Materiały źródłowe

• #1 Infections of the Respiratory System – Medical Microbiology – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK8142/

  Most upper respiratory infections are of viral etiology. […] Organisms gain entry to the respiratory tract by inhalation of droplets and invade the mucosa. Epithelial destruction may ensue, along with redness, edema, hemorrhage and sometimes an exudate. […] Organisms enter the distal airway by inhalation, aspiration or by hematogenous seeding. The pathogen multiplies in or on the epithelium, causing inflammation, increased mucus secretion, and impaired mucociliary function; other lung functions may also be affected. In severe bronchiolitis, inflammation and necrosis of the epithelium may block small airways leading to airway obstruction. […] The viruses appear to act through direct invasion of epithelial cells of the respiratory mucosa, but whether there is actual destruction and sloughing of these cells or loss of ciliary activity depends on the specific organism involved. There is an increase in both leukocyte infiltration and nasal secretions, including large amounts of protein and immunoglobulin, suggesting that cytokines and immune mechanisms may be responsible for some of the manifestations of the common cold.

• #2 Respiratory Tract Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7149513/

  Respiratory tract infections are among the most common and important problems in clinical medicine. The approach to these infections begins with a basic understanding of the pathophysiology of the respiratory tract and how immune defences interact with pathogens. […] The primary function of the respiratory tract is gas exchange between inspired air and circulating blood. […] In common with other infectious diseases, the outcome of RTIs is a complex interplay between the ability of the pathogen to infect, colonize and damage tissues and the capacity of the host to mount an effective immune response. […] The respiratory tract has evolved to withstand this onslaught of potential pathogens by a variety of innate and acquired immune defences. […] Most bacteria and viruses are so small that they can reach the terminal bronchioles and alveoli.

• #2 Respiratory Tract Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7149513/

  Any congenital or acquired damage to the mucociliary defence system increases the risk that infection will develop. […] Acquired damage to the mucociliary apparatus is extremely common and can result from a wide variety of insults to the respiratory tract. […] It is useful to divide RTIs into those involving the upper and the lower tracts. […] The clinical syndromes involving the upper tract include otitis media, mastoiditis, sinusitis and pharyngitis, while infections of the lower tract can be divided into tracheobronchitis, bronchiolitis and pneumonia. […] Pneumonia is characterized by inflammation of the lung parenchyma with infiltration of the alveolar spaces and pulmonary interstitium with fluid, inflammatory cells and fibrinous debris. […] The immune status of the patient is a crucial piece of clinical and epidemiologic information when evaluating RTIs.

• #3 What causes Respiratory Tract Infections (RTIs)? – Acare Global

  https://acare.abbott.com/en/respiratory-health/understanding-the-disease-respiratory-health/causes-respiratory-tract-infections/

  Respiratory tract infections (RTIs) are mostly caused by either viruses or bacterium. […] Most upper RTIs are caused by viruses, which cannot be treated with antibiotics (these only work on bacterial infections). […] Some lower RTIs like pneumonia are caused by bacteria. […] A virus is a microscopic organism that invades living cells in order to reproduce, and that causes disease in people. […] Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease. […] The immune system is the body’s defense system, which helps protect it from disease, bacteria and viruses. […] The most common RTIs are spread through the coughs and sneezes of someone with an infection. […] Infections can also spread through direct or indirect contact. […] RTIs can be spread from person to person through the coughs and sneezes of someone with an infection or through direct or indirect contact.

• #4 An Overview of Common Respiratory Tract Infections | Ausmed

  https://www.ausmed.com/learn/articles/respiratory-tract-infections

  Respiratory tract infections (RTIs) are various infections that affect parts of the respiratory system, such as the sinuses, throat, airway or lungs (NHS 2024a). […] Lower RTIs are generally longer-lasting and more serious (NHS 2024a). […] RTIs are generally transmitted by direct contact with a contaminated surface or an infected person expelling droplets into the air via coughing, sneezing or talking (SA Health 2022). […] Pneumonia is an infection that causes inflammation of the alveoli (air sacs) in one or both lungs. The alveoli fill with secretions and fluid, decreasing the ability for oxygen to be transported across the tissue to adequately oxygenate vital organs. […] Pneumonia can be a serious and potentially fatal infection, with young children, older adults and those with pre-existing health conditions most at risk of complications such as pleurisy, lung abscess or sepsis.

• #5 Infections of the Respiratory System – Medical Microbiology – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK8142/

  Infections caused by viruses or bacteria impair the ciliary activity of the epithelial lining of the sinuses and increased mucous secretions. This leads to obstruction of the paranasal sinusal ostia which impedes drainage. With bacterial multiplication in the sinus cavities, the mucus is converted to mucopurulent exudates. The pus further irritates the mucosal lining causing more edema, epithelial destruction and ostial obstruction. […] A viral upper respiratory infection may precede infection with H influenzae in episodes of epiglottitis. However, once H influenzae type b infection starts, rapidly progressive erythema and swelling of the epiglottis ensue, and bacteremia is usually present. Viral infection of laryngotracheitis commonly begins in the nasopharynx and eventually moves into the larynx and trachea. Inflammation and edema involve the epithelium, mucosa and submucosa of the subglottis which can lead to airway obstruction. […] Infectious agents gain access to the lower respiratory tract by the inhalation of aerosolized material, by aspiration of upper airway flora, or by hematogenous seeding. Pneumonia occurs when lung defense mechanisms are diminished or overwhelmed.

• #6 Respiratory Infections in Children: An Updated Review of Pathophysiology, Diagnosis, Treatment, Biochemical Aspects, and Nursing Interventions

  https://www.jmchemsci.com/article_211142.html

  The initial biochemical response involves the activation of pattern recognition receptors (PRRs), such as Toll-like receptors (TLRs), present on epithelial cells, macrophages, and dendritic cells in the respiratory tract. […] These receptors recognize pathogen-associated molecular patterns (PAMPs) and initiate signaling pathways, including the nuclear factor-kappa B (NF-B) pathway, which leads to the production of pro-inflammatory cytokines and chemokines. […] The most commonly produced cytokines during respiratory infections include tumor necrosis factor-alpha (TNF-), interleukin (IL)-1, IL-6, and IL-8. […] The immune response to respiratory infections, while essential for pathogen clearance, can also cause tissue damage, particularly when inflammation becomes excessive or uncontrolled.

• #7 Rhinovirus (RV) Infection (Common Cold): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/227820-overview

  A local inflammatory response to rhinovirus in the respiratory tract can lead to nasal discharge, nasal congestion, sneezing, and throat irritation. The nasal epithelium is not damaged. […] Various polymorphisms in cytokine genes have been shown to impact the severity of infection, suggesting a genetic predisposition. […] Detectable histopathology causing the associated nasal obstruction, rhinorrhea, and sneezing is lacking, which leads to the hypothesis that the host immune response plays a major role in the pathogenesis. […] Infected cells release interleukin (IL)8, which is a potent chemoattractant for polymorphonuclear (PMN) leukocytes. Concentrations of IL-8 in secretions correlate proportionally with the severity of common cold symptoms. Inflammatory mediators, such as kinins and prostaglandins, may cause vasodilatation, increased vascular permeability, and exocrine gland secretion. These, together with local parasympathetic nerve-ending stimulation, lead to cold symptoms.

• #7 Rhinovirus (RV) Infection (Common Cold): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/227820-overview

  Rhinoviruses (RVs) are the most common cause of the common cold. They chiefly cause upper respiratory tract infections (URTIs) but may infect the lower respiratory tract. […] Rhinovirus infections are chiefly limited to the upper respiratory tract but may cause otitis media and sinusitis; they also may exacerbate asthma, cystic fibrosis, chronic bronchitis, and serious lower respiratory tract illness in infants, elderly persons, and immunocompromised persons. […] The attachment of the virus to its receptors (ICAM-1, CHDR-3, low-density lipoprotein receptor [LDLR]) in susceptible individuals elicits an innate immune response leading to airway inflammation and remodeling. […] Few cells are actually infected by rhinovirus, and the infection involves only a small portion of the epithelium. Symptoms develop 1-2 days after viral infection, peaking 2-4 days after inoculation, though reports have described symptoms as early as 2 hours after inoculation with primary symptoms 8-16 hours later.

• #8 Identifying and testing for RTIs | Medical Laboratory Observer

  https://www.mlo-online.com/continuing-education/article/13017090/identifying-and-testing-for-rtis

  Respiratory tract infections (RTI) or infections in the respiratory tract are divided into upper respiratory tract infections (URI/URTI) and lower respiratory tract infections (LRI/LRTI). […] Respiratory tract infections can be caused by viruses or bacteria. Most of the time the infections caused by viruses do not require any treatment and resolve on their own; however, bacterial infections require appropriate antibiotic therapy. Hence, early detection of the causative organism is essential for proper patient management. […] UTRIs are caused by viruses in approximately 90 to 98 percent of cases. […] Human Respiratory Syncytial Virus (RSV) is one of the most common viruses to infect children worldwide and is increasingly being recognized as an important pathogen in adults, especially the elderly. It causes mild URIs but severe LRIs.

• #9 Upper Respiratory Tract Infections in Children and Adults: Burden and Management – European Medical Journal

  https://www.emjreviews.com/respiratory/symposium/upper-respiratory-tract-infections-in-children-and-adults-burden-and-management/

  The vast majority (90%) of RTI are caused by viruses. […] The predominance of viral rather than bacterial aetiology in RTI is most marked in preschool children, with 95% of infections being viral in this age group. […] The functional immune immaturity of infants combines with multiple risk factors to precipitate respiratory infections, including overexposure to antigens in nurseries, allergies, siblings, seasonality, environment, and lack of breast feeding. […] The burden of respiratory disease is borne both by the child and their family, leading to an overall economic burden, school and work absenteeism, misuse of antibiotics and associated resistance, decline in pulmonary function, and impact on QoL. […] The bacterial lysate immunomodulator OM-85 has the most robust and consistent evidence base.

• #10 Respiratory Infections Tests and Diagnostics

  https://www.biomerieux.com/corp/en/our-offer/point-of-care/patient-condition/respiratory-infections-tests-and-diagnostics.html

  Respiratory tract infections (RTIs) could be classified into two categories, based on the location of the infection: upper respiratory tract and lower respiratory tract. […] Upper respiratory tract infections (URTIs) affect one or more anatomical regions: ears (otitis), sinuses (sinusitis), throat (angina), and nasopharynx (nasopharyngitis). The main viruses identified in these infections are Rhinoviruses, Coronaviruses, Respiratory Syncytial Viruses, Influenza Viruses, Parainfluenza Viruses, Adenoviruses, Cytomegaloviruses, Epstein Barr Viruses, and Herpes Simplex Viruses, Human Metapneumovirus, and Enteroviruses. […] However, it is recommended to prescribe an appropriate antibiotic in certain clinical situations suggesting a bacterial infection. This is the case of acute purulent otitis media, certain sinusitis, and certain tonsillitis such as, for example, streptococcal angina.

• #11 Respiratory Infections Tests and Diagnostics

  https://www.biomerieux.com/corp/en/our-offer/point-of-care/patient-condition/respiratory-infections-tests-and-diagnostics.html

  Potentially more severe than URTIs, lower respiratory tract infections (LRTIs) include acute bronchitis, pneumonia, exacerbation of chronic bronchitis, and bronchiolitis (in young children in general.) […] Acute bronchitis is defined as acute inflammation of the bronchi and bronchioles. In the majority of cases it is caused by respiratory viruses including Influenza, Parainfluenza, Adenoviruses, and Respiratory Syncytial Viruses. […] Pneumonia is an infection of the lung parenchyma. In community-acquired pneumonia (CAP), bacteria are mainly identified as the source. Streptococcus pneumoniae and Haemophilus influenzae are at the top of the list and atypical bacteria can also be found. These bacteria are frequently associated with secondary infections following a viral respiratory infection.

• #12 The Epidemiological Features and Pathogen Spectrum of Respiratory Tract Infections, Istanbul, Türkiye, from 2021 to 2023

  https://www.mdpi.com/2075-4418/14/11/1071

  Respiratory tract infections (RTIs) can lead to both recurrent seasonal epidemic outbreaks and devastating pandemics. The aim of this study was to evaluate the epidemiologic characteristics and pathogen spectrum of RTIs using a multiplex RT-PCR panel. A total of 9354 cases with suspected RTIs between February 2021 and July 2023 were included in this study. A total of 11,048 nasopharyngeal and oropharyngeal samples from these patients were analyzed for 23 respiratory tract pathogens using multiplex RT-PCR. H. influenzae and S. pneumoniae were considered as colonizing bacteria. At least one pathogen was detected in 70.66% of the samples; viral pathogens were detected in 48.41% of the samples, bacterial pathogens were detected in 16.06% of the samples, and viral + bacterial pathogens were detected in 35.53% of the samples. The most frequently detected viral pathogen was rhinovirus/enterovirus (RV/EV) (19.99%).

• #13 Patterns of viral pathogens causing upper respiratory tract infections among symptomatic children in Mwanza, Tanzania | Scientific Reports

  https://www.nature.com/articles/s41598-020-74555-2

  Common viral agents which have been linked to RTIs include Rhinoviruses which accounts for 30%, Respiratory syncytial virus, influenza virus, Parainfluenza viruses, Human metapneumovirus and Adenoviruses accounting for 35% of RTI with about 10% being due to Coronaviruses. […] Bacterial upper respiratory infections are mainly due to Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis accounting to 90% of bacterial causes. […] The findings in this study are comparable to the previous study in Kenya among children below 5 years of age, whereby viruses were isolated in 45% of children with RTIs. […] In the current study, rhinitis was the commonest presenting disease, followed by pharyngitis and pneumonia. […] A previous study documented Rhinovirus to cause up to 25-85% of the upper respiratory tract infections.

• #14 Upper Respiratory Tract Infection: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/302460-overview

  URIs involve direct invasion of the mucosa lining the upper airway. Inoculation of bacteria or viruses occurs when a persons hand comes in contact with pathogens and the person then touches the nose or mouth or when a person directly inhales respiratory droplets from an infected person who is coughing or sneezing. […] After inoculation, viruses and bacteria encounter several barriers, including physical, mechanical, humoral, and cellular immune defenses. […] A host of inflammatory cytokines mediates the immune response to invading pathogens. Normal nasopharyngeal flora, including various staphylococcal and streptococcal species, help to defend against potential pathogens. […] Patients with suboptimal humoral and phagocytic immune function are at increased risk for contracting a URI, and they are at increased risk for a severe or prolonged course of disease.

• #14 Upper Respiratory Tract Infection: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/302460-overview

  Infection […] Person-to-person spread of viruses accounts for most URIs. […] Bacterial infections may develop de novo or as a superinfection of a viral URI. […] Most symptoms of URIs including local swelling, erythema, edema, secretions, and fever result from the inflammatory response of the immune system to invading pathogens and from toxins produced by pathogens. […] An initial nasopharyngeal infection may spread to adjacent structures, resulting in the following: Sinusitis, Otitis media, Epiglottitis, Laryngitis, Tracheobronchitis, Pneumonia. […] Inflammatory narrowing at the level of the epiglottis and larynx may result in a dangerous compromise of airflow, especially in children, in whom a small reduction in the luminal diameter of the subglottic larynx and trachea may be critical.

• #14 Upper Respiratory Tract Infection: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/302460-overview

  Beyond childhood, laryngotracheal inflammation may also pose serious threats to individuals with congenital or acquired subglottic stenosis. […] Genetic susceptibility is involved in determining which patients have more severe disease courses than others. […] There are some recognized candidate gene polymorphisms with known functional changes in genes that may lead to immunosuppression. […] It has also been shown that host immunogenetic variation plays a role in the immune response to H1N1 and H5N1 viruses, thereby influencing disease severity and outcome in influenza caused by these viruses.

• #15 Diagnosing upper and lower respiratory tract infections | Medical Laboratory Observer

  https://www.mlo-online.com/continuing-education/article/21292505/diagnosing-upper-and-lower-respiratory-tract-infections

  Initial research suggested that HRV is a benign virus restricted to growth within the upper airways of humans. However, recent research shows that HRV is not only able to effectively reach, penetrate, and replicate within the lower airway epithelium of individuals in vivo, but also causes histologic changes of the lung interstitium and alveoli. Moreover, HRVs have now been shown to be an important cause of superinfection, with bacteria like Streptococcus pneumoniae and Staphylococcus aureus. […] Recent clinical studies in pediatrics have also shown the association of HRVs with lower respiratory tract infections including bronchiolitis and pneumonia. However, it is still not totally understood if HRVs can cause LRIs on their own. […] The burden of influenza (flu) disease in the United States varies widely and is determined by the characteristics of circulating viruses, the timing of the season, how well the vaccine is working to protect against illness, and how many people got vaccinated. Influenza can cause mild to severe illness, and at times can lead to death.

• #16 Respiratory tract infection – Wikipedia

  https://en.wikipedia.org/wiki/Respiratory_tract_infection

  Respiratory tract infections (RTIs) are infectious diseases involving the lower or upper respiratory tract. An infection of this type usually is further classified as an upper respiratory tract infection (URI or URTI) or a lower respiratory tract infection (LRI or LRTI). Lower respiratory infections, such as pneumonia, tend to be far more severe than upper respiratory infections, such as the common cold. […] Lower respiratory tract infections (LRIs) are generally more severe than upper respiratory infections. LRIs are the leading cause of death among all infectious diseases. […] Influenza affects both the upper and lower respiratory tracts, but more dangerous strains such as the highly pernicious H5N1 tend to bind to receptors deep in the lungs. […] Antibiotics are a medicine designed to treat bacterial infections that need a more severe treatment course; antibiotic use is not recommended for common bacterial infections as the immune system will resolve such infections. This medicine does not effectively treat a viral infection like sore throats, influenza, bronchitis, sinusitis and common respiratory tract infections.

• #16 Respiratory tract infection – Wikipedia

  https://en.wikipedia.org/wiki/Respiratory_tract_infection

  The CDC has reported that antibiotic prescription is high; 47 million prescriptions in the United States in 2018 were made for infections that do not need antibiotics to be treated with. […] A combination of topical and systematic antibiotics taken prophylactically can prevent infection and improve adults’ overall mortality in the ICU for adult patients receiving mechanical ventilation for at least 48 hours, and topical antibiotic prophylaxis probably reduces respiratory infections but not mortality. […] There is no sufficient evidence to recommend that antibiotics be used to prevent complications from an RTI of unknown cause in children under the age of 5 years old. […] Viruses that cause RTI are more transmissible at very high or low relative humidity; ideal humidity for indoor spaces is between 40 and 60%. Therefore, relative humidity in this range can help lessen the risk of aerosol transmission. […] Respiratory infections often have strong seasonal patterns, with temperate climates more affected during the winter. Several factors explain winter peaks in respiratory infections, including environmental conditions and changes in human behaviors.

• #17 Rhinovirus (RV) Infection (Common Cold): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/227820-overview

  Deficient production of interferon beta by asthmatic bronchial epithelial cells has been proposed as a mechanism for increased susceptibility to rhinovirus infections in individuals with asthma. […] Viral clearance is associated with the host response and is due in part to the local production of nitric oxide. Rhinovirus is shed in large amounts, with as many as 1 million infectious virions present per milliliter of nasal washings. Viral shedding can occur a few days before cold symptoms are recognized by the patient, peaks on days 2-7 of the illness, and may last as long as 3-4 weeks.

• #18 Respiratory Tract Infection- Symptoms, Causes and Treatment

  https://www.careinsurance.com/blog/health-insurance-articles/check-if-you-have-respiratory-tract-infection-rti

  Any kind of infection only brings misery and helplessness. Infections related to respiration are terrible infections as they restrict your respiratory system, resulting in discomfort and pain. Respiratory tract infection is the most widespread infection these days. The respiratory tract consists of all the organs involved in breathing, affecting the lungs, airways, sinuses, and throat. […] Viruses, bacteria, mycoplasma, and fungi attack the respiratory system and cause respiratory problems. It is a communicable infection as bacteria or viruses can easily enter the tract when people inhale or come into contact with infected patients. […] Various microorganisms cause lower respiratory tract infections. The common causes include- […] Bacterial infection is one of the most common causes of LRTIs. These infections result in Chlamydia pneumoniae, streptococcus pneumoniae (pneumococcus), Mycoplasma pneumoniae, Legionella pneumophila and Haemophilus influenzae.

• #19 Post-Travel Respiratory Infections | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/posttravel-evaluation/respiratory-infections

  Respiratory infections are a major reason for returning travelers to seek medical care. […] In general, the respiratory infections that affect travelers are like those in non-travelers, but it is important for healthcare professionals to be vigilant for travelers’ potential exposure to novel, emerging, or geographically restricted respiratory pathogens. […] Bacterial causes of respiratory illnesses include Bordetella pertussis, Burkholderia pseudomallei (the cause of melioidosis), Chlamydia pneumoniae, Corynebacterium diphtheriae, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae. […] Viral pathogens are the most common causes of respiratory infection in travelers. […] Other viruses of special concern to travelers include Middle East respiratory syndrome (MERS) coronavirus and highly pathogenic avian influenza viruses; consider these viruses in travelers with new-onset respiratory illness, including people requiring hospitalization, when no alternative cause has been identified.

• #20

  https://consensus.app/questions/respiratory-tract-infections/

  Respiratory tract infections (RTIs) are highly prevalent and contribute significantly to global morbidity and mortality. […] These infections can be caused by a variety of pathogens, including bacteria, viruses, and fungi, and they affect both the upper and lower respiratory tracts. […] Successful bacterial colonization in the upper airway is a prerequisite for these infections, requiring the bacteria to attach to the epithelial lining, grow on the mucosal surface, and evade the host immune response. […] Bacterial colonization in the upper airway is crucial for respiratory tract infections, and understanding this process reveals evolutionary pressures that contribute to virulence and pathogenesis. […] Inflammation and the innate immune system play crucial roles in acute lower respiratory tract infections, but their interaction can lead to dangerous climaxes and potentially fatal outcomes.

• #21 Diagnosis and Management of Recurrent Respiratory Tract Infections in Children: A Practical Guide

  https://brieflands.com/articles/apid-20283.html

  There is also evidence of a synergistic effect between viruses and bacteria in the pathogenesis of respiratory infections. A classic example is the synergism between influenza viruses and S. pneumonia. […] Recurrent infections of the respiratory tissues may result in virus-induced immune dysfunction and can lead to a vicious cycle of recurrent RTIs with bacterial super-infections, exacerbation of cough, and increased risk of asthma development. […] Immunostimulants (also known as immunomodulators or immune enhancers) are effective complementary measures that can be used alongside vaccines to enhance or modulate the patients innate immune response. […] The use of bacterial lysates (immunomodulators) to enhance non-specific immunity is shifting to the forefront of preventive strategies for recurrent RTIs. Bacterial lysate immunostimulants were first introduced in the 1980s and are the most widely studied.

• #21 Diagnosis and Management of Recurrent Respiratory Tract Infections in Children: A Practical Guide

  https://brieflands.com/articles/apid-20283.html

  Respiratory tract infections (RTIs) affect children all over the world and are associated with significant morbidity and mortality. RTIs are usually triggered by viruses, though bacterial infections are also common. […] Children are particularly susceptible to RTIs due to the relative immaturity of their immune systems, and genetic factors (such as family history of atopy) and/or environmental factors (such as exposure to pollution and pathogens) also render certain populations more vulnerable to infection. Furthermore, RTIs tend to be recurrent and can result in multiple infections per year. […] The main pathogens that trigger respiratory infections are viruses (such as the respiratory syncytial viruses, rhinoviruses, and influenza viruses). Although viruses are often responsible for RTIs, bacterial super-infections commonly occur. Bacterial infections are observed in up to 60% of patients whose RTI symptoms last for 10 days or more.

• #22 Diagnosis and Management of Recurrent Respiratory Tract Infections in Children: A Practical Guide

  https://brieflands.com/articles/apid-20283

  The main pathogens that trigger respiratory infections are viruses (such as the respiratory syncytial viruses, rhinoviruses, and influenza viruses). Although viruses are often responsible for RTIs, bacterial super-infections commonly occur. Bacterial infections are observed in up to 60% of patients whose RTI symptoms last for 10 days or more. […] There is also evidence of a synergistic effect between viruses and bacteria in the pathogenesis of respiratory infections. A classic example is the synergism between influenza viruses and S. pneumonia. […] Several characteristics of RTIs contribute to the burden of illness. First, RTIs tend to recur in pediatric patients. The clinical sequelae of RTIs can result in long-term complications and further contribute to the disease burden, resulting in secondary infections, wheezing, and the development of asthma.

• #23 Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06954-3

  Preventing respiratory tract infections (RTIs) could have profound effects on quality of life, primary care workload, antibiotic prescribing and stewardship. […] We identified several modifiable risk factors associated with increased likelihood of acquiring RTIs in the community, including low BMI, contact with children and pets. […] Respiratory tract infections (RTIs) are the single most common infections seen in primary care, and a major contributor to the overall burden of disease worldwide. […] On average, adults will have between two and five RTIs annually, usually the common cold or upper respiratory infections. […] RTIs are also the most common indications for antibiotic prescribing, accounting for around 60% of all antibiotics prescribed in primary care, despite rarely providing patient benefit.

• #24 Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06954-3

  This systematic review and meta-analysis aims to identify the factors increasing and decreasing the risk of acquiring respiratory infections in communities within OECD member countries. […] Our rigorously conducted systematic review meta-analysis suggests chronic liver and renal conditions, previous hospitalisation, low BMI, male sex, and contact with children and pets all increase the likelihood of people living in OECD member countries acquiring a respiratory infection. […] We identified several risk factors associated with increased likelihood of individuals acquiring RTIs in the community, including chronic liver disease, low BMI, and contact with children and pets.

• #25

  https://bpac.org.nz/2019/rti.aspx

  Most RTIs are of viral origin, rather than bacterial, and in either case, the infection is likely to be self-limiting and the negligible benefit of antibiotic treatment does not outweigh the potential harms […] Most RTIs are caused by viruses and are self-limiting, and antibiotics are not appropriate. However, in some cases it is difficult to be certain if an infection is viral or bacterial, who would most benefit from antibiotic treatment and the likelihood of complications. […] Viral RTIs can occur at any time of year, however, the incidence increases in the colder months. Factors such as spending more time in closer proximity to others in homes or workplaces with little ventilation, enhanced survivability of air-borne pathogens in colder temperatures, seasonal changes in immune function increasing susceptibility to infection and activation of dormant viruses within the respiratory tract have been proposed to explain the seasonality of viral illnesses.

• #25

  https://bpac.org.nz/2019/rti.aspx

  There are two main decision points when determining whether antibiotic treatment is indicated for a patient presenting with an RTI: Is the infection viral or bacterial? If bacterial, is antibiotic treatment indicated (and which antibiotic and for how long) and is it needed for this particular patient? […] In a typical primary care setting, it is often not possible to definitively determine the type of infection (viral versus bacterial). Instead, clinicians rely on their clinical findings and judgement to make a presumption about the infection type and consequently whether antibiotic treatment is indicated. […] The threshold for considering antibiotics for patients with a suspected or confirmed bacterial RTI should be low for those who are at high risk of complications due to compromised immune function.

• #26 Post-Travel Respiratory Infections | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/posttravel-evaluation/respiratory-infections

  The air quality at many travel destinations might be poor, and exposure to carbon monoxide, nitrogen dioxide, ozone, sulfur dioxide, and particulate matter is associated with health risks, including respiratory tract inflammation, exacerbations of asthma or COPD, impaired lung function, bronchitis, and pneumonia. […] Most respiratory infections, especially those of the upper respiratory tract, are mild. […] Lower respiratory tract infections, particularly pneumonia, can be more severe. […] People with COVID-19 might have a similar clinical presentation, but mild disease and asymptomatic infection also are common. […] Manage travelers with respiratory infections similarly to non-travelers but evaluate those who are severely ill for diseases specific to their travel destinations and exposure history.

• #27 Early-life viral infections may increase risk of respiratory infections later in life – UMC Utrecht

  https://www.umcutrecht.nl/en/over-ons/nieuws/pers/early-life-viral-infections-may-increase-risk-of-respiratory-infections-later-in-life

  Early-life viral infections may increase the risk of respiratory tract infections during the first year of life. […] Perturbed development of the respiratory microbial community during early-life has been associated with increased susceptibility to respiratory tract infections (RTIs) later in life. […] Early-life viral infection, though mostly asymptomatic, coincided with stronger interferon activity, which was related to specific microbiota changes, characterized by enrichment of Gram-negative bacteria, such as Moraxella and Haemophilus spp. This was in turn related to a higher number of subsequent RTIs during the first year of life. […] By combining multiple datasets, the researchers provide support for the hypothesis that first viral encounters trigger an interferon-associated pro-inflammatory environment, which selects for specific pathobionts that further drive airway inflammation and symptomatology in a self-enforcing positive feedback loop. This pro-inflammatory and microbiologically perturbed environment in turn renders an individual more vulnerable to recurrent (viral) RTIs. […] The current publication therefore strongly contributes to a better understanding of the risk of respiratory infection in infants.

• #28 Respiratory tract infections (RTIs) in primary care: narrative review of C reactive protein (CRP) point-of-care testing (POCT) and antibacterial use in patients who present with symptoms of RTI | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/7/1/e000624

  POCTs increase diagnostic precision for GPs in the better management of patients with RTI. […] The literature is abundant with work on CDRs: pharyngitis identifying patients with group A streptococcus infection, […] The CRB-65 rule was developed to predict the risk of admission to the intensive care unit and mortality in hospitalised patients with community-acquired pneumonia. […] A systematic review of studies reporting reduction of antibiotic prescriptions for ARTIs in primary care found that communication skills training and POCT were the most effective interventions and that trials with initially lower prescription rates were less likely to be successful. […] The accurate and rapid assessment of whether patients need antibiotics when they present to primary care with symptoms of RTI continues to challenge primary care clinicians and researchers. […] There is overwhelming evidence that CRP POCT can offer a significant strengthening of primary care clinicians diagnostic precision in addressing whether or not a patient presenting with symptoms of RTI needs antibiotics or not.

• #29 Respiratory tract infections

  https://diagnostics.roche.com/us/en/article-listing/health-topics/infectious-diseases/respiratory-tract-infections.html

  Acute lower respiratory infections are one of the leading causes of death and disability in the world. […] Respiratory tract infections (RTIs) include both upper tract infections, like the common cold, and lower tract infections, such as pneumonia and bronchitis. […] Respiratory infections are caused by a wide variety of pathogens. […] The non-specific clinical presentation of respiratory infections poses a considerable challenge to the differential diagnosis of pathogens. […] An early and accurate diagnosis is essential to identifying the cause of a respiratory infection and ensuring appropriate antimicrobial therapy. […] To optimize time-to-treatment, the diagnosis of acute respiratory tract infections cannot always rely on the traditional method of culture alone. […] Therefore, other methods for antibody and antigen detection, and especially nucleic acid amplification techniques (NAAT), have been developed in order to improve sensitivity, specificity, and detection time of pathogens causing RTIs.

• #30

  https://journals.lww.com/co-pulmonarymedicine/fulltext/2016/05000/Host_directed_therapies_for_antimicrobial.4.aspx?generateEpub=Article%7Cco-pulmonarymedicine:2016:05000:00004%7C%7C

  Antimicrobial-resistant respiratory tract infections (AMR-RTIs) are increasing, presenting important management challenges worldwide. Current management of AMR-RTI patients focuses on pathogen-directed antimicrobial treatment. Overt lung inflammation, parenchymal damage, and ineffective immune activation perpetrate increased patient morbidity and mortality. Immunomodulatory and tissue-regenerative host-directed therapies (HDT) may improve treatment outcomes. […] Various HDTs are being developed or evaluated for adjunctive AMR-RTI treatment. […] Novel HDTs may revolutionize future treatment regimens for AMR-RTIs.

• #31 Protective mechanism of quercetin and its derivatives in viral-induced respiratory illnesses | The Egyptian Journal of Bronchology | Full Text

  https://ejb.springeropen.com/articles/10.1186/s43168-022-00162-6

  Quercetin supplementation consistently showed promising effects to reduce the level of these three cells corroborating with declining chemokine levels. […] Quercetin supplementation before or during RV infection has the ability to diminish RV infection at multiple stages in the viral life cycle. […] Quercetin, on the other hand, inhibited RV-induced cleavage of eIF4GI while increasing the phosphorylation of eIF2a. […] Quercetin blocks viral endocytosis via inhibition of PI3k/Akt pathway, viral genome transcription by inhibiting RNA polymerase 3D POL, and viral protein translation by facilitating eIF4G cleavage. […] Oral treatment with quercetin 3-rhamnoside (Q3R) as compared to placebo and oseltamivir-treated groups showed effectiveness against influenza A/WS/33 (H1N1) virus in mouse models.

• #32 Zinc & Respiratory Tract Infections

  https://www.doctorsformulas.com/en/category/newsposts/zinc-respiratory-tract-infections.htm

  Acute viral respiratory tract infections (RTIs) are ubiquitous in the community. Clinical presentations range from milder cold and influenza-like illnesses to more serious conditions such as viral pneumonia and severe acute respiratory syndrome. […] The mechanisms for how zinc might work include broad-spectrum antiviral properties in vitro against most of the common respiratory viruses, including coronaviruses. […] The rationale for topical intranasal and sublingual zinc is based on the in vitro effects of zinc ions that can inhibit viral replication, stabilise cell membranes and reduce mucosal inflammation. […] Clarification of the efficacy and mechanism of zinc in viral respiratory infections, including SARS-CoV-2 infections, warrants further research.

• #33 The role of the oral cavity microbiome in respiratory infections in ch | PHMT

  https://www.dovepress.com/oral-cavity-microbiome-impact-on-respiratory-infections-among-children-peer-reviewed-fulltext-article-PHMT

  Understanding the impact of oral cavity and upper respiratory microbiome could lead to improved management and prevention strategies for respiratory infections in children. […] The respiratory system is always in communication with the outside world. Previous investigations on the microorganisms found in respiratory samples examined for pathogen research. High-throughput sequencing technologies have progressively made it possible to characterize and describe the commensal resident bacterial flora and examine how it affects innate or acquired immune responses throughout the respiratory tree. […] Viral infections are the primary cause of acute respiratory infections. Less than thirty percent of the causes of low respiratory infections (bronchial or lung damage) are not viral. […] The impact of the microbiome in the pathogenesis of viral respiratory infections is therefore strongly suspected. […] The microbiome could therefore serve, ultimately, as a prognostic marker by helping to take into account the early management of at-risk patients.

• #34 Research shows why some athletes are more likely to develop respiratory tract infections | Royal Brompton & Harefield hospitals

  https://www.rbht.nhs.uk/research/research-shows-why-some-athletes-are-more-likely-develop-rti

  New research led by colleagues at Royal Brompton and Harefield hospitals (RBHH) has helped shed light on the link between respiratory tract infections (RTI) and athlete performance. […] RTIs are infections in parts of the body involved in breathing, including the sinuses, throat, airways and lungs, and are a common affliction in the general population. […] However, compared to the wider population, some elite athletes have been shown to be more susceptible to developing RTIs, suffering from recurrent infections throughout the year. […] In collaboration with the EIS, Dr Anand Shah, respiratory consultant, and Dr Hull, led a research study which aimed to characterise the immune factors which make some elite athletes more susceptible to developing RTIs. […] The results indicated that elite athletes with a higher risk of developing RTIs had fewer numbers of a particular type of white blood cell (known as T regulatory cells), an imbalance in their airway microbiome and specific differences in their metabolism, compared to the less susceptible elite athletes and healthy controls.

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