Bronchitis, pneumonitis and pneumonia in University of Wisconsin students

The History of Mycoplasma pneumoniae Pneumonia

In the United States in the 1930s, although the pathogen was not known, atypical pneumonia was clinically distinguished from pneumococcal pneumonia by its resistance to sulfonamides. Reimann (1938) reported seven patients with an unusual form of tracheo bronchopneumonia and severe constitutional symptoms. He believed the clinical picture of this disease differed from that of the disease caused by influenza viruses or known bacteria and instead suspected "primary atypical pneumonia." For many years, the responsible infectious agent was tentatively classified as a filterable virus that could pass through a Seitz filter to remove bacteria and was reported to be a psittacosis-like or new virus. After that, Eaton et al. (1942, 1944, 1945) identified an agent that was the principal cause of primary atypical pneumonia using cotton rats, hamsters, and chick embryos. Eaton et al. (1942, 1944, 1945) did not perform an inoculation study in human volunteers. During the 1940s, there were three groups engaged in discovering the etiology of the primary atypical pneumonia. (1) Commission on Acute Respiratory Diseases Diseases directed by John Dingle, (2) Dr. Monroe Eaton's group, the Virus Research Laboratory of the California State Public Health Department, (3) The Hospital of the Rockefeller Institute for Medical Research directed by Horsfall. During 1940s, the members of the Commission on Acute Respiratory Diseases concluded that the bacteria-free filtrates obtained from the patients, presumably containing a virus, could induce primary atypical pneumonia in human volunteers via Pinehurst trials. During 1950s, serological approaches for identification of the Eaton agent developed such as Fluorescent-Stainable Antibody, and at the beginning of the1960s, the Eaton agent successfully grew in media, and finally accepted as a cause of primary atypical pneumonia. Thus, technical difficulties with visualizing the agent and failure to recognize the full significance of the Pinehurst transmission experiments resulted in a lapse of 20 years before acceptance of the Eaton agent as Mycoplasma pneumoniae. This review describes the history of M. pneumoniae pneumonia with a special focus on the recognition between the 1930 and 1960s of the Eaton agent as the infectious cause.

Chinese medicinal herbs for acute bronchitis

BACKGROUND

Acute bronchitis is one of the most common diagnoses made by primary care physicians. It is traditionally treated with antibiotics (although the evidence for their effectiveness is weak, and modest at best) and other even less effective treatments. Chinese medicinal herbs have also been used as a treatment.

OBJECTIVES

This review aimed to summarise the existing evidence on the comparative effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4) which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 19 September 19, 2011), EMBASE (1988 to 19 September 2011) and CNKI and the Chinese Biomedical Database (CBM) (1980 to 19 September, 2011).

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing Chinese medicinal herbs with placebo, antibiotics or other Western medicines for the treatment of uncomplicated acute bronchitis.

DATA COLLECTION AND ANALYSIS

At least two review authors independently extracted data and assessed trial quality.

MAIN RESULTS

In this updated review, 74 studies involving 6877 participants were reported as RCTs by the study authors. None of them met the inclusion criteria for this review. Out of the 74 trials, we identified 39 as non-RCTs and 35 compared different Chinese herbal medicines in the intervention and control groups.

AUTHORS' CONCLUSIONS

There is insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. Trial design limitations of the individual studies meant that we could not draw any conclusions about the benefits of Chinese herbs for acute bronchitis. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence for these herbs, although adverse events were reported in some case reports.

The first atypical pneumonia: the history of the discovery of Mycoplasma pneumoniae

The subject of atypical pneumonias is of great medical and historical interest to modern physicians. Although these diseases have no doubt affected humans throughout our history, it is not until the mid-twentieth century that physicians first began to differentiate certain atypical pulmonary infectious processes from typical pneumonia. Physicians at the time were unclear as to the precise etiology of these infections. As time progressed and study of these organisms continued, physicians were better able to identify the causative agent and devise tests with which to detect the disease. This article focuses on the description and ultimate identification of Mycoplasma pneumoniae.

Chinese medicinal herbs for acute bronchitis

BACKGROUND

Acute bronchitis is one of the most common diagnoses made by primary-care physicians. It is traditionally treated with antibiotics (although the evidence for their effectiveness is weak and modest at best), and other even less effective treatments. Chinese medicinal herbs have also been used as a treatment.

OBJECTIVES

This review aimed to summarise the existing evidence on the comparative effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, Issue 1), which includes the Cochrane Acute Respiratory Infections Group's specialised register; MEDLINE (1966 to March Week 1, 2007); EMBASE (1988 to January 2007); The Chinese Cochrane Centre's Controlled Trials Register (up to January 2007); and the Chinese Biomedical Database (CBM) (1980 to January 2007).

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing Chinese medicinal herbs with placebo, antibiotics or other Western medicines for the treatment of uncomplicated acute bronchitis.

DATA COLLECTION AND ANALYSIS

At least two review authors independently extracted data and assessed trial quality.

MAIN RESULTS

No studies met the inclusion criteria for this review. One study with 300 participants but uncertain randomisation was analysed . The study showed that treatment with the Chinese medicinal herb Huoke granules leads to a shorter duration of cough, fever and sputum compared to using penicillin and Xiaoer Shangfeng Zhike tangjiang syrup. However, the study also lacked allocation concealment and blinding. There was a high possibility of conflict of interest as the Huoke granules were made by the trial author's hospital.

AUTHORS' CONCLUSIONS

There is insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. Study-design limitations of the individual studies meant that no conclusion about the benefits of Chinese herbs could be taken. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence on these Chinese herbs, though adverse events were reported in some case reports.

A Systematic Review of Chinese Medicinal Herbs for Acute Bronchitis

OBJECTIVES

To assess the effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis.

DATA SOURCES

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which includes the Cochrane Acute Respiratory Infections Group's specialized register; The Chinese Cochrane Centre's Controlled Trials Register; MEDLINE; EMBASE; and the Chinese Biomedical Database (CBM).

METHODS

We only included randomized controlled trials. At least two authors extracted data and assessed trial quality.

MAIN RESULTS

Four trials reported the time to improvement of cough, fever, and rales associated with bronchitis and showed that patients treated with Chinese herbs had a shorter duration of signs and symptoms. Two trials reported the proportion of patients with improved signs and symptoms at follow-up and showed that Chinese herbs were beneficial in terms of relief of signs and symptoms. Thirteen (13) trials analyzed the data on physician global assessment of improvement at follow-up. Nine (9) of 13 trials showed that Chinese herbs were superior to routine treatment and the other four trials showed a similar effect to routine treatment. In general, Chinese herbs appeared beneficial. Only one trial reported adverse effects during treatment.

CONCLUSIONS

There are insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. The benefit found in this systematic review could be due to publication bias and study-design limitations of the individual studies. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence on these Chinese herbs, though adverse events are rarely reported.

Chinese medicinal herbs for acute bronchitis

BACKGROUND

Acute bronchitis is one of the most common diagnoses made by primary-care physicians. It is traditionally treated with antibiotics, (although the evidence for their effectiveness is weak and modest at best), and other even less effective treatments. Chinese medicinal herbs have been also used as treatment.

OBJECTIVES

This review aims to summarise the existing evidence on the comparative effectiveness and safety of Chinese medicinal herbs for treating uncomplicated acute bronchitis.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005), which includes the Cochrane Acute Respiratory Infections Group's specialised register; The Chinese Cochrane Centre's Controlled Trials Register (up to December 2004); MEDLINE (1966 to March Week 1, 2005); EMBASE (1988 to December 2004); and the Chinese Biomedical Database (CBM) (1980 to December 2004).

SELECTION CRITERIA

Randomised controlled trials comparing Chinese medicinal herbs with placebo, antibiotics or other Western medicines for the treatment of uncomplicated acute bronchitis.

DATA COLLECTION AND ANALYSIS

At least two authors extracted data and assessed trial quality.

MAIN RESULTS

Four trials reported the time to improvement of cough, fever, and rales associated with bronchitis and showed that patients treated with Chinese herbs had a shorter duration of signs and symptoms. Two trials reported the proportion of patients with improved signs and symptoms at follow up and showed that Chinese herbs were beneficial in terms of relief of signs and symptoms. Thirteen trials analysed the data on physician global assessment of improvement at follow up. Nine of thirteen trials showed that Chinese herbs were superior to routine treatment and the other four trials showed a similar effect to routine treatment. In general, Chinese herbs appeared beneficial. Only one trial reported on adverse effects during treatment.

AUTHORS' CONCLUSIONS

There is insufficient quality data to recommend the routine use of Chinese herbs for acute bronchitis. The benefit found in this systematic review could be due to publication bias and study-design limitations of the individual studies. In addition, the safety of Chinese herbs is unknown due to the lack of toxicological evidence on these Chinese herbs, though adverse events are rarely reported. Chinese herbs should be used carefully.

Epidemic pneumonia in university students

Longitudinal surveillance of pneumonia in a university student health service was conducted from 1965-1971 and 1984-1987. Of 104 pneumonia cases documented by chest x-ray, only six were presumed to have bacterial etiology; the remaining 98 were characteristic of atypical pneumonia syndrome. Mycoplasma pneumoniae was the etiology in 51% of the pneumonias in the 1960s and 13% in 1984-1987. Pneumonia incidence was highest in the fall semester in seven of 11 years studied. Annual incidence followed a three- to four-year periodicity. Both of these observations mirror the epidemiology of M. pneumoniae in the world population. Symptoms of cough, headache, malaise, and absence of the physical finding of wheezing were seen more consistently in M. pneumoniae pneumonia than in other atypical pneumonias; other clinical features varied among epidemics. Rapid cold agglutinin tests were positive in 27% of our clinically diagnosed pneumonias and in 36% of those with documented mycoplasmal infections. This study appears to provide a basis for predicting future epidemics of atypical pneumonia in student populations.

Antigen detection for the rapid diagnosis of mycoplasma and Legionella pneumonia

Immunologic attempts to detect mycoplasma antigens in fluids of infected patients have been rare and largely unsuccessful. Nucleic acid hybridization procedures appear promising on the basis of successes in detecting mycoplasmal contamination of tissue culture cells; results of attempts to apply these techniques to human infections have not been reported. Antigens can be detected in the urine of about 80% of patients with serogroup 1 Legionella pneumophila pneumonia and of some patients with serogroup 4 Legionella pneumophila and Legionella dumoffii pneumonia. The specificity of these assays is greater than 99%. In a test population in which the prevalence of Legionella pneumophila was 4%, the posterior probabilities of positive and negative results of tests for antigen were 86.5% and 99.3%, respectively. Antigen is detectable within the first 3 days of illness approximately as often as at later periods, and antigen may remain detectable for a few days to 1 yr after successful therapy. Antigen is detectable in serum, but the concentrations are considerably lower than in urine. Combining urinary antigen detection with direct fluorescent antibody examination of secretions increases the rapid diagnostic yield by 10%-20%. Monoclonal antibody studies demonstrate that subgroup specificities are present among the serogroup 1 urinary antigens. Radiometric and enzyme immunoassays detect antigen in equal proportions of patients. Latex agglutination results are positive in about 80% of those cases positive by the other methods.

Occurrence of serologically verified Mycoplasma pneumoniae infections in Finland and in Scandinavia in 1970--1977

This study analyses the numbers of serologically verified Mycoplasma pneumoniae infections in Finland as a whole and by regions, and in Scandinavia in 1970--77 on the basis of reports collected in the countries concerned. Two peaks of occurrence were found to have extended over most parts of Finland and across Scandinavia; in addition, there were separate local epidemics. Thus, M. pneumoniae infections showed a periodicity of occurrence, but not a regular cyclic pattern. The figures do not necessarily reflect the true incidence of M. pneumoniae infections in the areas investigated.

Response of airborne Mycoplasma pneumoniae to abrupt changes in relative humidity

The effect of an abrupt change in the relative humidity on the viability of airborne Mycoplasma pneumoniae has been examined. When the microbial aerosols were permitted to equilibrate in air held at either low or high humidities and were then subjected to a sudden shift to a mid-range humidity, a significant loss (>90%) of the colony-forming units per liter of aerosol occurred within 8 min. In contrast, a change in the relative humidity of more than 18% in either direction from a lethal mid-range humidity noticeably decreased the rate of biological decay. Double humidity shifts (i.e., from dry to a mid-range level and then to a high humidity range) were very detrimental, with very few survivors after 8 min. These results indicate that the biological stability of airborne M. pneumoniae may be easily modified by a sudden change in the relative humidity, such as occurs in natural atmospheres. This increased sensitivity brought about by producing changes in relative humidity through the lethal humidity range may provide a method whereby the control of these organisms in naturally contaminated indoor air environments may be eventually achieved.