Acute bacterial upper respiratory infections include acute rhinosinusitis, acute pharyngotonsillitis, acute laryngitis, and acute epiglottitis. These are common reasons for primary care visits. Acute bacterial sinusitis usually occurs as a secondary complication of acute viral sinusitis. Acute viral sinusitis will recover over the course of 7-10 days without antibiotics. Amoxicillin is a drug of choice for acute bacterial sinusitis in the practice guidelines. Patients with acute pharyngotonsillitis should be treated with antibiotics (amoxicillin) for 10 days with the purpose of prevention of rheumatic fever. Use of rapid antigen detection should be encouraged for the appropriate use of antibiotics, especially in Korea. Etiologies of acute laryngitis in adults are mainly viruses. However, M. pneumoniae, M. catarrhalis, H. influenzae are major bacterial pathogens of laryngtitis. Acute epiglottitis, cellulitis of the epiglottis, is a life-threatening infection. Airway keeping and antibacterial therapy against H. influenzae and other bacterial pathogens are main stays of management. Evidence-based approach is greatly in need for appropriate care for patients with bacterial upper respiratory infections.
Adult ; Amoxicillin ; Anti-Bacterial Agents ; Bacterial Infections ; Cellulitis ; Epiglottis ; Epiglottitis ; Evidence-Based Practice ; Humans ; Influenza, Human ; Korea ; Laryngitis ; Pneumonia ; Primary Health Care ; Respiratory Tract Infections ; Rheumatic Fever ; Sinusitis

No abstract available.
Anti-Infective Agents* ; Bronchitis ; Child* ; Common Cold ; Humans ; Otitis Media ; Pharyngitis ; Respiratory Tract Infections* ; Sinusitis

BACKGROUND: Although influenza has been a leading cause of global morbidity and mortality, we have few data regarding the epidemiological and clinical characteristics of influenza activity in Korea. Since an outbreak of influenza was recognized during winter of 1996-1997, we analyzed the epidemiological and clinical features of influenza activity in the hospital setting. METHODS: All clinical specimens requested for isolation of influenza virus at Samsung Medical Center from October 1996 to April 1997 were included. Mardin- Darby canine kidney (MDCK) cell line was used for virus culture. Isolated viruses were confirmed with immunostain followed by subtyping. The demographic and clinical characteristics of the patients were reviewed retrospectively. RESULTS: Ninety-eight influenza viruses were isolated from 461 patients (21.3%). Influenza A and B virus was isolated from 58 (54 children and 4 adults) and 40 pediatric patients, respectively. One of 31 influenza A viruses were confirmed as A/Wuhan/359/95-like strain and 5 of 12 influenza B viruses were confirmed as B/Guangdong/8/97-like strains. Two distinctive peaks of influenza activity were recognized and the most common age of patients was less than 1 year for influenza A, and 3 to 5 years for influenza B. Common lower respiratory infections were pneumonia followed by croup, bronchiolitis and laryngitis. CONCLUSION: We analyzed the epidemiological and clinical features of influenza activity during winter of 1996-1997. Although this study was performed not in the community but in the hospital setting, the morbidity caused by influenza may not be low in Korea. Therefore, nationwide surveillance for influenza activity is warranted.
Bronchiolitis ; Cell Line ; Child ; Croup ; Epidemiology ; Herpesvirus 1, Cercopithecine ; Humans ; Influenza A virus ; Influenza B virus ; Influenza, Human* ; Kidney ; Korea ; Laryngitis ; Mortality ; Orthomyxoviridae ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies

BACKGROUND: Azithromycin has broad spectrum and is effective to treat several bacterial respiratory tract infection. It is also relatively safe and tolerable to pediatric patient. Careful use of azithromycin is also required for the prescribers because it could cause cardiovascular toxicity (QTc prolongation) and ototoxicity. There has been no study on duration of azithromycin use in pediatric patients in Korea. METHODS: The outpatient sample data on the azithromycin prescription was obtained from Korean health insurance review and assessment service. The characteristics of azithromycin prescription were analyzed with two different years (2011 and 2014). RESULTS: Total 4,215 cases were analyzed. The azithromycin was prescribed the most frequently in the children (73.2% in 2011 and 62.5% in 2014) and for the condition of bronchopneumonia (28.7% in 2011 and 21.7% in 2014) in both years. The duration of prescribed for azithromycin has significantly different between 2011 and 2014. In 2014, 94.3% of prescription were indicated less than 5 days, but 86.6% were in 2011. Acute bronchiolitis and bronchopneumonia prescriptions more longer duration of treatment compared with acute bronchitis and others. CONCLUSION: The pattern of prescribing azithromycin has been changed for the treatment of several infectious diseases in pediatric patients. The rate of appropriate duration of azithromycin treatment has increased.
Azithromycin* ; Bronchiolitis ; Bronchitis ; Bronchopneumonia ; Child ; Communicable Diseases ; Health Care Surveys ; Humans ; Insurance, Health ; Korea ; Outpatients ; Pediatrics ; Prescriptions* ; Respiratory Tract Infections

PURPOSE: Pertussis, a respiratory tract infection caused by Bordetella pertussis, is an important cause of morbidity in children. But diagnosis of pertussis is often delayed because of late development of typical symptoms and difficulties in culture. There has been no bacteriologically confirmed case of B. pertussis infection in Korea. Lower respiratoy tract may be involved in pertussis. We performed the polymerase chain reaction(PCR) assay for B. pertussis from children with lower respiratory tract infections. METHODS: One hundred eighty nine nasopharyngeal aspirates were collected from children with lower respiratory tract infections during the period from November 1990 to February 1995. Three 24-mer primers derived from DNA sequences upstream of the structural genes for the porin proteins of Bordetella: P1 is shared by all three species and P2 is specific for B. pertussis and P3 is specific for B. parapertussis and B. bronchiseptica. Amplifications resulted in 159-bp PCR products specific for B. pertussis and 121-bp PCR products specific for B. parapertussis and B. bronchiseptica. A confirmatory cleavage of 159-bp PCR products of B. pertussis by Hae III revealed two bands of 22 and 137 bp. RESULTS: B. pertussis specific PCR products were visualized in 6 patients during 1991 and 5 of these had received appropriate doses of the combined DPT vaccine. They had had cough over 2 weeks in all and high fever in 4. They had been diagnosed as viral pneumonia in 5 and bronchiolitis in 1, but viral cultures for respiratory syncytial virus, parainfluenza virus, influenza virus, adenovirus were negative. There was no PCR product compatible with B. parapertussis or B. bronchiseptica. CONCLUSIONS: PCR assay is effective in diagnosis of B. pertussis infections. We suggest that there was an epidemic of pertussis in 1991 despite high rate of pertussis vaccine coverage in Korea.
Adenoviridae ; Base Sequence ; Bordetella pertussis* ; Bordetella* ; Bronchiolitis ; Child ; Cough ; Diagnosis* ; Diphtheria-Tetanus-Pertussis Vaccine ; Fever ; Humans ; Korea ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pertussis Vaccine ; Pneumonia, Viral ; Polymerase Chain Reaction* ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Whooping Cough

Vaccination in adults is recommended according to the age group and underlying diseases or risks of exposure. Patients with chronic diseases including chronic obstructive pulmonary diseases are susceptible to infectious diseases and related serious complications. They need risk-related vaccination along with age-related vaccination. Both influenza and pneumococcal vaccination are recommended in patients with chronic obstructive pulmonary diseases. They are additive if administered simultaneously. Pertussis vaccination is also needed in adolescents and adults. Although there is strong need for these vaccinations, the actual vaccination rate is low. Measures to effectively enhance the vaccination rate are needed.
Adolescent ; Adult ; Chronic Disease ; Communicable Diseases ; Humans ; Influenza, Human ; Lung Diseases, Obstructive ; Respiratory Tract Infections ; Streptococcus pneumoniae ; Vaccination ; Whooping Cough

BACKGROUND: Antibiotics are often indiscriminately prescribed for respiratory tract infections. This study was conducted to describe the prescription pattern of family physicians for respiratory tract infections. METHODS: In each clinic of 50 representative family practitioners, about 20 consecutive patients with diagnosis of respiratory tract infection were enrolled into the study. The data were collected by questionnaire to physicians just after patient interview. RESULTS: The number of study subjects was 1020, of which 55.7% was less than 15 year old. Antibiotics were prescribed to 73.9% of total subjects. According to diagnosis, the antibiotic prescription rate was 51.5% in common cold, 86.0% in pharyngitis, 88.6% in bronchitis, 98.9% in sinusitis, and 100% in otitis media. In common cold, the factors which significantly increased the antibiotic prescription were 1)patient age less than 15 year old (OR=1.70, CI=1.06-2.73), 2)more than two visits during the same episode(OR=1.95, CI=1.27-2.99), 3)yellow and thick rhinorrhea(OR=2.22, CI=1.16-4.25), 4)yellow and thick sputum(OR=3.31, CI=1.34-8.19), and 5)throat injection(OR=2.50, CI=1.42-4.39). Among patients to whom antibiotics were prescribed, 48.7% of patients were given the antibiotics by intramuscular injection. The most frequently prescribed antibiotics were penicillin and macroride among per-oral medicine and ribostamycin and lincomycin among intramuscular medicine. The reason for antibiotic prescription were 1)posssibility of bacterial infection(43.4%), 2)prevention of bacterial complication(23.7%), and 3)definite evidence of bacterial infection(22.5%). CONCLUSION: Family practitioners prescribe antibiotics indiscriminately for the respiratory tract infection. The prescription was influence by patient's age, number of clinic-visit, and clinical symptoms and signs.
Adolescent ; Anti-Bacterial Agents* ; Bronchitis ; Common Cold ; Diagnosis ; Humans ; Injections, Intramuscular ; Lincomycin ; Otitis Media ; Penicillins ; Pharyngitis ; Physicians, Family ; Prescriptions* ; Respiratory System* ; Respiratory Tract Infections* ; Ribostamycin ; Sinusitis ; Surveys and Questionnaires

OBJECTIVETo investigate the changes and clinical significance of lymphocyte subsets in infants with bronchitis, bronchopneumonia, and bronchiolitis.

METHODSA total of 111 children with bronchitis, 418 children with bronchopneumonia, and 83 children with bronchiolitis were enrolled as disease groups, and 235 healthy children were enrolled as control group. Flow cytometry was applied to measure lymphocyte subsets.

RESULTSThe bronchitis group had significantly lower numbers of T cells and CD3+CD8+ T cells than the control group (P<0.05). The bronchopneumonia group had significantly lower numbers of T cells and CD3+CD8+ T cells, a significantly higher number of T helper (Th) cells, and a significantly higher CD4/CD8 ratio than the control group, as well as a significantly higher number of Th cells than the bronchitis group. Compared with the children with mild bronchopneumonia, those with severe bronchopneumonia showed a reduction in T cells and an increase in B cells (P<0.05). The bronchiolitis group had a significantly higher number of Th cells, a significantly higher CD4/CD8 ratio, and a significantly lower number of CD3+CD8+ T cells than the control group (P<0.01). The disease groups showed a significantly higher number of B cells and a significantly lower number of natural killer cells than the control group (P<0.05).

CONCLUSIONSA low, disturbed cellular immune function and a high humoral immune function are involved in the development and progression of lower respiratory tract infectious diseases. The changes in immune function are related to the type and severity of diseases.

Bronchiolitis ; immunology ; Bronchitis ; immunology ; Bronchopneumonia ; immunology ; CD4-CD8 Ratio ; Child, Preschool ; Female ; Humans ; Infant ; Killer Cells, Natural ; immunology ; Lymphocyte Subsets ; immunology ; Male ; Respiratory Tract Infections ; immunology

PURPOSE:To identify the clinical features of human metapneumovirus (hMPV) and the respiratory syncytial virus (RSV) infection in children. METHODS:The participants of our study were 1,104 children who were admitted to Bungdang CHA hospital for lower respiratory infection from August 2006 through July 2007. Nasopharyngeal swabs were taken from the patients, and viruses were identified by RT-PCR. The clinical features of 51 patients with hMPV infection and 138 patients with RSV infection were compared by retrospective review of their medical records. RESULTS:The peak incidence of hMPV infection was noted in April, and that of RSV was noted in November. Both viruses had the highest incidence in patients age <1 year and hMPV infections occurred in 40% and 25% of patients age <6 months, respectively. In the hMPV group, 33.4% of the patients were age > or =2 years, while in the RSV group, 19% were age > or =2 years. In both groups, pneumonia was the most common clinical diagnosis, followed by acute bronchiolitis, acute bronchitis, and asthma. The white blood cell counts were higher in the RSV group, and fever was more frequent on admission in the hMPV group. CONCLUSION:hMPV was the fourth most common virus causing lower respiratory tract infections in children. The clinical features of hMPV infection were similar to those of RSV infection. This study may be helpful for the effective treatment of lower respiratory tract infection in children.
Asthma ; Bronchiolitis ; Bronchitis ; Child ; Fever ; Humans ; Incidence ; Leukocyte Count ; Metapneumovirus ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Retrospective Studies ; Viruses

The sputum eosinophilia has been observed in various allergic disease of respiratory tract, even non allergic disease, and as well as malignant disease of respiratory tract by several authors in adult patient. This studies were undertaken to evaluate sputum eosinphils in normal and in acute respi ratory tract infection in children. Sputum eosinophils were studied in 10 cases of normal child and in 30 cases of acute respiratory infection. Sputum was liquified by trypsin for 2 hours at 37degrees C in incubator and stained sputum eosinophils with Hinkelman's solution specifically. The stained eosinophils in 1mm3 of sputum were counted by hemocytometer. The results were as follows : 1. Average sputum eosinophil counts in normal child were 120+316 cell/mm3. 2. Average sputum eosinophil counts in acute respiratory tract infection were 10597+/-13207 cell/mm3, which was significantly increased than normal child(p<0.005). 3. Average sptum eosinophil counts in acute bronchitis and bronchiolitis were 10417+/-9295 cell/mm3, 7724+/-6136 cell/mm3 in acute pnemonia, 800 cell/mm3 in bronchial asthma, and 1945+/-2468 cell/mm3 in pulmonary tuberculosis. There were no significant differences of sputum eosinophils between acute respiratory infections. 4. Average sputum eosinophils in acute respiratory infection by different age group were 11178+9632 cell/mm3 below 1 year of age, 8816+/-8933 cell/mm3 in 1~6 years of age, 18798+/-29847 cell/mm3 in 6~10 years of age, and 1400+/-1697 cell/mm3 above 10 years of age. Average sputum eosinophil counts in male patient were 8428+/-9067 cell/mm3, 10597+/-13207 cells/mm3 in female patient. There were no significant differences of sputum eosinophils by age and sex in acute respiratory infection.
Adult ; Asthma ; Bronchiolitis ; Bronchitis ; Child ; Eosinophilia ; Eosinophils* ; Female ; Humans ; Incubators ; Male ; Respiratory System ; Respiratory Tract Infections ; Sputum* ; Trypsin ; Tuberculosis, Pulmonary