Frequency Of Upper Respiratory Tract Infections Research Articles

Asthma and serum IgE levels in children in a desert country.

The frequency of asthma admissions to the paediatric outpatient clinic in a teaching hospital in Kuwait was found to increase from 8.8 to 14.9% of all admissions during a 3-year period. Seasonal variation of admissions was consistent, with peak incidences during the cold and humid months. The incidence of asthma was remarkably well correlated to low temperature and high frequency of upper respiratory infections but not to pollen seasons or occurrence of dust storms. In agreement with the clinical impression that atopic allergy is frequent in Kuwait, high levels of IgE were found in different groups of individuals. In umbilical cord serum, elevated IgE levels in blood donors and in children with asthma or other diseases were clearly higher than those found in corresponding groups in Western countries. Possible factors contributing to the generally increased IgE levels may be endemic diseases, like viral hepatitis and brucellosis.

HEREDITY IS THE STRONGEST DETERMINANT OF INFANTILE ATOPY; PROLONGED EXCLUSIVE BREAST FEEDING GIVES NO ADVANTAGE

We followed 183 infants for 2 years. A short breast feeding group (F3.5) (N=32) was fully weaned by age 3.5 months (median 70 days) while group BE9 (N=31) was exclusively breast fed for 9 months. We assessed heredity for atopy, infections, and duration of breast feeding as determinants of atopy. We saw an atopic manifestation during the 1st year of life in 14 infants. The parents reported atopy-like signs during the 2nd year in another 31 infants. Heredity was the most significant predictor of atopy (30 % of heredity + infants had atopy v. 18 % of heredity -infants, p=0.04). Other significant predictors were late exposure to cow-milk and frequent upper respiratory tract infections (URTI). The type of feeding associated with atopy particularly among the heredity - infants. Of them fewer infants had atopy in group F3.5 than in group BE9 (1/19 v. 5/18, p=0.06). Furthermore, atopic manifestations during the 1st year were less common in group F3.5 (independent of heredity) than in group BE9 (0/32 v. 5/31, p=0.02). The duration of breast feeding did not associate with the frequency of URTI. Diarrhoea during the 1st year was more common in group F3.5 than in group BE9. Prolongation of exclusive breast feeding from 2 to 9 months does not contribute to prevention of infantile atopy and respiratory tract infections.

Selective IgA deficiency and chronic obstructive pulmonary disease--a family study.

A 43 year old housewife with far advanced chronic obstructive pulmonary disease (COPD) was referred for evaluation of alpha1 antitrypsin (AAT) type because of the early onset of her disease and her family history. Gradually progressive dyspnea on exertion and productive cough had been present for six years. There had been frequent upper respiratory infections and a mastoidectomy in the past. She had been a 2 pack per day cigaret smoker for years. On physical exam she was a cachectic woman in moderate respiratory distress. Breath sounds were almost absent at the lung bases and scattered wheezes and rhonchi were present. The chest film showed hyperexpansion and a suggestion of cyst formation at the bases. Pulmonary function testing showed severe obstruction which did not respond to broncho-dilators. AAT quantitation and phenotyping by starch gel electrophoresis and subsequent crossed electrophoresis were normal. Quantitative immunoglobulin determinations revealed less than 4 mg./100 cc. of IgA in serum (adult normals 50–250) and slightly elevated IgG and IgM. IgE level was 44 ng./cc. (Normal—less than 500) Concentrated parotid secretions also showed no IgA.

Branchial Cleft Remnants Suggesting Tuberculous Lymphadenitis

Branchial cleft remnants are seen clinically as cysts, sinus tracts, skin tags, or various combinations of these lesions. The case of a 26year-old girl of Mexican heritage was presented in which cervical epidermal cysts were noted in such number and location to suggest they represented remnants of the first branchial cleft. Because she reported frequent upper respiratory infections, cervical lymphadenopathy, and prior treatment of what was thought to be scrofuloderma, it was necessary to exclude the diagnosis of tuberculosis of the cervical lymph nodes. A friable syringocystadenoma papilliferum of the scalp further complicated the clinical evaluation in her case because the most common cause of masses in the neck, with the exception of benign thyroid enlargement, is metastatic cancer in the lymph nodes.

Clatworthy's Sign

A valuable roentgenographic sign—anterior displacement of the duodenum in a patient with portal hypertension—has been described by surgeons (1) and apparently gone unnoticed. An appropriate case and a well read colleague (2) called our attention to the finding which we term “Clatworthy's sign.” Case Report This 6-year-old white girl had required exchange transfusions for erythroblastosis in the neonatal period. The umbilical vein had been used until it became unsatisfactory, and transfusion was completed through the femoral vein. Abdominal swelling was first noted at eight months of age, but definite ascites was never demonstrated. Subsequently, the child did fairly well but was seen at the University of Colorado Medical Center at the age of six years because of chronic diarrhea and frequent upper respiratory infections. Fibrocystic disease was ruled out by appropriate tests, but an upper gastrointestinal examination revealed esophageal varices, splenomegaly, and anterior displacement of the duodenum. Two months later, the first episode of hematemesis occurred. A repeat barium meal examination confirmed the previous findings (Fig. 1). A splenoportogram demonstrated a thread-like obstructed splenic vein with collateral runoff via the ascending vertebral plexus (Fig. 2). Laparotomy was performed and a shunting procedure attempted, but no adequate portal vessel could be found. The vena cava was buried in a “woody” retroperitoneal space, thick with edematous fibrous tissue and large lymph nodes. A splenectomy was performed. The spleen and four retroperitoneal lymph nodes and surrounding connective tissue were submitted to Dr. R. M. Mulligan of the Department of Pathology, who found congestive splenomegaly, including a weight of 245 g, biphasic active lymphoid nodules, and red pulp cords thickened with reticulum fibers. The lymph nodes revealed no diagnostic features. Subsequently, the patient has required iron replacement therapy for mild chronic gastrointestinal blood loss. Discussion The neonatal transfusions apparently contributed to an omphalitis which led to portal vein thrombosis. Roentgenographic evidence of esophageal varices and a large spleen suggested the diagnosis, and the splenoportogram confirmed the extrahepatic location of the obstruction. Rather massive, poorly controlled hematemesis demanded an attempt at a shunting procedure despite the positive Clatworthy sign—anterior displacement of the duodenum in a patient with portal hypertension. This sign indicates retroperitoneal edema and suggests that collateral circulation is as yet poorly established. We are prone to equate anterior displacement of the duodenum with the presence of a discrete retroperitoneal mass, and consequently to think in terms of pancreatic neoplasm or pseudocyst, lymphoma, neuroblastoma, etc.

Prolonged Use of Oxytetracycline Hydrochloride with Glucosamine in Twenty-five Patients for Nonspecific Complications Associated with Pulmonary Tuberculosis

The beneficial effect of 1,000 milligrams per day of oxytetracycline along with the regular antituberculosis drugs in cases of pulmonary tuberculosis complicated by secondary infections such as sinusitis, bronchitis, frequent upper respiratory infections or secondary infections of other nature has been demonstrated.

Bilateral eosinophilic granulomas of the mastoid processes. Report of a case in a two-year-old boy, with review.

In 1952, Harris and Spencer 1 reported a case of a 3-year-old girl who suffered from eosinophilic granulomas of both mastoids, and they stated that, until then, only three instances of bilateral xanthomatous lesions of the mastoids had been described since the original description, by Schuller, of the complex known as Hand-Schuller-Christian syndrome. 2-4 Therefore, in view of the extreme rarity of this distribution of lesions, which are in themselves sufficiently rare, we feel that it is worth while to report the following case. Report of Case A 2-year-old white boy was admitted to the Charles V. Chapin Hospital on June 28, 1957, complaining of a painful swelling behind his left ear of two days' duration. Since his fourth month the child had had frequent upper respiratory infections, and eight weeks prior to his admission he complained of fever and left-sided earache, which was treated by his family doctor. The

Special study in the use of cold vaccine.

Introduction Since the introduction of antibiotics to the medical armamentarium little attention has been given to the value of bacterial vaccines for the prevention and treatment of the common cold. The use of antibiotics has greatly reduced the serious complications of upper respiratory infections. We see very few serious complications such as mastoiditis, meningitis, extensive sinus infections, etc. However, it is our feeling that there has been a definite increase in the frequency of upper respiratory infections. A patient develops an acute cold, with secondary bacterial invaders producing the disagreeable symptoms that go with an acute cold. He or she is given intensive antibiotic or sulfonamide therapy. The patient recovers from this upper respiratory infection only to develop another within one to three weeks. This is repeated over and over again until the patient seems to have a continuous upper respiratory problem. It is our feeling that the use of

Incidence and frequency of infections at specific ages in infancy and childhood; with special reference to upper respiratory infections in potentially rheumatic-susceptible children.

THE INCIDENCE and relative frequency of upper respiratory infections at various ages in infancy and childhood have been incompletely documented. Reimann,1in a current review of infectious diseases, states that it has been estimated that six attacks of minor respiratory infections occur per person per year and that hemolytic streptococci are the cause in about 25% of cases of acute pharyngitis. In a recent symposium, studies dealing with families living in Cleveland are described by Rammelkampf.2He states, Children in this area have approximately 12 respiratory illnesses per year, the total number of bacterial illnesses being less than 2 per cent. In the same symposium, Rantz3summarizes his observations on ambulatory infants and children attending the Stanford University Hospital Clinic. He found that approximately 20% of all respiratory infections in children between the ages of 2 and 10 years were caused by Group A hemolytic streptococci and