Procalcitonin to guide antibiotic administration in COPD exacerbations: a meta-analysis

Challenges in the differentiation of the aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to significant overuse of antibiotics. Serum procalcitonin, released in response to bacterial infections, but not viral infections, could possibly identify AECOPD requiring antibiotics. In this meta-analysis we assessed the clinical effectiveness of procalcitonin-based protocols to initiate or discontinue antibiotics in patients presenting with AECOPD.Based on a prospectively registered protocol, we reviewed the literature and selected randomised or quasi-randomised trials comparing procalcitonin-based protocols to initiate or discontinue antibiotics versus standard care in AECOPD. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses.We included eight trials evaluating 1062 patients with AECOPD. Procalcitonin-based protocols decreased antibiotic prescription (relative risk (RR) 0.56, 95% CI 0.43-0.73) and total antibiotic exposure (mean difference (MD) -3.83, 95% CI (-4.32--3.35)), without affecting clinical outcomes such as rate of treatment failure (RR 0.81, 0.62-1.06), length of hospitalisation (MD -0.76, -1.95-0.43), exacerbation recurrence rate (RR 0.96, 0.69-1.35) or mortality (RR 0.99, 0.58-1.69). However, the quality of the available evidence is low to moderate, because of methodological limitations and small overall study population.Procalcitonin-based protocols appear to be clinically effective; however, confirmatory trials with rigorous methodology are required.

Low Serum Levels of Vitamins A, D, and E Are Associated with Recurrent Respiratory Tract Infections in Children Living in Northern China: A Case Control Study

Background

This study aimed to investigate the association of serum concentrations of vitamin A, D, and E with recurrent respiratory tract infections (RRTIs).

Methods

A total of 1200 children aged at 0.5–14 years were selected via a face-to-face survey in Harbin, China. Among the participants, 600 children with RRTIs comprised the symptomatic group (RRTI group), whereas 600 healthy children were used as controls (control group). Blood samples were collected to measure serum levels of vitamins A and E by HPLC; the serum level of 25-hydroxycholecalciferol (25(OH)D), was measured by HPLC-MS/MS.

Results

Serum levels of vitamins A and E, as well as 25(OH)D, were significantly lower in the RRTI group than the control group. The conditional logistic regression model and the receiver-operating characteristic curve showed that the insufficiency or deficiency of vitamins A, D, and E was positively correlated with RRTI occurrence (p < 0.05).

Conclusions

Low serum concentrations of vitamins A, D, and E were associated with RRTIs in children from northern China.

Probiotic Supplements Beneficially Affect Tryptophan-Kynurenine Metabolism and Reduce the Incidence of Upper Respiratory Tract Infections in Trained Athletes: A Randomized, Double-Blinded, Placebo-Controlled Trial

Background: Prolonged intense exercise has been associated with transient suppression of immune function and an increased risk of infections. In this context, the catabolism of amino acid tryptophan via kynurenine may play an important role. The present study examined the effect of a probiotic supplement on the incidence of upper respiratory tract infections (URTI) and the metabolism of aromatic amino acids after exhaustive aerobic exercise in trained athletes during three months of winter training. Methods: Thirty-three highly trained individuals were randomly assigned to probiotic (PRO, n = 17) or placebo (PLA, n = 16) groups using double blind procedures, receiving either 1 × 10¹⁰ colony forming units (CFU) of a multi-species probiotic (Bifidobacterium bifidum W23, Bifidobacterium lactis W51, Enterococcus faecium W54, Lactobacillus acidophilus W22, Lactobacillus brevis W63, and Lactococcus lactis W58) or placebo once per day for 12 weeks. The serum concentrations of tryptophan, phenylalanine and their primary catabolites kynurenine and tyrosine, as well as the concentration of the immune activation marker neopterin were determined at baseline and after 12 weeks, both at rest and immediately after exercise. Participants completed a daily diary to identify any infectious symptoms. Results: After 12 weeks of treatment, post-exercise tryptophan levels were lowered by 11% (a significant change) in the PLA group compared to the concentrations measured before the intervention (p = 0.02), but remained unchanged in the PRO group. The ratio of subjects taking the placebo who experienced one or more URTI symptoms was increased 2.2-fold compared to those on probiotics (PLA 0.79, PRO 0.35; p = 0.02). Conclusion: Data indicate reduced exercise-induced tryptophan degradation rates in the PRO group. Daily supplementation with probiotics limited exercise-induced drops in tryptophan levels and reduced the incidence of URTI, however, did not benefit athletic performance.

Single Nucleotide Polymorphisms at +191 and +292 of Galectin-3 Gene (LGALS3) Related to Lower GAL-3 Serum Levels Are Associated with Frequent Respiratory Tract Infection and Vaso-Occlusive Crisis in Children with Sickle Cell Anemia

INTRODUCTION

Patients with sickle cell anemia (SCA) may present chronic hemolytic anemia, vaso-occlusion and respiratory tract infection (RTI) episodes. Galectin-3 (GAL-3) is a multifunctional protein involved in inflammation, apoptosis, adhesion and resistance to reactive oxygen species. Studies point to a dual role for GAL-3 as both a circulation damage-associated molecular pattern and a cell membrane associated pattern recognition receptor.

OBJECTIVE

To investigate associations between the SNPs of GAL-3 gene (LGALS3) and serum levels with RTI and vaso-occlusive crisis (VOC) in children with SCA.

MATERIALS AND METHODS

SNPs +191 and +292 in LGALS3 were studied using the TaqMan real-time PCR system; GAL-3 serum levels were measured by ELISA. The study included 79 children with SCA ranging from 2 to 12 years old.

RESULTS

GAL-3 serum levels were associated with LGALS3 +191 and +292 genotypes (p <0.0001; p = 0.0169, respectively). LGALS3 +191, AA genotype was associated with low and CC with higher levels of GAL-3. For LGALS3 +292, the CC genotype was associated with lower GAL-3 and AA with higher levels. Patients with Frequency of RTI (FRTI) ≥1 presented higher frequency of +191AA (p = 0.0263) and +292AC/CC genotypes (p = 0.0320). SNP +292 was associated with Frequency of VOC (FVOC) (p = 0.0347), whereas no association was shown with SNP +191 and FVOC. However, CA/AC and AA/CC genotypes with lower GAL-3 levels showed a higher frequency in patients with FRTI ≥1 (p = 0.0170; p = 0.0138, respectively). Also, patients with FVOC ≥1 presented association with CA/AC (p = 0.0228). LGALS3 +191 and +292 combined genotypes related to low (p = 0.0263) and intermediate expression (p = 0.0245) were associated with FRTI ≥1. Lower GAL-3 serum levels were associated with FRTI ≥1 (p = 0.0426) and FVOC ≥1 (p = 0.0012).

CONCLUSION

Variation of GAL-3 serum levels related to SNPs at +191 and +292 may constitute a susceptibility factor for RTI and VOC frequency.

Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children

BACKGROUND

To analyse specific immune response to the 23-valent pneumococcal polysaccharide vaccine by measuring pneumococcal antibodies in children with asthma and with respiratory recurrent infection (RRI) as compared to healthy children.

METHODS

The study included 60 children, divided into three groups: 20 with asthma, 20 with RRI, and 20 healthy controls. Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) contained in the 23-valent pneumococcal polysaccharide vaccine (PPV) were measured. A specific IgG concentration ≥1.3μg/mL was considered a protective response to the vaccine. For statistical analysis, levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the x(2) test.

RESULTS

All of the children showed antipneumococcal antibody levels >1.3μg/mL for over 70% of the serotypes, considered within the normal range of response. Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied.

CONCLUSION

The asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children. Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency (SAD). Because asthma patients are at high risk for invasive pneumococcal infections, it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine, considering the positive response to PPV reported here.

Assessment of the levels of serum Hsp 70 and ghrelin in children with simple febrile convulsions

BACKGROUND

In this study we aimed to evaluate the serum levels of Heat-shock protein (Hsp) 70 and acylated and desacylated ghrelin in patients suffering from a simple febrile convulsion.

METHODS

This cross-sectional study included patients who were diagnosed with a simple febrile convulsion, afebrile tonic-clonic epileptic seizure and upper respiratory tract infection when admitted to our hospital. All patients were aged between six months and 60 months. Patients enrolled in this study were divided into five groups. Group I: patients with a simple febrile convulsion and body temperature of 38º C to 39° C; group II: patients with a simple febrile convulsion and body temperature of 39.1° C to 41° C; group III: patients with primary generalised tonic-clonic seizure and normal body temperature; group IV: patients with upper respiratory infection without convulsion and a body temperature of 38° C to 39° C; and group V: patients with upper respiratory infection without convulsion and a body temperature of 39.1° C to 41° C. The control group included healthy children who were followed up in the healthy children polyclinic. Serum levels of Hsp70 and acylated and des-acylated ghrelin were studied from the blood samples collected from the patients and control group.

RESULTS

Serum levels of Hsp70 were higher in the febrile convulsion (groups I, II) and epileptic convulsion and infection (groups IV, V) groups than in the controls (P<0.0001). Moreover, serum levels of acylated and desacylated ghrelin were higher in the simple febrile convulsion (groups I and II) and epileptic convulsion and infection (groups IV and V) groups than in the control (P<0.05).

CONCLUSIONS

We demonstrated that serum levels of Hsp70 and acylated and desacylated ghrelin increased in patients with a simple febrile convulsion.

Association of haematological and radiological Findings with clinical outcome in hospitalized Children 2-36 months old with severe lower Respiratory tract infection

BACKGROUND

Despite reduction in child mortality during last decade, lower respiratory tract infection (LRTI) remained number one killer of under-five. The current study aimed to assess the association of haematological and radiological findings with clinical outcome in hospitalized children 2-36 months old with severe LRTI.

METHODS

In the current cross sectional study, 581 children 2-36 months old with severe LRTI were enrolled and followed at the Children Hospital, Islamabad, between 2011 and 2014. At the time of enrolment, complete history of present illness, anthropometric measurements, blood sample and chest radiograph were obtained. The primary outcome was either early clinical response (within 72 hours) or delayed clinical response (>72 hours). Multivariable logistic regression was performed to examine the association between haematological and radiological findings with clinical outcome, adjusted for potential confounding factors.

RESULTS

Of 581 enrolled children, 292 (50.3%) children had early, and 289 (49.7%) had delayed clinical response. The multivariable logistic regression showed that leucocytosis (OR 1.79, 95% CI 1.15-2.79), neutrophilia (OR 1.91, 95% CI 1.29-2.84), radiological interstitial pneumonia (OR 2.49, 95%CI 1.70-3.64), and lobar consolidation (OR 6.00, 95%CI 2.41-14.96) were significantly associated with delayed clinical response, after adjusted for potential confounding factors.

CONCLUSIONS

Delayed clinical response was significantly associated with abnormal haematological and radiological findings at the time of admission in children 2-36 months old with severe LRTI. Haematological and radiological findings at the time of presentation are useful for predicting delayed clinical response in children 2-36 months old with severe LRTI.

Predictors of early infection in cerebral ischemic stroke

BACKGROUND

Infection is the most common complication of stroke.

AIM

To determine the risk factors and predictors of post-stroke infection (PSI), which developed within 7 days from the onset of acute ischemic stroke.

SUBJECTS

The study included 60 ischemic stroke patients admitted in the Neurology Department of Zagazig University, Egypt, who were subdivided into: [Non Stroke Associated Infection group (nSAI); 30 patients having stroke without any criteria of infection within 7 days from the onset and Stroke Associated Infection group (SAI); 30 patients having stroke with respiratory tract infection (RTI) or urinary tract infection within 7 days], in addition to 30 healthy sex and age-matching subjects as control.

METHODS

All the patients had a detailed history taking, thorough clinical general and neurological examination, laboratory tests (Urine analysis & urine culture, blood sugar, lipid profile and serum tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-10), a chest radiography to assess RTI and brain computed tomography (CT) to exclude the hemorrhagic stroke and to confirm the ischemic stroke.

RESULTS

SAI patients were found to be significantly older with higher baseline blood glucose level. Also the number of patients with tube feeding, lower conscious level, more stroke severity and more large size infarcts were significantly higher in SAI patients. There was a significant elevation in the IL-10, a significant decrease in the TNF-α and a significant decrease in the TNF-α/ IL-10 ratio, in the SAI group. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and size of infarct area > 3.5 cm3 were found to be the independent predictors of PSI.

CONCLUSION

Patients with older age, tube feeding, lower conscious level, worse baseline stroke severity, large cerebral infarcts in CT scan, and increased IL-10 serum level were more susceptible to infection. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and the size of infarct area > 3.5 cm3 were the independent predictors of PSI.

[Is procalcitonin measurement useful in managing respiratory tract infections?]

Better use of current antibiotics is warranted to curb increasing antimicrobial resistance rates. Procalcitonin guidance can safely reduce antibiotic usage when used to initiate or discontinue antibiotics in adult patients with a respiratory tract infection. However, the claimed reductions in antibiotic usage are mainly achieved in patients with acute bronchitis and exacerbations of COPD, conditions for which guidelines already discourage antibiotic treatment. Sequential procalcitonin measurements can also reduce the treatment duration of community-acquired pneumonia from 10-12 to 5-7 days, which is, however, already the recommended treatment duration for in- and outpatients under the current Dutch guidelines. Investigating why physicians do not follow these guidelines might therefore be more helpful than introducing new laboratory tests such as that for procalcitonin. Determination of the aetiology of community-acquired pneumonia is an important clinical problem. Host gene expression pattern assays are promising for diagnosis of the aetiology of acute respiratory illness. This might be helpful to guide antibiotic therapy.

Prevalence of respiratory tract infections, allergies and assessment of humoral immunity within the Malopolska region's cohort of 11- year old children born with extremely low birth weight in comparison with to their term born peers

BACKGROUND

Children born with extremely low birth weight (ELBW) have more respiratory tract complications during childhood. Little is known about respiratory and allergy problems in ELBW children at the threshold of adolescence.

MATERIALS AND METHODS

A follow-up study was conducted at the age of 11 among ELBW children (n=65) and age-matched controls (n=36). The primary outcomes in the study were the occurrence of respiratory and allergy problems and the rate of hospitalization due to respiratory complications at the age of 11 years, assessed with a questionnaire. Secondary outcome variables were serum levels of immunoglobulin classes.

RESULTS

ELBW children had more respiratory tract infections (31 vs.11%, p = 0.03), but less allergies (3 vs. 22%, p < 0.01) compared with controls and had lower level of serum tIgE (geometric mean: 46.5 vs. 89.3 kU/l, p = 0.02). The risk factors for the occurrence of respiratory tract disorders in the ELBW group were: low gestational age, need for surfactant therapy and length of ventilatory support in the neonatal period.

CONCLUSIONS

ELBW children have more frequent respiratory tract complications, but fewer allergies at the age of 11 years compared with children born at term. Lower respiratory tract problems decrease in ELBW children with age. Respiratory tract infections are not connected with deficiency in humoral immunity.

[Procalcitonin as biomarker for infections]

- Inappropriate use of antibiotics in patients without bacterial infection contributes significantly to worldwide antibiotic resistance.- The goal of this review is to summarise evidence from randomised trials investigating the value of the biomarker procalcitonin (PCT) in patients with symptoms of a bacterial infection in the emergency department (ED) and intensive care (IC).- In patients with a lower respiratory infection in the ED, RCTs demonstrate that withholding or shortening of antibiotic treatment in patients with low PCT levels does not lead to a change in clinical outcome. Similar results were observed in IC patients, where a reduction in PCT level indicates that antibiotics can be discontinued sooner.- In conclusion, initiating and discontinuing antibiotics in ED and IC patients based on PCT levels is safe, appears cost-saving and leads to a reduction in antibiotic use due to fewer antibiotics prescriptions and shortened courses.

What a difference a CRP makes. A prospective observational study on how point-of-care C-reactive protein testing influences antibiotic prescription for respiratory tract infections in Swedish primary health care

OBJECTIVE

To explore how C-reactive protein (CRP) tests serve to support physicians in decisions concerning antibiotic prescription to patients with respiratory tract infections (RTI).

DESIGN

Prospective observational study.

SETTING

Primary health care centres in western Sweden.

SUBJECTS

Physicians in primary health care. Patients with acute RTI.

MAIN OUTCOME MEASURES

Physician willingness to measure CRP, their ability to estimate CRP, and changes in decision-making concerning antibiotic treatment based on error estimate and the physician's opinion of whether CRP measurement was crucial.

RESULTS

Data from 340 consultations were gathered. CRP testing was found to be crucial in 130 cases. In 86% of visits decisions regarding antibiotic prescription were unchanged. Physicians considering CRP crucial and physicians making an error estimate of CRP altered their decisions concerning antibiotic prescription after CRP testing more often than those who considered CRP unnecessary, and those making a more accurate estimate. Physicians changed their decision on antibiotic prescription in 49 cases. In the majority of these 49 cases physicians underestimated CRP levels, and the majority of changes were from "no" to "yes" as to whether to prescribe antibiotics.

CONCLUSION

CRP is an important factor in the decision on whether to prescribe antibiotics for RTIs. Error estimates of CRP and willingness to measure CRP are important factors leading to physicians changing decisions on antibiotic treatment. Key points There is a generally low antibiotic prescription rate and a high frequency of C-reactive protein (CRP) testing for respiratory tract infections (RTIs) in Sweden. CRP testing was considered essential to further management in 38% of cases. In 86% of visits decisions concerning antibiotic prescription were unchanged. The strongest predictors for revised decisions on antibiotic treatment were error estimates of CRP and the physician's opinion that CRP measurement was crucial.

[Value of serum procalcitonin for the guidance of antibiotic therapy in children with lower respiratory tract infection]

OBJECTIVE

To evaluate the value of serum procalcitonin (PCT) for the guidance of antibiotic therapy in children with lower respiratory tract infection (LRTI).

METHODS

A prospective randomized controlled study was conducted in 396 children with LRTI who visited Weifang Maternity and Child Care Hospital. The participants were randomly assigned into a PCT group in which the antibiotic therapy was guided by serum PCT level and a control group in which the standard therapy was given according to clinical guidance. Afterwards, a subgroup analysis was performed according to whether the patient was diagnosed with community-acquired pneumonia (CAP). After 14-day treatment, antibiotic prescription rate, duration of antibiotic treatment, and side events were compared between the groups.

RESULTS

A total of 396 cases were recruited and equally assigned into the PCT group and the control group, among whom the numbers of the children with CAP were 125 and 123, respectively. The mean duration of antibiotic treatment was significantly shorter in the PCT group than in the control group (P<0.05). The subgroup analysis showed that the duration of antibiotic treatment in both CAP and non-CAP PCT subgroups was significantly shorter than in the control subgroups (P<0.05), however, the antibiotic prescription rate in the non-CAP PCT subgroup was significantly higher than that in the non-CAP control subgroup (P<0.05). There were no differences in the rate and duration of side events from antibiotic therapy, hospitalization rate, the length of hospital stay, and safety between the PCT and control groups.

CONCLISOPNS

Serum PCT-based guidelines on antibiotic use can shorten the duration of antibiotic therapy in children with LRTI.

Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective

BACKGROUND

Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment.

METHODS

To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact model based on patient-level meta-analysis data of randomized trials. The meta-analytic data was adapted to the US setting by applying the meta-analytic results to US lengths of stay, costs, and practice patterns. We estimated the annual ARI visit rate for the one million member cohort, by setting (inpatient, ICU, outpatient) and ARI diagnosis.

RESULTS

In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the one million member cohort was $2,083,545, compared to $2,780,322, resulting in net savings of nearly $700,000 to the IDN for 2014. In the ICU and outpatient settings, savings were $73,326 and $5,329,824, respectively, summing up to overall net savings of $6,099,927 for the cohort. RESULTS were robust for all ARI diagnoses. For the whole US insured population, procalcitonin-guided care would result in $1.6 billion in savings annually.

CONCLUSIONS

Our results show substantial savings associated with procalcitonin protocols of ARI across common US treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and the savings can be achieved without any negative impact on treatment outcomes.

Respiratory tract infections in diabetic and non-diabetic individuals are linked with serum surfactant protein-D

OBJECTIVE

To find out the rate of respiratory tract infections in diabetic and non-diabetic individuals and their relation with surfactant protein D.

METHODS

The cross-sectional study was conducted at Dow University of Health Sciences, Karachi, from September 2011 to April 2012, and comprised subjects of both genders between ages of 30 and 60 years. The subjects were divided into four groups: diabetic obese, non-diabetic obese, diabetic non-obese, and non-diabetic-non-obese. A structured questionnaire was used to collect information about respiratory tract infections. Serum surfactant protein D levels were analysed using human surfactant protein D enzyme-linked immunosorbent assay kit. Statistical analysis was performed using SPSS 16.

RESULTS

Of the 90 subjects, there were 20(22.2%) diabetic obese, 30(33.3%) non-diabetic obese, 10(11.1%) diabetic non-obese, and 30(33.3%) non-diabetic-non-obese. The overall mean age was 36.6±103 years. Among the diabetic obese, 15(75%) had respiratory tract infections which was higher than the other study groups, and patients having respiratory tract infections had lower surfactant protein D levels than those who did not have infections (p=0.01).

CONCLUSIONS

Diabetic obese subjects had greater rate of recurrent respiratory tract infections and had lower concentration of serum surfactant protein D compared to subjects without respiratory tract infections.

Mixed group of Rhizobiales microbes in lung and blood of a patient with fatal pulmonary illness

We examined the microbial composition in the diseased lung and early-phase microbial cultures from the blood of a patient with a rapidly progressing fatal pulmonary illness. Although no microbes could be isolated from such cultures during the initial study, the HTS-microbiome study revealed the presence of a unique mixture of alphaproteobacteria, composed mainly of different families of Rhizobiales microbes. Microbial 16S rDNA sequences matching closely to Afipia cberi were identified mainly in the patient's diseased lung tissue, but only rarely in the early-phase blood cultures. Conversely, the high abundance of sequences found in early-phase blood cultures of different broth media matched closely with those of the families Methylobacteriaceae, Phyllobacteriaceae and Sphingomonadaceae. The two species that successfully adapted to grow in a laboratory culture system were A. cberi and Mesorhizobium hominis, which eventually were isolated from a previously cryopreserved blood culture of SP4 broth. Many other species, including members of the Bradyrhizobiaceae and Phyllobacteriaceae families, and all members of the Methylobacteriaceae and Sphingomonadaceae families identified by HTS remained non-cultivated. We developed specific PCR primers and FISH probes, which detected the target Rhizobiales microbes in former blood cultures and autopsy lung tissues. It is unclear what role these Rhizobiales microbes might have played in the patient's complex disease process. However, the above mentioned assays should help in rapidly detecting and identifying these previously unrecognized Rhizobiales microbes in patients.

The association between 25-dehydroxy vitamin D and lower respiratory infection in children aged less than "5" years in Imam Reza hospital, Bojnurd, Iran

OBJECTIVE

To clarify the association between vitamin D deficiency and acute respiratory infection in children below age 5 years.

METHODS

The cross-sectional study was conducted at Imam Reza Hospital in Bojnurd, Iran, in June 2013 and comprised 90 children below 5 years of age suffering from respiratory infections. They was selected on the basis of purposive sampling and were then categorised into two equal groups of 'acute' and 'non-acute' respiratory infection. Data collection was done using a questionnaire and serum level of 25-dehydroxycalcciferol was measured. SPSS 11 was used to analyse and interpret the data.

RESULTS

In the group of children with respiratory disorders, 9 (42.9%) exhibited vitamin D deficiency. There were no significant differences between the two groups in terms of demographic characteristics such as age, intrauterine age, weight, birth-weight, head circumference, height, gender, living area and respiratory distress (p>0.05 each). Vitamin D deficiency showed no meaningful statistical relation with acute respiratory infections (p>0.05).

CONCLUSIONS

More studies with higher sample size and are recommended.

Selective subnormal IgG3 in 121 adult index patients with frequent or severe bacterial respiratory tract infections

We characterized 121 adults with frequent or severe bacterial respiratory tract infections at diagnosis of selective subnormal IgG3. Mean age was 47 ± 13 (SD)y; 87.6% were women. Associated disorders included: autoimmune conditions 33.1%; hypothyroidism 14.9%; atopy 29.8%; and other allergy manifestations 41.3%. In 34.1%, proportions of protective Streptococcus pneumoniae serotype-specific IgG levels did not increase after polyvalent pneumococcal polysaccharide vaccination. Blood CD19+, CD3+/CD4+, CD3+/CD8+, and CD56+/CD16+ lymphocyte levels were within reference limits in most patients. In regression analyses, independent variables age; sex; autoimmune conditions; hypothyroidism; atopy; allergy manifestations; corticosteroid therapy; and lymphocyte subsets were not significantly associated with IgG subclass, IgA, or IgM levels. Frequencies of HLA haplotypes A*01, B*08; A*02, B*14; A*02, B*15; A*02, B*44; A*02, B*57; and A*03, B*07 were greater in 80 patients than 751 controls. We conclude that subnormal IgG3 and non-protective S. pneumoniae IgG levels contribute to increased susceptibility to respiratory tract infections.

[Plasma levels of mannan-binding lectin-associated serine protease 2 in children with upper respiratory tract infection]

OBJECTIVE

To explore the significance of plasma levels of mannan-binding lectin (MBL)-associated serine protease 2 (MASP2) in children with upper respiratory tract infection (URTI).

METHODS

A total of 103 children with URTI and 35 healthy children were examined for plasma levels of MASP2 and C-reactive protein (CRP). According to CRP levels, white blood cell count (WBC), stage of infection, and administration of treatments, the children with URTI were divided into the elevated CRP group (n=48) and the normal CRP group (n=54), elevated WBC group (n=61) and normal WBC group (n=40), the early stage of infection without treatment group (n=68) and mid-late stage of infection with treatment group (n=35).

RESULTS

Plasma MASP2 levels was significantly higher in URTI group than in the healthy control group (P<0.001) and showed a close correlation with age (r=0.302, P<0.01). Plasma MASP2 level was significantly correlated with CRP level in elevated CRP group (r=0.310, P<0.05) but not in normal CRP group (P>0.05), correlated with WBC in elevated WBC group (r=0.392, P<0.01) but not in normal WBC group (P>0.05), and was significantly higher in early stage infection without treatment group than in mid-late stage of infection with treatment group (P<0.01). MASP2, MBL2 and CRP genes had a common binding site for the transcription factor HNF-4α.

CONCLUSIONS

MASP2 may be an acute-phase protein, and its plasma level might serve as a new reference index in the diagnosis of URTI in children.

Significance of lipopolysaccharide detection in children with pulmonary infections

OBJECTIVE

The present study aimed to observe the alterations of lipopolysaccharide (LPS) and some other laboratory indexes in children suffering from pulmonary infections, and to investigate the condition of Gram-negative bacterial infection.

PATIENTS AND METHODS

All the patients received routine blood test, C reactive protein (CRP), erythrocyte sedimentation rate (ESR), Mycoplasma pneumoniae antibody IgM (MP-IgM), LPS, blood culture and chest X-ray examination. The clinical data was collected followed by induction arrangement and statistical analysis.

RESULTS

In terms of the rate of abnormity in peripheral white blood cell count and positive rate of blood CRP, no significant difference was found between children with pulmonary infections and the healthy individual in the control group (p > 0.05). The positive rates of blood MP-IgM were 33.33% and 32.26% in children with different progressive stages of pulmonary infections, which were significantly lower than those in the control group (62.96%) (p < 0.05). The positive rates of blood LPS in the observation group were higher than those in the control group, especially for those children at progressive stages within one week; and the difference between them was significant (p < 0.05). With regard to blood bacterial culture, the positive rates were 9.52% and 29.03% for children in progressive stages within one week and over one week in the observation group, respectively; the latter was significantly higher than that in the control group (p < 0.05). The result of the correlation analysis suggested a weak correlation between the positive rate of increased blood LPS in the observation group and that in blood bacterial culture (χ2 = 6.61, p < 0.05; Pearson's contingency coefficient C = 0.34). However, there was no significant correlation between the positive rate of increased blood LPS and peripheral blood white cell count, CRP, or MP-IgM (p > 0.05).

CONCLUSIONS

Endotoxemia is often accompanied by pulmonary infections, and gram-negative bacterium is a common pathogenic bacterium in children with different progressive stages of pneumonia.

Reporting effectiveness of an extract of three traditional Cretan herbs on upper respiratory tract infection: results from a double-blind randomized controlled trial

ETHNOPHARMACOLOGICAL RELEVANCE

Observations from the island of Crete, Greece suggest that infusions of traditional Cretan aromatic plants, well known for their ethnopharmacological use in Eastern Mediterranean region and Near East, could be effective in the prevention and treatment of upper respiratory tract infections, including viral-induced infections. The aim of this study was to report the effectiveness of an essential-oil extract of three Cretan aromatic plants in the treatment of cases with an upper respiratory tract infection.

MATERIALS AND METHODS

A double blind randomized controlled trial was implemented between October 2013 and February 2014. An essential-oil extract of Cretan aromatic plants in olive oil (total volume of 15ml of essential oil per litre of olive oil) was administered as 0.5ml soft gel capsules, twice a day, for 7 days. Placebo treatment was 0.5ml olive oil in soft gel capsules. Eligible patients were those presenting for clinical examination in the selected setting with signs and symptoms of upper respiratory tract infection that had begun within the previous 24 hours. Real-Time Polymerase Chain Reaction (PCR) was used for the detection of respiratory viruses. The primary outcome was the severity and duration of symptoms of upper respiratory tract infection, assessed using the Wisconsin Upper Respiratory System Survey (WURSS-21) questionnaire. A secondary outcome of interest was the change in C-reactive protein (CRP) status.

RESULTS

One hundred and five patients completed the study: 51 in the placebo group, and 54 in the intervention (treated) group. Baseline characteristics were similar in the two groups. No statistically significant differences were found in symptom duration or severity between the two groups, although small and clinically favorable effects were observed. When the analysis was restricted to subjects with a laboratory-documented viral infection, the percentage of patients with cessation of symptoms after 6 days of treatment was 91% in the intervention group and 70% in the control group (p=0.089). At baseline, one third of the patients in each group had elevated CRP levels. At follow-up, the respective proportions were 0% in the intervention group and 15% in the placebo group (p=0.121). The data were also in a favorable direction when 50% and 80% symptom reduction points were considered for specific virus types.

CONCLUSIONS

Compared with placebo the essential-oil extract of three Cretan aromatic plants provided no detectable statistically significant benefit or harm in the patients with upper respiratory illness, although descriptive differences were identified in favorable direction mainly in the virus-positive population.