNL4-rs368234815-dG allele had an increased number of clinical malaria episodes. In addition, there was a significant association between earlier age of first malaria infection with carriers of the IFNL4-dG allele (p-value: 0.021).ConclusionThe results suggest that the ability to produce IFN-λ4 negatively affects host immune protection against P. falciparum malaria in Kenyan children.

Probiotic Supplementation and Respiratory Infection and Immune Function in Athletes: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To evaluate the effectiveness of probiotic supplementation on upper respiratory tract infection (URTI) and inflammatory markers in elite athletes. We searched the PubMed, EBSCOhost, Scopus, and Web of Science databases using the following terms: probiotic OR probiotics AND exercise OR sport OR athletes AND URTI OR respiratory infection OR URTIs OR inflammation OR inflammatory OR cytokines. We screened the titles and abstracts of 2498 articles using our inclusion criteria. A total of 14 articles were selected for further analysis. For each study, 2 independent reviewers extracted the study design, participant characteristics, inclusion and exclusion criteria, intervention characteristics, outcome measures, and main results. We did not observe an effect of probiotic supplementation on the number of days of illness or the mean number or duration of URTI episodes but did note an effect of probiotic supplementation on the total symptom severity score (-0.65; 95% CI = -1.05, -0.25; P = .02). Lower levels of interleukin 6 (-2.52 pg/mL; 95% CI = -4.39, -0.66 pg/mL; P = .002) and tumor necrosis factor α (-2.31 pg/mL; 95% CI = -4.12, -0.51 pg/mL; P = .01) were also reported after supplementation. This meta-analysis provides evidence that probiotic supplementation, especially among professional athletes, is an effective way to decrease the total URTI symptom severity score. In addition, probiotic supplementation may decrease interleukin 6 and tumor necrosis factor α levels. More studies involving larger groups are needed to better assess this effect. The optimal timing, duration, composition, and dose of such supplementation need to be determined.

Medical Cost of Upper Respiratory Tract Infections in Children in Ambulatory Care

ObjectiveThe aim of this study was to estimate the direct cost per episode and the annual cost for upper respiratory tract infection (URTI) in children in Ambulatory Health Centers of the Ministry of Public Health (MSP) of Ecuador. MethodsA cost of illness study with a provider perspective was carried out through a micro-costing of health resources and valuated in international dollars. Medical visits, laboratory tests, imaging examinations, and other procedures were valued using the tariff framework of services for the National Health System, and for prescribed medication a reported cost registry of pharmacy purchases made in the year of study was used. ResultsWe included 380 electronic health records of children. We found a re-consultation rate of 22.89%, a medicine prescription rate of 95.52%, and an antibiotic prescription rate of 45.26%. The first medical consultation accounted for 71.9% of the total cost of URTI, the following visits accounted for 11.82%, and medication accounted for 14.68%. Antibiotics accounted for 58.92% of the total cost of medication. ConclusionThe direct medical cost to the MSP of Ecuador of 1 episode of URTI in children in primary care was around I$37.28 (2017 dollars) (95% CI: I$35.81-I$38.75). The total cost of URTI cases in children to the MSP in 2017 was at least I$50.478 million (2017 dollars) (95% CI I$48.527m-I$52.523m). Re-consultation and the prescription of medication represent an important component of the direct cost of medical care of URTI.

Patterns of Recurrence and Antimicrobial Management in Respiratory Infections: A Real-World Retrospective Study

Objectives: Respiratory tract infections (RTIs) significantly contribute to morbidity and mortality. Management of RTIs is complex with several etiological agents, development of resistance to antimicrobials, and multiple risk factors which may result in recurrence of infections. Therefore, choice of antibiotic therapy needs to be evidence-based for appropriate treatment and prevention of recurrence. This study aimed to explore the pattern of recurrence in RTIs and the type of antimicrobials used in real-world clinical settings. Methods: This study was a retrospective, cross-sectional, observational, multicenter study. Electronic medical records of patients with upper RTIs (URTIs) and lower RTIs (LRTIs) visiting three centers from 2014 to 2020 were considered for the analysis. Results: A total of 236 patients had an overall 531 episodes of RTIs with a mean age of 41.75 years. There were 391 LRTIs and 140 URTIs. Majority of the patients were adults (64.83%), and males were predominant (65.68%). In LRTI episodes, the most frequently prescribed antimicrobial monotherapy/fixed dose combination was macrolide (clarithromycin) (12.53%), followed by cefpodoxime-clavulanic acid (9.97%). Majority of the URTIs were managed with clarithromycin (49.28%) and azithromycin (16.43%). Recurrence of LRTI was observed in 23 patients with gram stain positive cocci. Additionally, out of 27 patients with culture-positive pseudomonas infections, 10 had recurrent LRTI episodes. Macrolides and cephalosporins were mostly prescribed in these episodes. Conclusion: This study highlights that one of the major causes of recurrence could be incomplete eradication of pathogens. In the real-world scenario, recurrent URTI and LRTI episodes can be managed by macrolides and cephalosporins.