Lower Respiratory Tract Infections

CRP is an acute-phase protein with levels quickly rising during inflammatory processes [2]. Relationship between CRP and infection of the lower respiratory tract was indi- cated by different studies in literature. High CRP levels were reported sensitive and specific to determine lower respira- tory diseases [13]. Almirres et al. reported that CRP levels have been shown to be also useful in confirming the diagno- sis, since they were significantly higher in patients with true pneumonia than in those in whom the diagnosis was not confirmed at follow up [14]. Macfarlane et al. in a study of lower respiratory tract infections in patients attending an outpatient setting, reported that 65% of patients with radio- graphically confirmed disease showed high serum CRP levels (above 5 mg/dL) compared with 40% in those with radiographic findings that were consistent with infection, and 11% in those who had no changes consistent with infection [1]. Melbye et al. showed that serum CRP level of above 5 mg/dL in patients with symptoms of re- spiratory infection who had been treated as outpatients had

Upto 13% of in-patient deaths in pediatric wards are due to LRTI. 1 ABSTRACT Background: Lower Respiratory Tract Infections (LRTI) continues to threaten the health of children worldwide. Up to 13% of inpatient deaths in pediatric wards are due to LRTI. Platelets play a major role in antimicrobial host defence, the induction of inflammation and tissue repair. Inflammatory thrombocytosis is related to increased levels of several cytokines such as thrombopoietin, interleukin-6, interleukin-1alpha, interleukin-8 and tumour necrosis factor alpha.

In summary, lower respiratory tract infections are among the most commonly encountered infectious diseases causing sig- nificant morbidity and mortality. The role of the microbiology laboratory in diagnosis remains controversial until better stan- dardization of methods and outcomes data are generated. Em- pirical treatment approaches are recommended for bronchitis and CAP not requiring hospitalization. In the hospitalized patient, although diagnostic tests are imperfect, they are sug- gested. This is particularly true for the immunocompromised host, for whom invasive procedures guided by clinical and epidemiological data may reveal unsuspected opportunistic pathogens.

Lower respiratory tract infections (LRTIs) are among the most common infectious diseases affecting humans worldwide (1). They are important causes of morbidity and mortality for all age groups, and each year approximately 7 million people die as a direct consequence of acute and chronic respiratory infections (2). In Nigeria, LRTIs continue to be the major cause of morbidity (3). Age, gender, and season are factors that have been implicated to affect the prevalence of LRTIs (4).

cute bronchitis is one of the most fre- quent reasons for prescribing antibiotics to adults. 1,2 Acute bronchitis is distinct from acute exacerbation of chronic bronchitis in that patients who present with cough and symptoms of acute lower respiratory tract infections (LRTIs) usually do not have underlying chronic lung dis- ease. 3,4 Prescribing rates for adults with acute bronchitis have been reported to range from 66%

with software package "SPSS program version 13" .The study sample was divided into two groups: Group1(cases, hypoxic) children having oxygen saturation <95%, Group 2( control, non-hypoxic) children complaining from lower respiratory tract infections that having oxygen saturation >95%. Cases and controls were matched for age, sex, weight and other possible confounding factors that might play role in one way or another in tachypnea in chil- dren like feeding pattern, family history of atopy, parental smoking, previous history of wheezing and fever. Baseline character- istics were compared. Frequency of differ- ent symptoms and signs in both groups was calculated. Sensitivity, specificity, positive and negative predictive values were calculated for different signs. Chi- square and t-test were used as indicated. Different combinations of signs found to be significant in the univariate analysis were evaluated for their ability to predict hypoxe- mia. P.value of <0.05 was considered sig- nificant.

Z ETTI Z AINOL R ASHID*, P EI C HUEN L EE, U MI K ALSOM A LI, M UTTAQILLAH N AJIHAN A BDUL S AMAT & S WEE F ONG T ANG ABSTRACT Acute respiratory infections cause significant morbidity and mortality in children. Several new respiratory viruses have been identified and co-detection of multiple viruses is commonly reported. This is part of a prospective study which aims to detect respiratory viruses by multiplex molecular method and conventional methods. Nasopharyngeal aspirate specimens were taken from hospitalised children aged less than 5 years with lower respiratory tract infections. These were tested using viral culture, immunofluorescence and Seegene Anyplex™ II RV16 real-time polymerase chain reaction.

common among those who didn’t receive vaccinations properly; this data showed by others in Iraq 23 , while one other study in Iraq showed weak association of vaccina- tion with lower respiratory tract infection 24 . This study showed that children with lower anthropometric measures are more prone to get lower respiratory tract infections as these data agrees with other studies 16,26 . The present study demonstrated a signifi- cant association of lower respiratory infec- tion with presence of respiratory infection in another household sibling which agrees with other studies 24,27 . The study of Yousif and Khaleq resulted in that children with household members affected with ARI were 4.17 more at risk to develop respira- tory infections than those with no such history, but others found week correlation

Abstract: BACKGROUND: Knowledge of key drivers for antibiotic prescribing in pediatric lower res- piratory tract infection (LRTI) could support rational antibiotic use. Thus, we aimed to determine the impact of clinical and laboratory factors on antibiotic prescribing in children and adolescents with febrile LRTI. METHODS: Pediatric patients from the standard care control group of a randomized controlled trial (ProPAED) investigating procalcitonin guided antibiotic treatment in febrile LRTI were included in a multivariate logistic regression analysis to evaluate the impact of laboratory and clinical factors on antibiotic prescribing. RESULTS: The standard care control group of the ProPAED study comprised 165 LRTI patients (median age: 2.7 years, range: 0.1-16), out of which 88 (55%) received antibiotic treatment. Factors significantly associated with antibiotic prescribing in patients with complete clinical and laboratory documentation (n = 158) were C-reactive protein (OR 5.8 for a 10-fold increase, 95%CI 2.2-14.9), white blood count beyond age-dependent reference range (OR 3.9, 95%CI 1.4-11.4), body tem- perature (OR 1.7 for an increase by 1°C, 95%CI 1.02-2.68), and pleuritic pain (OR 2.8, 95%CI 1.1-7.6). Dyspnea (OR 0.3, 95%CI 0.1-0.7) and wheezing (OR 0.3, 95%CI 0.13-0.95) were inversely associated with antibiotic prescribing. CONCLUSION: Laboratory markers were strong drivers of antibiotic prescrib- ing in children with febrile lower respiratory tract infections, in spite of their known poor prediction of antibiotic need. Building on current guidelines for antibiotic treatment in children with febrile LRTI, a reliable decision algorithm for safe antibiotic withholding considering the laboratory and clinical factors evaluated in this study has the potential to further reduce antibiotic prescribing.

Background: WHO estimated burden of respiratory tract infections in 2010, estimates four and half million deaths due to respiratory tract infections among children every year. In India, 1.2 million deaths have been reported among children due to RTI among 5.9 million deaths globally. Lower respiratory tract infections are most common causes of death than upper respiratory tract infections. Pneumonia and Bronchiolitis are most common types of LRTI in children. Pneumonia accounts for most of the deaths in children < 5 years of age. The present study was undertaken with an objective to know the various types of lower respiratory tract infections in children less than 12 years of age.

We report rates of hospitalization for severe LRTI among children in the United States, the fi rst reported rates for severe LRTI in the United States that we are aware of. The large data sets used to estimate our rates, MarketScan com- mercial and Medicaid databases, cover a wide geographic area and include children with private and government- sponsored insurance. During 2007 through 2011, young children had the highest rate of hospitalization for severe LRTI. Among children hospitalized for LRTI, children with underlying medical con- ditions were at greatest risk for severe LRTI. Given these fi ndings, prevention strategies to reduce LRTI among children should focus on young children (and people who may transmit infections to them), children with underlying med- ical conditions, and children in socio- economic settings requiring public insurance, including expanded cover- age for recommended vaccines to meet Healthy People 2020 goals. Pre- paredness planning for respiratory related emergencies should account for the large need for ICU and me- chanical ventilation among infants and young children.

information on ICU use that is not available in other data sets. Finally, in our combined age and insurance ad- justed rates, we assumed that children without insurance were more similar to those covered by Medicaid; this may not be true. However, during the study pe- riod, the proportion of uninsured chil- dren was , 10% of all children. 15 We report rates of hospitalization for severe LRTI among children in the United States, the fi rst reported rates for severe LRTI in the United States that we are aware of. The large data sets used to estimate our rates, MarketScan com- mercial and Medicaid databases, cover a wide geographic area and include children with private and government- sponsored insurance. During 2007 through 2011, young children had the highest rate of hospitalization for severe LRTI. Among children hospitalized for LRTI, children with underlying medical con- ditions were at greatest risk for severe LRTI. Given these fi ndings, prevention strategies to reduce LRTI among children should focus on young children (and people who may transmit infections to them), children with underlying med- ical conditions, and children in socio- economic settings requiring public insurance, including expanded cover- age for recommended vaccines to meet Healthy People 2020 goals. Pre- paredness planning for respiratory related emergencies should account for the large need for ICU and me- chanical ventilation among infants and young children.

Between 1 January 1985 and 31 March 1985, 226 patients whose expectorated sputum in culture yielded potential pathogens were evaluated for clin- ical and radiologic evidence of upper or [r]

aeruginosa to be most common isolate (35%) from patients with LRTIs admitted to intensive care units. Gonlugur et al. (15) found Klebsiella spp (35%), A. baumanii (27%), and E. coli (15%) to be the most common organisms causing LRTIs. In the present study, a significant number (37%) of Gram-negative bacilli were found to be MDR with K. pneumoniae 85(48.6%) and Acinetobacter spp. 59(33.7%) being the most common MDR Gram-negative bacilli isolated from LRTIs. Higher rates of multidrug resistance (83%) among Gram-negative pathogens have been reported by Gagneja et al. (16) Goel et al. (14) found very high rate of resistance (60-100%) among A. baumannii and K. pneumoniae isolates. In contrast to the present study, Goel et al. (14) found high rates of multidrug resistance among P. aeruginosa. This is probably because their study was based on infections in intensive care unit, whereas the present study included both community acquired and nosocomial infections. Another important finding in the present study is presence of ESBL production in 65% and 70% of MDR strains of K. pneumoniae and E. coli respectively. The importance of ESBL producing strains lies in the fact that they are difficult to treat because they carry plasmids that confer resistance to many other antibiotics. Betalactam-betalactamase inhibitors and carbapenems are the only options to treat these infections. Gonlugur et al. (15) have reported lower rates of ESBL production among the respiratory isolates of K. pneumoniae (12%) and E. coli (21%).

KEYWORDS: Equalization of crackles, Respiratory sound analysis, Fuzzy-based expert system, Neuro-fuzzy Approach, respiratory inductance plethysmography(RIP), Mel frequency Cepstral Coefficient(MFCC). I. I NTRODUCTION Artificial Neural Network and Fuzzy Logic have been broadly utilized for finding of various ailments of human body [1-3]. Neuro-fuzzy alludes to blends of artificial neural networks and fuzzy logic. Neuro-fuzzy hybridization brings about a half breed savvy framework that synergizes these two strategies by consolidating the human-like thinking style of fuzzy frameworks with the learning and connectionist structure of neural networks. The paper underscores on the Neuro-Fuzzy approach for examination and determination of respiratory contamination maladies. Experimentations for grouping of respiratory ailments utilizing respiratory sound examination has enhanced the concentration of the work.

clearance, as observed through the changes in cell recruitment and inflammatory cytokine production. The main finding of this study is that the mechanism of bacterial death affected the inflammatory response in vivo. While heat-killed and gentamicin-killed bacteria were able to induce robust inflammatory responses, CATH-2-killed bacteria induced a significantly lower inflammatory response, as fewer neutrophils were recruited, and the concentration of inflammatory cytokines recovered from the BALF was significantly lower for multiple different markers. CATH-2’s ability to kill bacteria without inducing an inflammatory response has previously only been documented in vitro, as it was shown that treatment of macrophages with peptide-killed E. coli, S. enteritidis, or P. aeruginosa exhibit a reduced inflammatory response after co-incubation (19). Our data provides clear evidence that this phenomenon also occurs in the multicellular in vivo environment within the lung. Taken together, these studies strongly support the conclusion that the cathelicidin peptide CATH- 2 can not only kill bacteria directly, but is also able to dampen the immunogenic response induced by the bacterial components, such as endotoxins and other bacterial structures, released upon bacterial cell death.

Children younger than 3 years of age were eligible for inclusion if they attended one of the two hospitals in Nijmegen from September until May with symptoms of an acute viral lower respiratory tract infection (LRTI). Symptoms included signs of increased respiratory effort (e.g. tachypnea and/or use of accessory respiratory muscles or retractions) and/or expiratory wheezing and/or crackles and/or apnea. Patients with congenital or acquired immune deficiencies, immunosuppressive medication (including > 24 hours of corticosteroids) or severe psychomotor retardation were excluded. Eligible patients were identified by their physician, who notified the study team. When informed consent of both parents was obtained within 24 hours of admission patients were included in the study. Data on clinical parameters, course of disease, medical history and demographics were retrieved from medical records and questionnaires. Retrospectively, after discharge patients were allocated into three groups: mild, send home or only clinical observation; moderate, patients with need for supplemental oxygen and/or nasogastric feeding; and severe, patients with mechanical ventilation. Supplemental oxygen was started according to the protocols from the clinical wards in patients with an oxygen saturation of ≤ 92% for at least 10 minutes after use of decongestives. Results were evaluated in a training cohort (n=104, 2010-2012) and subsequently tested in a larger historical validation cohort with the same inclusion and exclusion criteria (n=141, 2006-2009). The study was approved by the Committee on Research involving Human Subjects.

Considering that RSVIG appears somewhat effec- tive in preventing the frequency and consequences of RSV infection in high-risk infants, why does it ap- pear not to have therapeutic value? The simplest explanation is that by the time an infant has respira- tory symptoms attributable to RSV infection, the vi- rus has penetrated respiratory epithelial cells and is sequestered from humoral immunity. In contrast, prophylactic administration of RSVIG may neutral- ize infectious virus before cellular penetration, pre- venting progressive disease. It also is possible that the absence of an apparent therapeutic effect reflects an imbalance between viral and antibody concentra- tions at the mucosal surface. Indeed, antibodies ap- plied topically to the airways of RSV-infected ani- mals appear to be more beneficial than systemically administered immunoglobulin. Topical application of high-titer antibody preparations results in a 30- fold greater reduction in pulmonary viral titers com- pared with preparations with lower antibody titers. 21 Although aerosolized immunoglobulin therapy ap- peared safe in a pilot study, 22 a placebo-controlled randomized trial in 65 patients observed no benefit from treatment. 23 Furthermore, two IVIG recipients COMMENTARIES 473 at Viet Nam:AAP Sponsored on August 30, 2020

specific infection with different epidemiologies, pathogeneses, clinical presentations, and outcomes. The etiology and symptomatology of respiratory diseases vary with age, gender, season, the type of population at risk, and other factors. LRTIs are frequently the first infection to occur after birth and pneumonia is too often the final illness to occur before death [5]. The etiological agents of LRTIs cannot be determined clinically and differ from area to area [6].

156 7. Concluding Remarks The lower respiratory tract is a diverse environment harbouring complex microbial communities. In previous studies, it has been demonstrated that bacterial, fungal and viral pathogens cause lung function decline and ultimately result in death due to respiratory failure. However, how these communities interact and the factors that cause particular organisms to frequently colonise this environment remains to be elucidated. In this study we aimed to characterise the intrinsic and extrinsic factors which have an effect on bacterial and fungal communities present in the CF lung in a cohort of patients who were homo- or heterozygous for the F508del CFTR allele. A further objective was to follow these patients longitudinally, to determine the stability of the CF lung microbiota, the effects of antibiotic therapy, and to assess if any changes occurred in the CF lung during times of pulmonary exacerbation which could be identified as the causative agent.