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1.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32934151

RESUMO

OBJECTIVES: Although the airway microbiota is a highly dynamic ecology, the role of longitudinal changes in airway microbiota during early childhood in asthma development is unclear. We aimed to investigate the association of longitudinal changes in early nasal microbiota with the risk of developing asthma. METHODS: In this prospective, population-based birth cohort study, we followed children from birth to age 7 years. The nasal microbiota was tested by using 16S ribosomal RNA gene sequencing at ages 2, 13, and 24 months. We applied an unsupervised machine learning approach to identify longitudinal nasal microbiota profiles during age 2 to 13 months (the primary exposure) and during age 2 to 24 months (the secondary exposure) and examined the association of these profiles with the risk of physician-diagnosed asthma at age 7 years. RESULTS: Of the analytic cohort of 704 children, 57 (8%) later developed asthma. We identified 4 distinct longitudinal nasal microbiota profiles during age 2 to 13 months. In the multivariable analysis, compared with the persistent Moraxella dominance profile during age 2 to 13 months, the persistent Moraxella sparsity profile was associated with a significantly higher risk of asthma (adjusted odds ratio, 2.74; 95% confidence interval, 1.20-6.27). Similar associations were observed between the longitudinal changes in nasal microbiota during age 2 to 24 months and risk of asthma. CONCLUSIONS: Children with an altered longitudinal pattern in the nasal microbiota during early childhood had a high risk of developing asthma. Our data guide the development of primary prevention strategies (eg, early identification of children at high risk and modification of microbiota) for childhood asthma. These observations present a new avenue for risk modification for asthma (eg, microbiota modification).


Assuntos
Asma/etiologia , Microbiota , Nariz/microbiologia , Aerococcaceae/isolamento & purificação , Fatores Etários , Asma/diagnóstico , Asma/microbiologia , Criança , Pré-Escolar , Feminino , Finlândia , Seguimentos , Perfilação da Expressão Gênica/métodos , Haemophilus/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Aprendizado de Máquina , Masculino , Microbiota/genética , Moraxella/isolamento & purificação , Análise Multivariada , Estudos Prospectivos , RNA Ribossômico 16S/genética , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Risco , Streptococcus/isolamento & purificação
2.
PLoS One ; 15(9): e0239258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32961548

RESUMO

BACKGROUND: Viral infections in children and adolescents with malignancy are commonly encountered and have a significant impact on morbidity and mortality. Studies and epidemiological data regarding viral infections in children with cancer in developing countries are lacking. This retrospective cohort study aims to assess the burden of viral infections in children and adolescents with cancer, by assessing prevalence, risk factors, as well as morbidity and mortality of common viruses over a period of 8 years. METHODS AND FINDINGS: Medical records of cancer patients treated at the Children Cancer Center of Lebanon were reviewed and 155 participants under the age of 21 were identified with at least one documented viral infection during the period from July 2009 to November 2017. This subset included 136 participants with active malignancy and 19 participants with a history of cancer who underwent hematopoietic stem cell transplantation [HSCT] and were in remission; the latter group was analyzed separately. Information regarding participant characteristics, hospital course, and complications were obtained. Associations between viral infections and certain factors were assessed. In the cohort, 64% were male, 81% were Lebanese. In participants with active malignancy, 90% received chemotherapy in the 6 months preceding the viral infection episode, 11% received radiotherapy. 51% of participants were neutropenic at the time of viral detection, and 77% were lymphopenic. 17% experienced a bacterial co-infection, and 3 experienced a viral co-infection. Among 162 viral infection episodes, clinically diagnosed skin infections, mainly herpes simplex virus type 1 and varicella-zoster virus, were the most common [44% of cases]. These were followed by laboratory-proven systemic herpes infections: cytomegalovirus [14%] and Epstein-Barr virus [6%]. Respiratory viruses: influenza and respiratory syncytial virus, accounted for 9% and 4%, respectively, whereas rotavirus represented 11% and BK virus represented 3% of cases. Acute lymphocytic leukemia was the most prevalent neoplasia [57%]. Fever was the most common presenting symptom [55%] and febrile neutropenia was the reason for admission in 24% of cases. The mean length of stay was significantly longer in participants with cytomegalovirus infections and significantly lower in rotavirus infection. Admission to the ICU occurred in 9%, complications in 8%, and mortality in 5%. Participants with viral infections post-HSCT were noted to have a significantly longer length of hospital stay compared to non-HSCT participants, with no other significant differences in clinical course and outcome. The study was limited by its retrospective nature and by the late introduction and underuse of multiplex PCR panels, which may have led to underdiagnosis of viral infections. CONCLUSIONS: Viral infections were prevalent in our sample of cancer patients and may have contributed to morbidity and mortality. Newly available viral diagnostics are likely to vastly increase the number and scope of detectable viral infections in this population. Prospective studies using multiplex PCR technology with systematic testing of patients will be more helpful in defining the burden of viral infections. Furthermore, efforts at antimicrobial stewardship would benefit from the identification of viral causes of infection and limit the unnecessary use of antibiotics in the pediatric cancer population.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Influenza Humana/epidemiologia , Neoplasias/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Criança , Criança Hospitalizada , Pré-Escolar , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/virologia , Feminino , Transplante de Células-Tronco Hematopoéticas , Hospitais , Humanos , Lactente , Influenza Humana/complicações , Influenza Humana/diagnóstico , Influenza Humana/virologia , Líbano/epidemiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/virologia , Pediatria , Vírus Sincicial Respiratório Humano/genética , Vírus Sincicial Respiratório Humano/isolamento & purificação , Vírus Sincicial Respiratório Humano/patogenicidade , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Estudos Retrospectivos , Infecções por Rotavirus/complicações , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/patologia
4.
PLoS Med ; 17(7): e1003202, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32702001

RESUMO

BACKGROUND: Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed. METHODS AND FINDINGS: We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57-82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0-4 years old, the NNT was 29,773 (95% UI 18,458-71,091) in boys and 27,014 (16,739-65,709) in girls; over 85 years old, NNT was 262 (236-293) in men and 385 (352-421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55-64 years, the NNT was 247 (156-459) in men and 343 (234-556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65-74 years, the NNT following RTI was 1,257 (1,112-1,434) in men and 2,278 (1,966-2,686) in women; the NNT following skin infection was 503 (398-646) in men and 784 (602-1,051) in women; following UTI, the NNT was 121 (102-145) in men and 284 (241-342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently. Lack of random allocation to antibiotic therapy might have biased estimates; patients may sometimes experience sepsis or receive antibiotic prescriptions without these being recorded in primary care; recording of sepsis has increased over the study period. CONCLUSIONS: These stratified estimates of risk help to identify groups in which antibiotic prescribing may be more safely reduced. Risks of sepsis and benefits of antibiotics are more substantial among older adults, persons with more advanced frailty, or following UTIs.


Assuntos
Infecções/complicações , Sepse/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Prescrições de Medicamentos , Feminino , Idoso Fragilizado , Fragilidade , Humanos , Lactente , Recém-Nascido , Infecções/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Atenção Primária à Saúde , Probabilidade , Encaminhamento e Consulta , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Reino Unido/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Adulto Jovem
5.
Acta Clin Croat ; 59(1): 63-66, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32724276

RESUMO

There are many reasons for abnormal lymphocyte and platelet counts. In this study, we aimed to assess the prevalence of thrombocytosis, thrombocytopenia, lymphocytosis and lymphocytopenia in patients with lower respiratory tract infection (LRTI) and patients with urinary tract infection (UTI). This retrospective study included 52 LRTI patients and 60 UTI patients. Control group consisted of 70 healthy individuals admitted to the infectiology outpatient unit. No statistically significant relationship was found between the groups of subjects and platelet count. Seven (11.7%) UTI patients and four (7.7%) LRTI patients had lymphocytopenia but there was no statistically significant relationship between the groups of subjects and lymphocyte count. Study results suggested a conclusion that lymphocyte and platelet counts could be within the normal ranges in patients with UTI, as well as in those with LRTI.


Assuntos
Linfocitose , Linfopenia , Infecções Respiratórias , Trombocitopenia , Trombocitose , Infecções Urinárias , Humanos , Linfocitose/epidemiologia , Linfopenia/epidemiologia , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Trombocitopenia/epidemiologia , Trombocitose/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia
6.
PLoS One ; 15(6): e0234413, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32511255

RESUMO

BACKGROUND: Chlamydia pneumoniae is an obligate intracellular bacterium that causes respiratory infection. There may exist an association between C. pneumoniae, asthma, and production of immunoglobulin (Ig) E responses in vitro. Interleukin (IL-4) is required for IgE production. OBJECTIVE: We previously demonstrated that doxycycline suppresses C. pneumoniae-induced production of IgE and IL-4 responses in peripheral blood mononuclear cells (PBMC) from asthmatic subjects. Whereas macrolides have anti-chlamydial activity, their effect on in vitro anti-inflammatory (IgE) and IL-4 responses to C. pneumoniae have not been studied. METHODS: PBMC from IgE- adult atopic subjects (N = 5) were infected +/- C. pneumoniae BAL69, +/- azithromycin (0.1, 1.0 ug/mL) for 10 days. IL-4 and IgE levels were determined in supernatants by ELISA. IL-4 and IgE were detected in supernatants of PBMC (day 10). RESULTS: When azithromycin (0.1, 1.0 ug/ml) was added, IL-4 levels decreased. At low dose, IgE levels increased and at high dose, IgE levels decreased. When PBMC were infected with C. pneumoniae, both IL-4 and IgE levels decreased. Addition of azithromycin (0.1, 1.0 ug/mL) decreased IL-4 levels and had no effect on IgE levels. CONCLUSIONS: These findings indicate that azithromycin decreases IL-4 responses but has a bimodal effect on IgE responses in PBMC from atopic patients in vitro.


Assuntos
Azitromicina/farmacologia , Chlamydophila pneumoniae/imunologia , Imunoglobulina E/biossíntese , Interleucina-4/biossíntese , Idoso , Antibacterianos/farmacologia , Asma/complicações , Asma/tratamento farmacológico , Asma/imunologia , Infecções por Chlamydophila/complicações , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/imunologia , Chlamydophila pneumoniae/efeitos dos fármacos , Chlamydophila pneumoniae/patogenicidade , Feminino , Humanos , Hipersensibilidade Imediata/complicações , Hipersensibilidade Imediata/imunologia , Hipersensibilidade Imediata/microbiologia , Imunoglobulina E/sangue , Técnicas In Vitro , Interleucina-4/sangue , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/microbiologia , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/imunologia , Adulto Jovem
7.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32527752

RESUMO

In this case series, we describe the clinical course and outcomes of 7 febrile infants aged ≤60 days with confirmed severe acute respiratory syndrome coronavirus 2 infection. No infant had severe outcomes, including the need for mechanical ventilation or ICU level of care. Two infants had concurrent urinary tract infections, which were treated with antibiotics. Although a small sample, our data suggest that febrile infants with severe acute respiratory syndrome coronavirus 2 infection often have mild illness.


Assuntos
Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Febre de Causa Desconhecida/etiologia , Pneumonia Viral/diagnóstico , Infecções Respiratórias/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Infecções Urinárias/diagnóstico , Fatores Etários , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Febre de Causa Desconhecida/diagnóstico , Seguimentos , Hospitais Pediátricos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Infecções Respiratórias/complicações , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Infecções Urinárias/complicações
8.
BMC Infect Dis ; 20(1): 387, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32473625

RESUMO

BACKGROUND: To compare the clinical characteristics of acute lower respiratory tract infections (ALRTIs) caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV) and to explore the relationship between the development of recurrent wheezing/asthma and RSV/ HRV infections in infancy. METHODS: Retrospective study was conducted to compare the clinical characteristics of acute lower respiratory tract infections (ALRTIs). Hospitalized patients with ALRTIs from March 2007 to December 2016 were screened. Single RSV cases (s-RSV), single HRV cases (s-HRV), and cases who had co-infection with the two viruses were enrolled. Follow-up was performed to determine whether either specific respiratory virus infection was related to subsequent development of recurrent wheezing/asthma. RESULTS: The s-RSV children were the youngest (P = 0.021), they experienced the most serious condition (P < 0.001) and respiratory failure (P < 0.001), they also required highest demand of oxygen therapy (P < 0.001). And in s-RSV group, the incidence of development of recurrent wheezing was significantly higher in subgroup with the family history of wheezing than that without (P < 0.001). CONCLUSION: The s-RSV cases suffered from the worst severity of illness, respiratory failure and required highest demand of oxygen therapy. Recurrent wheezing was more common in s-RSV group with family history of wheezing than those without.


Assuntos
Asma/epidemiologia , Infecções por Picornaviridae/complicações , Infecções por Vírus Respiratório Sincicial/complicações , Infecções Respiratórias/complicações , Asma/etiologia , Criança , Pré-Escolar , Coinfecção/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Infecções por Picornaviridae/epidemiologia , Sons Respiratórios/etiologia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Estudos Retrospectivos
9.
BMC Infect Dis ; 20(1): 388, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487032

RESUMO

BACKGROUND: Neurogenic pulmonary edema is a rare but serious complication of febrile status epilepticus in children. Comprehensive screening for viral pathogens is seldomly performed in the work-up of febrile children. CASE PRESENTATION: A 22-month-old girl presented with her first episode of febrile status epilepticus, after which she developed acute pulmonary edema and respiratory failure. After the termination of seizure activity, the patient was intubated and managed on mechanical ventilation in the emergency room. The resolution of respiratory failure, as well as the neurological recovery, was achieved 9 h after admission, and the patient was discharged 6 days after admission without any complications. Molecular biological diagnostic methods identified the presence of human coronavirus HKU1, influenza C virus, and human parainfluenza virus 2 from the patient's nasopharyngeal specimens. CONCLUSIONS: Neurogenic pulmonary edema following febrile status epilepticus was suspected to be the etiology of our patient's acute pulmonary edema and respiratory failure. Timely seizure termination and rapid airway and respiratory intervention resulted in favorable outcomes of the patient. Molecular biological diagnostic methods identified three respiratory viruses; however, their relevance and association with clinical symptoms remain speculative.


Assuntos
Edema Pulmonar/etiologia , Infecções Respiratórias/virologia , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/terapia , Coronavirus/isolamento & purificação , Infecções por Coronavirus , Feminino , Febre/complicações , Humanos , Lactente , Influenza Humana , Influenzavirus C/isolamento & purificação , Técnicas de Diagnóstico Molecular , Nasofaringe/virologia , Vírus da Parainfluenza 2 Humana/isolamento & purificação , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/terapia , Infecções Respiratórias/complicações , Estado Epiléptico
10.
Am J Trop Med Hyg ; 103(2): 887-893, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32588795

RESUMO

Increasing access to rapid diagnostic tests for malaria (mRDTs) has raised awareness of the challenges healthcare workers face in managing non-malarial febrile illnesses (NMFIs). We examined NMFI prevalence, clinical diagnoses, and prescribing practices in outpatient clinics across different malaria transmission settings in Malawi. Standardized facility-based malaria surveillance was conducted at three facilities one of every 4 weeks over 2 years. Information on demographics, presenting symptoms, temperature, clinical diagnosis, and treatment were collected from outpatients presenting with malaria-like symptoms. Of the 25,486 patients with fever, 69% had NMFI. Non-malarial febrile illness prevalence was lower in 5- to 15-year-old patients (55%) than in children < 5 years (72%) and adults > 15 years of age (77%). The most common clinical diagnoses among febrile patients with negative mRDTs in all age-groups and settings were respiratory infections (46%), sepsis (29%), gastroenteritis (13%), musculoskeletal pain (9%), and malaria (5%). Antibiotic prescribing was high in all age-groups and settings. Trimethoprim-sulfamethoxazole (40%) and amoxicillin (29%) were the most commonly prescribed antibiotics and were used for nearly all clinical diagnoses. In these settings with minimal access to diagnostic tools, patients with fever and a negative mRDT received a limited number of clinical diagnoses. Many were likely to be inaccurate and were associated with the inappropriate use of the limited range of available antibiotics. Prescription and diagnostic practices for NMFIs in the facilities require research and policy input. Resource-limited malaria-endemic countries urgently need more point-of-care diagnostic tools and evidence-based diagnosis and treatment algorithms to provide effective and cost-efficient care.


Assuntos
Antibacterianos/uso terapêutico , Febre/epidemiologia , Gastroenterite/epidemiologia , Malária/epidemiologia , Dor Musculoesquelética/epidemiologia , Infecções Respiratórias/epidemiologia , Sepse/epidemiologia , Adolescente , Assistência Ambulatorial , Amoxicilina/uso terapêutico , Criança , Pré-Escolar , Gerenciamento Clínico , Doenças Endêmicas , Feminino , Febre/etiologia , Gastroenterite/complicações , Gastroenterite/tratamento farmacológico , Humanos , Malária/complicações , Malária/diagnóstico , Malaui/epidemiologia , Masculino , Dor Musculoesquelética/complicações , Dor Musculoesquelética/tratamento farmacológico , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Sepse/complicações , Sepse/tratamento farmacológico , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
11.
PLoS One ; 15(6): e0235164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574206

RESUMO

Inappropriate use of antibacterials is a major public health challenge as it can promote emergence of resistance, wastage of financial resources, morbidity and mortality. In this study, we determined the prevalence and factors associated with antibacterial use in managing symptoms of acute respiratory tract infections (ARIs) in households in rural communities of Gulu district, northern Uganda. A cross-sectional study was conducted among households selected using multi-stage sampling. Data were collected through interviews with care-givers of children under five years, using a structured interviewer administered questionnaire. Out of the 856 children who had symptoms of ARIs, 515 (60.2%; CI: 54.5%-65.6%) were treated with antibacterials. The most commonly used antibacterials were amoxicillin (55.2%, n = 358), cotrimoxazole (15.4%, n = 100) and metronidazole (11.4%, n = 74). The determinants of antibacterial use included; getting treatment from a health facility (AOR: 1.85, CI: 1.34-2.56, P < 0.001), households located in peri-urban area (AOR: 2.54, CI: 1.34-4.84, P = 0.005), and a child having cough (AOR: 7.02, CI: 4.36-11.31, P < 0.001). The prevalence of antibacterial use among children under five years with symptoms of ARIs is high in communities of Gulu district, northern Uganda. Getting treatment from a health facility, if a household was located in a peri-urban area and having a cough are positive predictors of antibacterial use. There is need for targeted education on appropriate antibacterial use in rural communities and hospital settings where over prescription is most likely especially in treating symptoms of ARIs among children under five years.


Assuntos
Antibacterianos/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Amoxicilina/uso terapêutico , Pré-Escolar , Tosse/complicações , Tosse/diagnóstico , Tosse/tratamento farmacológico , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Masculino , Metronidazol/uso terapêutico , Análise Multivariada , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Fatores de Risco , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Uganda/epidemiologia
12.
Ann Otol Rhinol Laryngol ; 129(10): 977-982, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32456451

RESUMO

OBJECTIVES: The aims of the present study were to clarify the time-course of olfactory recovery and the prognostic factors in PIOD patients treated with Toki-shakuyaku-san (TSS). METHODS: A retrospective cohort study of patients with PIOD was conducted by reviewing patients' medical records. This study included patients who received TSS or a combination of TSS and zinc sulfate. Olfactory function was examined by T&T olfactometer at each 3-monthly follow-up visit. Patients with normal and mild olfactory dysfunction were excluded. Gender, age, treatment, duration of disease until the first visit and olfactory function scores of the T&T olfactometer at the first visit were analyzed as candidate clinical predictors of recovery. RESULTS: A total of 82 PIOD patients with ages ranging from 16 to 79 years were included. The mean duration of follow-up was 14.5 months (range 3-45 months). The number of patients with olfactory recovery increased for 24 months and the cumulative recovery rate was 77.3%. In about 60% of patients, olfactory recovery occurred within 6 months. Multivariate analysis showed that younger age (<65 years) and residual olfactory function were significantly associated with good olfactory recovery. CONCLUSIONS: We revealed recovery rates over time in patients with PIOD. The recovery of olfactory function often occurred during the early period (≤6 months). However, the number of patients with olfactory recovery increased for a long-term of 24 months after the first visit. Residual olfactory function and younger age were prognostic factors exactly. TSS may be a useful therapeutic agent for patients with PIOD. We believe that these results provide important information that is useful for counseling patients with PIOD.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Transtornos do Olfato/tratamento farmacológico , Recuperação de Função Fisiológica , Infecções Respiratórias/complicações , Sulfato de Zinco/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Humanos , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
13.
PLoS One ; 15(5): e0231782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369487

RESUMO

RATIONALE: Severe early-life respiratory illnesses, particularly those caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV), are strongly associated with the development of asthma in children. Puerto Rican children in particular have a strikingly high asthma burden. However, prior studies of the potential associations between early-life respiratory illnesses and asthma in Puerto Rican and other minority populations have been limited. OBJECTIVES: We sought to determine whether early-life respiratory illness was associated with asthma in Puerto Rican, Mexican American, and African American children. METHODS: Using a logistic regression analysis, we examined the association between early-life respiratory illnesses (report of upper respiratory infection (URI), pneumonia, bronchitis, and bronchiolitis/RSV) within the first two years of life and physician-diagnosed asthma after the age of two in a large cohort of Puerto Rican, Mexican American, and African American children. MEASUREMENTS AND MAIN RESULTS: While early-life respiratory illnesses were associated with greater asthma odds in Puerto Ricans, Mexican Americans, and African Americans, these associations were stronger among Puerto Rican children. Specifically, in Puerto Ricans, the odds was 6.15 (95% CI: 4.21-9.05) if the child reported at least one of the following respiratory illness: URI, pneumonia, bronchitis or bronchiolitis. The odds were also higher in Puerto Ricans when considering these conditions separately. CONCLUSIONS: We observed population-specific associations between early-life respiratory illnesses and asthma, which were especially significant and stronger in Puerto Ricans. Taken together with the known high burden of RSV in Puerto Rico, our results may help explain the high burden of asthma in Puerto Ricans.


Assuntos
Afro-Americanos/estatística & dados numéricos , Asma/epidemiologia , Hispano-Americanos/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Adolescente , Asma/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Infecções Respiratórias/complicações , Infecções Respiratórias/virologia , Estados Unidos/etnologia , Adulto Jovem
14.
PLoS One ; 15(5): e0232977, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469981

RESUMO

INTRODUCTION: Antiretroviral therapy has improved the health of people living with HIV (PLW-HIV), though less is known about how this impacts on acute respiratory illness. These illnesses are a common cause of ill health in the general population and any increase in their frequency or severity in PLW-HIV might have significant implications for health-related quality of life and the development of chronic respiratory disease. METHODS: In a prospective observational cohort study following PLW-HIV and HIV negative participants for 12 months with weekly documentation of any acute respiratory illness, we compared the frequency, severity and healthcare use associated with acute respiratory illnesses to determine whether PLW-HIV continue to have a greater frequency or severity of such illnesses despite antiretroviral therapy. RESULTS: We followed-up 136 HIV positive and 73 HIV negative participants for 12 months with weekly documentation of any new respiratory symptoms. We found that HIV status did not affect the frequency of acute respiratory illness: unadjusted incidence rates per person year of follow-up were 2.08 illnesses (95% CI 1.81-2.38) and 2.30 illnesses (1.94-2.70) in HIV positive and negative participants respectively, IRR 0.87 (0.70-1.07) p = 0.18. However, when acute respiratory illnesses occurred, PLW-HIV reported more severe symptoms (relative fold-change in symptom score 1.61 (1.28-2.02), p <0.001) and were more likely to seek healthcare advice (42% vs 18% of illnesses, odds ratio 3.32 (1.48-7.39), p = 0.003). After adjustment for differences in baseline characteristics, PLW-HIV still had higher symptom scores when unwell. CONCLUSIONS: HIV suppression with antiretroviral therapy reduces the frequency of acute respiratory illness to background levels, however when these occur, they are associated with more severe self-reported symptoms and greater healthcare utilisation. Exploration of the reasons for this greater severity of acute respiratory illness may allow targeted interventions to improve the health of people living with HIV. TRIAL REGISTRATION: ISRCTN registry (ISRCTN38386321).


Assuntos
Infecções por HIV/complicações , Infecções Respiratórias/complicações , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Infecções por HIV/tratamento farmacológico , Soronegatividade para HIV , Soropositividade para HIV/complicações , Humanos , Incidência , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Qualidade de Vida , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Índice de Gravidade de Doença
16.
Int Arch Allergy Immunol ; 181(7): 499-506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32388510

RESUMO

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) develops in the presence of predisposing conditions such as asthma and cystic fibrosis. Even ABPA accompanied by asthma is often complicated by chronic Pseudomonas aeruginosa or nontuberculous mycobacterial infection of the lower respiratory tract, rendering treatment with corticosteroids difficult. There have been several reports on the effectiveness of omalizumab, an anti-IgE antibody, in patients with ABPA. We analyzed the effectiveness and adverse effects of omalizumab in ABPA patients with chronic respiratory infections. METHODS: Using our nationwide survey database and published case reports, we identified patients with severe asthma and ABPA who fulfilled the International Society for Human and Animal Mycology criteria and who had been treated with omalizumab. Exacerbation rates, control of symptoms, doses of oral corticosteroids, and pulmonary function were evaluated. RESULTS: Among 25 patients with ABPA treated with omalizumab (median age 62 years, range 33-83 years), 12 patients had a chronic bacterial infection of the lower airways attributable to P. aeruginosa (n = 6) or nontuberculous mycobacteria (n = 6) at the initiation of omaliz-umab. Treatment with omalizumab reduced the frequency of exacerbations and systemic corticosteroid doses and improved pulmonary function. There were no significant adverse events or worsening of infection during treatment with omalizumab, except for injection-site reactions. CONCLUSIONS: Treatment with omalizumab was effective and safe in patients with ABPA, regardless of comorbid chronic respiratory tract infections.


Assuntos
Antiasmáticos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Omalizumab/uso terapêutico , Infecções Respiratórias/complicações , Adulto , Idoso , Asma/tratamento farmacológico , Asma/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Pseudomonas/complicações , Infecções Respiratórias/microbiologia , Estudos Retrospectivos
17.
Acta Otorrinolaringol Esp ; 71(6): 379-385, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32466862

RESUMO

There is debate as to whether olfactory dysfunction should be considered a symptom of COVID-19 infection. We undertook a systematic literature review of the articles indexed in PubMed on olfactory disorders in viral respiratory tract conditions, with special emphasis on COVID-19. The main objective was to find evidence of clinical interest to support the relationship between anosmia and COVID-19. Olfactory disorders in upper respiratory tract infections are frequent, most caused by obstruction due to oedema of the nasal mucosa. Occasionally, post-viral sensorineural olfactory dysfunction occurs, with a variable prognosis. The evidence on anosmia in COVID-19 patients is extremely limited, corresponding to a level 5 or D of the Centre for Evidence-Based Medicine. According to the available evidence, it seems reasonable to apply isolation, hygiene and social distancing measures in patients with recent olfactory disorders as the only symptom, although the usefulness of diagnostic tests for this type of patient should be studied.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Transtornos do Olfato/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Humanos , Higiene , Transtornos do Olfato/diagnóstico , Mucosa Olfatória/anatomia & histologia , Pandemias , Isolamento de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Prognóstico , Quarentena , Infecções Respiratórias/complicações , Infecções Respiratórias/virologia , Viroses/complicações
18.
Int J Pediatr Otorhinolaryngol ; 134: 110057, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32388322

RESUMO

OBJECTIVES: Children admitted with stridor and respiratory distress comprise a complex patient group that requires the otolaryngologist to decide when to assess and intervene with direct laryngoscopy and bronchoscopy (DLB). Historically, the diagnosis of viral upper respiratory tract infection (URTI) can lead to postponement of surgery due to concerns of perioperative complications related to acute illness. Respiratory viral panels (RVP) are often used to confirm the presence of recent or active viral infection and can affect the differential diagnosis of upper airway obstruction. This study examined whether positive RVP testing is associated with perioperative complications and operative findings in pediatric patients undergoing inpatient DLB. METHODS: A retrospective chart review of 132 pediatric patient encounters was performed. Viral testing results, DLB indication, DLB findings, and perioperative complications were compared. RESULTS: Sixty encounters (45.5%) involved a positive RVP, and 72 (54.5%) involved a negative RVP. Those with positive RVP were less likely to have a preoperative structural airway diagnosis (P =.0250) and more likely to have a history of recurrent upper respiratory infections (P =.0464). The most common reason for DLB was the need to assess the airway due to concern for structural pathology. Anatomic abnormalities were seen in a majority of encounters (77.3%) Laryngospasm occurred in 1 (1.7%) RVP positive and 1 (1.4%) RVP negative encounter, and 2 (2.8%) RVP negative encounters required reintubation. No other major complications were observed. No association was noted between RVP results and incidence of major or minor complication. CONCLUSIONS: Major perioperative complications after surgical intervention with DLB for the management of complex, inpatient children with stridor and respiratory distress are rare. RVP positivity, specific pathogens identified on RVP, and presence of URI symptoms were not associated with perioperative complications.


Assuntos
Insuficiência Respiratória/etiologia , Sons Respiratórios/etiologia , Anormalidades do Sistema Respiratório/diagnóstico por imagem , Infecções Respiratórias/diagnóstico , Viroses/diagnóstico , Broncoscopia/efeitos adversos , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Complicações Intraoperatórias/etiologia , Laringismo/diagnóstico por imagem , Laringismo/etiologia , Laringoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/cirurgia , Anormalidades do Sistema Respiratório/complicações , Infecções Respiratórias/complicações , Infecções Respiratórias/virologia , Estudos Retrospectivos , Medição de Risco , Viroses/complicações
19.
Pediatr Pulmonol ; 55(7): 1567-1583, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32364320

RESUMO

Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) during early childhood may be associated with subsequent pulmonary sequelae, including recurrent wheezing and asthma. We undertook a systematic review to investigate the pulmonary function sequelae following RSV LRTI in the first 3 years of life. The systematic review protocol was registered on PROSPERO (CRD42018087168). PubMed, Scopus, Cochrane Library, and World Health Organization Global Index Medicus, as well as ClinicalTrials.gov and Cochrane Central Register of Controlled Trials, were searched up until 15 June 2019 for published and unpublished interventional and observational studies with the end-point outcome of pulmonary function testing (PFT) after a proven RSV LRTI in the first 3 years of life. Two independent reviewers screened all the titles, abstracts and full texts. Data were extracted using a standardized data extraction form. Corresponding authors were contacted for additional information if required. All studies were assessed for risk of bias using the Newcastle-Ottawa quality assessment scale. The final analysis included 31 studies. Thirteen studies using spirometry reported no association between RSV LRTI and pulmonary function sequelae. The remaining 16 reported abnormal spirometry; 12 obstructive airways disease, three restrictive lung disease, and one mixed lung disease. The heterogeneity in PFT techniques, different ages at testing, and methods used for reporting outcomes made direct comparisons or pooled effect estimates impossible. Children with confirmed RSV LRTI during the first 3 years of life often have abnormal PFTs, favoring obstructive airways disease. The evidence, however, is not overwhelming with conflicting results between studies.


Assuntos
Infecções por Vírus Respiratório Sincicial/complicações , Infecções Respiratórias/complicações , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes de Função Respiratória , Infecções por Vírus Respiratório Sincicial/fisiopatologia , Infecções Respiratórias/fisiopatologia
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