Type Of Respiratory Infection Research Articles

Association between oral microbiome and five types of respiratory infections: a two-sample Mendelian randomization study in east Asian population.

To explore the causal relationship between the oral microbiome and specific respiratory infections including tonsillitis, chronic sinusitis, bronchiectasis, bronchitis, and pneumonia, assessing the impact of genetic variations associated with the oral microbiome. Mendelian randomization was used to analyze genetic variations, leveraging data from genome-wide association studies in an East Asian cohort to identify connections between specific oral microbiota and respiratory infections. Our analysis revealed that Prevotella, Streptococcus, Fusobacterium, Pauljensenia, and Capnocytophaga play crucial roles in influencing respiratory infections. Prevotella is associated with both promoting bronchitis and inhibiting pneumonia and tonsillitis, with a mixed effect on chronic sinusitis. Streptococcus and Fusobacterium show varied impacts on respiratory diseases, with Fusobacterium promoting chronic sinusitis, bronchiectasis, and bronchitis. Conversely, Pauljensenia and Capnocytophaga are linked to reduced bronchitis and tonsillitis, and inhibited pneumonia and bronchitis, respectively. These findings underscore the significant impact of the oral microbiome on respiratory health, suggesting potential strategies for disease prevention and management through microbiome targeting. The study highlights the complexity of microbial influences on respiratory infections and the importance of further research to elucidate these relationships.

The Effects of Vitamin D Supplementation on Respiratory Infections in Children under 6 Years Old: A Systematic Review.

Childhood respiratory tract infections (RTIs) pose a significant health burden, especially in children under six years old. The main objective of this systematic review was to assess the effectiveness of vitamin D supplementation in the prevention of RTI in this population while also exploring potential effect modifiers such as age, baseline vitamin D status, and type of respiratory infection. A systematic review of the literature published up to February 2023 was conducted according to PRISMA guidelines, searching PubMed, Web of Science, Cochrane, and Scopus databases. Eight studies met the inclusion criteria, which investigated the association between vitamin D supplementation and respiratory infections in children between zero and five years old. The included studies were conducted between 2012 and 2021, encompassing a total of 2189 children from five randomized trials, two case-control studies, and one prospective cohort study. The relationship between vitamin D supplementation and the prevention of childhood RTI was not consistently observed across all included studies. Pooled results demonstrated varied effects of vitamin D supplementation on respiratory infection incidence, severity, and symptoms. Three studies reported statistically significant associations between low vitamin D levels and respiratory infections (OR = 4.90, OR = 6.97), while one study found that children who received vitamin D supplementation of 800 UI/day for 3 months during the cold season had fewer episodes of respiratory symptoms (RR = 0.55) and recovered more quickly from acute RTI. Lastly, according to one study, vitamin D intake < 80 IU/kg/day was significantly associated with the risk of acquiring pneumonia (OR 7.9) but not bronchiolitis. The remaining five studies found no statistically significant differences in infection rates or severity (p-value > 0.050). The available evidence on the effectiveness of vitamin D supplementation for preventing and treating respiratory infections in children under six years old is limited, with only a few favorable effects being reported. In some cases, a dose of 80 UI/kg/day was found to provide significant protection for acute respiratory infections, although in the major trials the only benefit was a quicker recovery and fewer respiratory symptoms, with no impact on incidence and severity of respiratory infections. Nevertheless, the study protocol, the supplementation dose, and duration of supplementation had significant variations between studies, leading to inconclusive findings.

X-Ray image-based COVID-19 detection using deep learning.

COVID-19 is a type of respiratory infection that primarily affects the lungs. Obtaining a chest X-ray is one of the most important steps in detecting and treating COVID-19 occurrences. Our study's goal is to detect COVID-19 fromchest X-ray images using a Convolutional Neural Network (CNN). This study presentsan effective method for categorizing chest X-ray images as Normal or COVID-19 infected. We used CNN, activation functions dropout, batch normalization, and Keras parameters to build this model. The classification method was implemented usingopen source tools "Python" and "OpenCV," both of which are freely available. The acquired images are transmitted through a series of convolutional and max pooling layers activated with the Rectified Linear Unit (ReLU) activation function, and then fed into the neurons of the dense layers, and finally activated with the sigmoidal function. Thereafter, SVM was used for classification using the knowledge from the learning model to classify the images into a predefined class (COVID-19 or Normal). As the model learns, its accuracy improves while its loss decreases. The findingsof the study indicate thatall models produced promising results, with augmentation, image segmentation, and image cropping producing the most efficient results, with a training accuracy of 99.8% and a test accuracy of 99.1%. As a result, the findings show that deep features provided consistent and reliable features for COVID-19 detection. Therefore,the proposed method aids in faster diagnosis of COVID-19 and thescreening of COVID-19 patientsby radiologists.

Antibiotic choice for respiratory infection in pediatric

Respiratory infection (RTI) is one of the leading factors of death in children in India. In most countries, RTI is a common cause of hospitalisation in children under five years old. There are different guidelines for management of various type of RTI. Most of these, emphasis on use of antibiotics in specific sub type of RTI. While literatures recommend avoiding antibiotic in viral infections, they mostly suggest beta lactams as first line drugs. Depends on patients, amoxicillin remains drug of choice for most of out-patients. In case of hypersensitivity to penicillin, cephalosporin commonly will be substituent. If specific and atypical organism found, need to switch to other type such as macrolides. In this research, we aimed to briefly review current guidelines and literatures regarding antibiotic selection in paediatrics suffering from different type of respiratory tract infection.

The threat of multidrug-resistant/extensively drug-resistant Gram-negative respiratory infections: another pandemic.

Antibiotic resistance is recognised as a global threat to human health by national healthcare agencies, governments and medical societies, as well as the World Health Organization. Increasing resistance to available antimicrobial agents is of concern for bacterial, fungal, viral and parasitic pathogens. One of the greatest concerns is the continuing escalation of antimicrobial resistance among Gram-negative bacteria resulting in the endemic presence of multidrug-resistant (MDR) and extremely drug-resistant (XDR) pathogens. This concern is heightened by the identification of such MDR/XDR Gram-negative bacteria in water and food sources, as colonisers of the intestine and other locations in both hospitalised patients and individuals in the community, and as agents of all types of infections. Pneumonia and other types of respiratory infections are among the most common infections caused by MDR/XDR Gram-negative bacteria and are associated with high rates of mortality. Future concerns are already heightened due to emergence of resistance to all existing antimicrobial agents developed in the past decade to treat MDR/XDR Gram-negative bacteria and a scarcity of novel agents in the developmental pipeline. This clinical scenario increases the likelihood of a future pandemic caused by MDR/XDR Gram-negative bacteria.

May Mutation of SNP rs1800947 Affects Length of Stay Outcome of COVID-19 suspects?

Coronavirus disease 2019 (COVID-19) is a new type of respiratory infection that first emerged in December 2019 in Wuhan, Hubei, China. COVID-19 is caused by a new type of virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to determine the association of SNP CRP rs1800947 gene in suspected COVID-19 patients to length of stay at Al Ihsan Hospital, and Banten Hospital in June-November 2020. This study used data from 60 patients, all patients were suspect COVID-19. The subject was 29 COVID-19 people were confirmed, whereas 31 people were not. A statistics analysis due to pearson correlation and linear multi regretion. This study found a significant assosiation between the subject. The results of this study were the relationship between SNP rs1800947 and outcome, a fairly strong association level relationship was found in the SNP rs1800947 (p-value= 0.045, association= 0.537). The association between length of stay and CRP levels has a low level of association (p-value=0.015, association=0.378). The SNP genotype rs1800947 G had a longer treatment duration of 0.14778 days compared to the SNPrs1800947 C genotype. CRP levels showed that higher CRP levels increased the length of treatment compared to normal CRP levels. Where high CRP levels are at risk of 0.6330 days longer than normal CRP while very high CRP is at risk of 2.9561 days longer than Normal CRP levels. In general, the gene SNP rs1800947 and CRP levels, together affect the outcome of patients with suspected COVID-19.

Taste Receptors: The Gatekeepers of the Airway Epithelium.

Taste receptors are well known for their role in the sensation of taste. Surprisingly, the expression and involvement of taste receptors in chemosensory processes outside the tongue have been recently identified in many organs including the airways. Currently, a clear understanding of the airway-specific function of these receptors and the endogenous activating/inhibitory ligands is lagging. The focus of this review is on recent physiological and clinical data describing the taste receptors in the airways and their activation by secreted bacterial compounds. Taste receptors in the airways are potentially involved in three different immune pathways (i.e., the production of nitric oxide and antimicrobial peptides secretion, modulation of ciliary beat frequency, and bronchial smooth muscle cell relaxation). Moreover, genetic polymorphisms in these receptors may alter the patients’ susceptibility to certain types of respiratory infections as well as to differential outcomes in patients with chronic inflammatory airway diseases such as chronic rhinosinusitis and asthma. A better understanding of the function of taste receptors in the airways may lead to the development of a novel class of therapeutic molecules that can stimulate airway mucosal immune responses and could treat patients with chronic airway diseases.

Detection of respiratory pathogens by application of multiplex PCR panel during early period of COVID-19 pandemic in a tertiary hospital in Central Taiwan.

BackgroundRespiratory tract infections (RTIs) represent a major cause of clinical visits worldwide. Viral epidemiology of RTIs in adults has been less studied compared to children. FilmArray respiratory panel (FA-RP), a multiplex, real time polymerase chain reaction method can simultaneously detect the nucleic acids of multiple pathogens. The purpose of this study is to analyze the epidemiology and clinical presentations of an RTI cohort.MethodsThis retrospective cohort study was conducted at China Medical University Hospital (CMUH) and China Medical University Children's Hospital (CMUCH), from January 2020 to June 2020. The FA-RP results were collected and analyzed according to upper versus lower RTIs.ResultsAmong 253 respiratory samples tested, 135 (53.4%) were from adults and 118 (46.6%) from children. A total positive rate of 33.9% (86/253) was found, with 21.48% (29/135) in adults and 48.31% (57/118) in children. Human rhinovirus/Enterovirus (HRV/EV) was detected in most of the age groups and was more common in URIs. HRV/EV was found as a frequent co-detection virus. Among children, HRV/EV was the most detected pathogen of URIs, while the most predominant pathogen in LRIs was Mycoplasma pneumoniae.ConclusionsFA-RP has the potential to improve the detection rate of respiratory pathogens. The positive rate of FA-RP was higher in children compared to adults, which likely corresponds to the higher incidence of viral RTIs in children. Different pathogens may lead to different types of respiratory infections.

Activation of Vasopressin System During COVID-19 is Associated With Adverse Clinical Outcomes: An Observational Study.

BackgroundActivation of the vasopressin system plays a key role for the maintenance of osmotic, cardiovascular, and stress hormone homeostasis during disease. We investigated levels of copeptin, the C-terminal segment of the vasopressin prohormone, that mirrors the production rate of vasopressin in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).MethodsWe measured levels of copeptin on admission and after days 3/4, 5/6, and 7/8 in 74 consecutive hospitalized adult COVID-19 patients and compared its prognostic accuracy to that of patients with community-acquired pneumonia (n = 876) and acute or chronic bronchitis (n = 371) from a previous study by means of logistic regression analysis. The primary endpoint was all-cause 30-day mortality.ResultsMedian admission copeptin levels in COVID-19 patients were almost 4-fold higher in nonsurvivors compared with survivors (49.4 pmol/L [iterquartile range (IQR) 24.9–68.9 pmol/L] vs 13.5 pmol/L [IQR 7.0–26.7 pmol/L]), resulting in an age- and gender-adjusted odds ratio of 7.0 (95% confidence interval [CI] 1.2–40.3), p < 0.03 for mortality. Higher copeptin levels in nonsurvivors persisted during the short-term follow-up. Compared with the control group patients with acute/chronic bronchitis and pneumonia, COVID-19 patients did not have higher admission copeptin levels.ConclusionsA pronounced activation of the vasopressin system in COVID-19 patients is associated with an adverse clinical course in COVID-19 patients. This finding, however, is not unique to COVID-19 but similar to other types of respiratory infections.

Could BCG Vaccination Indeed Have a Key Role for Reducing the Spread and Mortality of COVID-19 Worldwide?

Dear Editor, COVID-19 is a new type of respiratory infection and might lead to serious pneumonia causing acute respiratory distress syndrome (ARDS). Most people infected with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) manifest as having asymptomatic or mild to moderate upper respiratory tract disease. However, a minority of all can have severe course and even death, especially elderly patients.1 Here, one of the possible reasons, BCG vaccination and its impact, causing this difference in a population is delineated more. Can BCG vaccine reprogram natural (innate) immunity and decrease spread of COVID-19? Since the first use of BCG vaccine in Europe in the 1920s, a serious decrease in infant mortality has been reported. It is not likely to explain this decline only with the decrease in tuberculosis frequency. The reason for this decrease in infant mortality was reported to be associated with decline in neonatal sepsis and respiratory infections. In another study, this hypothesis was supported by showing that the frequency of respiratory syncytial virus (RSV) infection reduced in population after BCG vaccine.2 In a South African study, 70 percent of BCG vaccinated adolescents had a decrease in respiratory infections as well. BCG application also reduced influenza A viral load in mice through affecting macrophages. Similarly, BCG vaccine increased the cytokines and peritoneal macrophages against many unrelated pathogens in mice. In the healthy population, BCG vaccination increased the release of proinflammatory cytokines (eg. IL-1β, TNF-α and IL-6).3 Could BCG vaccine be a weapon in reducing the morbidity and mortality of COVID-19? The countries such as Italy, Holland and USA applying non-universal BCG vaccination policies, it is noteworthy that COVID-19 progresses more severely, compared to the countries following the universal policy. In epidemiological studies, the rate and death of COVID-19 in countries where BCG vaccination applied was also quite lower than non-vaccinated countries. Statistical evaluation of the current data of both European countries and countries in the Northern and Southern Hemisphere, the incidence and mortality of COVID-19 per population was also found lower in BCG-vaccinated countries. If same countries were separately assessed, BCG vaccination has not been performed in Italy, England and France where mortality of COVID-19 was higher. Nevertheless the mortality rates were relatively lower in the countries (Qatar, Saudi Arabia and China); whose BCG vaccination rates in 2018 were very high at 99%, 98%, 99%; respectively.4,5 Although there are differences in genetic, demographic, non-pharmacological measures, diagnosis and reporting between nations, possible inverse direct relation between BCG vaccination and COVID-19 looks interesting. Severity of SARS-CoV-2 infection in elderly might be due to long time past after the BCG’s positive effect on innate immunity. Consistently, COVID-19 often manifests as asymptomatic/mildly symptomatic since shorter time passed in younger than in the elderly after BCG vaccination.

Taste receptors in the upper airway.

Taste receptors were named for their originally-identified expression on the tongue and role in the sensation of taste (gustation). They are now known to be involved in many chemosensory processes outside the tongue. Expression of the receptors for bitter, sweet, and umami was recently identified in many organs, including the brain, airway, gastrointestinal tract, and reproductive systems. We do not yet know the full roles of these receptors in all of these tissues, nor do we know all of the endogenous ligands that activate them. However, taste receptors are emerging as potentially important therapeutic targets. Moreover, they may mediate some off target effects of drugs, as many medications in common clinical use are known to be bitter. The focus of this review is on recent basic and clinical data describing the expression of bitter (T2R) and sweet (T1R) receptors in the airway and their activation by secreted bacterial compounds. These receptors play important roles in innate immune nitric oxide production and antimicrobial peptide secretion, and may be useful targets for stimulating immune responses in the upper respiratory tract via topical therapies. Moreover, genetic variation in these receptors may play a role in the differential susceptibility of patients to certain types of respiratory infections as well as to differential outcomes in patients with chronic rhinosinusitis (CRS). CRS is a syndrome of chronic upper respiratory infection and inflammation and has a significant detrimental impact on patient quality of life. CRS treatment accounts for approximately 20% of adult antibiotic prescriptions and is thus a large driver of the public health crisis of antibiotic resistance. Taste receptors represent a novel class of therapeutic target to potentially stimulate endogenous immune responses and treat CRS patients without conventional antibiotics.

A study on distribution pattern of lower respiratory tract infections in children under 5 years in a tertiary care centre

Background: Respiratory infections are the leading cause of mortality in children below 5 years in India as well as worldwide. 16% mortality in children below 5 years is attributed to lower respiratory tract infection. Various factors influence the occurrence of the disease like environmental factors, lack of immunization, malnutrition. Present study was conducted to know the distribution pattern of lower respiratory tract infections, common pathogens associated with respiratory infections and risk factors associated with it. Methods: This study was conducted in Department of Pediatrics, KIMS Bangalore for a period of 1 year from January 2016 to December 2016. Total of 172 children admitted to ward and ICU with history suggestive of respiratory infection were included in the study after excluding congenital heart problems, congenital lung problems and immunodeficiency state.Results: In the present study, male predominance (59.3%) was observed. The incidence of respiratory tract infection was 17.5%. The common pathogen isolated was streptococcus pneumoniae. Most common respiratory infections included bronchopneumonia followed by bronchiolitis, croup, and lobar pneumonia. The common symptoms were cough, fever and hurried breathing. Anemia was observed in majority of them. Conclusion: Respiratory infections if timely managed, the mortality associated with it can be reduced. Pneumonia is a major killer disease in children below 5 years in India. Understanding the symptoms and signs and time of referral to tertiary centre not only reduces the mortality but it also reduces morbidity. So, it is important to create awareness among the health care personnel regarding common age of presentation of various types of respiratory infection and warning sign.

Prevalence of Carbapenemases among Klebsiella Pneumoniae Strains Isolated from Respiratory Tract Specimens

Background: The intensive use of carbapenems has resulted in the emergence of carbapenem-resistant isolates. Carbapenemase-producing Klebsiella pneumoniae has rapidly emerged as a major pathogen among carbapenemase-producing bacteria. Objectives: We aimed to characterize 28 Klebsiella pneumoniae strains isolated from respiratory specimens in Assiut University Hospitals, Egypt from May 2015 to August 2015. Methodology: We characterized the antimicrobial susceptibility profile of Klebsiella pneumoniae by disk diffusion method. Detection of carbapenemase genes (blaKPC-1, blaVIM-1, blaVIM-2, blaIMP-1, blaIMP-2, and bla-SPM-1) was performed by polymerase chain reaction. Results: Patients infected by Klebsiella pneumoniae experienced different types of respiratory infections. Carbapenemase genes were detected in 12 (43%) Klebsiella pneumoniae isolates. blaKPC-1 was found in 9 (32%) isolates, blaVIM-1 was detected in two (7%) isolates, and blaIMP-1 gene was expressed by two (7%) isolates. blaVIM-2, blaIMP-2, and blaSPM-1 genes were not expressed by any of the isolates. Carbapenemase-producing Klebsiella pneumoniae showed higher resistance rates to carbapenems and other antibiotics. Conclusion: The high resistance rates in our carbapenemase-producing strains impose limitations in the therapeutic options available. This should alert the medical authorities of our University to establish rigorous methods for more efficiently control the dissemination of antimicrobial resistance genes in the hospital environment.

Antibiotic use in early life and development of allergic diseases: respiratory infection as the explanation

Early antibiotic use has been postulated to increase the development of allergic disease. Antibiotic use results from infection. Early infection may play a confounding role in the relationship between antibiotic use and allergic disease. We aimed to investigate the relationship between antibiotic use during the first year of life and the development of allergic diseases in a birth cohort study, and also to carefully address the confounding effect of early respiratory infection. Three thousand three hundred and six children were included in this study who participated in investigations at all occasions of 2 months, 1, 4 and 8 years of age. Data on antibiotic use and respiratory infections were collected at the age of 1 year. Diagnoses of allergic diseases at 4 and 8 years of age were derived from the follow-up questionnaires. During the first year of life, 43% (n=1420) of the children received antibiotics and 32% (n=1046) of the children had at least one type of respiratory infection among pneumonia, bronchitis and otitis. In univariate logistic regression analysis and after adjustment for early life factors, antibiotic use during the first year of life was associated with wheeze, asthma, eczema and food hypersensitivity at 4 years of age. After adjustment for the above respiratory infections during the first year of life, only the associations with wheeze and asthma at age 4 years remained statistically significant. These associations became non-significant in a subgroup analysis in children without early allergic signs. At age 8 years, antibiotic use during the first year of life was significantly associated with wheeze and eczema after adjustment for early life factors. The significant associations at age 8 years faded away following further adjustment for the respiratory infections. Our study indicated that the association between early antibiotic use and later allergic disease could at least partially be explained by early respiratory infection.

Immunization and health workers: overview

The need for effective defences against attack by pathogens is a key requirement for all workers particularly in the health care setting where there is the everpresent risk of nosocomial infection. In a review conducted between 1983 and 1996, .15 different types of respiratory infections were documented as having been acquired by health care workers in the occupational setting [1], and in the recent severe acute respiratory syndrome (SARS) outbreak up to 10% of infections were occupationally acquired. Protection against such infections is based on appropriate isolation of the patient and effective precautions for the worker (including hand hygiene); for a smaller number of infections, specific vaccinations provide an additional protective measure. The first article in this series of three will look at the use of vaccination in the occupational health setting. Paper 1 will review both the innate and adaptive responses to invading pathogenic microorganisms and the mechanisms of recognition and elimination of invading pathogens as these are also the basis for the immunization process. Paper 2 will consider active and passive immunity and the types of vaccines used in the occupational health setting; it will then explore adaptive responses with particular reference to immunization in the occupational health setting. Paper 3 provides an update on current practice in relation to immunization of health care workers. Updates on vaccine safety assurance are discussed in particular focusing on influenza, chickenpox and hepatitis B vaccines.

The four ages of Down syndrome

Down syndrome (DS) affects approximately 1 per 650-1000 live births and is the most common known genetic cause of intellectual disability. A highly significant change in the survival of people with DS has occurred during the last two generations, with life expectancy estimates increasing from 12 to nearly 60 years of age. Detailed information on 1332 people in Western Australia with DS was abstracted from a specialist statewide database for the period 1953-2000 and electronically linked with three other state or national health and mortality data sources and the state Birth Defects Registry. Over the last 25 years the percentage of women over 35 years giving birth increased from 4.8 to 18.6%, accompanied by an increase in the overall prevalence of DS from 1.1 to 2.9 per 1000 births. Four life stages of DS were identified: prenatal, childhood and early adulthood, adulthood, and senescence. Although pneumonia, or other types of respiratory infections, was the most common cause of death across the entire lifespan, ranging from 23% of deaths in adulthood to 40% in senescence, each life stage exhibited a particular profile of comorbidities. Congenital heart defects were common causes in childhood (13%) and adulthood (23%), whereas in senescence coronary artery disease (10%) and cardiac, renal, and respiratory failure (9%) were leading causes of mortality. A major re-appraisal in attitudes towards DS is required to ensure that the medical and social needs of people with the disorder are adequately met across their entire lifespan. In particular, specific recognition of the comorbidities that can arise at different ages is needed, accompanied by the provision of appropriate levels of care and management.

Neutrophil alkaline phosphatase activity in respiratory viral infection

Neutrophil alkaline phosphatase (NAP) is used as a diagnostic marker in several hematological disorders. In regard to the role of NAP in infectious diseases, previous investigators have presented the hypothesis that NAP activity is useful to distinguish viral infections from bacterial infections. Because the numbers of patients enrolled in previous studies of viral infections were limited, we intended to evaluate the hypothesis by measuring NAP activity in a large number of pediatric patients with respiratory viral infections. A cytochemical analysis of NAP was performed in 160 patients with various types of respiratory infections. In patients with adenovirus or respiratory syncytial (RS) virus infection, NAP activity was significantly higher than the control value newly established at our department, while in patients with Epstein-Barr virus, measles, or influenza infection, it was comparable to the control value. On an individual basis, NAP scores (determined from NAP cytochemical activity) in 22 of 26 patients (84.6%) with adenovirus infection, and 31 of 42 patients (73.8%) with RS virus infection were found to exceed the 95% confidence upper limit of the control group. In conclusion, NAP activity is quite varied among different respiratory viral infections. When NAP activity is high in respiratory infections, adenovirus or RS virus infection, as well as bacterial infections, should be taken into consideration.

Neutrophil alkaline phosphatase activity in respiratory viral infection

<h2>Abstract</h2> Neutrophil alkaline phosphatase (NAP) is used as a diagnostic marker in several hematological disorders. In regard to the role of NAP in infectious diseases, previous investigators have presented the hypothesis that NAP activity is useful to distinguish viral infections from bacterial infections. Because the numbers of patients enrolled in previous studies of viral infections were limited, we intended to evaluate the hypothesis by measuring NAP activity in a large number of pediatric patients with respiratory viral infections. A cytochemical analysis of NAP was performed in 160 patients with various types of respiratory infections. In patients with adenovirus or respiratory syncytial (RS) virus infection, NAP activity was significantly higher than the control value newly established at our department, while in patients with Epstein-Barr virus, measles, or influenza infection, it was comparable to the control value. On an individual basis, NAP scores (determined from NAP cytochemical activity) in 22 of 26 patients (84.6%) with adenovirus infection, and 31 of 42 patients (73.8%) with RS virus infection were found to exceed the 95% confidence upper limit of the control group. In conclusion, NAP activity is quite varied among different respiratory viral infections. When NAP activity is high in respiratory infections, adenovirus or RS virus infection, as well as bacterial infections, should be taken into consideration.

PAR5: DIRECT AND INDIRECT COSTS OF RESPIRATORY INFECTIONS

OBJECTIVES: Morbidity due to respiratory infections leads to significant adverse societal and economic consequences. This study investigates the extent to which treatment for respiratory infections imposes a financial burden on an employer, and documents variations in employer payments between specific respiratory infections. METHODS: The data source is a rich administrative claims database for a national, Fortune 100 manufacturer. It includes 1997 medical, pharmaceutical, and disability claims for employees, spouses, dependents, and retirees (n> 100,000) under age 65. The research sample consists of individual patients with one or more medical or disability claims for at least one of eleven respiratory infection condition. Resource utilization is contrasted with a 10 percent random sample of the employer's overall beneficiary population. RESULTS: Direct (medical and pharmaceutical) and indirect (disability and sporadic absenteeism) costs are analyzed. The average per capita annual costs are: for the entire employer population, $2,368; for all respiratory infections patients, $4,397; and for respiratory infections employees eligible for disability, $6,838. Total costs for respiratory infections patients are 1.8 times those for the typical beneficiary. Total costs are highest for patients with pneumonia ($11,544) and lowest for patients with acute tonsillitis and acute pharyngitis ($2,180). Medical and pharmaceutical treatment account for 65% of total costs for all respiratory infections employees, while the remaining 35% of costs are attributable to disability and sporadic absenteeism. CONCLUSIONS: Respiratory infections impose a significant financial burden on the employer. Resource utilization by respiratory infections patients is substantial, not only for the direct treatment of respiratory infections, but also for the treatment of co-morbid medical conditions of respiratory infections patients. These costs also vary considerably by type of respiratory infection. The study also shows that respiratory infections impose substantial indirect costs on employers from work loss associated with these infections.

Assessment of Antibiotic Prescription in Acute Respiratory Infections in Adults

Objective: This study aims to ascertain the variability in the use of antibiotics for the treatment of acute respiratoryinfections in several hospital emergency services in Spain, as well as the appropriateness of antibiotics prescription through evaluation by a panel of experts using available scientific evidence.Method: A cross-sectional study was carried out in the emergency services of 10 hospitals in different Spanish regions. We chose patients diagnosed as having acute respiratory infection, aged over 14 years. Among the collected variables were: type of respiratory infection, antibiotic prescription, comorbidity, qualification of the prescribing doctor andhospital admission. The consensus conference held by a panel of experts established first choice treatment and the alternative and inappropriate use for each respiratory infection, based on the available scientific evidence. All the observed prescriptions in our study were classified according to this pattern.Results: A sample of 2899 acute respiratory infections was studied (5.5% of all emergencies). Antibacterial agenttreatment was prescribed in 82.6% of these, varying according to the infection between 98.5% of pneumonias and 49% of croup-influenza-common cold. The most commonly used antibiotics were amoxicillin-clavulanate and cefuroxime. The global percentage of inappropriate prescription was 40.5% (95% CI; 35.4–45.5). The prescriptions were inappropriate in 16.9% of cases of pharyngotonsillitis, 17.8% of chronic bronchitis, 26.9% of acute bronchitis, 29.3% of pneumonias, 30.8% of otitis and sinusitis and in 70.8% of croup, flu, common cold and non-specified infections. Significant variability among participating centres was observed, both in choice of antibiotics and in their degree of appropriateness.Conclusions: There is excessive use of antimicrobial drugs in acute respiratory infections, and the majority are used for viral infections. There is indiscriminate use of broad spectrum antibiotics, which are valid in some infections but clearlyinappropriate in others. Similarly, there are important differences in the choice of antibiotics and their degree ofappropriateness among hospitals.