Common upper respiratory tract problems in the elderly—A guide to clinical diagnosis and prudent prescription

SUMMARYOccupants of 482 long-stay and 33 short-stay beds in 11 Leicester City Council homes for the elderly were studied during a 30-week period from September 1988 to March 1989 to determine the incidence, aetiology, morbidity, and mortality of acute upper respiratory tract viral infections and the use of influenza vaccine.Influenza immunization rates by home ranged from 15·4 to 90% (mean 45%). There were no differences in the distribution of medical conditions by home. The highest immunization rates were seen in people with chest disease (77%), heart disease (60%), diabetes (56%), and those with three medical conditions (75%). There was an average of 0·7 upper respiratory episodes per bed per annum with a mortality of 3·4% (6/179). Half of all episodes were seen by a general medical practitioner and 81 of 90 (90%) referrals were prescribed antibiotics costing approximately £7.50 per patient. Lower respiratory tract complications developed during 45 (25%) of 179 episodes including 3 of 12 coronavirus infections, 3 of 9 respiratory syncytial virus infections, 2 of 4 adenovirus infections, 1 of 11 rhinovirus infections, but none of 5 influenza infections. Respiratory infections were caused mostly by pathogens other than influenza virus during the influenza period documented nationally. This highlights the role of coronaviruses, respiratory syncytial virus, and unidentified agents in the elderly, and questions the assumptions made in American estimates on the impact of influenza and the value of influenza vaccines.

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Sensitivity of RT-PCR testing of upper respiratory tract samples for SARS-CoV-2 in hospitalised patients: a retrospective cohort study

10.1101/2020.06.19.20135756 ◽

2020 ◽

Cited By ~ 4

Author(s):

Thomas C Williams ◽

Elizabeth Wastnedge ◽

Gina McAllister ◽

Ramya Bhatia ◽

Kate Cuschieri ◽

...

Keyword(s):

Respiratory Tract ◽

Clinical Diagnosis ◽

Gold Standard ◽

Upper Respiratory Tract ◽

Repeated Testing ◽

Rt Pcr ◽

Hospitalised Patients ◽

Human Rnase ◽

Increased Sensitivity ◽

Upper Respiratory

ABSTRACTObjectivesTo determine the sensitivity and specificity of RT-PCR testing of upper respiratory tract (URT) samples from hospitalised patients with COVID-19, compared to the gold standard of a clinical diagnosis.MethodsAll URT RT-PCR testing for SARS-CoV-2 in NHS Lothian, Scotland, United Kingdom between the 7th of February and 19th April 2020 (inclusive) was reviewed, and hospitalised patients were identified. All URT RT-PCR tests were analysed for each patient to determine the sequence of negative and positive results. For those who were tested twice or more but never received a positive result, case records were reviewed, and a clinical diagnosis of COVID-19 allocated based on clinical features, discharge diagnosis, and radiology and haematology results. For those who had negative URT RT-PCR tests but a clinical diagnosis of COVID-19, respiratory samples were retested using a multiplex respiratory panel, a second SARS-CoV-2 RT-PCR assay, and a human RNase P control.ResultsCompared to the gold standard of a clinical diagnosis of COVID-19, the sensitivity of an initial URT RT-PCR for COVID-19 was 82.2% (95% confidence interval 79.0-85.1%). Two consecutive URT RT-PCR tests increased sensitivity to 90.6% (CI 88.0-92.7%). A further 2.2% and 0.9% of patients who received a clinical diagnosis of COVID-19 were positive on a third and fourth test.ConclusionsThe sensitivity of a single RT-PCR test of an URT sample in hospitalised patients is 82.2%. Sensitivity increases to 90.6% when patients are tested twice. A proportion of cases with clinically defined COVID-19 never test positive on URT RT-PCR despite repeated testing.

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Streptococcus pneumoniae Colonization Disrupts the Microbial Community within the Upper Respiratory Tract of Aging Mice

Infection and Immunity ◽

10.1128/iai.01275-15 ◽

2016 ◽

Vol 84 (4) ◽

pp. 906-916 ◽

Cited By ~ 19

Author(s):

Netusha Thevaranjan ◽

Fiona J. Whelan ◽

Alicja Puchta ◽

Eta Ashu ◽

Laura Rossi ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Respiratory Tract ◽

Bacterial Colonization ◽

The Elderly ◽

Rrna Gene ◽

Host Immune System ◽

Upper Respiratory Tract ◽

Content Type ◽

Increased Risk ◽

Upper Respiratory

Nasopharyngeal colonization by the Gram-positive bacteriumStreptococcus pneumoniaeis a prerequisite for pneumonia and invasive pneumococcal diseases. Colonization is asymptomatic, involving dynamic and complex interplay between commensals, the host immune system, and environmental factors. The elderly are at an increased risk of developing pneumonia, which might be due to changes in the respiratory microbiota that would impact bacterial colonization and persistence within this niche. We hypothesized that the composition of the upper respiratory tract (URT) microbiota changes with age and subsequently can contribute to sustained colonization and inefficient clearance ofS. pneumoniae. To test this, we used a mouse model of pneumococcal colonization to compare the composition of the URT microbiota in young, middle-aged, and old mice in the naive state and during the course of colonization using nasal pharyngeal washes. Sequencing of variable region 3 (V3) of the 16S rRNA gene was used to identify changes occurring with age and throughout the course ofS. pneumoniaecolonization. We discovered that age affects the composition of the URT microbiota and that colonization withS. pneumoniaeis more disruptive of preexisting communities in older mice. We have further shown that host-pathogen interactions followingS. pneumoniaecolonization can impact the populations of resident microbes, includingStaphylococcusandHaemophilus. Together, our findings indicate alterations to the URT microbiota could be detrimental to the elderly, resulting in increased colonization ofS. pneumoniaeand decreased efficiency in its clearance.

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The Loss of Topography in the Microbial Communities of the Upper Respiratory Tract in the Elderly

Annals of the American Thoracic Society ◽

10.1513/annalsats.201310-351oc ◽

2014 ◽

Vol 11 (4) ◽

pp. 513-521 ◽

Cited By ~ 93

Author(s):

Fiona J. Whelan ◽

Chris P. Verschoor ◽

Jennifer C. Stearns ◽

Laura Rossi ◽

Kathy Luinstra ◽

...

Keyword(s):

Respiratory Tract ◽

Microbial Communities ◽

The Elderly ◽

Upper Respiratory Tract ◽

Upper Respiratory

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Efficacy and safety of Aviron Rapid® in 18-60-year-old patients with clinical diagnosis of acute respiratory viral infection: a multicenter, randomized, double-blind, placebo-controlled clinical trial

Folia Medica ◽

10.3897/folmed.63.e64415 ◽

2021 ◽

Vol 63 (1) ◽

pp. 129-137

Author(s):

Georgi Popov ◽

Margarita Gospodinova-Bliznakova ◽

Zlatko Kalvatchev ◽

Andrey Tchorbanov

Keyword(s):

Respiratory Tract ◽

Viral Infection ◽

Clinical Diagnosis ◽

Symptomatic Therapy ◽

Upper Respiratory Tract ◽

Double Blind ◽

Double Blind Placebo ◽

Duration Of Disease ◽

Upper Respiratory ◽

Tract Infections

Aim: Prevention and treatment of upper respiratory tract infections are given the highest priority because of the tremendous health and economic impact of these diseases. Development of novel effective and safe options for treatment can contribute considerably to decrease the burden of disease. Materials and methods: We designed a multicenter, randomized, double-blind, placebo-controlled study in ambulatory-treated adult patients with a clinical diagnosis of acute upper respiratory tract viral infection. The patients (18-60 years old) were randomized into two groups and followed-up for 5 days. Group 1 received the standard symptomatic therapy + Aviron Rapid®, and Group 2 received the standard symptomatic therapy + placebo. The primary endpoint of the study was defined as the duration of disease measured by the percentages of disease-free patients for every 12-hour period of the study.  Results: Treating clinically relevant patients with the natural product Aviron Rapid® for 5 days decreases the duration of disease, the intake of antipyretics and the severity of symptoms. Significant difference between the tested groups for most of studied parameters was found as soon as 12 or 24 hours after initiation of administration in favour of active arm and was the most prominent on days 3 and 4. Significant decrease in the total score of symptoms severity was achieved on day 4 and extended to the end of study. There were no dif-ferences in the adverse events between the groups and the tested product demonstrated excellent safety profile.  Conclusions: This study is a clinical confirmation of well documented antiviral activity of the product targeting multiple points in viral replication and covering broad spectrum viral pathogens.

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Sensitivity of RT-PCR testing of upper respiratory tract samples for SARS-CoV-2 in hospitalised patients: a retrospective cohort study

Wellcome Open Research ◽

10.12688/wellcomeopenres.16342.1 ◽

2020 ◽

Vol 5 ◽

pp. 254

Author(s):

Thomas C. Williams ◽

Elizabeth Wastnedge ◽

Gina McAllister ◽

Ramya Bhatia ◽

Kate Cuschieri ◽

...

Keyword(s):

Respiratory Tract ◽

Clinical Diagnosis ◽

Gold Standard ◽

Upper Respiratory Tract ◽

Rt Pcr ◽

Reverse Transcription Pcr ◽

Hospitalised Patients ◽

Increased Sensitivity ◽

Upper Respiratory ◽

Pcr Test

Background: This study aimed to determine the sensitivity and specificity of reverse transcription PCR (RT-PCR) testing of upper respiratory tract (URT) samples from hospitalised patients with coronavirus disease 2019 (COVID-19), compared to the gold standard of a clinical diagnosis. Methods: All URT RT-PCR testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in NHS Lothian, Scotland, United Kingdom between the 7th of February and 19th April 2020 (inclusive) was reviewed, and hospitalised patients were identified. All URT RT-PCR tests were analysed for each patient to determine the sequence of negative and positive results. For those who were tested twice or more but never received a positive result, case records were reviewed, and a clinical diagnosis of COVID-19 allocated based on clinical features, discharge diagnosis, and radiology and haematology results. For those who had a negative RT-PCR test but a clinical diagnosis of COVID-19, respiratory samples were retested using a multiplex respiratory panel, a second SARS-CoV-2 RT-PCR assay, and a human RNase P control. Results: Compared to the gold standard of a clinical diagnosis of COVID-19, the sensitivity of a single upper respiratory tract RT-PCR for COVID-19 was 82.2% (95% confidence interval 79.0-85.1%). The sensitivity of two upper respiratory tract RT-PCR tests increased sensitivity to 90.6% (CI 88.0-92.7%). A further 2.2% and 0.9% of patients who received a clinical diagnosis of COVID-19 were positive on a third and fourth test; this may be an underestimate of the value of further testing as the majority of patients 93.0% (2999/3226) only had one or two URT RT-PCR tests. Conclusions: The sensitivity of a single RT-PCR test of URT samples in hospitalised patients is 82.2%. Sensitivity increases to 90.6% when patients are tested twice. A proportion of cases with clinically defined COVID-19 never test positive on URT RT-PCR despite repeat testing.

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