Upper Respiratory Tract Infection Ebook

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'Rhinitis' which literally means inflammation of the nasal mucosa is a non-specific term. The multifactorial aetiology and overlapping symptomatology makes 'rhinitis' extremely difficult to classify. Up to date, the classification proposed by the 'International Rhinitis Management Working Group' in 1994 is the most comprehensive one although is still far from being universally accepted. The commonest cause being allergy. For a long time, allergic rhinitis is classified as seasonal or perennial. More recently, it is being reclassified as intermittent or persistent depending on the total duration of the symptomatic period. Management of rhinitis is dependent on the underlying cause. Superimposed infection is not uncommon and should be treated accordingly.

Biological Basis Of Adenoviruses

The adenovirus was first isolated in the early 1950s as a cytopathogenic agent from primary cell cultures derived from human adenoids and respiratory secretions of patients with acute respiratory illnesses (23,24). This virus was actually a group of nonenveloped viruses containing linear, double-stranded DNA encapsulated in an icosahedral protein capsid. To date, more than 100 types of adenoviruses that infect a wide range of mammalian and avian hosts have been identified (25). At least 51 human adenovirus serotypes have been isolated they are classified into six subgroups (A to F) (25,26) on the basis of their ability to agglutinate red blood cells (27). Except for the group C and E viruses, other human adenoviruses can induce tumors in rats and hamsters, yet no evidence has been found that links adenoviruses to cancers in humans (25). Adenovirus infections in humans usually result in mild signs and symptoms of respiratory illness, conjunctivitis, or gastroenteritis (25). However, an...

Prototypes Creating Representations of Illness and Targets for Management

The CSM provides a detailed description of the processes involved in the activation of prototypes, the process that elaborates the meaning of implicit and explicit observations of somatic and functional cues. The core of the process is an ongoing scanning, checking, and comparing of somatic sensations, as well as physical and mental function, to the underlying prototype and schemata of the physical and functional self. A representation of illness is activated when the scanning or check process detects a deviation in somatic sensations and or physical and mental function that exceeds normally expected variability in the self and matches an underlying illness prototype. The representation formed at that moment is an operating hypothesis about the nature and meaning of the experienced deviations. For example, the deviations may reflect one of several acute conditions such as a migraine headache, common cold, heartburn, and or stomach ache from bad food, or a potentially chronic condition...

Congenital General Anosmia

It is estimated that approx 1 of the Western world population suffers from chemosensory disorders. Most of the people suffering from smell disorders have an acquired condition, which develops during life, owing to allergy, viral upper respiratory tract infection, nasal sinus diseases, head trauma, inhalation of noxious chemicals, or medicinal drug intake (32,33). A much smaller minority is born without a sense of smell, an affliction referred to here as

Disease associations of HHV6A and 6B variants

It was previously thought that primary infection of HHV-6 in infants and young children lead to roseola and febrile illnesses. This infection was attributed to HHV-6B (Yamanishi et al., 1988). Some of the symptoms identified include diarrhea, vomiting, seizure, nasal congestion, rash and high fever. Similar symptoms were noted in Africa in children and the DNA analysis from the peripheral blood from these children revealed HHV-6A infections (Hidaka et al., 1997 Kasolo et al., 1997 Randhawa et al., 1997). It is, therefore, obvious that both variants A and B participate in infecting growing children with identical pathologies. Hall et al. (1994) also observed that one third of congenital infection was due to HHV-6A. Later on these children still retained HHV-6A DNA. There have not been longitudinal follow-up studies to assess whether these children with congenital HHV-6A infection could be at risk of developing a central nervous system (CNS) illness such as multiple sclerosis.

Positive Well Being and Physical Health

Positive affect is related to other severe health outcomes as well. For example, Ostir and colleagues (2001) have reported that positive affect was associated with a reduced risk of stroke in a population of older men and women after controlling for relevant covariates, and in another analysis with lower blood pressure and less hypertension (Ostir et al, 2006). A study of older patients with coronary artery disease demonstrated that functional decline was reduced in those reporting high levels of positive emotion (Brummett et al, 2009b). Cohen and colleagues (2003, 2006) have used experimental exposure to infectious respiratory pathogens such as influenza virus, in order to analyze the role of emotional states under relatively controlled conditions. In these studies, volunteers were administered standard doses of virus and were then quarantined for a number of days to assess the development of objective illness. It was found that participants with a more positive emotional style...

Noninvasive Fungal Masses Fungal Balls

The masses themselves are mycelial mats which can rest in the sinus cavities for months or years without any sort of tissue invasion. They are described as cheeselike, gritty, rubbery, or greasy masses that are easily discernible from the surrounding mucosa. They may be black or brownish in color, and often have a fetid odor associated with them. A small, localized inflammatory response may be seen, but the integrity of the nasal architecture is unchanged (Washburn, 1994). The benign mass is usually limited to the maxillary sinus cavity, with infections occurring infrequently in the sphenoid cavity as well. Symptoms include chronic nasal congestion, pain localized to the maxillary sinus, and a postnasal drip. Often a superimposed acute bacterial infection will occur, though the infection is opportunistic and not directly integrated with the fungal sinusitis.

Allergic Fungal Rhinosinusitis

Allergic fungal rhinosinusitis (AFRS or AFS in the literature) is a hypersensitivity disease of the paranasal sinuses afflicting patients who are immunocompetent albeit with a history of atopy and allergic rhinitis to fungi. The disease process begins as the fungi become entrapped within the nasal cavity, presumably because of ostium obstruction or mucociliary disorder, and initiate a hypersensitive immune response. Just as with the other forms of fungal sinusitis, A. fumigatus is the most common etiological agent associated with AFRS (Table 1.1).

Clinical Manifestations

After an incubation of two to four days, colonizing toxigenic diphtheria strains produce toxin locally with initiation of the signs and symptoms of disease (5). In nasal disease, typically seen in infants, the illness appears similar to the common cold but then progresses to a serosanguinous and mucopurulent rhinitis. Excoriation of the nares and upper lip and a white septal pseudomembrane may be seen. Spread of the disease to the pharynx occurs next, causing a sore throat, tonsillitis, low-grade temperature and a white to gray pseudomembrane extending from the tonsils to the posterior pharyngeal pillars and nasopharynx, the most common site for clinical diphtheria. Hoarseness and a barking cough accompany the progression of disease. Laryngeal diphtheria most often develops as an extension of pharyngeal involvement, although occasionally it may be an isolated manifestation of diphtheria. As toxin production continues, there is profound malaise, weakness, cervical lymphadenitis, soft...

Classic Infectious Disease

Infecting most individuals in early and late childhood, respectively (Gardner, 1973 Padgett and Walker, 1973 Taguchi et al., 1982). BKV is thought to cause mild respiratory illness, which would correlate with its appearance in the population at early ages (Goudsmit et al., 1981, 1982 Hashida et al., 1976 Min-inberg et al., 1982 Padgett et al., 1983). Indeed, both viruses can be detected in tonsillar tissue, and JCV has been shown to infect tonsillar lymphocytes and stromal cells (Goudsmit et al., 1982 Monaco et al., 1998a,b). The viruses then disseminate and establish a subclinical, persistent infection in the urinary tract and lymphocytes (and, for JCV, the brain). To obtain overt disease, the individual usually must be immunocompromised. Most commonly affected are patients with AIDS or transplant recipients taking immunosuppressive drugs. The pathology of the disease is thought to be due to destruction of the infected tissue due to viral replication. The molecular mechanisms of...

Pharmacological Toxicological Effects 51 Immunological Effects

A double-blind, placebo-controlled, randomized trial evaluating Echinacea for the treatment of colds involved 559 adult patients and three different Echinacea products (Echinaforce E. purpurea 95 herb and 5 root , E. purpurea concentrate, and E. purpurea root preparation). In the patients that were treated, two of the Echinacea products produced a statistically significant reduction in symptoms compared to placebo and the E. purpurea root preparation (10). In another study evaluating the prophylactic role of Echinacea, 302 patients were enrolled in a three-armed, randomized, double-blind, placebo-controlled trial. Each of the groups was given ethanolic extract of E. purpurea roots, E. angustifolia roots, or placebo for 12 weeks. They did not find a significant reduction in occurrence of URI in either treatment group however, they speculated from their results and the results of two other similar studies that there was a 10 to 20 relative risk reduction for URI. It was concluded that...

Perfecting Case And Outbreak Detection

Figure 13.13 Daily sum of syndrome probabilities produced by SyCO2. SyCO2 computes the posterior probability that a patient has a flu-like illness from his chief complaint. (From Espino, J., Dara, J., Dowling J, et al. (2005). SyCo2 A Bayesian Machine Learning Method for Extracting Symptoms from Chief Complaints And Combining Them Using Probabilistic Case Definitions. Pittsburgh, PA Center for Biomedical Informatics, University of Pittsburgh, with permission.) An outbreak-detection system would sum the posterior probabilities of flu-like illness from all patients seen in 24-hour periods to form a time series of expected daily counts of patients with respiratory illness. Readers familiar with Bayesian statistics will recognize this sum as the expectation for the number of individuals with a given diagnosis. figure 13.13 Daily sum of syndrome probabilities produced by SyCO2. SyCO2 computes the posterior probability that a patient has a flu-like illness from his chief complaint. (From...

Computerinterpretable Case Definitions

Case definitions, as currently written, are not well suited for automation. The authors of the SARS case definition intended it for use by physicians and epidemiologists, not computers. The clause findings of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing) does not enumerate all findings of lower respiratory illness. A computer requires a complete enumeration of all findings that it should count as evidence of lower respiratory illness (e.g., cough, shortness of breath, difficulty breathing, wheezing, cyanosis, tachypnea, dullness to percussion, fremitus, whispered pectoriloquy, rales, and rhonchi). The findings would also have to be described more precisely. For example, a physician or an epidemiologist would not count chronic cough or cough associated with asthma as a finding of lower respiratory illness when applying this case definition, but a computer would (unless told otherwise). Note that it is difficult, if not impossible, to enumerate all...

Reflection of Effects on Th1 Th2 and Treg Differentiation

Also Lactobacillus strains have been shown to confer differential effects on cytokine production and expression of surface markers on murine dendritic cells (85). Furthermore, lactobacilli induced in vitro, in a strain dependent manner, Treg-like low proliferating Th population producing TGF-b and IL-10 (86). TGF-b is the key cytokine in induction of T-cell differentiation towards Tregs (Fig. 2) (87). In a clinical study, improvement in atopic eczema symptoms following oral administration of lactobacilli was accompanied by increased serum concentrations of TGF-b (17). Interestingly, oral supplementation of lactobacilli in breast-feeding mothers was followed by increased TGF-b concentrations in breast-milk (88). This increase may have contributed to subsequently lower prevalence of atopic eczema in children. It should be noted, however, that allergic sensitization was not affected and allergic rhinitis and asthma may have increased in frequency (89). Nevertheless, these studies are not...

Determining Whether Bayesian Algorithms Are Well Calibrated

We note that an algorithm can trivially meet this requirement by simply outputting the prior probability of an outbreak for each day therefore, such an evaluation represents a necessary but not sufficient test of the algorithm. As illustrated in Figure 13.13 (Chapter 13), the RODS system uses the case detection algorithm SyCO2 to compute a time series of daily counts of respiratory syndrome'' by summing the posterior probability of respiratory syndrome'' produced by SyCO2 for all patients visiting an emergency room on each day. If SyCO2 is well-calibrated, the daily sums should equal the actual number of patients with respiratory illness each day, which could be verified by examination of patient charts or some other gold-standard ascertainment method.

Air Pollution Global and Regional Respiratory and Other Adverse Health Effects

This is particularly the case with urban air pollution, which has, in recent decades, become a worldwide public health problem.9,10 That is, although it does not constitute an integrated 'global' environmental change, its widespread occurrence as a locally generated and locally acting health hazard makes it, now, a 'worldwide' problem. An estimated 130000 premature deaths and 50-70 million incidents of respiratory illness occur each year due to episodes of urban air pollution in developing countries, half of them in East Asia. An even greater toll of chronic disease is attributable to long-term exposures to urban air pollution. i2 A recent analysis of three European countries estimated that 6 of total mortality (over 40 000 attributable cases per year) was caused by air pollution. 13 This study also demonstrated that air pollution resulting from motorized traffic accounted for over 16 million person-days of restricted activities. For the world as a whole, it has been...

Perivenous Encephalomyelitis

AHL is usually fatal disorder characterized clinically by an abrupt onset of fever, neck stiffness, hemiplegia or other focal signs, seizures, and impaired consciousness. Thankfully, it is rare but has been reported in patients of all ages. Most cases follow an upper respiratory tract infection, typically 1 to 13 days earlier. At autopsy, the brain is congested and swollen, sometimes asymmetrically, and herniation is frequent. Multiple petechial hemorrhages are distributed diffusely throughout the brain. The perivas-cular lesions chiefly consist of ball or ring hemorrhages surrounding necrotic venules, sometimes with fibrinous exudates present within the vessel wall or extending into adjacent tissue. Perivascular cuffs of mononuclear cells with neutrophils are often prominent. Perivenous demyelinating lesions, identical to those of ADEM, may be present. Most authors believe that AHL represents a hyperacute form of ADEM.

Aspirin nsaid hypersensitivity

NSAID hypersensitivity tends to present in early adult years as rhinorrhea, nasal congestion, and hyposmia. In patients with asthma, NSAID hypersensitivity may develop concurrently or some years after the diagnosis of asthma has been established. In both groups, peripheral blood and tissue eosinophilia and pansinusitis with nasal polyposis are common. Approximately 10 of patients with steroid-dependent asthma have been found to be NSAID hypersensitive, whereas one-third of asthmatics with associated nasal polyposis and chronic sinusitis are sensitive to this class of drug. Although most normal patients tolerate these drugs, epidemiological studies suggest adverse reaction rates of up to 1 . patients with this syndrome, pansinusitis is common. Although nasal polyps may complicate ordinary allergic rhinitis (approximately 1-2 in some studies) and are a common manifestation of cystic fibrosis (up to 50 of such patients), the highest incidence of nasal polyps occurs in the patients with...

Availability Of Overthecounter Sales Data

Bought cough syrup and tissues is more likely to have an acute respiratory illness (or an acquaintance or child with respiratory illness) than someone who purchased cough syrup and a pack of cigarettes. The major barrier to obtaining these additional data is the reluctance of retailers to provide the data due to concerns about the volume of data they would have to process on behalf of a biosurveillance organization, proprietary business concerns, and that participation in loyalty card programs may be adversely affected.

Surveys of Sick Individuals about their Use of OTC Healthcare Products

Another survey found that 76 of individuals who reported an upper respiratory tract infection in the last two weeks self-treated with an OTC medication only 14 visited a physician (McIsaac et al., 1998). This survey did not assess the timing of OTC use relative to the timing of visits to physicians, but it did assess the timing of visits to physicians in the course of illness. The study found that nearly two-thirds of sick individuals who visited a physician did not do so until after the second day of illness and one-third did not do so until after the fourth day of illness. This survey was extensive. The researchers interviewed

Cough Cold Sinus and Allergy Medications

Ohkusa et al. (2005) used correlation analysis to study the relationship between sales of OTC cold remedies and influenza activity in Japan. They found a poor correlation, with the adjusted r2 never rising above 0.50. However, they performed the analysis at the national level with respect to geography, as opposed to other studies discussed in this chapter, which analyzed data at the metropolitan level. Also, the study included herbal remedies in the cold remedy category, a type of medication not included in other analyses. Finally, the authors caution that their results are preliminary, and that they plan to conduct additional analyses.

Flu Remedies and Chest Rubs

Of historical interest, a study by Welliver et al. (1979) was the first to provide a quantitative estimate of the lead time of OTC sales data over data collected during physician office visits. Welliver and colleagues observed a strong peak in sales of cold remedies (another synonym for flu remedies) just before the rise in physician encounters with patients subsequently diagnosed as having influenza B virus, and one week before the peak in those encounters. They also observed an earlier rise in sales of cold remedies approximately coincident with the early winter rise in non-influenza respiratory virus activity as evidenced by laboratory test results. They found no correlation between sales of antifever medications, such as aspirin (either adult or pediatric), and influenza. Welliver's study was based on two outbreaks in a single city, and utilized OTC data that were aggregated at the weekly level.

Prevalence Of Latelife Depression And Anxiety

Depression is often thought of as the common cold of geriatric mental health but Blazer (1997) states that anxiety is more common than major depression in later life. Using data from the ECA, Regier et al. (1988) reported one-month prevalence rates of 5.5 for older adults. As with depression, anxiety was less common in later life as the prevalence rate was 7.3 for younger adults (for review see Powers et al., 2002). Lindesay, Brigs & Murphy (1989) reported prevalence rates of 10 overall for anxiety disorders in their older adults sample. In older people, generalized anxiety disorder (GAD) and the phobias (agoraphobia,

Immediate Hypersensitivity

Immediate hypersensitivity can produce allergic rhinitis (chronic runny or stuffy nose) conjunctivitis (red eyes) allergic asthma atopic dermatitis (urticaria, or hives) and other symptoms. These symptoms result from the immune response to the allergen. In people who are not allergic, the allergen stimulates one type of helper T lymphocyte, the TH1 cells, to secrete interferon-y and inter-leukin-2. In people who are allergic, dendritic cells stimulate the other type of helper T lymphocytes, the TH2 cells, to secrete other lymphokines, including interleukin-4 and interleukin-13. These, in Allergens that provoke immediate hypersensitivity include various foods, bee stings, and pollen grains. The most common allergy of this type is seasonal hay fever, which may be provoked by ragweed (Ambrosia) pollen grains (fig. 15.28a). People who have chronic allergic rhinitis and asthma because of an allergy to dust or feathers are usually allergic to a tiny mite (fig. 15.28b) that lives in dust and...

Categories of ICD Codes Code Sets

Despite the potential for high diagnostic precision, biosurveillance researchers and developers group ICD codes into categories ( code sets'') such as respiratory illness.'' The set of all 60 ICD codes for tuberculosis mentioned above is an example of an ICD code set. It is not necessary to group ICD codes into codes sets, although it is almost always done. For example, we could monitor for the single ICD code for inhalational anthrax (022.1). Creators of code sets usually group codes of diseases and syndromes that share similar early presentations to form syndrome code sets. Respiratory, gastrointestinal, neurological, rash and febrile illnesses are representative of code sets in common use.

Otitis media with effusion

Clinical diagnosis is straightforward when otological examination shows a fluid level (Fig. 20.2) or bubbles behind the eardrum. In more subtle cases, tympanometric studies may be required. The finding of a flat (type b) tympanogram is diagnostic. Initial treatment of OME should be conservative. Coexisting allergic rhinitis, URTI should be adequately treated. The use of antibiotics is controversial. However if there is any evidence of acute otitis media, a course of antibiotics is advisable. Persistent OME is more effectively treated with myringotomy and insertion of a grommet (Fig. 20.3). In infants and young children, adenoidectomy

Internet As Sentinel I Promedmail

There were 15 additional postings between February 10 and March 14. On March 14, ProMED-mail disseminated five reports of outbreaks of deadly or severe respiratory illness in four countries in East Asia (Singapore, Taiwan, Vietnam, and China), many in hospitals, and all with no known etiology (ProMED-mail, 2003b). That same day, ProMED-mail disseminated a Government of Ontario Press Release about four cases of atypical pneumonia in Canada (Toronto and British Columbia), and the editor noted an unconfirmed report that the British Columbia case had a travel history to Hong Kong (ProMED-mail, 2003a). On March 15, 2003, ProMED-mail followed up with a formal WHO report of a new entity named SARS (ProMED-mail, 2003f).

Independent Nonprescription And Alternative Therapies

A senior who is taking a coxib should not also take an over-the-counter NSAID (e.g., ibuprofen or naprosyn). These medications are found in many cold remedies and the like, and vigilance is required to avoid inadvertently taking such medication while taking a prescription coxib. The combination of NSAID and coxib may increase the likelihood of an adverse event, with particular concern about effects on the intestinal tract, cardiovascular system, or kidneys. The concern about over-the-counter medications extends to aspirin and acetaminophen as well as other nonanalgesic products. Because many nonprescription medications are in many combination products, it is important to check all of the ingredients before taking any such medication.

System Example New York City

Noted an increase in the frequency of syndrome visits or admission of seriously ill patients. If there is concern a field investigation is done with chart review, patient interviews, and on-site discussions with clinicians. In the first year of operation the system did not identify any BT-related illness but was able to identify community increases in gastrointestinal illness, respiratory illness, and fever associated with the peak of influenza activity.

Evaluation Of The Returned Worker

Although there is limited data on humanitarian disaster workers and patterns of disease and injury, some data from travel medicine studies can be extrapolated. It should be remembered that common accidents (car accidents, drowning) and illnesses (coronary artery disease, upper respiratory tract infections, bronchitis, pneumonia, urinary tract infections) still happen abroad. Fever, diarrhea, and skin conditions are common complaints. A detailed discussion of the febrile traveler is beyond the scope of this chapter. However, initial evaluation entails a careful history and physical exam. Laboratory results can help limit the differential diagnosis and should include a complete blood count with differential, thick and thin blood film for malaria (where endemic), blood cultures, urinalysis, and liver function tests. Chest x-ray and serolog-ical studies may be obtained depending on the history. Patients with diarrhea should have three sets of stool examined for fecal leukocytes, ova, and...

Invasive Fungal Sinusitis

Most cases of acute sinusitis begin with the onset of the common cold (NIAID, 2002). These viral colds do not cause acute sinusitis per se, but rather act to inflame the sinuses and surrounding mucosa. Even if immunocompromised, most hosts would still be able to clear fungal spores from the nasal cavity via ciliated cells (Baraniuk, 1994). However with the overproduction of mucus and increased inflammation caused by the cold, the size of the ostium becomes limited, and any fungi present in the sinuses can no longer be mediated effectively. This is also the case for other opportunistic organisms such as Haemophilus influenzae and Streptococcus pneumoniae (NIAID, 2002).

Ramona Sunderworth md

The widening economic disparity between the rich and poor counties contributes to social inequity and worsens the poverty responsible for diseases claiming children's lives. Infant mortality rates are approximately five times higher in less developed nations than in the more developed nations. At present, between 11 and 12 million children under 5 die each year (99 of these in developing nations). About 70 of these deaths are caused by five largely preventable illnesses acute respiratory illness (ARI), diarrhea (dehydration), measles, malaria, and perinatal causes. Malnutrition (protein caloric and micronutrient) is a factor contributing to 60 of these deaths. One third of African children are underweight. Poverty is a major cause of malnutrition combined with inadequate health services, care and support for women and children.

Rhinocerebral Mucormycosis

And soft-tissue swelling are initially seen, followed in a few days by double vision, increasing fever, and obtundation. Examination reveals a unilateral generalized reduction of ocular motion, chemosis, and proptosis. Facial skin adjacent to paranasal sinuses may be invaded by direct extension, turning progressively red, purple, and black. Fever, decreased vision, and facial swelling are the most common complaints in the first 72 hours of the disease (6). Other common complaints include facial pain and nasal congestion or discharge. Headache was found early in the disease in only 25 of patients in one large study but may be a common late finding.

Representations Create a Context for Management

In summary, the system is dynamic and the representations and actions are fluid. The underlying prototypes can vary from highly stable (e.g., the self) to moderately stable (e.g., lifetime experience with colds and migraine), to vague and readily changeable (e.g., SARS). Given its complexity and flexibility, the model speaks to a wide range of situations and poses challenges to our ingenuity in creating interventions and measures to test specific hypotheses.

Allergic rhinosinusitis

Allergic rhinosinusitis is a diagnosis made clinically, as there are no definitive objective tests available for routine clinical use to confirm this entity. There are two major forms of this disorder seasonal and perennial. Thus, it is a diagnosis based on history (often by questionnaire) and physical examination. In some epidemiological studies, the presence of allergy is confirmed by results of skin prick tests or in vitro allergy testing. The prevalence of this disorder varies widely in the literature, based upon the different sources of the data (i.e., questionnaires, phone interviews, and direct examination), but the majority of the literature suggests that 20 to 25 of children and about 15 of adults suffer from this condition (1). Peak prevalence is between 10 and 30 years in most countries (2). Atopic individuals are at much increased risk for this disorder and there is a significant correlation between the report of nasal symptoms and the prevalence of allergen-specific IgE....

Allergy and Dermatitis

There is clear evidence that otitis media with effusion is highly related to an allergic diathesis. When this converts to chronic draining otitis media, the allergic component would seem to still be relevant, although direct evidence is scant (17-19). Therefore, the surgeon must consider allergy evaluation, based on a patient history of other allergic diatheses, especially of the unified respiratory epithelium. Patients with chronic draining ear and allergic rhinitis, chronic rhinosinusitis, and asthma are strong candidates for allergy workup before contemplating surgical treatment.

B DNA Tumor Viruses

Human adenoviruses are responsible for upper respiratory tract infections. Many rodent cells can be transformed with adenoviruses. The transformed cells do not contain a complete adenovirus genome but do consistently include the ad-enovirus E1A and E1B genes. Conserved regions of E1A bind the pRb, p107, and p130 family of proteins, as well as p300. Simultaneously, the E1B protein binds the N-terminus of p53 and blocks its transactivation function. Because of these properties, adenoviruses have found great utility as vectors for numerous novel approaches to gene transfer therapy in the treatment of various cancers.

Elizabeth Hewat

Human rhinoviruses (HRVs) are a major cause of the common cold. They are small, icosahedral viruses, 300 A in diameter, and belong to the Picornaviridae family, which includes Rhinovirus, Aphthovirus, Enterovirus, Cardiovirus, etc. Their capsid is composed of 60 copies each of four viral coat proteins, VP1, VP2, VP3, and VP4, on a T 1 (or pseudo T 3) icosahedral lattice 2 . The three major capsid proteins VP1, VP2, and VP3 all have the same basic eight-stranded P-barrel fold and a molecular weight of around 30 kDa. VP4 is a small protein located inside the capsid. The capsid encloses a single positive RNA strand of about 7000 bases. The HRV capsid has a star-shaped dome on each of the five-fold axes surrounded by a shallow depression or canyon and a triangular plateau centered on each three-fold axes and around each five-fold axes (Fig. 1). 2. Rossmann, M. G., Arnold, E., Erickson, J. W., Frankenberger, E. A., Griffith, J. P., Hecht, H. J., Johnson, J. E., Kamer, G., Luo, M., Mosser,...

Mast cells

Although functionally akin to basophils, they are long living and thought to belong to the tissue macrophage family. They are not phagocytic and do not present antigen to lymphocytes. Upon binding of foreign antigen to its membrane receptors, degranulation occurs with release of histamine, heparin and other vasoactive peptides. Activation also results in the release of leukotrienes (LT) from the surface membrane. Mast cells are important effector cells of many of the manifestations of hypersensitivity or allergic reactions, such as urticaria, rhinitis and bronchospasm.

Other Effects

Aged garlic extract has been shown in in vitro and animal studies to protect against liver toxicity from environmental substances, such as bromobenzene (72), protect against cardiotoxicity from doxorubicin (73), and improve age-related spatial memory deficits (74). A placebo-controlled human study showed that garlic may also be useful as a tick repellent (75). In addition, a double-blind, randomized, placebo-controlled human study showed that garlic supplements taken over a 12-week period in the winter significantly reduced the incidence of the common cold (p 0.001), and reduced the duration of symptoms when they occurred (p 0.001) (76).

Irritant Gases

Careful attention to the eyes is important since there may be late development of cataracts with heavy exposures. If the gas has already been identified, then knowing its solubility can help in the triage of exposed victims. For example, high-solubility gases (sulfur dioxide or ammonia) affect the upper airways and only cause lower-airway injuries when the dose effect is large. Thus, if a potential victim, exposed to ammonia, has no upper-airway signs or symptoms (watery, teary eyes, red face, rhinitis, red sore nose, erythema of the posterior pharynx or hoarseness), it is unlikely that the patient has inhaled a dose high enough to cause lower-airway injury. The patient who presents with tachypnea and stridor, particularly with some hoarseness, is at a high risk of developing progressive laryngeal edema and complete obstruction of the airway, and therefore should be considered for emergency intubation. Certainly if symptoms of upper-airway damage are present, a prompt inspection of...

Congenital Syphilis

Similar to acquired syphilis, congenital infection is divided into early and late stages. There are often no abnormalities noted at birth, but exam or diagnostic findings are nearly always present by three months of age. However, the severity of early disease can range from asymptomatic imaging findings to severe, life-threatening multiorgan system disease. Early congenital syphilis characteristically first presents with a serosanguinous nasal discharge and rhinitis known as snuffles. The rash of early syphilis is a diffuse maculopapular rash that develops into epithelial sloughing. Vesicles or bullae may also be present and the fluid within is highly infectious. Oral mucous patches are often seen. Facial lesions on the lips and nose, as well as anal lesions, may heal with radiating scars known as rhagades. Visceral involvement is relatively frequent, with the liver often heavily infected, leading to jaundice, splenomegaly, anemia, and thrombocytopenia. Bony abnormalities related to...

Epidemic Detection

To define retrospective outbreaks of pediatric respiratory and gastrointestinal syndromes over a five year period (1998-2001) in four contiguous counties in Utah. Outcome measures were reported for correlation between chief complaint classifications and ICD-9 classifications and for timeliness of detection. Figure 17.7 from the Ivanov publication shows the time series plot of respiratory illness admissions (reference standard) and chief complaints. It is evident from the plot that chief complaints generated the same type of signal that the reference standard generated. Chief complaint classification detected three respiratory outbreaks with 100 sensitivity and specificity, and time series of chief complaints correlated with hospital admissions and preceded them by an average of 10.3 days.

Detection of Cases

Espino and Wagner conducted the first study of case detection accuracy of an ICD code set for a diagnostically imprecise syndrome (Espino and Wagner, 2001).They studied the ability of ICD codes for ED chief complaints and ICD codes for ED diagnoses to detect patients with acute respiratory syndrome (defined as symptom duration of five days or less). In this ED, registration clerks assigned ICD codes to the chief complaints and ED physicians assigned ICD codes to the diagnoses at the time of the patient's visit. Two internists created the gold standard by reviewing the dictated ED visit note and assigning patients to acute respiratory if the duration of illness was five days or less and the patient had respiratory symptoms, abnormal pulmonary examination, or radiological evidence of pneumonia. The sensitivity and specificity of a respiratory ICD code set (that contained 64 ICD codes) for detecting patients with acute respiratory illness from chief complaints were 0.44 and 0.97,...

Acute otitis media

Following an upper respiratory tract infection (URTI), as ascending infection through the Eustachian tube. The natural course of acute otitis media is best described in four stages hyperaemic, inflammatory, suppurative and resolution phases. In the hyperaemic phase, the patient has otalgia without hearing loss and otoscopy reveals a hyperaemic eardrum. The inflammatory phase that follows is characterized by increasing otalgia and hearing loss. Fever is usually present at this phase. Otoscopy reveals a hyperaemic eardrum and middle ear effusion. The disease reaches a climax at the suppurative phase. The patient often becomes irritable because of intense otalgia and hyperpyrexia is frequently present. Otoscopy reveals pus collecting behind a bulging and intensely hyperaemic eardrum. The eardrum is now under severe tension and may rupture spontaneously. Once the eardrum ruptures, the condition enters the resolution phase. All the symptoms especially otalgia resolves rapidly.


This usually present with chronic nasal congestion and recurrent mucopurulent rhinorrhoea (Level 2 symptoms). There is usually an underlying cause such as nasal polyposis, a septal deviation, an abnormal middle turbinate, etc. The presence of any condition which obstructs mucous transportation out of the sinus will lead to recurrent infection and sinusitis becomes chronic. Therefore, surgery is frequently required as a definitive procedure. Functional endoscopic sinus surgery (FESS) which aims at re-establishing normal


Mycoplasma pneumoniae is a small bacterium that lacks a cell wall and commonly causes upper respiratory tract infections and pneumoniae. The overall incidence of infection in the United States has been estimated at 1.7 cases 1000 people year (38) with 6.8 of all pneumonia caused by this pathogen (39). Symptoms include fever, cough, malaise, and headache, but as many as 25 of patients are asymptomatic. Extrapulmonary manifestations do occur, with neurologic sequelae estimated in 0.1 of all cases (39). Neurologic findings are variable and include psychosis, meningitis, transverse myelitis, ataxia, peripheral neuropathies, and cranial neuropathies. Facial nerve involvement, alone or in conjunction with other neurologic sequelae, is considered rare but has been reported by several authors (40-42). Bilateral facial paralysis has also been associated with mycoplasm infections (43,44).

Sleep Continuity

As reviewed by Mezick and colleagues (under review), five of seven longitudinal studies reported that poor sleep continuity, measured by self-report, was a significant predictor of incident cardiovascular disease after adjusting for symptoms of depression and other relevant covariates. Findings were similar for self-reported sleep continuity and incident diabetes in the two longitudinal studies published to date (as reviewed by Mezick et al, under review). Sleep efficiency may also protect against the common cold. In a study of 153 young to mid-life adults, diary-assessed sleep efficiency was a significant predictor of susceptibility to the common cold following experimental rhinovirus exposure (Cohen et al, 2009).

Sleep Quality

The majority of studies that have evaluated subjective sleep quality and indicators of health have been cross-sectional. For example, patients with hypertension, diabetes, kidney disease, polycys-tic ovary syndrome, and cancer report greater subjective sleep quality complaints than do age- and sex-matched healthy controls (e.g., Alebiosu et al, 2009 Haseli-Mashhadi et al, 2009 Knutson et al, 2006 Liu et al, 2009 Sabbatini et al, 2008 Tasali et al, 2006). In a community-based study of mid-life adults without clinical cardiovascular disease, Jennings and colleagues reported that higher PSQI-assessed sleep quality complaints were associated with increased prevalence of the metabolic syndrome (Jennings et al, 2007). Although these data preclude attributions of causality, sleep quality is likely related to health in complex and sometimes indirect ways. For example, evidence that sleep quality improves with treatment of the primary medical disease (e.g., allergic rhinitis, hypertension,...

Respiratory Diseases

Allergic rhinitis is highly prevalent and one identified study examined how relevant medications may affect neurophysiological functioning, particularly sleepiness and alertness. Ng and colleagues (2004) failed to find any differences between first and second generation antihistamines in a study of children using a cross-over design that also included a placebo condition. The latency of the P300 in an oddball task was increased by both antihistamines relative to placebo although sleepiness alertness ratings were unaltered. The authors suggest that the electrophysiology measures were more sensitive than ratings and should be used to determine the effects on alertness of antihistamines.

Infection Viral

Pharyngitis is a frequent component of the common cold. It may be caused by several upper respiratory viruses. Rhinovirus is the most common pathogen. Others viruses include parainfluenza virus, influenza virus, and coronavirus. The common cold will occur in any age group but extremes of age, immunosuppressed, and immunocompromised persons are most susceptible. The average healthy adult experiences cold-like symptoms at least twice a year. Transmission of viral particles occurs by inhaling respiratory particles or from direct contact. Signs and symptoms of viral pharyngitis are similar to those of bacterial pharyngitis. The incidence of laryngeal involvement is more common with viral infection when compared with bacterial infection and may help distinguish between the two etiologies. Other upper respiratory complaints include rhinorrhea, postnasal drip, nasal congestion, hoarseness, and cough. When associated with the influenza virus, gastrointestinal (GI)...

Garlic Allergy

Allergic reactions to garlic have also been reported in the literature. Garlic allergy can manifest as occupational asthma, contact dermatitis, urticaria, angioedema, rhinitis, and diarrhea. A 35-year-old woman experienced several episodes of urticaria and angioedema associated with ingestion of raw or cooked garlic, as well as urticaria from touching garlic. Two garlic extracts as well as fresh garlic produced a 4+ reaction on skin prick tests (SPTs) in this patient, but no other food allergens produced positive results. The patient's symptoms were immunoglobulin E (IgE)-mediated, but she also produced specific IgG, which confounded the results of IgE testing (90). A group of 12 garlic workers with respiratory symptoms associated with garlic exposure underwent SPTs using garlic powder in saline, commercial garlic extract, and various other possible allergens bronchial provocation tests with garlic powder oral challenge with garlic dust and specific IgE testing using the CAP (CAP...


The vast majority of hexactinellids live at depths greater than 1,000 ft (304.8 m). In a few coastal locations, however, such as Antarctica, the northeastern Pacific, New Zealand, and some caves in the Mediterranean, species are found at depths accessible by scuba divers. These habitats have in common cold water (35-52 F, or 2-11 C), relatively high levels of dissolved silica, and low light intensity. Although many hexactinellids require a firm substratum, such as rocks, for attachment, others grow on fused skeletons of dead sponges, and still others live over soft sediments. The latter group, though not numerous, support themselves on struts made of bundles of long spicules that project down into the sediment.

Outbreak Detection

Lyme Disease Outbreak History

Showing that if the diagnostic data available support a more diagnostically precise case detection (i.e., SARS-like syndrome rather than respiratory syndrome), then subsequent analysis of the case data is expected to detect smaller clusters of disease against the background levels of individuals presenting with respiratory illness.