Epidemiology of gastro-intestinal and respiratory tract diseases in rural areas of Varanasi (India)

The pattern of gastro-intestinal (GIT) and Respiratory tract (RTI) diseases in rural areas of the Varanasi district, U.P. (India) was studied from the outpatient (OPD) attendance between July 1985 to June 1986. Out of a total of new patients, 19.71% had respiratory diseases in contrast to 27.9% with GIT disease. A decreasing trend was observed in attendance rates as age advanced. The difference in age distribution of males and females was statistically significant. The attendance rates for GIT diseases were higher in female (29.16%) than in males (25.16%) whereas in RTI, the rates were higher in males (19.39%) than in females (18.77%). The attendance rate was found to be higher in rainy season (23.59%) followed by summer (14.50%). Diarrhoea (15.44%) and upper (URTI) respiratory tract infection (19.93%) occupied the major recorded episodes.     

Hospitalization rates for human metapneumovirus infection among 0- to 3-year-olds in Gipuzkoa (Basque Country), Spain

Numerous studies have been published on human metapneumovirus (HMPV) infection, but few have been population based. The main aim of this study was to estimate the incidence rate of hospitalization for community-acquired HMPV infection in infants and children aged <3 years. Between July 2004 and June 2007, 796 episodes (742 patients) of community-acquired acute respiratory infection were hospitalized. HMPV was detected in 90 episodes (11.3%). Fifty-nine episodes occurred in infants aged <1 year. The mean length of hospital stay was 6.2 days (range 2-31 days). Thirteen children required admission to the intensive care unit. Viral co-infections were detected in 46 episodes (51.1%). The incidence rate of hospitalization per 1000 inhabitants was 2.6 (95% CI 2.1-3.2), lower than that for respiratory syncytial virus, but higher than that observed for the influenza and parainfluenza viruses. HMPV is a major respiratory pathogen that leads to a high hospitalization rate.     

Pneumocystis jirovecii dihydropteroate synthase genotypes in immunocompetent infants and immunosuppressed adults, Amiens, France

To date, investigations of Pneumocystis jirovecii circulation in the human reservoir through the dihydropteroate synthase (DHPS) locus analysis have only been conducted by examining P. jirovecii isolates from immunosuppressed patients with Pneumocystis pneumonia (PCP). Our study identifies P. jirovecii genotypes at this locus in 33 immunocompetent infants colonized with P. jirovecii contemporaneously with a bronchiolitis episode and in 13 adults with PCP; both groups of patients were monitored in Amiens, France. The results have pointed out identical features of P. jirovecii DHPS genotypes in the two groups, suggesting that in these groups, transmission cycles of P. jirovecii infections are linked. If these two groups represent sentinel populations for P. jirovecii infections, our results suggest that all persons parasitized by P. jirovecii, whatever their risk factor for infection and the form of parasitism they have, act as interwoven circulation networks of P. jirovecii.     

Incidence of GP-diagnosed respiratory tract infections according to age, gender and high-risk co-morbidity: the Second Dutch National Survey of General Practice

BACKGROUND: Figures on GP-diagnosed respiratory tract infections (RTI) are outdated because of demographic changes and increase in co-morbid conditions, respiratory vaccination programmes and change in illness behaviour. OBJECTIVE: To determine the incidence of RTI in patients presenting to the GP according to age, gender and common high-risk co-morbidity in primary care. METHODS: In the Second Dutch National Survey of General Practice 90 computerized general practices with 358,008 patients recorded all consecutive patient contact by use of the ICPC coding system in a year. Incidences were calculated using the mid-year population in the denominator and RTI episodes as the nominator. RESULTS: In all, 4.2% of the patient population were diagnosed with RTI with an incidence rate of 144 per 1000 person-years. Upper RTI were more common in children of 0-4 years than in other year-cohorts [392 versus 80 per 1000; relative risk 4.9, 95% confidence interval (95% CI) 4.8-5.0]. An U-shape association was observed between age and lower RTI (78 and 70 per 1000 in children and persons aged 75 years or over, respectively, versus 23 per 1000 in other age-categories). Females had slightly higher incidence rates of URTI (relative risk 1.4, 95% CI 1.35-1.45) and similar rates for LRTI. Patients with chronic medical conditions as pulmonary and cardiac disease, and diabetes. DISCUSSION: A small proportion of the patient population present themselves to the GP with a RTI. RTI are more common among children, elderly persons and patients with pulmonary and cardiac disease, and diabetes of the ICPC coding system.     

Concentrated bovine colostrum protein supplementation reduces the incidence of self-reported symptoms of upper respiratory tract infection in adult males

Summary.Background: Anecdotal reports suggest that bovine colostrum may prevent upper respiratory tract infection (URTI). There is scant evidence to support such claims, although salivary IgA protects against URTI, and it was recently shown that bovine colostrum increases salivary IgA.Aim of the study: The present invesigation examined whether concentrated bovine colostrum protein (CBC) affected the incidence or duration of self-reported symptoms of URTI in adult males.Methods: We examined logbooks containing self-reported symptoms of illness from previous studies which examined physiological effects of CBC. In these double-blind, placebo controlled studies, subjects had been randomly allocated to consume 60g · day^–1 of CBC (n = 93) or whey protein (WP) (n = 81) for eight weeks. Symptoms were coded using established criteria to identify those related to URTI. Since the incubation period for an URTI is up to five days, symptoms reported during the first week of supplementation (PRE-EXP) were analysed separately to preclude those arising from infection prior to study commencement.Results: During PRE-EXP, there was no difference in the proportion of subjects taking the different supplements who reported symptoms of URTI (CBC, 11%,WP, 5%; 95% Confidence Interval (95% CI) –14% to 2%; P = 0.16). During the subsequent seven weeks (i. e. the experimental period), a significantly lesser proportion of subjects taking CBC reported symptoms of URTI compared with those taking WP (CBC, 32%,WP, 48%, P = 0.03; 95 % CI –30 % to –2 %), but symptom duration did not differ (CBC, 6.8 ± 4.2 days,WP, 6.0 ± 4.4 days; P = 0.27).Conclusion: This study provides preliminary evidence that CBC may enhance resistance to the development of symptoms of URTI.     

Iron supplementation improves iron status and reduces morbidity in children with or without upper respiratory tract infections: a randomized controlled study in Colombo,Sri Lanka

BACKGROUND: Iron deficiency anemia and recurrent infections are common among children of low socioeconomic status. OBJECTIVE: The objective was to evaluate the effects of iron supplementation on iron status and morbidity in children with or without infection. DESIGN: Children aged 5-10 y were recruited for a randomized, controlled, double-blind study from outpatients attending the Children's Hospital, Colombo, Sri Lanka. Clinical, inflammatory, nutritional, and iron statuses were determined at baseline and after the intervention. Children with a history of recurrent upper respiratory tract infections (URTIs) and with laboratory and clinical evidence of a current URTI constituted the infection group (n = 179), and children without infection constituted the control group (n = 184). Subjects in both groups were supplemented with ferrous sulfate (60 mg Fe) or placebo once daily for 8 wk. Morbidity from URTIs, the number of gastrointestinal infections, and compliance were recorded every 2 wk. RESULTS: The overall prevalence of anemia was 52.6%. Iron supplementation significantly improved iron status by increasing hemoglobin (P < 0.001) and serum ferritin (P < 0.001) concentrations from baseline values in the children with or without infection. There was no significant improvement in iron status in the children who received placebo. In both the infection group and the control group, the mean number of URTI episodes and the total number of days sick with an URTI during the period of intervention were significantly lower (P < 0.005 and P < 0.001, respectively) in the children who received iron supplements than in those who received placebo. CONCLUSION: Iron supplementation significantly improves iron status and reduces morbidity from URTIs in children with or without infection.     

The impact of climate on the prevalence of respiratory tract infections in early childhood in Lahore, Pakistan.

BACKGROUND: Respiratory tract infections are a major health problem in developing countries. The aim of this study was to analyse the impact of the climate on the prevalence of upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) in four socioeconomically different groups in a developing country. METHODS: A prospective cohort study was conducted among children in four socioeconomically different groups in Lahore, Pakistan. Monthly observations were made on 1476 infants born during 1984-1987 and followed for 24 months. Prevalence of URTI and LRTI was analysed according to age, area of living, family size, time of birth, the season of the year and climate variables such as rain, temperature and humidity. RESULTS: Low monthly average minimum day temperature was associated with high prevalence of URTI and LRTI. For LRTI the impact of temperature was larger for boys, children living in larger families and children living in the poorer areas. This pattern was not seen for URTI. A peak in prevalence for LRTI was shown at 5-6 months of age for LRTI and at 10-12 months of age for URTI. CONCLUSIONS: Temperature is related to prevalence of URTI and LRTI in a developing society. The effect of temperature on health varies between different subgroups. These effects should be considered in planning health actions to prevent respiratory tract infections.     

Invasive group B streptococcal disease in infants: a 19-year nationwide study. Serotype distribution, incidence and recurrent infection

During the period 1984-2002, 472 cases of invasive group B streptococcal (GBS) disease in infants aged 0-90 days in Denmark were registered. The overall incidence was 0.4/1000 live births. Most infants (73%) had early-onset GBS infection with 53% registered within the first day. Serotype III predominated (59%) with other serotypes as follows: Ia (16%), Ib (8%), NT (7%), II (6%), other serotypes (5%). Recurrence of GBS infection was registered in six infants, and the interval with no antibiotic therapy varied from 2 to 39 days. The serotypes of the isolates obtained from first and second episodes were identical (serotype III in five, and serotype Ia in one infant). Paired isolates were indistinguishable by PFGE and antibiotic susceptibility testing. Invasive GBS infections in infants are still a problem in Denmark, and recurrent infections are registered in 1% of these infants.     

Prevention of upper respiratory tract infections by gargling: a randomized trial

BACKGROUND: Gargling to wash the throat is commonly performed in Japan, and people believe that such hygienic routine, especially with gargle medicine, prevents upper respiratory tract infections (URTIs). Its effectiveness, however, has not been established by clinical trials. DESIGN: Randomized controlled trial carried out in 2002-2003 winter season and analyzed in 2003 and 2004. PARTICIPANTS: Healthy volunteers (387) aged 18 to 65 years. INTERVENTION: Participants were randomly assigned to water gargling, povidone-iodine gargling, and usual care (control). Subjects in the two gargling groups were requested to gargle with water or diluted povidone-iodine at least three times a day. Participants were followed for 60 days. MAIN OUTCOME MEASURES: The primary outcome measure was first URTI incidence. Severity of URTI symptoms among incident cases was also evaluated. Both outcomes were assessed with a self-administered symptom record. Analyses were performed on an intention-to-treat basis. RESULTS: A total of 130 participants contracted URTIs. The incidence rate of first URTI was 0.26 episodes/30 person-days among control subjects. The rate decreased to 0.17 episodes/30 person-days in the water gargling group, and 0.24 episodes/30 person-days in the povidone-iodine gargling group. Respective incidence rate ratios against controls were 0.64 (95% confidence interval [CI]=0.41-0.99) and 0.89 (95% CI=0.60-1.33). A Cox regression (proportional hazard model) revealed the efficacy of water gargling (hazard ratio=0.60, 95% CI=0.39-0.95). Even when a URTI occurred, water gargling tended to attenuate bronchial symptoms (p=0.055). CONCLUSIONS: Simple water gargling was effective to prevent URTIs among healthy people. This virtually cost-free modality would appreciably benefit the general population.     

Hospital-acquired infection surveillance in a neurosurgical intensive care unit

A prospective study on hospital-acquired infection (HAI) was undertaken in the eight-bed neurosurgical intensive care unit (NSICU) of a teaching hospital in Rome, Italy. All patients admitted for >48 h between January 2002 and December 2004 were included. The infection control team collected the following data from all patients: demographic characteristics, patient origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated micro-organisms and antibiotic susceptibilities. Overall, 323 patients were included in the study. Mean age was 55.5 years (range 17-91), and mean American Society of Anesthesiologists' score was 2.88. Seventy (21.7%) patients developed 132 NSICU HAIs: 43 pneumonias, 40 bloodstream infections (BSIs), 30 urinary tract infections (UTIs), 10 cases of meningitis associated with an external ventricular drain (EVD) and nine surgical site infections (SSIs). The SSI rate was high (5.6%), but a reduction was achieved during the three-year period. There were 7.2 bloodstream infection episodes per 1000 days of device exposure; 11.00 pneumonias per 1000 days of mechanical ventilation and 4.5 UTIs per 1,000 days of urinary catheterisation. Among patients with an EVD, the SSI relative risk was 11.3 [95% confidence intervals (CI) 4.2-30.6; P<0.01]. Sixty-one (18.9%) patients died. Logistic regression analysis showed that mortality was significantly associated with infection [odds ratio (OR)=2.28; 95%CI 1.11-4.71; P=0.02] and age (OR=1.04; 95%CI 1.01-1.06; P=0.002). Candida spp. were the leading cause of UTIs (40.0%) and the third most common cause of BSIs (12.7%). Antibiotic-resistant pathogens included meticillin-resistant staphylococci (77.5%), carbapenem-resistant Pseudomonas aeruginosa (36.4%), and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (75.0%). Although the overall incidence of infection (21.7%) was within the range of published data, the associated mortality, the increasing severity of illness of patients, and the emergence of multi-drug-resistant organisms shows the need to improve infection control measures.     

Rotavirus infection in Brazil: epidemiology and challenges for its control

Worldwide, rotaviruses account for 600,000 to 870,000 deaths per year among infants and young children. In Brazil, rotaviruses were first seen in 1976 by scanning electron microscopy of stool samples from diarrheic infants in Belém, Pará. Hospital-based studies have shown that rotaviruses are associated with 12-42% of cases of acute diarrhea. In addition, community-based studies yielded an average of 0.25 rotavirus-related diarrheal episodes per child per year. G types 1 to 4 account for about two-thirds of circulating strains, but the (unusual) P[8],G5 genotype has been claimed to cause over 10% of rotavirus diarrheal episodes. It has been shown that over 70% of children develop rotavirus antibodies by the age of 4-5 years. The tetravalent rhesus-human rotavirus vaccine (RRV-TV) conferred 35% protection according to a two-year follow-up study in Belém, Pará, Brazil, but reached an efficacy of 60% during the first year of life. RRV-TV was also shown to be 75% protective against very severe gastroenteritis in northern Brazil. Vaccination with RRV-TV has been suspended recently in the United States because of the detection of intussusception as a side effect. Therefore, further vaccine trials in Brazil will probably involve rotavirus candidate vaccines other than RRV-TV.     

Epidemiology and predictors of infant morbidity in rural Malawi

In rural Malawi, 703 newborns were visited monthly for 1 year to describe the epidemiology and health-seeking behaviour during acute episodes of diarrhoea, respiratory infections (ARI) and malaria. On average, the infants suffered from 1.3 annual episodes (11.0 illness days) of diarrhoea, 1.1 episodes (9.4 days) of ARI and 0.7 episodes (4.8 days) of malaria. Multivariate analysis with polychotomous logistic regression indicated that the amount of morbidity was associated with the child's area of residence, weight in early life, number of siblings, father's marital status and the source of drinking water. Diarrhoea and malaria were most common at 6-12 months of age and during the rainy months whereas respiratory infections peaked at 1-3 months of age and in the cold season. Ten per cent of diarrhoea, 9% of ARI and 7% of malaria episodes lasted for more than 14 days. Fifty-eight infants died, giving case fatality rates of 1% for diarrhoea, 2% for ARI and 4% for malaria. One-third (37%) of the illness episodes were managed at home without external advice. A traditional healer was consulted in 16% of episodes and a medical professional in 55% of episodes. If consulted, traditional healers were seen earlier than medical professionals (median duration after the onset of symptoms 0.7 vs. 1.8 days, P < 0.001). Traditional healers were significantly more commonly used by those families whose infants died than by those whose infants did not die (odds ratio 1.8, 95% CI 1.1, 3.0). Our results emphasise the influence of seasonality, care and living conditions on the morbidity of infants in rural Malawi. Case fatality for diarrhoea, ARI and malaria was high and associated with health-seeking behaviour among the guardians. Future interventions must aim at early and appropriate management of common childhood illnesses during infancy.     

西安地区儿童副流感病毒感染状况分析

【目的】 分析西安地区儿童副流感病毒(parainfluenza virus,PIV)感染情况及与中性粒细胞减少的关系。 【方法】 采用酶联免疫吸附(ELISA)法检测血清中副流感病毒特异性IgM抗体(PIV-IgM),血细胞分析仪检测外周血白细胞。 【结果】 1~6岁年龄组PIV感染阳性率较其他年龄组明显升高,1~3岁年龄组中性粒细胞减少症发生率较高,PIV感染与中性粒细胞减少的发生关系密切。 【结论】 西安地区儿童呼吸道PIV感染阳性率较高,常规进行病原血清特异性抗体检测有助于临床医生合理用药。     

Immunoglobulin A antibodies directed against Campylobacter jejuni flagellin present in breast-milk.

We studied the relationship between IgA anti-campylobacter flagellin antibodies in breast milk samples and protection of breastfed infants living in a rural Mexican village from campylobacter infection. There were fewer episodes of campylobacter infection (symptomatic and asymptomatic combined) in infants breastfed with milk containing specific anti-flagellin antibodies (1.2/child/year, 95% CI 0.6-1.8) versus non-breastfed children (3.3/child/year, 95% CI 1.8-4.8; P < 0.01). Infants breastfed with milk that was anti-flagellin antibody negative by ELISA also had fewer episodes of infection compared with non-breastfed children, but the difference did not reach statistical significance (1.8/child/year, 95% CI 0.7-3.0 versus 3.3/child/year, 95% CI 1.8-4.8, P > 0.05). Breastfeeding has a protective effect against campylobacter infection and is associated with the presence of specific antibodies directed against campylobacter flagellin.     

女性生殖道感染流行病学调查和阴道分泌物病征处理探索性研究

目的 调查深圳市各类育龄妇女生殖道感染（RTI）的流行情况及宫颈感染（淋病和衣原体感染）的影响因素。进而探索阴道分泌物病征处理方案的可行性。方法 2001年10月至2002年4月，分别针对深圳市三种不同类型的育龄妇女共4744名（其中3895名一般人群。438名有症状的妇科和性病门诊就诊者和411名高危人群）进行了妇科检查和各种RTI的实验室诊断调查，其中淋球菌和衣原体用PCR方法检测，同时使用结构式调查表收集研究对象婚育史，生殖道感染相关行为等，分析宫颈感染的相关危险因素。症状和体征，在此分析的基础上探索阴道分泌物的病征处理方案的形成和可行性。结果 深圳市一般人群中有27.6%的妇女患有至少一种生殖道感染。宫颈感染率为5.0%，分析发现近3个月有新性伴（OR=1.6,95%CI:1.1-2.4)，有人工流产史（OR=1.6,95%CI:1.1-2.4)。年龄小于25岁（OR=1.6,95%CI:1.1-2.4)，有人工流产史（OR=1.6,95%CI:1.1-2.4)。年龄小于25岁（OR=1.6,95%CI:1.1-2.4)。有人工流产史（OR=1.6,95%CI:1.1-2.4)。年龄小于25岁（OR=1.6,95%CI:1.1-2.4)和不使用避孕套（OR=1.7，95%CI：1.1-2.4)是宫颈感染的危险因素，危险评估和阴道分泌物异常体征对宫颈感染的灵敏度为63.8%，特异度为55.1%。阳性预测值为7.0%。结论 深圳市三类育龄妇女RTI感染均较多，其中高危人群的患病率最高，其次是门诊就诊人群。宫颈感染病征处理在一般人群中使用效果不能令人满意。     

Previous respiratory tract infections and antibiotic consumption in children with long- and short-term carriage of penicillin-resistant Streptococcus pneumoniae

Previous respiratory tract infections (RTI) and antibiotics consumption as possible risk factors for extended duration of PRP carriage were investigated in 24 children (cases) with previous carriage of penicillin-resistant pneumococci (PRP) for a duration exceeding 120 days (median 168 days) and a control group of 53 children with a duration of PRP carriage less than 90 days (median 21 days). The cases had experienced 0.99 episodes of acute otitis media (AOM) per life-year compared to 0.79 episodes in the controls (P = 0.32). For antibiotic-treated RTI other than AOM, the corresponding numbers were 0.49 and 0.29 episodes per life-year, respectively (P = 0.01). No differences in antibiotic consumption in the 3 months preceding the carriage, nor during the carriage period were noted. Other factors than impaired host defence to respiratory tract pathogens or antibiotics consumption seem to be more important in determining the duration of PRP carriage.     

Clinical and laboratory profile of febrile respiratory infections in general practice

BACKGROUND: Respiratory tract infection (RTI) is a common diagnosis in the primary care setting. The aim of the study was to characterize the clinical course and laboratory manifestations of febrile RTI in Israeli adults presenting to primary care clinics. METHODS: A prospective study over a 3-month winter period in 3 urban university primary care clinics of 122 consecutive adult patients seen by their family practitioners. All participants were interviewed and had chest radiographs, tests of oxygen saturation, and blood tests. RESULTS: Study group included 122 adults (mean age, 44.8 +/- 14.2 years; men, 38%). Fever lasted for a mean of 4.0 +/- 1.7 days, and the mean number of days off work/activities was 5.3 +/- 1.0. Pneumonia was clinically suspected in 33 patients (27%), but documented in 7 (6%). Antibiotics were given to 94 patients (77%). The group of treated patients had a lower mean oxygen saturation (P <.05) and a higher erythrocyte sedimentation rate (P <.05). Blood tests were found to be abnormal, although not clinically significant, in some patients, and all resolved spontaneously. CONCLUSIONS: RTIs are usually of short duration with a benign course where laboratory blood tests have no clinical implication. Radiographs may distinguish the 6% of patients having pneumonia from the 27% with suspected cases.     

Reduction of crying episodes owing to infantile colic: A randomized controlled study on the efficacy of a new infant formula

OBJECTIVES: The aim of this study was to evaluate the efficacy on crying episodes owing to infantile colic of a new infant formula containing partially hydrolysed whey proteins, prebiotic oligosaccharides (OS), with a high beta-palmitic acid content. DESIGN: Prospective randomized controlled study. SETTING: Italy. SUBJECTS: Two hundred and sixty-seven formula-fed infants, aged less than 4 months, with infantile colic, were randomized to receive either the new infant formula (study treatment (ST)) or a standard formula and simethicone (6 mg/kg twice a day) (control treatment (CT)). A questionnaire was given to parents to evaluate for 14 days the daily number of colic episodes and crying time. RESULTS: Out of the 199 infants who completed the study, 96 were treated with the new formula and 103 were not treated. Infants receiving the new formula had a significant decrease in colic episodes after 1 week (2.47+/-1.94 at day 7 vs 5.99+/-1.84 at the study entry) compared to infants receiving the CT (3.72+/-1.98 at day 7 vs 5.41+/-1.88 at the study entry) (P < 0.0001). Also at day 14, the crying episodes were significantly different between the two groups of infants (1.76+/-1.60 in ST vs 3.32+/-2.06 in CT) (P < 0.0001). CONCLUSIONS: The use of a partially hydrolysed formula supplemented with fructo- and galacto-OS induces a reduction of crying episodes in infants with colic after 7 and 14 days when compared with a standard formula and simethicone.     

Partial breastfeeding protects Bedouin infants from infection and morbidity: prospective cohort study

The benefits of exclusive breastfeeding for health in infants have been widely described. The goal of this study was to determine whether partial breastfeeding has protective effects against enteric infection and associated morbidity in population where early addition of supplementation is common. In this prospective study 238 Bedouin infants were followed from birth to age 18 months. Exclusive breastfeeding was protective against infection and morbidity at ages 0 to 3 months. In the age range of 4 to 6 months, partial versus non breastfeeding was associated with lower rates of infection with Cryptosporidium spp (Odds Ratio OR 0.34, 95% confidence interval CI 0.18; 0.65), and Campylobacter spp (OR 0.58, CI 0.35; 0.98), lower rates of ear infections (OR 0.47, CI 0.24; 0.90) and of asthma (OR 0.33, CI 0.13; 0.81). In older children (10-12 month age range) partial breastfeeding as compared to none, protected against infections with Cryptosporidium spp (OR 0.57, CI 0.36; 0.91) and Giardia lamblia (OR 0.92, CI 0.85; 0.99). In Bedouins, and possibly in other populations, even partial breastfeeding, especially at ages 4 to 6 months offers protection against infection. Thus, encouraging mothers to continue to at least partially breastfeed past age 3 months may help reduce infections and morbidity in infants.     

Stress and acute respiratory infection

To examine the relationship between stress and upper respiratory tract infection, 235 adults aged 14-57 years, from 94 families affiliated with three suburban family physicians in Adelaide, South Australia, participated in a six-month prospective study. High and low stress groups were identified by median splits of data collected from the Life Events Inventory, the Daily Hassles Scale, and the General Health Questionnaire, which were administered both before and during the six months of respiratory diary data collection. Using intra-study stress data, the high stress group experienced significantly more episodes (mean of 2.71 vs. 1.56, p less than 0.0005) and symptom days (mean of 29.43 vs. 15.42, p = 0.005) of respiratory illness. The two groups were almost identical with respect to age, sex, occupational status, smoking, passive smoking, exposure to air pollution, family size, and proneness to acute respiratory infection in childhood. In a multivariate model with total respiratory episodes as the dependent variable, 21% of the variance was explained, and two stress variables accounted for 9% of the explained variance. Significant, but less strong relationships were also identified between intra-study stress variables and clinically "definite" episodes and symptom days in both clinically definite and total respiratory episodes. Pre-study measures of stress emphasized chronic stresses and were less strongly related to measures of respiratory illness than those collected during the study. However, significantly more episodes (mean of 2.50 vs. 1.75, p less than 0.02) and symptom days (mean of 28.00 vs. 17.06, p less than 0.03) were experienced in the high stress group. In the multivariate analyses, pre-study stress remained significantly associated with total respiratory episodes and symptom days in total and "definite" respiratory episodes. In all of the multivariate analyses performed, sex (female) and age also appeared as important correlates of respiratory illness.