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Vaccine Sep 2008The pathology of human influenza has been studied most intensively during the three pandemics of the last century, the last of which occurred in 1968. It is important to... (Review)
Review
The pathology of human influenza has been studied most intensively during the three pandemics of the last century, the last of which occurred in 1968. It is important to revisit this subject because of the recent emergence of avian H5N1 influenza in humans as well as the threat of a new pandemic. Uncomplicated human influenza virus infection causes transient tracheo-bronchitis, corresponding with predominant virus attachment to tracheal and bronchial epithelial cells. The main complication is extension of viral infection to the alveoli, often with secondary bacterial infection, resulting in severe pneumonia. Complications in extra-respiratory tissues such as encephalopathy, myocarditis, and myopathy occur occasionally. Sensitive molecular and immunological techniques allow us to investigate whether these complications are a direct result of virus infection or an indirect result of severe pneumonia. Human disease from avian influenza virus infections is most severe for subtype H5N1, but also has been reported for H7 and H9 subtypes. In contrast to human influenza viruses, avian H5N1 virus attaches predominantly to alveolar and bronchiolar epithelium, corresponding with diffuse alveolar damage as the primary lesion. Viremia and extra-respiratory complications appear to be more common for infections with avian H5N1 virus than with human influenza viruses. Further understanding and comparison of the pathology of human and avian influenza virus infections only can be achieved by directed and careful pathological analysis of additional influenza cases.
Topics: Bronchitis; Encephalitis, Viral; Humans; Influenza A Virus, H5N1 Subtype; Influenza, Human; Myocarditis; Myositis; Pneumonia, Viral; Tracheitis
PubMed: 19230162
DOI: 10.1016/j.vaccine.2008.07.025 -
Postgraduate Medical Journal Oct 1963
Review
Topics: Bacterial Infections; Bronchitis; Bronchopneumonia; Encephalitis; Heart Diseases; Humans; Influenza, Human; Klebsiella; Neurologic Manifestations; Pneumonia; Pneumonia, Viral; Polyradiculopathy; Staphylococcus; Streptococcus pneumoniae; Streptococcus pyogenes; Tracheitis
PubMed: 14053697
DOI: 10.1136/pgmj.39.456.578 -
Indian Journal of Pediatrics Nov 2021To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.
OBJECTIVE
To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.
METHODS
Retrospective study of 67 stridor cases in pediatric age group (from birth to 18 y), admitted to the Department of Pediatrics and ENT (Ear, Nose and Throat) from May 2018 to April 2020 were included in the study. Data were obtained from medical records regarding age, gender, clinical presentation, and management.
RESULTS
Out of 67 cases of pediatric stridor, 28.3% were infants, 50.7% were between 1 to 5 y, while 20.9% were between 5 to 18 y. Foreign body trachea (FB) was the most common (38.8%) cause of stridor. The commonest cause of stridor among infants was laryngomalacia (47.4%) while FB trachea (55.9%) was the commonest cause among 1 to 5 y age group. In age group between 5 to 18 y, peritonsillar abscess and bacterial tracheitis (21.4% each) were found to be the most common. Primary management with securing of airways were done in all cases. Curative treatment was provided according to the underlying pathology. Eight patients (11.9%) required tracheostomy to bypass airway obstruction. There was no mortality in the present study population.
CONCLUSION
Pediatric stridor management is a teamwork between ENT surgeons, pediatricians, and anaesthetists. Management starts with suspicion from history followed by clinical and radiological evaluation. Securing airway is of utmost importance and precise management of cause is carried out later.
Topics: Airway Obstruction; Child; Humans; Infant; Respiratory Sounds; Retrospective Studies; Tracheal Diseases; Tracheostomy
PubMed: 33728566
DOI: 10.1007/s12098-021-03722-8 -
Ear, Nose, & Throat Journal Dec 2022Necrotizing tracheitis is a rare condition, mainly seen in immunocompromised patients, that may lead to pseudomembrane formation, airway obstruction and in severe cases,...
Necrotizing tracheitis is a rare condition, mainly seen in immunocompromised patients, that may lead to pseudomembrane formation, airway obstruction and in severe cases, tracheal perforation. We present a case of a 32-year-old male with poorly controlled diabetes who presented with productive cough, dysphagia, and respiratory distress. Bronchoscopy revealed extensive tracheal necrosis along a 4-5 cm segment of cartilaginous trachea and was complicated by tracheal perforation with false passage into the anterior mediastinum. Once the airway was re-established, a multidisciplinary team discussed options for definitive airway management, including tracheal reconstruction, pulmonary stent, or tracheostomy. Ultimately, a distal XLT tracheostomy was placed. Microbiology specimens of the tracheal tissue were positive for . The patient was started on long-term antibiotics and diabetes management. At three-month follow-up, the trachea was patent with near complete mucosalization of the previously necrotic segment. An area of proximal tracheal stenosis was successfully managed with a customized tracheal T-tube. In conclusion, this is a case of necrotizing tracheitis complicated by tracheal perforation. Successful treatment required a multidisciplinary team for airway management as well as medical treatment of immunocompromising risk factors and antimicrobial therapy. This enabled timely healing of the trachea and a durable airway.
Topics: Humans; Male; Adult; Tracheitis; Trachea; Tracheal Diseases; Bacterial Infections; Tracheostomy; Anti-Bacterial Agents
PubMed: 36028929
DOI: 10.1177/01455613221123664 -
Pediatric Pulmonology Sep 2017Identify risk factors for readmission due to a bacterial tracheostomy-associated respiratory tract infection (bTARTI) within 12 months of discharge after tracheotomy.
OBJECTIVE
Identify risk factors for readmission due to a bacterial tracheostomy-associated respiratory tract infection (bTARTI) within 12 months of discharge after tracheotomy.
DESIGN/METHODS
We performed a retrospective cohort study of 240 children who underwent tracheotomy and were discharged with tracheotsomy in place between January 1, 2005 and June 30, 2013. Children with prolonged total or post-tracheotomy length of stay (LOS), less than 12 months of follow-up, or who died during the index hospitalization were excluded. Readmission for a bTARTI (eg, pneumonia, tracheitis) treated with antibiotics, as ascertained by manual chart review, was the outcome variable. We used multivariate logistic regression to identify the independent association between risk factors and hospital readmission for bTARTI within 12 months.
RESULTS
At index hospitalizations for tracheotomy, the median admission age was 5 months (interquartile range [IQR] 2-43 months) and median LOS was 73 days (IQR 43-121 days). Most patients were of Hispanic ethnicity (n = 162, 68%) and were publicly insured (n = 213, 89%). Nearly half (n = 112, 47%) were discharged on positive pressure mechanical ventilation. Many (n = 103, 43%) were admitted for bTARTI within 12 months of discharge. Only Hispanic ethnicity (adjusted odds ratio [AOR] 2.0; 95% confidence interval [CI]: 1.1-3.9; P = 0.03) and acquisition of Pseudomonas aeruginosa between tracheotomy and discharge from index hospitalization (AOR 3.2; 95%CI: 1.2-8.3; P = 0.02) were independently associated with increased odds of bTARTI readmission, while discharge on gastrointestinal pro-motility agents was associated with decreased risk (AOR = 0.4; 95%CI: 0.2-0.8; P = 0.01).
CONCLUSIONS
Hispanic ethnicity and post-tracheotomy acquisition of P. aeruginosa during initial hospitalization are associated with bTARTI readmission.
Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Length of Stay; Logistic Models; Male; Odds Ratio; Patient Discharge; Patient Readmission; Pneumonia; Pseudomonas Infections; Pseudomonas aeruginosa; Respiratory Tract Infections; Retrospective Studies; Risk Factors; Tracheitis; Tracheostomy; Tracheotomy
PubMed: 28440922
DOI: 10.1002/ppul.23716 -
Anaesthesia Dec 1985
Topics: Airway Obstruction; Child; Humans; Male; Pneumococcal Infections; Tracheitis
PubMed: 4083460
DOI: 10.1111/j.1365-2044.1985.tb10684.x -
Hospital Pediatrics Jan 2017Identify hospital-level care variations and association with length of stay (LOS) and hospital revisit in children with tracheostomies hospitalized for bacterial...
OBJECTIVES
Identify hospital-level care variations and association with length of stay (LOS) and hospital revisit in children with tracheostomies hospitalized for bacterial respiratory tract infections (bRTIs).
METHODS
A multicenter, retrospective cohort study that used the Pediatric Health Information System database between 2007 and 2014 of patients with tracheostomies aged ≤18 years with a primary diagnosis of bRTI (eg, tracheitis) or a primary diagnosis of a bRTI symptom (eg, cough) and a secondary diagnosis of bRTI. Primary outcomes were LOS and 30-day all-cause revisit rates. Secondary outcomes included hospital-level diagnostic testing and anti-Pseudomonas antibiotic use. We used mixed-effects negative binomial (for LOS) and logistic (for revisit) regression to explore the relationship between hospital-level diagnostic test utilization and the outcomes.
RESULTS
Data representing 4137 unique patients with a median age of 3 years (interquartile range: 1-9 years) were included. Median LOS was 4 days (interquartile range: 3-8 days), and the 30-day revisit rate was 24.9%. Use of diagnostic testing and empirical anti-Pseudomonas antibiotics varied significantly among hospitals (all P values <.001). After adjusting for patient and hospital characteristics, compared with low test utilization hospitals, there were no differences in 30-day all-cause revisit rates in moderate (adjusted odds ratio: 1.19; 95% confidence interval [CI]: 0.93-1.52) or high (adjusted odds ratio: 1.07; 95% CI: 0.82-1.39) utilization hospitals. LOS in hospitals with moderate (% difference: -0.8%; 95% CI: -14.4-14.9%) or high (% difference: 13.9%; 95% CI: -0.7-30.6%) test utilization was not significantly longer.
CONCLUSIONS
Given that care variations were not associated with outcomes, future research should focus on standardizing diagnosis and treatment of bRTIs and readmission prevention in this population.
Topics: Anti-Bacterial Agents; California; Child; Child, Preschool; Cohort Studies; Diagnostic Tests, Routine; Female; Humans; Infant; Length of Stay; Male; Odds Ratio; Outcome and Process Assessment, Health Care; Patient Care Management; Patient Readmission; Pseudomonas Infections; Respiratory Tract Infections; Retrospective Studies; Tracheostomy
PubMed: 27998905
DOI: 10.1542/hpeds.2016-0104 -
Drugs 2001Upper respiratory tract infections (URTIs) are responsible for a large amount of community antibacterial use worldwide. Recent systematic reviews have demonstrated that... (Review)
Review
Upper respiratory tract infections (URTIs) are responsible for a large amount of community antibacterial use worldwide. Recent systematic reviews have demonstrated that most URTIs resolve naturally, even when bacteria are the cause. The high consumer expectation for antibacterials in URTIs requires intervention by the general practitioner and a number of useful strategies have been developed. Generic strategies, including eliciting patient expectations, avoiding the term 'just a virus', providing a value-for-money consultation, providing verbal and written information, empowering patients, conditional prescribing, directed education campaigns, and emphasis on symptomatic treatments, should be used as well as discussion of alternative medicines when relevant. The various conditions have differing rates of bacterial infection and require different approaches. For acute rhinitis, laryngitis and tracheitis, viruses are the only cause and, therefore, antibacterials are never required. In acute sore throat (pharyngitis) Streptococcus pyogenes is the only important bacterial cause. A scoring system can help to increase the likelihood of distinguishing a streptococcal as opposed to viral infection, or alternatively patients should be given antibacterials only if certain conditions are fulfilled. Strategies for treating acute otitis media vary in different countries. Most favour the strategy of prescribing antibacterials only when certain criteria are fulfilled, delaying antibacterial prescribing for at least 24 hours. In otitis media with effusion, on the other hand, there is no primary role for antibacterials, as the condition resolves naturally in almost all patients aged >3 months. Detailed strategies for acute sinusitis have not been worked out but restricting antibacterial prescribing to certain clinical complexes is currently recommended by several authorities because of the high natural resolution rate.
Topics: Anti-Bacterial Agents; Drug Prescriptions; Drug Resistance; Humans; Patient Care Planning; Patient Satisfaction; Practice Patterns, Physicians'; Respiratory Tract Infections
PubMed: 11735633
DOI: 10.2165/00003495-200161140-00004 -
BMC Family Practice May 2021This paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications...
Clinical diagnosis and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship.
BACKGROUND
This paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications for future antibiotic stewardship.
METHODS
The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. It used mixed-methods comprising non-participative observations, exit-survey and microbiological study. Observations were conducted to record clinical diagnosis and antibiotic prescription. Semi-structured questionnaire survey was used to collect patient's sociodemographic information and symptoms. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.
RESULTS
A total of 1068 (51.0% male vs 49.0% female) patients completed the study with diagnosis of respiratory tract infection (326,30.5%), bronchitis/tracheitis (249,23.3%), pharyngitis (119,11.1%) and others (374, 35.0%). They provided 683 sputum and 385 throat swab specimens. Antibiotics were prescribed for 88% of the RTI patients. Of all the specimens tested, 329 (31%) were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24% in all specimens), H. influenza (16%), H. parainfluenzae (15%), P. aeruginosa (6%), S.aureus (5%), M. catarrhalis (3%) and S. pneumoniae (2%).
CONCLUSIONS
The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China. It reveals that prescription of antibiotics, especially broad-spectrum and combined antibiotics, is still very common and there is a clear need for stewardship programs aimed at both reducing the number of prescriptions and promoting single and narrow-spectrum antibiotics.
Topics: Ambulatory Care Facilities; Anti-Bacterial Agents; Antimicrobial Stewardship; China; Female; Humans; Male; Respiratory Tract Infections; Rural Population
PubMed: 33957884
DOI: 10.1186/s12875-021-01448-2 -
JAMA Network Open Dec 2021Endotracheal aspirate cultures are commonly collected from patients with mechanical ventilation to evaluate for ventilator-associated pneumonia or tracheitis. However,...
IMPORTANCE
Endotracheal aspirate cultures are commonly collected from patients with mechanical ventilation to evaluate for ventilator-associated pneumonia or tracheitis. However, the respiratory tract is not sterile, making differentiating between colonization from bacterial infection challenging, and results may be unreliable owing to variable specimen quality and sample processing across laboratories. Despite these limitations, clinicians routinely interpret bacterial growth in endotracheal aspirate cultures as evidence of infection, sometimes regardless of organism significance, prompting antibiotic treatment.
OBJECTIVE
To assess the variability in endotracheal aspirate culture rates and the association between culture rates and antibiotic prescribing among patients with mechanical ventilation across children's hospitals in the US.
DESIGN, SETTING, AND PARTICIPANTS
Cross-sectional retrospective analysis of data obtained from the Children's Hospital Association Pediatric Health Information System database between January 1, 2016, through December 31, 2019. Participants were all patients hospitalized with mechanical ventilation aged less than 18 years.
EXPOSURES
A charge for an endotracheal aspirate culture on a ventilated day.
MAIN OUTCOMES AND MEASURES
Endotracheal aspirate culture rate and antibiotic days of therapy per ventilated days. For mechanical ventilation, clinical transaction classification codes for mechanical ventilation other unspecified ventilator assistance were used. To identify respiratory cultures, the laboratory test code for aerobic culture was used and relevant keywords (ie, respiratory tract, sputum) were used to identify sources in the hospital charge description master.
RESULTS
A total of 152 132 patients were identified among 31 hospitals. Among these patients, 79 691 endotracheal aspirate cultures were collected on a ventilator-day (patients aged less than 1 year, 44%; 1-4 years, 27%, 5-11 years. 16%, and 12-18 years, 13%; 3% were Asian; 17% Hispanic; 21% non-Hispanic Black; 45% Non-Hispanic White patients; 14% were other; 56% of patients were male, 44% were female). The overall median rate of culture use was 46 per 1000 ventilator-days (IQR, 32-73 cultures per 1000 ventilator-days). The endotracheal aspirate culture rate was positively correlated with the hospital's antibiotic days of therapy rate (R = 0.46; P = .009). In a multivariable model adjusting for patient-level and hospital-level characteristics and among patients with mechanical ventilation, each additional endotracheal aspirate culture was associated with 2.87 (95% CI, 2.74-3.01) higher odds of receiving additional days of therapy compared with patients who did not receive and endotracheal aspirate culture.
CONCLUSIONS AND RELEVANCE
In this study, notable variability was found in endotracheal aspirate culture rates across US pediatric hospitals and pediatric intensive care units, and endotracheal aspirate culture use was associated with increased antibiotic use. These findings suggest an opportunity for diagnostic and antibiotic stewardship to standardize testing and treatment of suspected ventilator-associated infections in pediatric patients with mechanical ventilation pediatric patients.
Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Cross-Sectional Studies; Exudates and Transudates; Female; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Male; Respiration, Artificial; Trachea; United States
PubMed: 34935920
DOI: 10.1001/jamanetworkopen.2021.40378