Discomfort and disability in upper respiratory tract infection

Ambulatory patients with upper respiratory infection were studied to determine the relative contributions made by tissue pathology, psychologic and perceptual attributes, and demographic characteristics to reported discomfort and disability. Patients (n=115) attending a medical walk-in clinic completed self-report questionnaires to assess somatization, anxiety, depression, hostility, amplification, discomfort, disability, and demographic characteristics. Clinicians rated the extent of disease apparent on physical examination. Using stepwise multiple regression, demographic factors and physical findings explained 25% of the variance in reported discomfort. The addition of somatization scores increased the variance explained to 49%. The best model, including somatization and amplification, accounted for 54% of the variance. A model composed of demographic characteristics, physical findings, and somatization accounted for 25% of the variance in reported disability. The authors conclude that psychologic variables are important in the experience of discomfort, even after the extent of physical disease and demographic characteristics have been taken into account. Received from the Primary Care Program of the General Internal Medicine Unit, Department of Medicine, and the Department of Psychiatry; Massachusetts General Hospital and Harvard Medical School; Boston, Massachusetts. This study would not have been possible without the careful data collection of Robert Sorcher and the ongoing statistical consultation of Harriet Peterson and Paul Cleary.     

孕妇上呼吸道感染与TORCH感染的相关研究

目的探讨孕妇上呼吸道感染与TORCH感染的相关性。方法采用ELISA法检测165例上呼吸道感染孕妇的TORCH IgM,同期选择180例正常无上呼吸道感染的孕妇作为对照组。结果上呼吸道感染孕妇的TORCH IgM(+)总阳性率为10.30%(17/165),显著高于对照组TORCH IgM(+)总阳性率3.33%(6/180)(P<0.05)。结论有上呼吸道感染的孕妇是TORCH感染筛查的高危人群。     

Inhaled corticosteroid for persistent cough following upper respiratory tract infection

OBJECTIVE: The aim of this study was to determine the clinical effect of inhaled corticosteroid treatment for persistent cough, post upper respiratory tract infection (URTI) in previously healthy individuals, and on bronchial hyperresponsiveness (BHR). METHODOLOGY: This was a prospective, randomized, double-blinded, placebo-controlled study conducted at a university hospital. A total of 30 non-asthmatic, non-smoking patients who were >15 years old and who had persistent post-URTI cough for >3 weeks were assessed by a physical examination, CXR and spirometry, and were allocated to receive inhaled budesonide (400 microg/puff, twice daily) or placebo for 4 weeks. If a patient suffered from sinusitis, it was a requirement that it had been well treated. A symptom score (frequency of cough, frequency of coughing bouts, symptoms associated with cough, night-time cough, frequency of taking medications to relieve cough, and number of medications) was recorded at entry, and after 2 and 4 weeks of treatment. A methacholine challenge test was performed at entry and after 4 weeks of treatment. RESULTS: The mean symptom scores for the treatment group (9.4) and the placebo group (9.8) at baseline were not significantly different (P=0.79), and no differences were found between the groups after week 2 and week 4 of treatment (3.93 and 4.27 vs 2.26 and 2.66, P=0.29). The mean change in symptom scores from baseline to week 2 and to week 4 of treatment were also not different between groups (5.93 and 5.6 vs 7.00 and 7.58, P=0.23). No difference between groups was found in the mean changes in FEV(1), FVC, and FEF(25--75%) after 4 weeks of treatment. A positive bronchial provocation test occurred in three patients (10%) but these were borderline. CONCLUSION: Inhaled corticosteroid is ineffective in treating persistent post-URTI cough in previously healthy individuals.     

疏风解毒胶囊治疗老年急性上呼吸道感染的前瞻性研究

目的研究疏风解毒胶囊治疗老年急性上呼吸道感染的临床效果。 方法于2010年5月至2012年4月4所研究中心按照入排标准共纳入120例患者,对诊断明确的上感患者服用疏风解毒胶囊治疗4粒,3/日,连服3天,记录治疗前、治疗中、治疗后生命体征及发热、咽痛、头胀痛、鼻塞、流浊涕、咳嗽、咽黏膜充血等症状变化。分别对疾病疗效、体温疗效及单项症状疗效(分为痊愈、显效、有效、无效)行统计学分析,并进行量化评分,评价其安全性。 结果最终完成试验114例,其中男性54例,女性60例;疗效分析示总有效率94.7%(108/114),治疗3天后93.8%(107/114)患者体温恢复正常,中位体温起效时间为4.0 h。单项症状观察指标变化结果显示,咽痛、咳嗽、头胀痛、鼻塞、流浊涕和咽黏膜充血治疗总有效率(例)分别为：82.4%(94/114)、82.4%(94/114)、81.6%(93/114)、79.2%(89/114)、79.2%(89/114)和79.2%(89/114)。进一步量化分析后显示对发热、咽痛缓解明显,咳嗽、头胀痛、鼻塞、流浊涕和咽黏膜充血也有较好的缓解效果。对体温、呼吸频率、舒张压亦有改善。 结论疏风解毒胶囊对于老年急性上呼吸道感染有显著的治疗效果,可作为老年急性上呼吸道感染的选择。     

Cough induced by airway vibration as a model of airway hyperreactivity in patients with acute upper respiratory tract infection

Patients with acute upper respiratory tract infection (URTI) have been shown to be hyperreactive to inhaled tussigens such as citric acid and capsaicin, and the authors propose that this may be due to an increased sensitivity of airway receptors that mediate cough. In recent studies we have demonstrated that cough may be induced by vibration of the airway at the level of the throat or chest in patients with URTI but that the same stimuli induce little or no cough in healthy subjects. The difference between the patients with URTI and healthy subjects in their response to airway vibration may be explained on the basis of hyperreactivity of airway sensory receptors. We propose that the model of cough induced by airway vibration may be useful for studies on the pathophysiology and pharmacology of airway hyperreactivity in acute cough. The airway vibration model of cough may have some advantages over inhaled tussigens as the stimulus is easily controlled and the method is safe for use in children.     

老年糖尿病患者医院内获得性下呼吸道感染痰培养病原学分析

目的 探讨老年糖尿病患者医院内下呼吸道感染的临床特点及病原学情况。方法 回顾性调查85例老年糖尿病合并医院获得性下呼吸道感染患者的临床资料，分析病原学及细菌耐药性的特点与糖代谢的关系。结果 老年糖尿病患者下呼吸道感染的病原菌以革兰阴性杆菌为主，占73．9％，主要为铜绿假单胞菌18．2％、肺炎克雷伯菌15．9％、大肠杆菌14．8％。2种细菌混合感染占14．1％，细菌与真菌并存占6．8％。药物敏感试验提示：革兰阴性杆菌对抗菌素的敏感性依次为头孢他啶(Ceftazidime)72．3％、氧氟沙星(Ofloxacin)70．8％、头孢曲松(Ceftriaxone)63．1％、头孢噻肟(Cefotaxime)61．5％、头孢哌酮(Cefoperazone)61．5％、头孢唑啉(Cefazolin)60．O％、哌拉西林(Piperacillin)53．8％。革兰阳性球菌对万古霉素100％敏感。对青霉素、红霉素、四环素等呈现不同程度的耐药，耐药率在55％以上。血糖控制不好、基础疾病复杂、伴有并发症的老年糖尿病患者在医院内下呼吸道感染增多，且预后不良。结论 糖尿病患者中医院获得性下呼吸道感染常见，病原菌以革兰阴性杆菌为主，应参考药物敏感试验结果并在控制血糖的基础上进行抗炎治疗。     

The role of quinolones in upper respiratory tract infections

Fluoroquinolones are widely used in clinical practice because of their advanced pharmacokinetic properties, potential activity against most bacterial species, excellent clinical responses, and few side effects. Quinolones have no role in the treatment of pharyngitis or simple otitis media. Until recently, the available fluoroquinolones were not indicated for the treatment of acute purulent sinusitis because of their perceived inactivity against Streptococcus pneumoniae. Although not generally considered to be drugs of first choice, older quinolones have efficacy similar to that of cephalosporins and β-lactams in randomized clinical trials. Well-conducted clinical trials have shown that the new fluoroquinolones are as effective as standard comparators in patients with suspected or proven acute bacterial sinusitis and may allow shorter treatment. Ciprofloxacin remains the fluoroquinolone of choice for chronic otitis media and malignant otitis media. The new “respiratory“ fluoroquinolones have microbiologic and pharmacokinetic advantages over the older agents. Clinical trials have confirmed clinical activity, but superiority compared with older agents has not been conclusively shown. Trials devised to demonstrate clinical or pharmacoeconomic benefits are still required.     

The role of Chlamydia in upper respiratory tract infections

Although Chlamydia pneumoniae and Chlamydia psittaci are well-established causes of community-acquired pneumonia, little is known about the role of Chlamydia species in upper respiratory tract infections. C. pneumoniae may play a role in the pathogenesis of acute otitis media. Although C. pneumoniae has been isolated from the middle-ear fluid of children with otitis, children in whom the organism was isolated from middle-ear fluid improved despite being treated with antibiotics that are not active against C. pneumoniae. Although many patients with community-acquired pneumonia caused by C. pneumoniae have symptoms suggestive of sinusitis, there is only one report of isolation of the organism from the maxillary sinus of a patient with sinusitis. Studies of the association with pharyngitis are all based on serology, which often has a poor correlation with isolation of the organism by culture.     

78例传染性非典型肺炎病例临床分析

目的　分析传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)患者的临床特点 ,并对其诊断标准和治疗方法进行探讨。方法　对广州呼吸疾病研究所 2 0 0 2年 12月 2 2日至 2 0 0 3年 3月 31日收治的 78例SARS患者的临床、实验室、影像学资料进行回顾性分析。结果78例SARS患者 :男 4 2例 ,女 36例 ;年龄 2 0～ 75岁 ,平均 (37 5± 11 6 )岁 ;医务人员 4 4例 (5 6 % )。临床症状包括 :发热 (10 0 % )、咽痛 (17% )、咳嗽 (88% )、气促 (80 % )、畏寒 (5 9% )、肌肉酸痛 (41% )。血常规 :白细胞 (WBC) <4 0× 10 9/L 12例 (15 % ) ,WBC(4 0～ 10 0 )× 10 9/L 4 9例 (6 3% ) ,WBC >10 0× 10 9/L 17例 (2 2 % ) ,平均为 (7 6± 5 0 )× 10 9/L ;中性粒细胞为 0 75± 0 14 ,淋巴细胞 0 18±0 11。胸部X线和CT显示肺部斑片状阴影 ,短期内病灶增多 ,累计单侧 2 3例 (30 % )、双侧 5 2例(6 7% )。分析医护人员被感染途径 ,提示本病具有较强的飞沫近距离传染特性。出现急性肺损伤(ALI) 37例 (47% ) ,其中发展为急性呼吸窘迫综合征 (ARDS) 2 1例。 7例死亡患者均为ARDS合并有多器官功能衰竭综合征 (MODS)。结论　流行病接触史、发热、X线肺炎征及白细胞计数正常或减少是诊断本病的临床依据。     

Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection.

Inhalation of histamine diphosphate aerosol (1.6 per cent, 10 breaths) produced a 218 +/- 54.6 per cent (mean +/- SE) increase in airway resistance in 16 normal subjects with colds compared with a 30.5 +/- 5.5 per cent increase in 11 healthy control subjects (P less than 0.01). There was no significant difference in mean baseline airway resistance between the two groups. Inhalation of saline produced no significant change in airway resistance in either group. Isoproterenol hydrochloride (0.5 per cent, 1 breath) or atropine sulfate aerosol (0.2 per cent, 20 breaths) each reversed and prevented the increase in airway resistance by histamine, indicating that the bronchoconstriction was caused by smooth muscle contraction and that post-ganglionic, cholinergic pathways were involved in the mechanism. In 6 subjects with colds, citric acid aerosol (10 per cent, 5 breaths) caused bronchoconstriction that lasted up to 30 sec after inhalation, a significantly greater effect than that observed in control subjects or in the same subjects after recovery (P less than 0.05). Prior inhalation of atropine aerosol (0.2 per cent, 20 breaths) prevented the bronchoconstriction after citric acid aerosol in all 6 subjects. The threshold concentration of citric acid that produced cough in 7 subjects with colds was significantly lower than that in control subjects or in the 7 subjects after recovery (P less than 0.05), suggesting that the exaggerated cholinergic response was due to a decreased threshold for stimulation of the rapidly adapting sensory receptors in the airways. We have provided evidence that respiratory viral infections that produce airway epithelial damage temporarily cause these subjects to develop more bronchoconstriction after inhaling smaller doses of histamine than do healthy subjects. The fact that atropine prevents this response and that the threshold to cough is temporarily decreased is compatible with our hypothesis that airway epithelial damage by infection exposes and, thus, "sensitizes" the rapidly adapting airway receptors to inhaled irritants, causing increased bronchoconstriction via a vagal reflex. Damage to the airway epithelium may occur as a result of mechanical factors, inhaled chemicals, and pollutants, such as ozone, infections, or perhaps as a result of the action of materials released endogenously (e.g., from mast cells, white blood cells, or platelets). "Sensitization" of rapidly adapting sensory receptors in the airways may be an important factor in asthma and in other diseases of airways.     

克洛己新干混悬剂治疗儿童轻中度急性上呼吸道感染临床分析

目的分析克洛己新干混悬剂对儿童轻中度急性上呼吸道感染的临床疗效。 方法选择患儿2016年1月至2018年1月江苏省泰兴市人民医院儿科收治的69例轻中度急性上呼吸道感染者,分为对照组34例和观察组35例,对照组给予头孢呋辛治疗,观察组给予克洛己新干混悬剂治疗,两组均持续给药10d,比较两组临床疗效、细菌清除率、临床症状改善情况及药物安全性。 结果治疗后观察组总有效率较对照组明显高(87.50% vs. 67.50%),差异显著(P<0.05);观察组革兰阳性菌清除率(94.29% vs. 70.59%)、革兰阴性菌清除率(88.57% vs. 58.82%)较对照组明显高,差异有统计学意义(P<0.05);观察组咳嗽消失时间、发热消失时间、肺部啰音消失时间、脓栓消失时间较对照组明显短,差异有高度统计学意义(P<0.01);治疗后两组药物不良反应总发生率相较,差异无统计学意义(P>0.05)。 结论复方制剂克洛己新干混悬剂在儿童轻中度急性上呼吸道感染患儿中有明确临床疗效,可有效提高细菌清除率,缩短患儿症状消失时间,且安全性好。     

Clinical effects of piperacillin and tazobactam/piperacillin on Haemophilus influenzae lower respiratory tract infection in pediatric patients

OBJECTIVE: The prevalence of beta-lactamase-nonproducing ampicillin-resistant (BLNAR) Haemophilus influenzae (H. influenzae) has been increasing in recent years. Piperacillin (PIPC) is one of a few beta-lactams possessing good activity against BLNAR H. influenzae. We studied clinical efficacy of piperacillin and its beta-lactamase inhibitor, tazobactam/piperacillin (TAZ/PIPC) in children with lower respiratory tract infection caused by H. influenzae including resistance strains. METHODS: Subjects were 20 children with lower respiratory tract infection caused by H. influenzae treated with PIPC 100mg/kg/day (7 cases) or TAZ/PIPC 125mg/kg/day (13 cases). We selected cases from which resistant H. influenzae strains might be detected. Patients received prior antimicrobial therapy within two weeks before admission, or with underlying diseases. We examined patient profiles, clinical efficacy, susceptibilities for 6 beta-lactam antibiotics [PIPC, TAZ/PIPC, ampicillin (ABPC), cefotaxime (CTX), ceftriaxone (CTRX), and meropenem (MEPM)] and analyzed 6 genotype patterns of beta-lactam resistant genes by PCR. RESULTS: Efficacy was 7/7 in patients in PIPC group and 12/13 in patients in TAZ/PIPC group. Diminished efficacy was seen in only one case complicated with severe RSV infection. The susceptibility of all strains but one beta-lactamase producing, ABPC resistant (BLP) strain to PIPC and of all to TAZ/ PIPC was below 0.25 microg/mL. The genotype of the 15 strains isolated from the sputum on administration was as follows; beta-lactamase nonproducing, ABPC-susceptible (gBLNAS) strains were 4, gBLP strain was 1, beta-lactamase nonproducing, and ABPC-resistant (gLow-BLNAR) strains were 2, beta-lactamase nonproducing, ABPC resistant (gBLNAR) strains were 8. CONCLUSION: PIPC and TAZ/PIPC were useful against lower respiratory tract infection caused by H. influenzae including BLNAR in children.     

卒中单元护理对脑卒中患者下呼吸道感染的影响

目的探讨卒中单元管理模式对脑卒中患者下呼吸道感染及脑卒中预后的影响。方法将2009年1月～2009年11月入住卒中单元的脑卒中患者作为干预组,将2008年入住普通病房的脑卒中患者作为对照组,比较两组脑卒中患者下呼吸道感染发生率、平均住院日、抗感染治疗相关费用。结果对照组脑卒中患者下呼吸道感染率为13.30%,干预组下呼吸道感染率为7.76%。干预组平均住院日明显少于对照组（P=0.048）,干预组平均感染天数明显少于对照组（P=0.016）,干预组平均感染相关费用明显少于对照组（P=0.030）。结论通过卒中单元管理模式,可有效地降低下呼吸道感染率,减少平均住院日,降低住院费用。     

Exhaled carbon monoxide in patients with lower respiratory tract infection

The concentration of carbon monoxide (CO) in exhaled air is increased in patients with asthma, bronchiectasis and upper respiratory tract viral infections. However there is no information about the level of CO in patients with lower respiratory tract infection. We studied a group of 35 patients (22 males) aged 45 +/- 3 (SEM) years with cough productive of purulent phlegm and pyrexia in a general practice setting. All were non-smokers or ex-smokers and none had a previous history of respiratory problems or diabetes. We measured CO level in exhaled air before and after a course of antibiotics. Therapy was deemed successful when patient no longer complained of cough productive of purulent phlegm. Twenty-eight of 35 patients had elevated CO level at their initial visit. Twenty-two out of 35 patients reported clinical improvement after antibiotic treatment and this was associated with a fall in exhaled CO level from 5.2 +/- 0.5 ppm to 2.3 +/- 0.3 ppm (P < 0.0001). We suggest that simple CO measurements in exhaled air can detect the inflammatory process within the airways caused by infection and that a repeat measurement can be used to assess the nature of inflammation.