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To clarify the epidemiologic and clinical features of community-acquired influenza C infection in children, we took specimens throughout the year from a larger number of patients with acute respiratory illnesses in a pediatric clinic in Yamagata, Japan. During a 2-year survey, 20 strains of influenza C virus were isolated from 13,426 specimens. These isolates were recovered throughout the year. The ages of patients with influenza C virus isolates ranged from 2 months to 11 years and peaked at the age of 1 year. The clinical diagnosis of patients with influenza C virus infection included bronchitis in one child and pneumonia in four. Community-acquired influenza C infection in children can cause a variety of respiratory illnesses that cannot be clinically differentiated from those caused by other viruses.
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PMID:Community-acquired influenza C virus infection in children. 199 50

Out of 524 children with acute respiratory infections in 141 obstructive bronchitis was diagnosed (OZO). Seventy cases could be linked to viral infection. Viral infections tested (influenza virus A, B, parainfluenza typ 1-3, RSV, adenoviruses) were more frequently associated with OZO than other acute respiratory infections of unknown etiology. Majority infections induced by influenza virus A and parainfluenza virus typ 2 were accompanied by OZO symptoms. Of the highest risk of acquiring OZO despite of viral infection participation, were children of 4-12 months of age. OZO associated viral infections prevailed during autumn-winter season, while in spring-summer period undetermined factors were the major cause of OZO. In serum samples of children with OZO, despite of etiology of the disease, higher level of IgE was found than in a group of children without the symptoms. In the case of OZO of unestablished etiology the level of serum IgE was significantly higher than in the cases when viral etiology of the disease was found.
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PMID:[The role of respiratory tract viruses in the etiology of obstructive bronchitis in infants]. 208 49

From January 1986 to December 1987, 596 children less than 5 years of age with lower respiratory tract infection (LRI)--manifested as laryngitis, croup, bronchitis, bronchiolitis, and pneumonia--were studied for evidence of infection with respiratory tract viruses Mycoplasma pneumoniae, and Chlamydia trachomatis. Of the 596 children in the study, 315 were ambulatory and 281 were hospitalized. Virologic studies included isolation and rapid diagnosis of virus from specimens of nasopharyngeal aspirate (NPA) and serologic studies of blood samples. Cultures of NPA for C. trachomatis were performed for children less than 6 months of age who had pneumonia. Of the LRI cases, 45% were associated with viral infections of the respiratory tract and 12.1% were associated with C. trachomatis. Respiratory syncytial virus (RSV) accounted for 45.2% of infections with viral agents and was associated with acute bronchitis, acute bronchiolitis, and pneumonia. Parainfluenza type 3 virus was the most common virus found in conjunction with laryngitis and croup. The incidence of infections due to RSV peaked in July and August, while that of infections due to parainfluenza viruses peaked in February and March; influenza viruses and adenoviruses were isolated throughout the year.
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PMID:A study of nonbacterial agents of acute lower respiratory tract infection in Thai children. 212 59

Five-week-old specific-pathogen-free chickens inoculated intravenously with a waterfowl-origin type A influenza virus (A/mallard/Ohio/184/86) had swollen and mottled kidneys on days 3, 5, and 7 postinoculation (PI) and multiple raised nodules on days 5, 10, and 20 PI. Histologically, the kidneys had multifocal heterophilic tubulointerstitial nephritis with epithelial necrosis on day 3 PI, lymphoplasmacytic tubulointerstitial nephritis on day 5 PI, and fibrosing interstitial nephritis with cortical lobular collapse, atrophic tubules, glomerular aggregates, and interstitial lymphoid follicles and aggregates on days 7, 10, and 20 PI. Heterophilic intratubular medullary-cone nephritis was present in dead or moribund chickens on days 3 and 5 PI. Furthermore, the presence of mild multifocal heterophilic tubulointerstitial nephritis on day 20 PI suggests that a waterfowl-origin strain of type A influenza virus of low pathogenicity has the potential to produce acute and chronic active nephritis in the chicken and that the kidney is a potential site for influenza viral persistence. The acute, subacute, and chronic histopathologic renal lesions of this influenza virus in chickens are similar to lesions reported for some nephropathogenic infectious bronchitis viruses and avian nephritis picornavirus.
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PMID:Renal pathology in specific-pathogen-free chickens inoculated with a waterfowl-origin type A influenza virus. 214 19

In order to obtain more information on viral respiratory tract infections in Austrian infants and children, nasopharyngeal secretions from 1432 infants and children, collected from October 1984 to October 1985, were screened for the presence of respiratory syncytial virus (RSV), adenoviruses, parainfluenza virus type 1, 2, and 3, and influenza viruses type A and B, by enzyme-linked immunosorbent assay (ELISA). The results obtained were analyzed with respect to incidence, seasonal distribution and clinical syndromes associated with the different viral pathogens investigated and also with the practicability of ELISA diagnostics over long distances. A viral etiology of acute respiratory tract infection was confirmed in 372 (26%) infants. RSV was detected in 286 (20%) of the nasal secretions and was thus the most frequently encountered agent. RSV infections occurred mainly in the winter months and were often associated with bronchitis, bronchiolitis, and pneumonia. Only sporadic infections were found with one of the other viruses investigated.
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PMID:Surveillance of viral respiratory tract infections over a one year period in mainly hospitalized Austrian infants and children by a rapid enzyme-linked immunosorbent assay diagnosis. 215 81

The authors analyze the findings of epidemiological and virological surveillance of ARD in Bohemia during the season 1986/1987. In all, 57.5% of the Czech population was affected by acute respiratory disease (ARD). There were 5,950,832 cases reported, 124,444 complications (2.1% of the overall morbidity rate) and 5,374 deaths due to influenza, bronchitis, pneumonia and chronic pulmonary affection. The influenza epidemic commenced during the 48-th calendary week (CW) and lasted 5 weeks till the 52-nd CW. The epidemic was due to an influenza virus strain of the subtype A(H1N1) antigenically related to the drift variant A (Singapore) 6/86. Within an extremely short period of the epidemic, 1,094,865 influenza cases were reported and 22,313 cases of complications. 10.7% of the CSR population were affected during the epidemic in whose etiology noninfluenza respiratory viruses were significantly implicated, especially adenoviruses (41.7%) and the RS virus (26.9%). There was no excessive mortality in the course of the epidemic. The authors discuss the atypical nature of this particular influenza epidemic and the etiological role of respiratory viruses.
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PMID:Epidemiological analysis of acute respiratory disease (ARD) and characteristics of the influenza epidemic in Bohemia during the season 1986/1987. 221 37

Hemostasis was examined over time in 168 patients with influenza and ARVI. There were 53 elderly patients, 54 senile patients and 4 long-livers. 57 patients under 60 years made up a reference group. The patients with influenza did not differ significantly from those with ARVI as regards hemostasis. The elderly persons manifested pronounced acceleration of phases I-II blood coagulation. In the acute disease period, the old men demonstrated high platelet aggregation, whereas during convalescence, activation of the plasmic component of hemostasis in the presence of relatively low antithrombin III. Analysis was also made of the age-associated changes in hemostasis depending on influenza and ARVI complications (pneumonia, exacerbation of coronary disease, bronchitis). The changes revealed dictate the necessity of hemostasis control in elderly and senile persons afflicted with influenza and ARVI.
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PMID:[Hemostasis in influenza and acute respiratory viral infections in the middle-aged and elderly]. 225 73

Blacks in the US experience increased mortality (1113 versus 745 per 100,000 males; 631 versus 411 per 100,000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17,366 deaths and 286,813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986. 226 53

Whooping cough is endemic throughout the world. It becomes epidemic every 4-5 years (Yugoslavia 3-4 yrs). In Europe its incidence ranges from 0.4 (Hungary) to even 59/100.000 inhabitants (Rumania; Yugoslavia 28), with a general letality of 0.1% (infants: 1%; 75% children who die are younger than one yr). Only 5-10% cases are supposed to be registered. A low socioeconomic status is more and more emphasized as the principal risk factor. Its transmission rate is high (home contacts: 80-100%); infectivity lasts five weeks, disease from the beginning of incubation to the sanation lasts 50-60 days. Female children are more frequently affected. The term "Pertussis syndrome" is more end more used because a similar disease can be caused by various agents (B. pertussis; B. parapertussis: 5%-20%-30% cases; B. bronchiseptica rarely; adenoviruses, RS virus, parainfluenza virus, influenza A and B virus, HSV, CMV, EBV, entero-, adeno-, corona-, rota-viruses; chlamydiae and mycoplasmae). Prior to introducing vaccination, 95% of population have had a typical or atypical form of pertussis. Its differential diagnosis includes pneumonias of various etiology, bronchitis, bronchiolitis during an acute respiratory infection, bronchial asthma, cystic fibrosis, tuberculosis and lymphadenopathy. Morbidity in USA was reduced by vaccination from 157 to 0,5-1,5/100,000 inhabitants; in SR Croatia it was six times reduced in period 1959-1970. According to the official sources 81% of children in Croatia and Yugoslavia get primovaccinated; the 80% level is generally accepted as a rational goal. Immunization schedules differ from country to country. Local and general reactions after combined vaccines are mostly caused by pertussis component.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Review of the present status of prevention, prophylaxis and therapy of pertussis and parapertussis]. 229 2

The fifth leading cause of death in the United States, chronic obstructive respiratory conditions, cannot be cured but can be considerably ameliorated by appropriate management. Many patients with COPD have a combination of chronic bronchitis, asthma, and emphysema. While the damage due to emphysema is permanent, many of the pathophysiologic changes of asthma and bronchitis can be reversed to some extent, and such reversal should be a goal of therapy. Smoking cessation will help the patient more than any other medical treatment. Bronchodilator therapy is best given by inhalation from a metered dose inhaler and on a maintenance basis. Be sure to check inhaler technique. An anticholinergic agent, eg, ipratropium bromide, is probably most effective, but many patients prefer a beta 2-selective adrenergic agent. Xanthines are currently third choice but are very useful to cover nocturnal dyspnea. Corticosteroids are usually only used in acute exacerbations and then only for short courses. If prolonged use is required, however, the inhalation route minimizes side effects to which these patients are particularly prone. Antibiotics are also usually only used in exacerbations, but one can be liberal with them. Use the less expensive broad-spectrum options for ten days. Some clinicians believe that hydration is an effective expectorant. Mucolytic therapy is extensively used outside the United States. The appropriate role of mucolytic therapy in the treatment of bronchitis remains to be more fully explored. Low-flow oxygen is only used in the prevention or treatment of cor pulmonale when the PaO2 is persistently at or below 55, or with a rising hematocrit and right-sided cardiac changes. If used, oxygen is helpful only when given long term for at least 18 h per day, not on a prn basis. Cardiac glycosides are probably of little benefit, but diuretics have an important role in treatment of fluid retention. Pulmonary vasodilator therapy is still experimental, as is almitrine. Prophylaxis with pneumococcal vaccine and annual influenza vaccine is rational but has not been proven to be of value. Exercise and activity should be encouraged for all except those with frank congestive heart failure. The role of "breathing exercises" is currently being reevaluated. Surgery has almost no place in the management of COPD. Anesthesia often results in postoperative complications in this disease. Avoid all sedatives and tranquilizers.
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PMID:Chronic obstructive pulmonary disease. Current concepts and therapeutic approaches. 240 8


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