Upper Respiratory Tract Research Articles

Analyzing the characteristics of Otitis media with effusion following SARS-CoV-2 infection in China

ObjectiveThis study investigates the characteristics of Otitis Media with Effusion (OME) secondary to the SARS-CoV-2 pandemic, and examines whether SARS-CoV-2 is present in middle ear effusions (MEE).MethodsWe analyzed patients diagnosed with SARS-CoV-2 who presented with ear fullness between December 15, 2022, and January 20, 2023. After obtaining a detailed medical history and conducting audiometric assessments, we confirmed OME and performed tympanocentesis to test for SARS-CoV-2 in the MEE following informed consent. Post-procedure, patients received nasal decongestants and oral/nasal corticosteroids. Follow-up consultations, tympanic membrane examinations, and audiometric evaluations were conducted 2–4 weeks later, with a final assessment at three months.ResultsOur clinic recorded 311 OME cases during the study period, accounting for 9.5% of all patients—a significant increase from 2.2% the previous year and 2.5% the following year. The peak incidence occurred one week post-infection. Among the 311 patients, 52 underwent tympanocentesis (33 males, 19 females). 20 patients had bilateral onset, while 32 had unilateral onset. 31 patients were cured after a single tympanocentesis, whereas 21 required two or more procedures. 17 patients tested positive for SARS-CoV-2 in the MEE, but only one simultaneously tested positive in nasal secretions. At the three-month follow-up, 59.6% of patients were cured, 30.8% showed improvement without full recovery, and 9.6% had no improvement. Factors such as poor mastoid pneumatization, nasopharyngeal obstruction, and comorbidities (hypertension, diabetes) affected treatment efficacy. Among the 52 patients, 37 had conductive hearing loss (CHL), and 15 had mixed hearing loss (MHL).ConclusionsSARS-CoV-2 contributes to OME, primarily affecting one ear. The virus persists longer in MEE than in the upper respiratory tract, suggesting slower viral clearance in the middle ear compared to the nasopharynx. Conductive hearing loss (CHL) is the most common type post-infection, but mixed hearing loss (MHL) can also occur, particularly in older patients, with less favorable outcomes compared to CHL.

Marked reduction of SARS-CoV-2 infection and improved recovery following supplementation with a probiotic mix of four strains and two strains of Bifidobacterium breve in hamsters.

Our study investigated the potential benefits of specific probiotics in fighting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19). We tested two strains of Bifidobacterium breve selected based on their immune-boosting properties, along with a commercial mix of four probiotic strains chosen for its antiviral and immune-modulating effects. These probiotics were administered to hamsters over a week before and a week after infection. Supplementation with these probiotics significantly reduced the viral load in the upper respiratory tract and lungs, promoting recovery as demonstrated by the weight regain observed. In addition to reducing viral presence, the probiotics also helped lower inflammation and improved gut health by counteracting increased intestinal permeability. Our findings suggest that probiotics, particularly the mix of four strains, could support recovery from SARS-CoV-2 infection by reducing inflammation, viral load, and enhancing overall health.

Mechanism and clinical utility of abatacept in the treatment of rheumatoid arthritis.

Abatacept, a biological disease-modifying antirheumatic drug(bDMARD), has demonstrated unique and effective therapeutic properties for rheumatoid arthritis (RA). This review offers an in-depth examination of the mechanism by which abatacept exerts its effects in RA treatment and assesses its efficacy and safety based on a range of studies. We conducted a comprehensive search of PubMed, Embase databases, Web of Science, the Cochrane Library, MEDLINE, Wanfang Data, and CNKI from the time the databases were created until 30 July 2024. By modulating the CD28 and CD80/CD86 costimulatory signaling pathways, abatacept is instrumental in regulating immune cells and cytokines implicated in the pathogenesis RA. Longitudinal studies have highlighted its capacity to mitigate disease advancement and maintain joint functionality. The most frequently reported adverse effects associated with abatacept are headache, nausea, and upper respiratory tract infections, which are typically self-resolving. The incidence of serious infections was not high, mainly various types of bacterial pneumonia. Comparative safety analyses of abatacept with other DMARDs yield encouraging results. As our understanding of the mechanism of action of abatacept improves, we may be able to better identify appropriate biologic therapies and advanced combination therapies for RA patients and ultimately improve patient outcomes.

Factors Contributing to Refusal of Testing in the Pediatric COVID-19 Suspect Population

Background: Coronavirus has been declared a pandemic, and strategies like vaccination, social distancing, and extensive testing have played crucial roles in controlling its spread. Diagnosing COVID-19 in children is particularly challenging due to their susceptibility to upper respiratory tract infections. Studies have indicated that suspected patients often refuse COVID-19 testing.Objective: This study aimed to identify pediatric patients whose parents refused COVID-19 testing despite clinical symptoms and physicians' advice and to highlight significant factors contributing to this refusal.Material and Methods: A cross-sectional descriptive study was conducted at the Department of Pediatrics, Abbasi Shaheed Hospital, Karachi. After consent was obtained, data was collected from the parents of 146 pediatric patients suspected of having COVID-19 using a predesigned proforma. Both quantitative and qualitative data were analyzed.Results: The study showed that 78% (114) of parents refused COVID-19 testing for their children, while 22% (32) agreed. The primary reasons for refusal were: parents believing their child had another illness despite medical advice, fear of side effects, lack of knowledge, fear of quarantine, illiteracy, viewing COVID-19 as a social taboo, and fear of a positive test result.Conclusion: Illiteracy and lack of knowledge were major factors contributing to testing refusal and influenced other reasons as well. Through social and electronic media, it is essential to increase awareness and reduce the fear associated with the disease. Clinicians can play a significant role in educating parents. Enhancing awareness and alleviating fear may lead to greater testing acceptance, contributing to accurate disease statistics and benefiting future research.Keywords: COVID-19, Illiteracy Quarantine, Refusal, Testing.

Detection of Mycoplasma pneumoniae in hospitalized children with pneumonia in Laos

Mycoplasma pneumoniae has been described worldwide as an important cause of community-acquired pneumonia. From December 2013 to December 2014, 461 children admitted to Mahosot Hospital, Vientiane, Laos, with acute respiratory infection were investigated for upper respiratory microorganisms using probe-based real-time polymerase chain reaction (PCR) (FTD33). M. pneumoniae was detected by FTD33 in the upper respiratory tract of three patients, two girls and one boy, 5.7 and 3.9 years old and 13.6 years old, respectively. They presented with clinical features compatible with M. pneumoniae infection. They improved without M. pneumoniae directed therapy. The two girls were also positive for other potential pathogens. The boy had abnormal pulmonary auscultation, and one of the girls had significant anaemia. These results suggest that enhancement of diagnostic systems for M. pneumoniae detection is needed to improve understanding of the epidemiology of M. pneumoniae infection in Laos.

Community Education on Upper Respiratory Tract Infections and Peppermint Oil Inhalation Therapy

Upper respiratory tract infections (URTIs) is a condition in which a person suddenly expels air from the thoracic cavity through the epiglottis and mouth, usually accompanied by a cough with phlegm or no phlegm. Coughs and colds are common complaints experienced by children and adults, generally caused by viral infections such as influenza. The disease can affect the upper respiratory tract, including the lungs, nose and throat. Traditional treatments such as simple inhalation using peppermint oil can help alleviate URTI symptoms. This study aims to improve the community's understanding of the identification and traditional treatment of Acute Respiratory Infections (ARI), as well as assess the role of nurses in providing nursing care through simple inhalation therapy. In this activity, the nurse acts as a care giver who provides comprehensive nursing care, starting from assessment to evaluation. Based on the results of community service activities in Fampong Lam Neuheun, Kuta Baro, Aceh Besar, it is known that the community has gained a better understanding in recognizing the symptoms of URTI and performing traditional medicine appropriately.

Exploratory Safety Evaluation of Dupilumab Combined With Subcutaneous Immunotherapy in House Dust Mite-Sensitised Patients With Atopic Dermatitis: A Retrospective Case Series From Northern China.

Patients with atopic dermatitis (AD) are frequently sensitised to house dust mites (HDM). While Dupilumab is effective, the role of subcutaneous immunotherapy (SCIT) remains unclear. This study evaluated the safety and clinical outcomes of combined Dupilumab and SCIT in HDM-sensitised AD patients. In this retrospective study, 47 adults with HDM-sensitised AD received concurrent Dupilumab and HDM-SCIT for 48 weeks. Eczema Area and Severity Index (EASI) scores, total and HDM-specific IgE levels were monitored. Safety was assessed by adverse events related to SCIT and Dupilumab. EASI scores improved significantly from baseline (28.4 ± 6.9) to Week 12 (14.8 ± 4.5), Week 24 (12.7 ± 4.3) and Week 48 (5.2 ± 2.8). HDM-specific IgE (d1, d2) and total IgE decreased by Week 48 (p < 0.05). SCIT-related local and systemic reactions declined over time. Dupilumab-related conjunctivitis, head and neck dermatitis, and upper respiratory tract infections were transient and reduced during follow-up. The combination of Dupilumab and SCIT was well tolerated and associated with clinical improvement and IgE reduction in HDM-sensitised AD patients. These findings support further investigation in prospective controlled trials.

Central compartment of nasal cavity-derived MMP-9 enhances mixed-type 2 inflammation in eosinophilic chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is an inflammatory disease of the upper respiratory tract. Although previously classified based on the presence or absence of nasal polyps, it is now commonly classified by endotype. Eosinophilic CRS (ECRS) is based on type 2 inflammation and the formation of intractable nasal polyps with eosinophil infiltration. Endoscopic surgery is the preferred treatment modality; however, recurrent cases are common. The central compartment of the nasal cavity has been implicated in these recurrences. Notably, the middle turbinate is considered crucial, but discussions have primarily focused on its anatomical significance. To date, there lacks a biochemical perspective on the role of the middle turbinate in recurrence. In this study, we evaluated the role of the middle turbinate as a source of inflammation in ECRS. Differences in gene expression between ECRS and non-ECRS (NECRS) middle turbinates were evaluated using RNA sequencing. Gene changes induced by MMP-9 stimulation of human nasal epithelial cells were also evaluated by RNA sequencing. Comprehensive analysis showed an enhanced IL-4 signaling pathway in the ECRS middle turbinate. Additionally, gene expression of matrix metalloproteinase-9 (MMP-9) was higher in the middle turbinates of patients with ECRS than in those with NECRS (P=0.002). Furthermore, MMP-9 has been found to act on human nasal epithelial cells to enhance pathways such as IL-17, IL-6, and S100 family signaling. MMP-9 in the central compartment of the nasal cavity exacerbates ECRS by induction mixed-type 2 inflammation and airway remodeling.

Development and validation of a lateral flow immunoassay using colloidal gold for the identification of feline herpesvirus type 1

Feline herpesvirus type 1 (FHV-1) is a common and highly contagious pathogen in domestic cats that causes upper respiratory tract infections and ocular diseases. Accurate and rapid diagnosis of FHV-1 infections is essential for effective disease management and control. In this study, we developed an immunochromatographic lateral flow (ICLF) assay for the rapid and accurate detection of FHV-1-specific antibodies. The assay was founded upon the successful expression and purification of a 26 kDa recombinant glycoprotein B-glycoprotein D (gB-gD) fusion protein, which served as the primary antigen for the test. Rigorous testing for specificity and cross-reactivity confirmed the strip’s ability to exclusively detect FHV-1 antibodies, even in the presence of a variety of other feline viruses. The assay demonstrated excellent precision, reproducibility across dilutions, and long-term stability, retaining efficacy for 24 months during storage. Furthermore, clinical sample analysis revealed exceptional sensitivity (97%) and specificity (100%). In conclusion, the ICLF strip developed in this study represents a reliable, highly specific, and stable diagnostic tool for the rapid detection and management of FHV-1 infections in cats.

Safety, efficacy, and compliance of moderate-to-high dose eptinezumab and erenumab in chronic migraine patients with medication-overuse headache: an updated systematic review and meta-analysis

BackgroundThe use of monoclonal antibodies targeting Calcitonin Gene-Related Peptide (CGRP) is an established treatment for chronic migraine (CM). However, its efficacy in CM patients with medication overuse headache (MOH) remains underexplored, and data on the safety and patient compliance of standard-to-high doses, especially Eptinezumab and Erenumab, over at least three months are limited.ObjectiveThis study aims to evaluate the efficacy and safety of anti-CGRP therapy (Eptinezumab and Erenumab) in CM and MOH patients. Specifically, it assesses changes in monthly migraine days (MMDs) after 12 weeks, risk of treatment-emergent adverse events (TEAEs) leading to discontinuation, serious TEAEs, common adverse effects, and MOH remission at 6 months.MethodsA systematic search of PubMed, Cochrane, and Scopus databases identified randomized controlled trials (RCTs) evaluating standard or high dose anti-CGRP therapy in CM patients strictly with MOH. Studies included were required to report a ≥ 50% reduction in MMDs after ≥ 12 weeks, serious TEAEs, TEAEs leading to discontinuation, common adverse events, and MOH remission at 6 months. Heterogeneity was assessed using I² statistics and a random-effects model.ResultsThree RCTs with 769 patients receiving standard-to-high dose anti-CGRP monoclonal antibodies (Eptinezumab and Erenumab) for ≥ 12 weeks were included. Anti-CGRP therapy significantly increased the likelihood of a ≥ 50% reduction in MMDs compared to placebo (OR: 2.43; 95% CI: 1.68–3.51; p < 0.00001). No substantial differences were found in TEAEs leading to discontinuation, nasopharyngitis, upper respiratory tract infections, or serious TEAEs between the anti-CGRP and placebo groups. The likelihood of MOH remission was approximately double in the anti-CGRP group (OR: 1.97; 95% CI: 1.40–2.78; p = 0.0001).ConclusionStandard-to-high dose anti-CGRP therapies (eptinezumab, erenumab) effectively reduce monthly migraine days and improve MOH remission rates with minimal adverse effects, showing good tolerability in CM patients with MOH.

Frequency of Guillain-Barré Syndrome During the COVID-19 Pandemic: A Multicenter Study.

The incidence of Guillain-Barré syndrome (GBS) during the COVID-19 pandemic varies according to country. We investigated the changes in the number of patients with GBS and their characteristics who were reported in Tokyo in 2020 at the beginning of the COVID-19 pandemic, compared to those two years prior. Patients with GBS who were admitted between January 2018 and December 2020 to hospitals in Tokyo were retrospectively included. We collected data on preceding infections, clinical symptoms, spinal fluid test results, nerve conduction study results, and anti-glycolipid antibody levels. Thirty-four of 57 hospitals (59.6%) participated in this survey and reported 330 patients with GBS over three years. The number of patients in 2020 (n = 71) was significantly lower than in 2018 (n = 124) and 2019 (n = 135) (p = 0.0014). The number of patients with antecedent gastroenteritis (p = 0.03) or upper respiratory tract infections (p = 0.0003) in 2020 was significantly lower than the averages in 2018 and 2019. Analysis by subtype showed that the number of patients with Miller Fisher syndrome (p = 0.0009) and Bickerstaff brainstem encephalitis (p = 0.04) significantly decreased in 2020. The number of patients seropositive for anti-glycolipid antibodies, especially anti-GQ1b antibodies, decreased in 2020 (p = 0.0002). Infection control strategies during the COVID-19 pandemic resulted in fewer patients with preceding infections in Tokyo, which contributed to a decrease in the overall number of reported patients with GBS. Precautions for infection may reduce the frequency of patients with GBS.

Heat Abatement During the Pre-Weaning Period: Effects on the Nasal Microbiota of Holstein Male Calves.

Housing strategies to alleviate the negative effects of heat stress on the performance of pre-weaned dairy calves have become a focus of research in recent years. Experiments evaluating such strategies have focused on thermoregulatory responses, behavior, and performance. To date, no experiments have evaluated their effects on the microbiota of the upper respiratory tract. Understanding this relationship is crucial for assessing its impact on respiratory health, disease susceptibility, and calf well-being. We conducted an experiment to characterize nasal microbiota from calves housed outdoors, under a naturally-ventilated barn, with and without the provision of fans. The experiment was conducted in a commercial dairy in southern GA. Male Holstein calves (n = 60) were assigned randomly at birth (d 0) to 1 of 3 treatments: hutch outdoors with 50% of its area covered with plywood (control = 20), hutch in an open-sided barn with no supplemental cooling (SH = 21), and hutch in an open-sided barn with ceiling fans (SHF = 19), and followed until 68 d of age. Following the removal of obvious debris of the nostrils, nasal swabs were collected from all calves on week 5 (35 ± 8.9 d) and 9 (63 ± 3.2 d) of life and qPCR and 16S rRNA sequencing were performed. Treatment did not affect total bacterial 16S gene copy numbers or alpha diversity (i.e., Shannon and Simpson indexes) at 5 or 9 weeks of age. We observed differences, however, in the nasal microbiome structure at weeks 5 and 9 among treatments, with variations in the mean relative abundance (MRA) of certain bacterial genera. On week 5, SHF treatment had reduced MRA of Mycoplasma compared with control and SH treatments and greater MRA of Acinetobacter than calves in the SH treatment. On week 9, control calves had reduced MRA of Escherichia compared with SHF calves and greater Moraxella MRA compared with those in the SH and SHF treatments. We observed differences in nasal microbiome structure of pre-weaned dairy calves as a result of housing strategy. While the results presented herein suggest a potential link between housing conditions and the risk of respiratory disease, further research is necessary to investigate this hypothesis. Improved understanding of the impact of housing environment on respiratory health as well as on heat stress could help producers make informed management decisions to improve calf health and wellbeing.

Role of Respiratory Viruses in Severe Acute Respiratory Failure

Respiratory viruses are widespread in the community, affecting both the upper and lower respiratory tract. This review provides an updated synthesis of the epidemiology, pathophysiology, clinical impact, and management of severe respiratory viral infections in critically ill patients, with a focus on immunocompetent adults. The clinical presentation is typically nonspecific, making etiological diagnosis challenging. This limitation has been mitigated by the advent of molecular diagnostics—particularly multiplex PCR (mPCR)—which has not only improved pathogen identification at the bedside but also significantly reshaped our understanding of the epidemiology of respiratory viral infections. Routine mPCR testing has revealed that respiratory viruses are implicated in 30–40% of community-acquired pneumonia hospitalizations and are a frequent trigger of acute decompensations in patients with chronic comorbidities. While some viruses follow seasonal patterns, others circulate year-round. Influenza viruses and Pneumoviridae, including respiratory syncytial virus and human metapneumovirus, remain the principal viral pathogens associated with severe outcomes, particularly acute respiratory failure and mortality. Bacterial co-infections are also common and substantially increase both morbidity and mortality. Despite the growing contribution of respiratory viruses to the burden of critical illness, effective antiviral therapies remain limited. Neuraminidase inhibitors remain the cornerstone of treatment for severe influenza, whereas therapeutic options for other respiratory viruses are largely lacking. Optimizing early diagnosis, refining antiviral strategies, and systematically addressing bacterial co-infections are critical to improving outcomes in patients with severe viral pneumonia.

In vitro susceptibility profiles of invasive Candida bloodstream isolates to ten antifungal drugs in a southern area of China.

Introduction. In recent years, with the increase of drug resistance of Candida, the incidence rate and mortality of candidemia have gradually increased, which has brought a huge economic and health burden to people.Gap Statement. The epidemiological characteristics and antifungal drug sensitivity patterns in different regions have varied.Aim. To analyse the distribution and antifungal susceptibility of Candida strains isolated from bloodstreams and provide a basis for the use of antifungal drugs for treatment.Methodology. A total of 115 strains of Candida were collected from the bloodstream, and 28 strains of colonized Candida albicans were collected from the upper respiratory tract. Candida species were identified using matrix-assisted laser desorption/ionization time-of-flight technology. Antifungal susceptibility was assessed using broth microdilution combined with redox methods.Results. There were eight types of Candida strains isolated from the bloodstream; C. albicans was the most common species (36.5%), followed by Candida parapsilosis (24.3%), Candida glabrata (17.4%) and Candida tropicalis (14.8%). There was no significant difference in the resistance of C. albicans to azole drugs between the bloodstream infection group and the upper respiratory tract colonization group, but there was a significant difference in the MIC values of micafungin and fluconazole, with P values of 0.017 and 0.003, respectively. Amphotericin B and echinocandins are the most susceptible drugs for all Candida species, but the MICs of echinocandins against C. parapsilosis are significantly higher than those of other Candida species. Candida (except for C. glabrata) is highly resistant to azoles, with C. parapsilosis showing resistance rates of 89.3% and 82.1% to itraconazole and posaconazole, respectively; the resistance rates of C. tropicalis are 100% and 94.1%, respectively.Conclusion. C. albicans remains the predominant pathogen responsible for candidemia. Although the resistance of Candida to antifungals is relatively stable, there are significant differences in the MICs of antifungal drugs against Candida, indicating the importance of strain identification in the treatment of candidemia. For empirical treatment, the use of echinocandin drugs is recommended.

Influence of the properties of the elasticity modulus in the nasopharynx on the hydrodynamic characteristics of the flow in the upper respiratory tract

Influence of the properties of the elasticity modulus in the nasopharynx on the hydrodynamic characteristics of the flow in the upper respiratory tract

Mucosal vaccines with STING-agonist liposomal formulations inhibit RSV (respiratory syncytial virus) replication in cotton rats.

Mucosal vaccines with STING-agonist liposomal formulations inhibit RSV (respiratory syncytial virus) replication in cotton rats.

How air pollution and extreme temperatures affect emergency hospital admissions due to various respiratory causes in Spain, by age group: A nationwide study.

How air pollution and extreme temperatures affect emergency hospital admissions due to various respiratory causes in Spain, by age group: A nationwide study.

Identifying the most effective policies for minimising inappropriate use of antibiotics: A replicability study using three WHO datasets.

Identifying the most effective policies for minimising inappropriate use of antibiotics: A replicability study using three WHO datasets.

Determinants of community-acquired pneumonia among under-five children in Awi Zone, Northwest Ethiopia

BackgroundGlobally, community-acquired pneumonia is the leading cause of death in under-five children, accounting for 7.6 million deaths. Among these deaths, approximately 99% occur in low and middle-income countries. The present study aimed to assess the magnitude of community-acquired pneumonia and its associated factors among under-five children in Awi Zone.MethodsA community cross-sectional study was conducted on 1,368 participants from March to July 2023. A multistage sampling method was used. Data were entered into Epi-Data and exported to STATA for analysis. Bivariable and multivariable logistic regressions were used. Variables with a p-value of &amp;lt; 0.05 were considered statistically significant.ResultsThe percentage of community-acquired pneumonia among under-five children was 11.33% (95% CI: 9.75–13.12%). Primary education [AOR = 0.38; 95% CI:0.15, 0.95], stunting [AOR = 4.80; 95% CI: 2.31, 9.94], diarrhea [AOR = 3.75; 95% CI: 1.96, 7.18], acute lower respiratory tract infection [AOR = 14.57, 95% CI: 3.18, 66.78], acute upper respiratory tract infection [AOR = 9.06; 95% CI: 2.03, 40.42], and presence of separate kitchen [AOR = 0.38, 95% CI: 0.20, 0.72] were associated with community-acquired pneumonia.ConclusionIn this study, the percentage of community-acquired pneumonia was relatively high. Hence, we recommend adequate health education in areas such as nutritional intervention, the prevention and early treatment of diarrhea and acute respiratory tract infections (ARTI), and preventing indoor air pollution to reduce the risk of community-acquired pneumonia.

Causal relationships between air pollutants and upper respiratory tract infections: A two-sample, Mendelian randomization study.

Causal relationships between air pollutants and upper respiratory tract infections: A two-sample, Mendelian randomization study.