Respiratory Tract Secretions Research Articles

Candida in the respiratory tract secretions of critically ill patients and the impact of antifungal treatment: a randomized placebocontrolled pilot trial (CANTREAT study)

Candida spp. are frequently recovered from endotracheal secretions in critically ill patients suspected of having ventilator- associated pneumonia. Observational studies reported an association with worse clinical outcomes [1] but the effect of antifungal therapy in these patients remains unclear. We designed this pilot study to assess the feasibility of a larger trial and to evaluate inflammatory profiles and clinical outcomes in these patients.

Elevated metal concentrations in the CF airway correlate with cellular injury and disease severity

Bio-active trace metals have been identified in respiratory tract secretions of subjects with lung disease and may potentially influence bacterial virulence, inflammation and disease severity. We measured a diverse range of metal ions in sputum samples from subjects with CF and non-CF bronchiectasis (NCFB) compared to healthy controls and examined their relationship to airway inflammation, disease severity and the presence of bacterial pathogens. We studied 45 subjects with CF, 8 with NCFB and 8 healthy controls. Metal concentrations were measured in sputum supernatant by inductively-coupled plasma mass spectrometry and correlated with sputum inflammatory cell counts, lactate dehydrogenase (LDH) and interleukin (IL)-8 concentrations, atmospheric particulate matter, lung function, clinical status and participant demographics. Sputum from subjects with CF and NCFB contained increased concentrations of magnesium, calcium, iron and zinc. Metal ion concentrations correlated positively with LDH levels. The concentrations of magnesium, iron and zinc positively correlated with IL-8. A sub-group of CF subjects with severe lung disease demonstrated increased sputum molybdenum concentrations. Elevated concentrations of sputum metal ions appear to be associated with cell/tissue necrosis and inflammation in subjects with CF and NCFB. Sputum molybdenum concentrations may be a biomarker of severe CF airway disease.

Effect of Mechanical Cleaning of Endotracheal Tubes With Sterile Urethral Catheters to Reduce Biofilm Formation in Ventilator Patients

To investigate the effectiveness of mechanical cleaning with sterile urethral catheters to prevent formation of biofilms on endotracheal tubes. Forty-five children were randomized in equal numbers to endotracheal tube cleaning group for three times a day (group A), twice daily (group B), or to a control group with no endotracheal tube cleaning (group C). Bacterial studies and confocal laser scanning microscopy were performed to assess bacterial colonization and biofilm thickness on the internal surface of the endotracheal tube. In group B, the quantities of viable bacteria adhering to the endotracheal tube after 1 day of ventilation were similar to the control group but were significantly less by 3 days (p < 0.05). The quantities of viable bacteria adhering to the endotracheal tube in group A were significantly lower than group C from day 1 to day 7 (p < 0.05). The numbers of culture-positive endotracheal tube and lower respiratory tract secretions were both reduced in groups A and B compared with group C. Confocal laser scanning microscopy showed progressive development of mature biofilms in group C. Scattered bacteria were seen in group A with no biofilm formation. In group B, a small amount of extracellular polymeric substance was seen, with more bacterial cells than in group A. The biofilms in group B were significantly thinner than those in group C (p < 0.05). The occurrence of ventilator-associated pneumonia was significantly reduced by endotracheal tube cleaning. Mechanical cleaning with sterile urethral catheters reduced bacterial colonization, prevented formation of endotracheal tube biofilm, and reduced the occurrence of ventilator-associated pneumonia.

Pharmacokinetics and pharmacodynamics of glycopyrrolate following a continuous-rate infusion in the horse

Glycopyrrolate (GLY) is an antimuscarinic agent that is used in humans and domestic animals primarily to reduce respiratory tract secretions during anesthesia and to reverse intra-operative bradycardia. Although GLY is used routinely in veterinary patients, there is limited information regarding its pharmacokinetic (PK) and pharmacodynamic (PD) properties in domestic animals, and an improved understanding of the plasma concentration-effect relationship in racehorses is warranted. To accomplish this, we characterize the pharmacokinetic-pharmacodynamic (PK-PD) actions of GLY during and after a 2-h constant-rate intravenous infusion (4 μg/kg/h) and evaluate potential PK-PD models for cardiac stimulation in adult horses. Measurements of plasma GLY concentrations, heart and respiration rates, and frequency of bowel movements were performed in six Thoroughbred horses. The time course for GLY disposition in plasma followed a tri-exponential equation characterized by rapid disappearance of GLY from blood followed by a prolonged terminal phase. Physiological monitoring revealed significant (P < 0.01) increases in heart (>70 bpm) and respiratory rates accompanied by a marked and sustained delay in the frequency of bowel movements (1.1 ± 0.2 h [saline group] vs. 6.0 ± 2.0 h [GLY group]). Two of six horses showed signs of colic during the 8-h observation period after the end of the GLY infusion, but were treated and recovered without further complications. The relationship between plasma GLY concentration and heart rate exhibited counterclockwise hysteresis that was adequately described using an effect compartment.

PP010: Analysis of SPLUNC1 expression in saliva of patients under chemotherapy and radiotherapy for head and neck cancer

Purpose SPLUNC1 is a protein that participates in the host innate immunity, mainly expressed in the respiratory tract epithelium, secretions, salivary glands and saliva. Its expression was also described in infections, inflammatory disorders, and malignancies. Patients who underwent chemotherapy (CT) or radiotherapy (RT) for head and neck tumors may suffer important oral side effects, such as mucositis, candidosis, taste alterations and hypossalivation, which can interfere with SPLUNC1 expression. Therefore, the purpose of this study was to analyze the saliva of patients who underwent CT and/or RT and describe the association of SPLUNC1 expression and collateral effects of the therapy. Material and methods A prospective randomized study was performed with two groups, chemotherapy patients ( n = 10) and head and neck radiotherapy patients ( n = 10). Unstimulated saliva for 5 min was collected before, during, and after the treatment. Clinical data and collateral effects were obtained from the patients’ charts. SPLUNC1 expression was analyzed by western blotting, and densitometry was performed. The results were statistically analyzed (ANOVA, Tukey’s, p Results Twenty patients were included in this study, (mean age of 51 years). It was observed that 60% of the patients who received RT presented hypossalivation after treatment ( p = 0.001). Higher level of SPLUNC1 occurred in RT patients who had mucositis and candidosis ( p = 0.037), in all the three collected samples. On the other hand, SPLUNC1 proteins decreased in patients submitted to chemotherapy without correlation with any side effect. Conclusions The present study describes recent findings about expression of SPLUNC1 in cancer patients who underwent chemotherapy and head and neck radiotherapy before and after the treatment. Despite the small sample, this study suggests that changes in the SPLUNC1 expression could be associated with oral side effects during radiotherapy and chemotherapy.

CPC-085 Medicines and Their Costs in the Last Six Days of Life

BackgroundPalliative care provides many advantages to patients who face life-threatening illness. The five most common symptoms that usually occur in the last days of life are pain, nausea and vomiting,...

Aspergillosis in Solid Organ Transplantation

Invasive aspergillosis (IA) occurs in 1–15% of the solid organ transplant (SOT) recipients. Mortality rate in transplant recipients with IA historically has ranged from 65% to 92% (1–4). However, currently reported mortality rate in IA among SOT recipients is 22% (5). An estimated 9.3– 16.9% of all deaths in transplant recipients in the first year have been considered attributable to IA (6). Although the outcomes have improved in the current era, IA remains a significant posttransplant complication in SOT recipients. The review herein discusses the epidemiologic characteristics, risk factors, diagnostic laboratory assays and the approach to antifungal prophylaxis and treatment of IA in SOT recipients.

Treatment of an Acute Respiratory Failure Child Caused by Special Airway Foreign Body

Objective: To explore the combined treatment and effect because of lime foreign body in airway with inhalantion injury of children. Methods: One child whose respiratory tract was injured and obstructed by lime was admitted to our hospital, and systematic anti-infection and antishock procedures were performed. Then he received tracheal intubation and mechanical ventilation. The child underwent rigid bronchoscopy and the bronchial casts (lime) were removed under general anaesthesia. Subsequently, fiberoptic bronchoscopy was used again, the remaining lime powder was removed by hair brush, and then bronchoalveolar lavage was performed. The secretion of respiratory tract was retained for bacterial culture and susceptibility test. Results: The mechanical ventilation was withdrawn on the seventh day after perioperative treatment. The right upper lung which was atelectasis before surgery was improved after surgery. Pulmonary function showed that resistance of main air duct was normal while that of small air duct was elevated. Conclusion: The key for successful treatment is to remove bronchial casts (lime) as soon as possible. Bronchoalveolar lavage and bronchial scrubbing are also important. The combined perioperative treatment can reduce the operation risk and incidence of post-operative complication.

Alpha-1 Antitrypsin Reduces Severity of Pseudomonas Pneumonia in Mice and Inhibits Epithelial Barrier Disruption and Pseudomonas Invasion of Respiratory Epithelial Cells

Nosocomial pneumonia (NP) is the third most common hospital-acquired infection and the leading cause of death due to hospital-acquired infection in the US. During pneumonia and non-pneumonia severe illness, respiratory tract secretions become enriched with the serine protease neutrophil elastase (NE). Several NE activities promote onset and severity of NP. NE in the airways causes proteolytic tissue damage, augments inflammation, may promote invasion of respiratory epithelium by bacteria, and disrupts respiratory epithelial barrier function. These NE activities culminate in enhanced bacterial replication, impaired gas exchange, fluid intrusion into the airways, and loss of bacterial containment that can result in bacteremia. Therefore, neutralizing NE activity may reduce the frequency and severity of NP. We evaluated human alpha-1 antitrypsin (AAT), the prototype endogenous NE inhibitor, as a suppressor of bacterial pneumonia and pneumonia-related pathogenesis. In AAT+/+ transgenic mice that express human AAT in lungs, mortality due to Pseudomonas aeruginosa (P.aer) pneumonia was reduced 90% compared to non-transgenic control animals. Exogenous human AAT given to non-transgenic mice also significantly reduced P.aer pneumonia mortality. P.aer-infected AAT+/+ mice demonstrated reduced lung tissue damage, decreased bacterial concentrations in lungs and blood, and diminished circulating cytokine concentrations compared to infected non-transgenic mice. In vitro, AAT suppressed P.aer internalization into respiratory epithelial cells and inhibited NE or P.aer-induced disruption of epithelial cell barrier function. The beneficial effects of human AAT in murine P.aer pneumonia raise the possibility of AAT use as a prophylactic treatment for NP in humans, and suggest a role for AAT as an innate immune mediator.

Diagnosis of Bacterial Ventilator–Associated Pneumonia in Children

To evaluate the reproducibility of blind bronchial sampling in patients with suspected diagnosis of bacterial ventilator-associated pneumonia. Prospective study. Pediatric intensive care unit of a tertiary care, multidisciplinary, teaching hospital in Northern India. All consecutive patients on mechanical ventilation for >48 hrs were evaluated clinically for ventilator-associated pneumonia. Children with clinical ventilator-associated pneumonia were subjected to blind bronchial sampling twice. Sixty-eight blind bronchial sampling samples from 34 patients were analyzed for polymorphonuclear cells, the presence, type, and number of bacteria. Acinetobacter baumannii was the most common organism grown from distal respiratory secretions. For polymorphonuclear cells, the concordance between two blind bronchial samples was 85.3% and kappa coefficient was 0.65. The concordance for the presence and type of bacteria in Gram staining in two samples was 85.3% and kappa coefficient was 0.68. The intraclass coefficients for bacterial index and predominant species index were 0.82 (95% confidence interval 0.65-0.91) and 0.89 (95% confidence interval 0.78-0.94), respectively. The use of prior antibiotics did not adversely affect the reproducibility of blind bronchial sampling. No major complications were recorded during the procedure. Blind bronchial sampling of lower respiratory tract secretions in mechanically ventilated patients generates reproducible results of quantitative and qualitative cultures. We suggest that blind bronchial sampling may provide valuable clue to the bacterial etiology in ventilated child with suspected clinical ventilator-associated pneumonia.

Four Essential Drugs Needed for Quality Care of the Dying: A Delphi-Study Based International Expert Consensus Opinion

The majority of dying patients do not have access to necessary drugs to alleviate their most common symptoms, despite evidence of drug efficacy. Our aim was to explore the degree of consensus about appropriate pharmacological treatment for common symptoms in the last days of life for patients with cancer, among physicians working in specialist palliative care. Within OPCARE9, a European Union seventh framework project aiming to optimize end-of-life cancer care, we conducted a Delphi survey among 135 palliative care clinicians in nine countries. Physicians were initially asked about first and second choice of drugs to alleviate anxiety, dyspnea, nausea and vomiting, pain, respiratory tract secretions (RTS), as well as terminal restlessness. Based on a list of 35 drugs mentioned at least twice in the first round (n=93), a second Delphi round was performed to determine ≤ 5 essential drugs for symptom alleviation in the last 48 hours of life that should be available even outside specialist palliative care. There was ≥ 80% consensus among the participants (n=90) regarding morphine, midazolam, and haloperidol as essential drugs. For RTS, there was consensus about use of an antimuscarinic drug, with 9%-27% of the physicians each choosing one of four different drugs. Based on this consensus opinion and other literature, we suggest four drugs that should be made available in all settings caring for dying patients with cancer, to decrease the gap between knowledge and practice: morphine (i.e., an opioid), midazolam (a benzodiazepine), haloperidol (a neuroleptic), and an antimuscarinic.

Intraocular vaccination with an inactivated highly pathogenic avian influenza virus induces protective antibody responses in chickens

Because it is expected to induce cross-reactive serum and mucosal antibody responses, mucosal vaccination against highly pathogenic avian influenza (HPAI) is potentially superior to conventional parenteral vaccination. Here, we tested whether intraocular vaccination with an inactivated AI virus induced protective antibody responses in chickens. Chickens were inoculated intraocularly twice with 104 hemagglutination units of an inactivated H5N1 HPAI virus. Four weeks after the second vaccination, the chickens were challenged with a lethal dose of the homologous H5N1 HPAI virus. Results showed that most of the vaccinated chickens mounted positive antibody responses. The median serum hemagglutination inhibition titer was 1:80. Addition of CpG oligodeoxynucleotide 2006 or cholera toxin to the vaccine did not enhance serum antibody titers. Cross-reactive anti-hemagglutinin IgG, but not IgA, was detected in oropharyngeal secretions. In accordance with these antibody results, most vaccinated chickens survived a lethal challenge with the H5N1 HPAI virus and did not shed the challenge virus in respiratory or digestive tract secretions. Our results show that intraocular vaccination with an inactivated AI virus induces not only systemic but also mucosal antibody responses and confers protection against HPAI in chickens.

Rapid Detection of Staphylococcus aureus in Lower Respiratory Tract Secretions from Patients with Suspected Ventilator-Associated Pneumonia: Evaluation of the Cepheid Xpert MRSA/SA SSTI Assay

A preclinical evaluation was conducted to evaluate the performance of the Cepheid Xpert assay on 135 lower respiratory tract secretions for detection of methicillin-resistant Staphylococcus aureus and S. aureus. Compared with the quantitative culture, the sensitivity, specificity, and positive and negative predictive values were 99.0%, 72.2%, 90.7%, and 96.3%, respectively.

The polyomaviruses WUPyV and KIPyV: a retrospective quantitative analysis in patients undergoing hematopoietic stem cell transplantation

BackgroundThe polyomaviruses WUPyV and KIPyV have been detected in various sample types including feces indicating pathogenicity in the gastrointestinal (GI) system. However, quantitative viral load data from other simultaneously collected sample types are missing. As a consequence, primary replication in the GI system cannot be differentiated from swallowed virus from the respiratory tract.Here we present a retrospective quantitative longitudinal analysis in simultaneously harvested specimens from different organ sites of patients undergoing hematopoietic stem cell transplantation (HSCT). This allows the definition of sample types where deoxyribonucleic acid (DNA) detection can be expected and, as a consequence, the identification of their primary replication site.FindingsViral DNA loads from 37 patients undergoing HSCT were quantified in respiratory tract secretions (RTS), stool and urine samples as well as in leukocytes (n = 449). Leukocyte-associated virus could not be found. WUPyV was found in feces, RTS and urine samples of an infant, while KIPyV was repeatedly detected in RTS and stool samples of 4 adult patients.RTS and stool samples were matched to determine the viral load difference showing a mean difference of 2.3 log copies/ml (p < 0.001).ConclusionsThe data collected in this study suggest that virus detection in the GI tract results from swallowed virus from the respiratory tract (RT). We conclude that shedding from the RT should be ruled out before viral DNA detection in the feces can be correlated to GI symptoms.

Neutrophil necrosis and annexin 1 degradation associated with airway inflammation in lung transplant recipients with cystic fibrosis

BackgroundNeutrophils sequestered in lower respiratory tract secretions in the inflamed lung may undergo apoptosis and/or necrosis and release toxic cellular contents that can injure airways or parenchyma. This study examined the viability of neutrophils retrieved from the proximal airways of lung transplant recipients with bacterial tracheobronchitis.MethodsIntegrity and stability of intracellular proteins in neutrophils from proximal airways and peripheral blood from lung transplant recipients with bacterial tracheobronchitis were analyzed via Western blot analysis and determination of neutrophil viability by morphologic appearance and flow cytometry.ResultsNeutrophils in tracheobronchial secretions from lung transplant recipients with cystic fibrosis who had normal chest radiographic imaging but bronchoscopic evidence of purulent tracheobronchitis post-transplant were necrotic and associated with degradation of intracellular protein annexin 1. The neutrophil influx was compartmentalized to large airways and not detected in peripheral bronchoalveolar airspaces sampled via bronchoalveolar lavage. Peripheral blood neutrophils from healthy subjects cultured in vitro demonstrated that annexin 1 degradation, particularly to a 33 kDa annexin 1 breakdown product (A1-BP), was associated with neutrophil necrosis, but not apoptosis. Although annexin 1 degradation was not specific to neutrophil necrosis, it was a sensitive marker of intracellular protein degradation associated with neutrophil necrosis. Annexin 1 degradation to 33 kDa A1-BP was not observed in peripheral blood neutrophils from healthy subjects, but annexin 1 appeared to be degraded in peripheral blood neutrophils of lung transplant recipients despite a normal morphologic appearance of these cells.ConclusionsNeutrophils were necrotic from the proximal airways of lung transplant recipients with bacterial tracheobronchitis, and this process may begin when neutrophils are still in the systemic circulation prior to sequestration in inflamed airways. Annexin 1 degradation to 33 kDa A1-BP may be useful as a sensitive marker to detect neutrophil necrosis.

Randomized Double-Blind Trial of Sublingual Atropine vs. Placebo for the Management of Death Rattle

ContextNoisy breathing because of respiratory tract secretions (RTS), often referred to as “death rattle,” occurs in up to half of all dying patients. Despite a lack of evidence showing benefit compared with placebo, antimuscarinic medications have been used in an attempt to decrease noise associated with RTS and to decrease family distress. ObjectivesThe goal of this study was to compare the efficacy of the antimuscarinic medication atropine with that of placebo in reducing noise associated with death rattle. MethodsTerminally ill adult hospice inpatients who developed noisy breathing as a result of RTS were randomized to double-blind treatment with atropine or placebo. Study drug was given as a single sublingual dose. Noise from breathing was monitored at baseline and at two and four hours. ResultsOne hundred thirty-seven participants were randomized to atropine or placebo. Reduction in noise score from baseline to two hours after dose occurred in 37.8% and 41.3% of subjects treated with atropine and placebo, respectively (P=0.73). Noise score reduction at four hours occurred in 39.7% and 51.7% of subjects treated with atropine and placebo, respectively (P=0.21). Differences between groups were not significant at either time point. Atropine was well tolerated. Heart rate increased slightly in both groups (+1.1/minute for atropine and +3.1/minute for placebo) but not significantly. ConclusionSublingual atropine given as a single dose was not more effective than placebo in reducing the noise associated with death rattle.

Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia

Candida spp. airway colonization could promote development of ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa, a potentially multidrug-resistant (MDR) bacteria, and worsen the outcome of VAP regardless of pathogen. We therefore address the question of the risk of MDR bacteria isolation within the airway of patients with suspected VAP, whether Candida spp. is present or not. Prospective observational study in a teaching hospital. Consecutive patients with suspected VAP were included. Respiratory tract secretions were seeded on specific medium for yeast isolation in addition to standard culture. Outcome as well as presence of MDR bacteria were assessed according to fungal colonization. 323 suspected VAP were analysed. Among these, 181 (56 %) cases presented with Candida spp. airway colonization. Colonized and noncolonized patients were similar regarding baseline characteristics, prior exposure to antibiotics and VAP severity. However, mortality rate was greater in patients with fungal airway colonization than in those without (44.2 versus 31.0 %, respectively; p = 0.02). In addition, MDR bacteria isolation was 31.5 % in patients with Candida spp. colonization versus 23.2 % in those without (p = 0.13). Moreover, Candida spp. airway colonization was one independent risk factor for MDR bacteria isolation [odds ratio (OR) = 1.79, 95 % confidence interval 1.05-3.05; p = 0.03], in addition to the time elapsed between intensive care unit (ICU) admission and VAP suspicion. In patients with suspected VAP, Candida spp. airway colonization is frequent and associated with increased risk for MDR bacteria isolation. This could worsen outcome and should therefore be considered when choosing an empiric antibiotic therapy.

Metabolomic profiling of regulatory lipid mediators in sputum from adult cystic fibrosis patients

Retained respiratory tract (RT) secretions, infection, and exuberant inflammatory responses are core abnormalities in cystic fibrosis (CF) lung disease. Factors contributing to the destructive CF airway inflammatory processes remain incompletely characterized. The pro-oxidative inflammatory CF RT milieu is known to contain enzymatically and nonenzymatically produced regulatory lipid mediators, a panel of structurally defined oxidized metabolites of polyunsaturated fatty acids known to play a role in pathology related to inflammation. Using an extraction protocol that maximizes recoveries of sputum-spiked deuterated standards, coupled with an LC/MS/MS detection system, this study presents a metabolomic method to assess a broad spectrum of regulatory lipid mediators in freshly obtained sputum from CF patients. A broad range of both proinflammatory and anti-inflammatory lipid mediators was detected, including PGE2, PGD2, TXB2, LTB4, 6-trans-LTB4, 20-OH-LTB4, 20-COOH-LTB4, 20-HETE, 15-HETE, 11-HETE, 12-HETE, 8-HETE, 9-HETE, 5-HETE, EpETrEs, diols, resolvin E1, 15-deoxy-PGJ2, and LXA4. The vast majority of these oxylipins have not been reported previously in CF RT secretions. Whereas direct associations of individual proinflammatory lipid mediators with compromised lung function (FEV-1) were observed, the relationships were not robust. However, multiple statistical analyses revealed that the regulatory lipid mediators profile taken in aggregate proved to have a stronger association with lung function in relatively stable outpatient adult CF patients. Our data reveal a relative paucity of the anti-inflammatory lipid mediator lipoxin A4 in CF sputum. Patients displaying detectable levels of the anti-inflammatory lipid mediator resolvin E1 demonstrated a better lung function compared to those patients with undetectable levels. Our data suggest that comprehensive metabolomic profiling of regulatory lipid mediators in CF sputum should contribute to a better understanding of the molecular mechanisms underlying CF RT inflammatory pathobiology. Further studies are required to determine the extent to which nutritional or pharmacological interventions alter the regulatory lipid mediators profile of the CF RT and the impact of potential modulations of RT regulatory lipid mediators on the clinical progression of CF lung disease.

Specimen Collection for the Diagnosis of Pediatric Pneumonia

Diagnosing the etiologic agent of pneumonia has an essential role in ensuring the most appropriate and effective therapy for individual patients and is critical to guiding the development of treatment and prevention strategies. However, establishing the etiology of pneumonia remains challenging because of the relative inaccessibility of the infected tissue and the difficulty in obtaining samples without contamination by upper respiratory tract secretions. Here, we review the published and unpublished literature on various specimens available for the diagnosis of pediatric pneumonia. We discuss the advantages and limitations of each specimen, and discuss the rationale for the specimens to be collected for the Pneumonia Etiology Research for Child Health study.

Equine Influenza: Prevention and Control

Equine influenza (EI) is a highly contagious selflimiting respiratory disease in horses that is caused by equine influenza virus (EIV) infection. EIV is presented by horses worldwide and has a huge financial impact on the horse industry in many countries. Although an outbreak of EI can be controlled by prior immunization by using vaccination, the efficacy of the vaccine is influenced by antigenic differences between epidemic strains and vaccine strains. Thus, to keep the vaccine effective, the vaccine strains should be reviewed periodically on the basis of global surveillance, such as the epidemiological report issued annually in the bulletin of the World Organization for Animal Health. Once an outbreak occurs, sanitary management, including the restriction of horse movement, should be conducted to eliminate the source of the causative virus and protect susceptible horses. The rapid identification of EIV in respiratory tract secretions enables the prompt administration of sanitary management. Although commercially available rapid antigen detection tests should be improved in terms of sensitivity, one of the tests (ESPLINE Flu A+B) worked as a convenient method for the rapid diagnosis and screening of a number of horses for EI during the 2007 outbreak in Japan, in addition to laboratory tests such as virus isolation. A more sensitive test must be developed that can be performed easily without special equipment or technical expertise.