Symptoms Of Upper Respiratory Illness Research Articles

Prediction of Upper Respiratory Illness Using Salivary Immunoglobulin A in Youth Athletes.

To evaluate the relative importance and predictive ability of salivary immunoglobulin A (s-IgA) measures with regards to upper respiratory illness (URI) in youth athletes. Over a 38-week period, 22 youth athletes (age = 16.8 [0.5]y) provided daily symptoms of URI and 15 fortnightly passive drool saliva samples, from which s-IgA concentration and secretion rate were measured. Kernel-smoothed bootstrapping generated a balanced data set with simulated data points. The random forest algorithm was used to evaluate the relative importance (RI) and predictive ability of s-IgA concentration and secretion rate with regards to URI symptoms present on the day of saliva sampling (URIday), within 2 weeks of sampling (URI2wk), and within 4 weeks of sampling (URI4wk). The percentage deviation from average healthy s-IgA concentration was the most important feature for URIday (median RI 1.74, interquartile range 1.41-2.07). The average healthy s-IgA secretion rate was the most important feature for URI4wk (median RI 0.94, interquartile range 0.79-1.13). No feature was clearly more important than any other when URI symptoms were identified within 2 weeks of sampling. The values for median area under the curve were 0.68, 0.63, and 0.65 for URIday, URI2wk, and URI4wk, respectively. The RI values suggest that the percentage deviation from average healthy s-IgA concentration may be used to evaluate the short-term risk of URI, while the average healthy s-IgA secretion rate may be used to evaluate the long-term risk. However, the results show that neither s-IgA concentration nor secretion rate can be used to accurately predict URI onset within a 4-week window in youth athletes.

The Great Escape: The Surprising Finding in a Case of Acute Vomiting

Question: A 23-month-old girl with no chronic medical conditions presented to the emergency department for 4 days of nonbloody nonbilious emesis. The patient had decreased oral intake, decreased urine and stool output, and fatigue. The patient did not experience any fevers, upper respiratory illness symptoms, difficulty breathing, hematemesis, hematochezia, melena, or diarrhea. The physical examination did not reveal any peritoneal signs. An abdominal radiograph revealed multiple radiopaque beaded foreign bodies in a circular configuration located in the mid abdomen (Figure A).

Immune responses, upper respiratory illness symptoms, and load changes in young athletes during the preparatory period of the training periodization

ObjectiveThe aim of this study was to investigate the immunological responses and the association between variation in exercise load and self-reported occurrence of upper respiratory illness (URI) symptoms in young basketball athletes.Materials and methodsThe sample was composed of twelve young male athletes aged 12.7 ± 0.6 years, with a height of 170 ± 10 cm, body mass of 57.6 ± 12.6 kg, and fat-free mass of 18.7 ± 5.9%. Daily training and occurrences of URI symptoms were recorded. Blood samples were collected at baseline (M1) and after 8 weeks (M2) of the preparatory period of periodization training to measure total and differential leukocyte counts, serum interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α).ResultsThere was a significant decrease in monocytes at M2 compared to M1 (P = 0.004). There were no significant alterations in total leukocytes (P = 0.07), neutrophils (P = 0.07), or lymphocytes (P = 0.09). No significant changes in plasma concentrations of TNF-α (P = 0.30) or IL-6 (P = 0.90) were found. The weekly load from week 6 was higher when compared with weeks 1, 2, 4, and 8 (P < 0.05), and week 8 was the lowest when compared with week 5 (P < 0.05). Self-reported URI incidences were highest at weeks 1 and 2.ConclusionVariations in weekly training load during the preparatory period were not correlated with changes in self-reported occurrence of URI incidences, suggesting that young athletes may have an attenuated response to exercise-induced perturbations to the immune system.

Mucosal Immunity and Illness Incidence in Elite Rugby Union Players across a Season

To examine the relationship between upper respiratory illness (URI) incidence with changes in mucosal immunity (saliva immunoglobulin A (s-IgA) and saliva lysozyme (s-Lys)) and training load (TL) in a squad of elite rugby union players. Timed resting morning saliva samples were taken from players (n = 31) at preselected time points for 11 months. Weekly illness rates and TL were assessed using a Web-based diary and from medical/coaching staff reports. No significant correlation was found between absolute s-IgA or s-Lys concentrations and URI incidence. Peaks in URI (December and March) were preceded by periods of increased training intensity and reduced game activity. In 23% of all URI episodes, players reported that presence of an illness either reduced activity (14.4%) or felt the need to go to bed (8.6%). When s-IgA concentration was expressed relative to that when in a URI-free state, a 15% reduction (P = 0.08) was observed in individuals who had present URI symptoms. Decreases in absolute s-IgA (December) and s-Lys (November and February) concentrations were associated with a corresponding increase in saliva cortisol (P < 0.05). Lower s-IgA (P < 0.05) and s-Lys concentrations were consistently observed in backs than forwards, whereas URI incidence also differed for player position (3.4 forwards vs 4.3 backs). Regular monitoring of s-IgA and s-Lys may be useful in the assessment of exercise stress and URI risk status in elite team sport athletes. A combination of alterations in training intensity and seasonal influence is a likely contributor to observed peaks in URI incidence. It is probable that stress-induced increases in cortisol release contribute to reductions in mucosal immunity, which, when lowered, predispose rugby players to increased risk of illness.

Over-the-counter cough medicines in children: neither safe or efficacious?

Patients are encouraged to self-manage acute upper respiratory illness (URTI) and take over-the-counter treatments (OTC) to relieve symptoms rather than attend GPs or seek professional services out of hours.1 One of the most troublesome symptoms of acute URTI is cough, particularly in young children in whom nocturnal symptoms can cause considerable sleep disruption. Understandably, parents have a strong urge to relieve cough in their children with OTC cough medicines, and consumers purchase approximately 95 million of these products per year in the US alone.2 In the UK, there are approximately 24 million episodes of use of OTC cough medicines per year, with children being more likely to be exposed due to their higher frequency of URTI.3 Many different preparations are available for purchase, and the British National Formulary no longer provides a full listing, stating that ‘the rationale for some is dubious’. OTC cough medicines and their combinations of active ingredients vary from simple mucolytics to other active pharmacological agents such as bronchodilators, antihistamines, and centrally-acting cough suppressants. While the use of antihistamines may relieve symptoms in cough related to allergy, there is no rationale for their inclusion in OTC cough medicines targeted at all children, other than enabling suppliers to promote them as an aid to sleep, which, given their potential for misadventure, is inappropriate. There are growing concerns about safety and doubts about the efficacy around the use of OTC cough medicines in children.2,4 This highlights the difficulty in achieving a balance between evidence-based practice, benefits and harms of treatments, and patient self-management. This lack of evidence concerning OTC cough medicines falls into what has been referred …

Mood, Illness and Injury Responses and Recovery with Adventure Racing

Exercise stress, immune status, and mood are interrelated. The stress of adventure racing is unique; exercise is very prolonged and competitive, with severe sleep deprivation and sustained cognitive demands, usually in arduous terrain and environmental conditions. The purpose of this prospective, descriptive study was to identify mood changes along with symptoms of illness and injury during and in the weeks following an international-level adventure race. Mood, sleep, injury, and illness data were collected using questionnaires before, during, and for 2 weeks following New Zealand's Southern Traverse Adventure Race in November 2003. Mood was variable between athletes, but peaks of altered mood subscores were evident (P < .05) during the first 24 hours of racing, around race completion, and, as was hypothesized, 3 days after racing. Altered mood subscores resolved within 2 weeks. Symptoms of upper respiratory illness were most common immediately before (25/60, 42%) and after (28/49, 57%) racing, and largely resolved over the 2-week follow-up (5/27, 19%). Skin wounds and infections were common (43/49, 88%) immediately after the race but settled quickly. Pain was universal (100%), and musculoskeletal injury was common (38/48, 79%). Gastrointestinal complaints were common at the finish (8/49, 16%) and during the next 5 days but settled more quickly than upper respiratory symptoms. Adventure racing of approximately 100 hours causes significant symptomatic injury and illness and mood state disruption, which generally resolve within a fortnight following racing. Disrupted mood and symptoms of illness and injury indicate athlete susceptibility to overreaching or overtraining without sufficient recovery.

Vaginal ulcerations with acute mycoplasma infection

To the Editor: Mycoplasma pneumoniae is a major cause of respiratory illness in children. Genital ulcerations in patients with acute mycoplasma infection have not been described. We report two patients with upper respiratory illness symptoms and genital ulcerations with serology indicating acute M pneumoniae infection as the cause.

Exposure to community violence and upper respiratory illness in older adolescents

Purpose To examine the relationship between exposure to chronic community violence and upper respiratory illness (URI) symptoms among urban adolescents of color; and to test the generality of a model of the relationship between social stress and URI. Method The research used a cross-sectional correlational design. The sample was 769 first-semester first-year students in an urban nonresidential 4-year college from the academic years 1999–2002. Data were collected by a group-administered questionnaire in academic classes. The research used three multi-item additive scales (each with high reliability and validity): exposure to community violence, psychological distress, and URI symptoms. Multiple regression procedures were used to analyze the data. Results Positive correlations were obtained between: exposure to community violence and reporting of URI ( r = .19), exposure and psychological distress ( r = .22), and psychological distress and URI ( r = .51). The relationship between exposure to community violence and URI is greatly reduced when level of psychological distress is statistically controlled. Conclusions Exposure to community violence is related to experiencing URI symptoms among older urban adolescents of color; the effect size of the relationship is small-medium. Psychological distress mediates the impact of exposure to community violence on URI. The findings expand the range of social stressors that are empirically related to URI, and populations in which a relationship between social stressors and URI may be found.

Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress.

The purpose of this study was to investigate the relationship between the diurnal pattern of salivary free cortisol to perceived stress and susceptibility to symptoms of upper respiratory illness (URI). Salivary free cortisol concentration was determined in 34 healthy participants (students) at eight time points, synchronized to awakening, on 2 consecutive days. Participants completed a standard questionnaire to assess perceived stress and subsequently kept a daily record of social proximity and symptoms of upper respiratory illness for 2 weeks. Participants characterized by consistently larger awakening responses went on to report significantly more URI symptoms. Participants with less pronounced diurnal decline (flatter profiles) reported fewer URI symptoms. The two cortisol components were themselves related and interacted such that participants high on an interactive vector reported approximately three times more URI symptoms than other participants. The URI-associated cortisol components (dynamic changes) were not related to perceived stress, but underlying cortisol secretory activity (overall levels) in the first 45 minutes after awakening was. Dynamic components were, however, related to a social proximity measure, which in turn was related to URI symptoms. Proximity and the interactive cortisol vector together explained a substantial (28%) percentage of the variance in URI symptom reports. The cortisol vector independently and significantly explained 12% of the variation; the proximity measure independently and nonsignificantly contributed 6% of the variation. URI symptoms were associated with two related dynamic components of the cortisol cycle as determined by synchronization to awakening, whereas stress was related to a measure of overall secretory activity.

Epstein-Barr virus reactivation and upper-respiratory illness in elite swimmers.

The aim of this study was to investigate the relationships between latent viral shedding of Epstein-Barr virus (EBV) in saliva, upper-respiratory illness, and mucosal immune suppression in a cohort of highly trained swimmers undertaking intensive training. Saliva was collected before selected training sessions from 14 elite male swimmers during a 30-d period of intensive training. Prior infection with EBV was determined by EBV antibody serology. Salivary IgA concentrations were measured by enzyme linked immunosorbent assay (ELISA), and EBV viral shedding (EBV-DNA) was detected by polymerase chain reaction (PCR). Symptoms of upper-respiratory illness were recorded daily. Eleven swimmers (79%) were seropositive for prior EBV infection. Seven EBV seropositive swimmers (64%) had EBV-DNA detected during the study period. Upper-respiratory symptoms (URS) were reported in six of seven swimmers in whom EBV-DNA was detected and in three of four swimmers with no EBV-DNA detection. No URS were reported in the EBV seronegative swimmers. There was a statistically significant relationship between EBV serology status and URS (P = 0.027). EBV-DNA was detected in saliva before the appearance of URS. Salivary IgA levels were significantly lower immediately before the URS (P = 0.01) compared with subsequent peak IgA levels and declined to pre-URS levels on average 11 d after the first appearance of URS. The time course of appearance of EBV-DNA in relation to URS suggests latent viral EBV shedding may be a contributing factor in the URS. The low levels of salivary IgA detected before the URS indicated transient mucosal immune suppression in the study cohort. The viral shedding may alternatively be a reflection of the altered immune control mechanisms that occur in response to intensive exercise and unrelated to the URS.

Mending Broken Hearts: Effects of Expressive Writing on Mood, Cognitive Processing, Social Adjustment and Health Following a Relationship Breakup

Seventy-two male and 73 female undergraduates were randomly assigned to an experimental group, in which they wrote expressively about a relationship breakup, or to a control group, in which they wrote in a non-emotional manner about impersonal relationship topics. Control participants reported short-term increases in upper respiratory illness (URI) symptoms, tension and fatigue, whereas experimental participants did not. Further, higher levels of intrusive thoughts and avoidance were associated with short-term increases in URI symptoms in the control group, but were unrelated to URI symptoms in the experimental group. Finally, there was a trend ( p <0.06) suggesting that experimental participants were more likely to reunite with their ex-partner than were control participants. These findings indicate that expressive writing has a wide range of social, emotional, and physical health benefits for individuals coping with stressful events, particularly if they are experiencing ongoing intrusive thoughts and avoidance responses related to the stressor.

Pain and immunologic response to root canal treatment and subsequent health outcomes.

This study examined the effects of pain and stress associated with a dental procedure, root canal treatment (RCT), on natural killer cell cytotoxicity (NKCC) and the subsequent development of symptoms of upper respiratory illness during the following month. Patients (N = 33) were recruited from those scheduled for RCT appointments. Subjects for a non-RCT comparison group (N = 14) were also recruited from dental clinic patients. Peripheral blood was drawn by use of an indwelling catheter three times: just before RCT, 30 minutes after injection of a local anesthetic, and 30 minutes after RCT (a parallel time course was followed for the comparison group.) Blood was assayed for cortisol and NKCC. Subjects completed a health diary in the month after RCT. Patients showed a significant increase in NKCC between baseline and RCT and a significant decrease from RCT to after RCT, whereas the comparison group did not. The NKCC following the RCT was negatively correlated with the pain level during RCT (r = -0.48, p < .01) and pain levels 2 and 6 hours after RCT (r = -0.43, p < .05; r = -0.44 p < .05, respectively). The patient group reported significantly more illness episodes 2 weeks after RCT than the comparison group (Wilcoxon rank sum = 4.78, p = .03). Discriminant function analysis correctly classified 88% of the subjects into the illness category using predictor variables of post-RCT NKCC, stress, and pain levels during RCT (F(3,21) = 8.23, p < .001). Transitory changes in NKCC associated with pain and stress may be implicated in the development of infectious disease episodes after an acute stressful event.

Outbreak of pneumonia in a long-term care facility: antecedent human parainfluenza virus 1 infection may predispose to bacterial pneumonia.

To determine the causes of an outbreak of lobar pneumonia. Matched (1:2) case-control study. A 70-bed chronic care facility for older people. Residents of the facility. Ten residents developed pneumonia over a 10-day period. Two residents died. One case-patient had Streptococcus pneumoniae bacteremia; another had polymerase chain reaction evidence of S. pneumoniae infection. No other etiologic agent was identified. Only four of 10 case-patients had received routine diagnostic cultures of blood or sputum before the administration of antibiotics. Symptoms of upper respiratory illness (URI) among residents before the pneumonia outbreak corresponded with elevation of antibodies to human parainfluenza virus 1 (HPIV1). In a matched case-control study, six of 10 case-patients, compared with five of 20 controls, had symptoms of URI during the preceding month (matched odds ratio (MOR) = 4.5, 95% CI = 0.8-33). Nine case-patients had serum available, and five of these had both serologic evidence of recent HPIV1 infection and recent URI, compared with two of 18 controls (MOR = 9.0, 95% CI = 1.2-208). Only three residents had documentation of pneumococcal vaccination. Noninfluenza viral infections may play a role in the pathogenesis of some bacterial pneumonias. S. pneumoniae was the cause of at least two pneumonias; lack of preantibiotic cultures may have interfered with isolation of S. pneumoniae in others. Recent HPIV1 infection was epidemiologically linked to subsequently developing pneumonia. Spread of HPIV1 in the facility may have contributed to increased susceptibility to S. pneumoniae and, potentially, to other bacterial pathogens.

Individual differences in the diurnal cycle of cortisol.

This study investigated individual differences in the diurnal cycle of cortisol and explored their relation to several psychosocial variables and to upper-respiratory symptoms. Cortisol and daily experience were assessed for 2 days in 109 healthy employed and unemployed community residents (mean age = 36.4 +/- 12.1, 69% female); self-report upper respiratory illness (URI) symptoms were assessed for an additional 10 days. Fifty-six (51%) participants showed typical declines in cortisol during both days, 19 (17%) showed no significant diurnal pattern on both days, and 34 (31%) showed different diurnal patterns on the 2 days. Individuals with no cycles did not differ from those with normal or inconsistent cycles on demographic factors, baseline psychological measures, health behaviors, or daily experiences over the two assessment days. Individuals without cortisol cycles, however, reported fewer URI symptoms than the remaining subjects. That 17% of our sample did not exhibit diurnal cycles of cortisol was surprising, given established views of normal endocrine function. Although average daily level of cortisol is related to a number of psychosocial and psychiatric factors (e.g. stress and depression), pattern of diurnal cycle was not related to any demographic or psychosocial measures in this study. The finding that flat cycles were related to fewer reports of URI symptoms suggests that perturbations in cycle may be related to processes associated with symptom susceptibility or symptom expression.

Nursing in project Head Start: improving health.

The purpose of this study was to evaluate the effectiveness of a nurse-directed health promotion program in decreasing upper respiratory illness symptoms and injury rates in preschool children attending a Head Start (HS) program. The health promotion program presented to the Head Start staff consisted of signs and symptoms of childhood illnesses, infection control, injury prevention and first aid. The 47 children had their health evaluated by a registered nurse once per week for 4 weeks before the program and once per week for 4 weeks after the program. The children's health was evaluated using the Child Health Assessment Inventory. Symptoms of upper respiratory illness were significantly decreased after the intervention of the program. Injury rates increased, but further data analysis determined that 88% of the injuries had occurred at home.

Usefulness of empiric chest radiography and urinalysis testing in adults with acute sickle cell pain crisis

To determine the usefulness of obtaining routine chest radiographs and urinalyses on adults presenting to the emergency department in acute sickle cell pain crisis. The hypothesis tested is that in some adult sickle cell patients, sickle cell pain crises are precipitated or accompanied by acute infection that may be clinically occult and that routine screening for pulmonary or urinary tract infection would identify some of these precipitating illnesses. Prospective clinical study. A university hospital ED. All patients more than 14 years old with S-S, S-C, or S-beta-thalassemia sickle hemoglobinopathies who presented to the ED with acute nontraumatic painful complaints during a six-month period. All patients underwent posteroanterior and lateral chest radiography, routine urinalysis, and CBC count with reticulocyte count. A standard questionnaire for localizing symptoms of systemic, pulmonary, and urinary tract infection was completed for each patient. Urine cultures were ordered on all patients with voiding symptoms, flank pain, and/or more than 5 WBCs or RBCs per high-power field on urinalysis. Physical examination for evidence of pulmonary and urinary tract infection was carefully performed and recorded for subsequent analysis. Seventy-one patients with 134 ED presentations were studied over a six-month period. Eight diagnoses of acute pneumonia were made. Four of these patients complained of chest pain (50% vs 48% overall) and three had shortness of breath (38% vs 21%). None of these patients complained of fever or symptoms of upper respiratory illness. Ten diagnoses of urinary tract infection were made. Four of these patients complained of dysuria and frequency; three complained of flank pain. Eleven of the 18 infections (61.1%) did not have a typical history for or suggestive physical or laboratory findings of bacterial infection. In sickle cell disease patients with pain crisis, routine chest radiography and urinalysis may be clinically useful and cost effective in the early diagnosis of crisis-related infection.