Clinical and Virological Characteristics of Acute Sinusitis in Children

Abstract Background Acute bacterial sinusitis is a frequent complication of viral upper respiratory infection (URI). We describe the clinical and virologic features of URIs that remain uncomplicated and those that precede an episode of sinusitis. We hypothesize that certain viruses are more likely to lead to acute sinusitis, and we compare viruses identified at the time of diagnosis of sinusitis with those identified early in the URI. Methods Children aged 48–96 months were followed longitudinally for 1 year. Nasal samples were obtained at surveillance visits, on Day 3–4 of the URI, and on Day 10, when sinusitis was diagnosed. Molecular diagnostic testing was performed on nasal washes for common respiratory viruses and pathogenic bacteria. A standardized score was used to quantify symptom severity. Results We evaluated 519 URIs, and 37 illnesses in 31 patients met the criteria for sinusitis. Respiratory syncytial virus was detected more frequently in URI visits that led to sinusitis, compared to in uncomplicated URIs (10.8% vs 3.4%; P = .05). New viruses were detected in 29% of sinusitis episodes, and their pattern was different than those patterns observed at surveillance. The median number of URIs per subject per year was 1 (range 0–9) in uncomplicated URI subjects and 3 (range 1–9) in sinusitis subjects (P < .001). Conclusions Children who developed sinusitis experienced more frequent URIs, compared to children whose URIs remained uncomplicated. When nasal samples were obtained on the day of diagnosis of acute sinusitis, nearly 30% of children had a new virus identified, suggesting that some children deemed to have sinusitis were experiencing sequential viral infections.

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Intensivists’ beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00961-4 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Alyssa M. Pandolfo ◽

Robert Horne ◽

Yogini Jani ◽

Tom W. Reader ◽

Natalie Bidad ◽

...

Keyword(s):

Molecular Diagnostics ◽

Antimicrobial Stewardship ◽

Diagnostic Tests ◽

Pathogenic Bacteria ◽

Point Of Care ◽

Diagnostic Testing ◽

Molecular Diagnostic ◽

Antibiotic Prescribing ◽

Test Results ◽

Structured Interviews

Abstract Background Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians’ endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians’ beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care. Methods We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians’ beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically. Results Clinicians’ beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians’ prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device’s capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results. Conclusions Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests’ capabilities and integration into clinical practice. Implementation strategies should bolster users’ necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests’ purpose and benefits, identifying and addressing clinicians’ misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60–90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.

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Shortness of Breath

Acute Care Casebook ◽

10.1093/med/9780190865412.003.0061 ◽

2018 ◽

pp. 300-303

Author(s):

Sylvia E. Garcia

Keyword(s):

Respiratory Syncytial Virus ◽

Supportive Care ◽

Small Subset ◽

Shortness Of Breath ◽

Upper Respiratory Infection ◽

Bronchodilator Therapy ◽

Panel Testing ◽

Upper Respiratory ◽

Lower Airways ◽

Syncytial Virus

This case illustrates the classic presentation of bronchiolitis, which is a clinical diagnosis. The pathophysiology is that of an upper respiratory infection, most commonly respiratory syncytial virus, progressing to involve the lower airways, with subsequent wheezing and respiratory distress. Supportive care is the focus of management in the majority of cases, as interventions including bronchodilators, nebulized racemic epinephrine, nebulized hypertonic saline (for nonhospitalized settings), steroids, and antibiotics all provide inconsistent or no benefit. Although a small subset of patients has shown to benefit from bronchodilator therapy, no study clearly defines this group. In severe cases, noninvasive respiratory support may be needed. Radiographic imaging and respiratory panel testing for infectious causes are not routinely recommended.

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Bacterial communities of the upper respiratory tract of turkeys

Scientific Reports ◽

10.1038/s41598-021-81984-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Olimpia Kursa ◽

Grzegorz Tomczyk ◽

Anna Sawicka-Durkalec ◽

Aleksandra Giza ◽

Magdalena Słomiany-Szwarc

Keyword(s):

Respiratory Tract ◽

Bacterial Communities ◽

Pathogenic Bacteria ◽

Viral Infections ◽

Rrna Gene ◽

Respiratory Pathogens ◽

Upper Respiratory Tract ◽

Genus Level ◽

Upper Respiratory ◽

And Performance

AbstractThe respiratory tracts of turkeys play important roles in the overall health and performance of the birds. Understanding the bacterial communities present in the respiratory tracts of turkeys can be helpful to better understand the interactions between commensal or symbiotic microorganisms and other pathogenic bacteria or viral infections. The aim of this study was the characterization of the bacterial communities of upper respiratory tracks in commercial turkeys using NGS sequencing by the amplification of 16S rRNA gene with primers designed for hypervariable regions V3 and V4 (MiSeq, Illumina). From 10 phyla identified in upper respiratory tract in turkeys, the most dominated phyla were Firmicutes and Proteobacteria. Differences in composition of bacterial diversity were found at the family and genus level. At the genus level, the turkey sequences present in respiratory tract represent 144 established bacteria. Several respiratory pathogens that contribute to the development of infections in the respiratory system of birds were identified, including the presence of Ornithobacterium and Mycoplasma OTUs. These results obtained in this study supply information about bacterial composition and diversity of the turkey upper respiratory tract. Knowledge about bacteria present in the respiratory tract and the roles they can play in infections can be useful in controlling, diagnosing and treating commercial turkey flocks.

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Viral Coinfection and Nasal Cytokines in Children With Clinically Diagnosed Acute Sinusitis

Frontiers in Pediatrics ◽

10.3389/fped.2021.783665 ◽

2022 ◽

Vol 9 ◽

Author(s):

Santiago M. C. Lopez ◽

Nader Shaikh ◽

Monika Johnson ◽

Hui Liu ◽

Judith M. Martin ◽

...

Keyword(s):

Pathogenic Bacteria ◽

Clinical Presentation ◽

Bacterial Culture ◽

Positive Culture ◽

Clinical Information ◽

Acute Sinusitis ◽

Normal Flora ◽

Acute Bacterial Sinusitis ◽

Cytokine Levels ◽

Co Detection

Objective: Children with no pathogenic bacteria in the nasopharynx are unlikely to have acute bacterial sinusitis. We evaluated whether information on clinical presentation, viral co-detection, and mucosal cytokine levels could be used to predict presence of bacteria in the nasopharynx.Method: We obtained nasopharyngeal (NP) swabs from children diagnosed with acute sinusitis. NP swabs were processed for bacterial culture, viral PCR testing, and cytokine expression. We examined whether results of the bacterial culture could be predicted based on the presence of clinical information, presence of viruses or mucosal cytokine levels.Results: We enrolled 174 children; 123 (71%) had a positive culture for potentially pathogenic bacteria and 51 (29%) had normal flora. 122/174 (70%) tested positive for one or more viruses. Compared to children with normal flora, children with pathogenic bacteria were more likely to have viruses (p < 0.01), but this relationship disappeared when we adjusted for age. Children with pathogenic bacteria in their nasopharynx and children with normal flora had similar levels of nasal cytokines.Conclusion: In children with clinically diagnosed acute sinusitis, clinical presentation, levels of nasal cytokines, and presence of viruses do not differentiate children with and without pathogenic bacteria in their nasopharynx.

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A simulated client exploration of nonprescription availability of antibiotics at drugstores for childhood acute diarrhea and upper respiratory infection in Lahore, Pakistan

10.21203/rs.3.rs-103467/v1 ◽

2020 ◽

Author(s):

Usman Rashid Malik ◽

Jie Chang ◽

Furqan Hashmi ◽

Naveel Atif ◽

Hareem Basir ◽

...

Keyword(s):

Respiratory Infection ◽

Acute Diarrhea ◽

Viral Infections ◽

Cross Sectional Study ◽

Easy Access ◽

Categorical Variables ◽

P Value ◽

Cross Sectional ◽

Upper Respiratory Infection ◽

Upper Respiratory

Abstract Background The excessive consumption of antibiotics is a major contributor to antimicrobial resistance, especially in children. Children are often being advised antibiotics for viral infections. In developing countries, the drugstores are a prime source of easy access to nonprescription antibiotics. Also, in Pakistan, their irrational use is an “everyday routine”. The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics for children at drugstores of Lahore, Pakistan.Methods Using the pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan to explore the antibiotics’ ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square (x2) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing.Results Antibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. The qualified pharmacist was available in only 164 (21.2%) cases. Of 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits respectively. The considerable differences (p-value < 0.05) were observed between the practices of the towns, disease scenario presented, categories of drugstores, and pharmacist-supervised drugstores. Conclusions The inappropriate dispensing practices were prevalent to a large extent at the drugstores and antibiotics were effortlessly obtainable without prescriptions. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delays especially in major cities to help curb the felonious use of antibiotics.

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Bronchiolitis: State-of-the-art

Bangladesh Journal of Child Health ◽

10.3329/bjch.v44i3.52710 ◽

2021 ◽

Vol 44 (3) ◽

pp. 161-169

Author(s):

ARM Luthful Kabir

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Positive Airway Pressure ◽

State Of The Art ◽

Diagnostic Testing ◽

First Episode ◽

High Flow Nasal Cannula ◽

Winter Solstice ◽

Upper Respiratory Infection ◽

Upper Respiratory

The commonest cause of respiratory distress in young children is bronchiolitis. Bronchiolitis is an acute viral lower respiratory tract infection which predominantly affects children up to two years of age. It is a seasonal disease, dominating winter months, with a peak over 6 to 8 weeks around the winter solstice. The evidence and guideline recommendations consistently support a clinical diagnosis with the limited role for diagnostic testing for children who present with the typical clinical features of viral upper respiratory infection progressing to the lower respiratory tract. Management is largely supportive, focusing on maintaining oxygenation and hydration. Evidence suggest no benefit from bronchodilator or corticosteroid use in infants with first episode of bronchiolitis. Evidence for other treatment such as hypertonic saline is evolving. In case of severe bronchiolitis, there is some role for high-flow nasal cannula and continuous positive airway pressure use. Bangladesh J Child Health 2020; VOL 44 (3) :161-169

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Viral infections in pediatric solid organ transplantation recipients and the impact of molecular diagnostic testing

Current Opinion in Organ Transplantation ◽

10.1097/mot.0b013e3283398795 ◽

2010 ◽

Vol 15 (3) ◽

pp. 293-300 ◽

Cited By ~ 2

Author(s):

Rebecca Pellett Madan ◽

Betsy C Herold

Keyword(s):

Organ Transplantation ◽

Viral Infections ◽

Diagnostic Testing ◽

Solid Organ Transplantation ◽

Molecular Diagnostic ◽

Solid Organ ◽

Molecular Diagnostic Testing ◽

The Impact

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Is Fever a Red Flag for Bacterial Pneumonia in Children With Viral Bronchiolitis?

Global Pediatric Health ◽

10.1177/2333794x19868660 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1986866 ◽

Cited By ~ 2

Author(s):

Dominique Elmore ◽

Balfaqih Yaslam ◽

Krista Putty ◽

Thomas Magrane ◽

Anthony Abadir ◽

...

Keyword(s):

Retrospective Study ◽

Respiratory Syncytial Virus ◽

Early Diagnosis ◽

Respiratory Infection ◽

Bacterial Pneumonia ◽

Upper Respiratory Infection ◽

Red Flag ◽

Upper Respiratory ◽

Syncytial Virus ◽

Secondary Bacterial Pneumonia

We hypothesized that fever in children with viral bronchiolitis indicates the need for consideration of superimposed bacterial pneumonia. We conducted a retrospective study of 349 children aged 2 years and younger with diagnoses of respiratory syncytial virus (RSV) and viral upper respiratory infection. Data were analyzed using Pearson χ2 test. One hundred seventy-eight children had RSV with no other identified virus. The majority of children (56%) who had only RSV were afebrile. Febrile children with RSV were over twice as likely to be diagnosed with bacterial pneumonia as those who were afebrile (60% vs 27%, P < .001). In the 171 children who had bronchiolitis caused by a virus other than RSV, 51% were afebrile. These children were 8 times more likely to be diagnosed with pneumonia than those who were afebrile (65% vs 8%, P < .001). Evaluation of febrile children with viral bronchiolitis may allow early diagnosis and treatment of secondary bacterial pneumonia.

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