Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0242429 (sore throat)
 2,760 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Of approximately 200 members of a religious commune, 37 came to the emergency department of Cook County Hospital for primary medical care of respiratory illness. Of the 37, 31 were seen during a two-week period, indicating a rapid spread of disease. The major symptoms were cough, fever, coryza, and sore throat. Infiltrates were detected in 38%. Paired sera from four of nine patients showed a significant rise to Mycoplasma pneumoniae. Of 24 sera collected at the time of the first visit, 33% had a titer to the agent, of 64 or greater--presumptive evidence of Mycoplasma infection. Therefore, M pneumoniae was implicated as the causative agent in this outbreak of respiratory illness in a semi-closed community.
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PMID:An outbreak of mycoplasma pneumoniae respiratory illness in a semi-closed religious commune. 681 12

Most patients who seek medical attention for sore throat are concerned about streptococcal tonsillopharyngitis, but fewer than 10% of adults and 30% of children actually have a streptococcal infection. Group A beta-hemolytic streptococci (GAS) are most often responsible for bacterial tonsillopharyngitis, although Neisseria gonorrhea, Arcanobacterium haemolyticum (formerly Corynebacterium haemolyticum), Chlamydia pneumoniae (TWAR agent), and Mycoplasma pneumoniae have also been suggested as possible, infrequent, sporadic pathogens. Viruses or idiopathic causes account for the remainder of sore throat complaints. Reliance on clinical impression to diagnose GAS tonsillopharyngitis is problematic; an overestimation of 80% to 95% by experienced clinicians typically occurs for adult patients. Overtreatment promotes bacterial resistance, disturbs natural microbial ecology, and may produce unnecessary side effects. Existing data suggest that rapid GAS antigen testing as an aid to clinical diagnosis can be very useful. When used appropriately, it is sensitive (79% to 88%) in detecting GAS-infected patients and is specific (90% to 96%) and cost-effective. Penicillin has been the treatment of choice for GAS tonsillopharyngitis since the 1950s; 10 days of treatment are necessary for bacterial eradication. A single IM injection of benzathine penicillin is effective and obviates compliance issues. Until the early 1970s, the bacteriologic failure rate for the treatment of GAS tonsillopharyngitis ranged from 2% to 10% and was attributed to chronic GAS carriers. Since the late 1970s, the penicillin failure rate has frequently exceeded 20% in published reports. Explanations for recurrent GAS tonsillopharyngitis include poor patient compliance; reacquisition from a family member or peer, copathogenic colonization by Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, anaerobes that inactivate penicillin with beta-lactamase, or all these organisms; suppression of natural immune response by too-early administration of antibiotics; GAS tolerance to penicillin; antibiotic eradication of normal pharyngeal flora that normally act as natural host defenses; and establishment of a true carrier state. When therapy fails, milder symptoms may occur during the relapse. Several antimicrobials have demonstrated superior efficacy compared with penicillin in eradicating GAS and are administered less frequently to enhance patient compliance. In previously untreated GAS throat infections, cephalosporins produce a 5% to 22% higher bacteriologic cure rate; after a penicillin treatment failure, these differences are greater. Amoxicillin/clavulanate and the extended-spectrum macrolides clarithromycin and azithromycin may also produce enhanced bacteriologic eradication in comparison to penicillin.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Group A streptococcal tonsillopharyngitis: cost-effective diagnosis and treatment. 786 83

An epidemic of infection due to Mycoplasma pneumoniae occurred in Hong Kong in 1986-1988. One hundred and seventy-nine cases were identified at the Prince of Wales Hospital over this period. Clinically significant infection predominantly affected children under 12 years, with 32% of all infections occurring in children aged between 6 and 11 years, and 39% in children between 1 and 5 years. Ninety-seven percent of childhood infections were respiratory in nature, the other 4 presentations were neuropsychiatric. Adequate information was available on 36 of the 43 subjects over 12 years. One teenager presented with acute psychosis; all other cases (35) were respiratory. In these cases cough was universal, and fever was present in 34 (97%). A variety of non-specific symptoms (rigors/chills, malaise, headache, sore throat, sweating) were frequently noted. Sputum production was documented in 75% of cases, and was frequently purulent. Radiological consolidation was very common (95% of cases), but resolved fully after 4 weeks. Complications were rare and included acute pericarditis in 1 patient and haemolysis in another, and both patients recovered subsequently. Clinical recovery was otherwise rapid and complete in all other patients. Persisting dry cough was the only symptom documented at follow-up. Although infection due to M. pneumoniae in an ethnic Chinese population appears similar to that described in other populations, a higher incidence in younger children was recorded in this study.
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PMID:Mycoplasma pneumoniae infection in Hong Kong--clinical and epidemiological features during an epidemic. 826 80

During a 16-month period patients who presented to the Syracuse University Health Center with upper respiratory complaints had throat swabs obtained for viral, streptococcal and Mycoplasma pneumoniae cultures. Thirty-five of 613 patients (5.7%) had herpes simplex virus (HSV) isolated. All but 2 of the HSV isolates were found to be type 1 by immunofluorescent staining. Two HSV-positive patients also grew Group A Streptococcus, one grew M. pneumoniae and three had serum heterophile antibody tests that were positive. On physical examination 25 of the 35 HSV-positive patients had pharyngeal erythema and 14 had pharyngeal exudate. Twelve of these patients had vesicular lesions of the lips, throat or gums associated with their other symptoms. For 29 of the 35 HSV-positive students the primary diagnosis assigned was pharyngitis, for 2 the diagnosis was stomatitis and the remainder were assigned a primary diagnosis of upper respiratory infection, pneumonia, bronchitis or dental infection. Thirty-two of the 35 HSV-positive patients were treated with oral antibiotics and 7 were treated with oral or topical acyclovir. During the same 16-month period 89 (6.9%) of 1297 students presenting with sore throat were culture-positive for influenza A or B, 30 (2.3%) of 1283 were culture-positive for M. pneumoniae and 169 (2.8%) of the 6016 cultured for Group A Streptococcus were positive. Serum was tested for heterophile antibody in 2438 students, and 257 (10.5%) were positive. Herpes simplex virus is associated with pharyngeal symptoms in college students, and herpes simplex pharyngitis cannot easily be distinguished clinically from other causes of acute pharyngitis in this age group.
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PMID:Pharyngitis associated with herpes simplex virus in college students. 838 78

We present the results of the investigation of an epidemic outbreak of Mycoplasma pneumoniae infection which affected 95 schoolchildren from certain village in Catalonia. The investigation took an epidemiological, clinical and microbiological approach, detecting by capture enzyme-immunoassay technique the presence of IgM antibodies against M. pneumoniae. All cases occurred over a 9 week period. The attack rate in children under five was 18% and 8.2% in those from 5-14 years. The age mean and standard deviation of the cases was 5.2 +/- 3.5 years, the range being from 9 months to 14 years. Cough was the most common clinical manifestation (87.4%), followed by fever (67.4%), asthenia (21.1%), abdominal pain (18.9%), vomiting (13.7%), earache (8.4%) and sore throat (6.3%). There was no significant difference in the distribution of symptoms according to age groups. IgM anti M. pneumoniae was positive in 36 (37.9%) of the samples analysed. Treatment chosen in most cases (90) was eritromicin and there was a correct evolution in all cases except for two clinical and radiological recurrences. Hospitalization was only necessary in 5 cases. The present findings are important to emphasize the high incidence of M. pneumoniae respiratory disease in children under 5, and suggests that with respiratory processes affecting very young children, a possible Mycoplasma pneumoniae infection should also be considered and the necessary action taken in the form of early and appropriate treatment.
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PMID:Community outbreak of acute respiratory infection by Mycoplasma pneumoniae. 881 90

The objective of this investigation was to determine whether Chlamydia pneumoniae was involved in an outbreak of respiratory disease among military recruits, 92 patients (average age 20.1 years) were included in the study if they had a sore throat or cough for more than 1 week. In addition to sore throat and cough, fatigue, headache, dyspnoea and vertigo were the most frequent symptoms. The patients received standard treatment with 100 mg of doxycycline b.i.d. for 14 days. In 38.8% of cases symptoms were alleviated after 1-2 weeks of treatment, and in 22.4% of cases after 2-3 weeks of treatment. Pretreatment throat washings and sera were sampled for Chlamydia. Sera were drawn for Chlamydia, Mycoplasma and adenovirus serology. Cell culture (Hep-2) and 3 different serological methods-microimmunofluorescence (MIF), enzyme immunoassay with a recombinant glycoconjugate antigen (r-EIA) and immunoperoxidase assay (IPA)-were used. Cell culture was found to have too low a sensitivity to be of diagnostic value. Acute infection was demonstrated in 13% by MIF IgM and in an additional 21% by MIF IgG (titre rises). Enzyme immunoassay IgM was found in 17% and IPA IgM in 19% of individuals without MIF IgM antibodies. Microimmunofluorescence was found to be the most useful test for serodiagnosis. The combination of serological methods showed that 40 out of 52 (76.9%) had an acute infection with possible chlamydial aetiology. In conclusion, methodological improvements are necessary for the aetiological diagnosis of chlamydial respiratory infections.
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PMID:Respiratory tract infection due to Chlamydia pneumoniae in military personnel. 925 77

GABHS is the most common bacterial cause of tonsillopharyngitis, but this organism also produces acute otitis media; pneumonia; skin and soft-tissue infections; cardiovascular, musculoskeletal, and lymphatic infections; bacteremia; and meningitis. Most children and adolescents who develop a sore throat do not have GABHS as the cause; their infection is viral in etiology. Other bacterial pathogens produce sore throat infrequently (e.g., Chlamydia pneumoniae and Mycoplasma pneumoniae), and when they do, other concomitant clinical illness is present. Classic streptococcal tonsillopharyngitis has an acute onset; produces concurrent headache, stomach ache, and dysphagia; and upon examination is characterized by intense tonsillopharyngeal erythema, yellow exudate, and tender/enlarged anterior cervical glands. Unfortunately only about 20% to 30% of patients present with classic disease. Physicians overdiagnose streptococcal tonsillopharyngitis by a wide margin, which almost always leads to unnecessary treatment with antibiotics. Accordingly, use of throat cultures and/or rapid GABHS detection tests in the office is strongly advocated. Their use has been shown to be cost-effective and to reduce antibiotic overprescribing substantially. Penicillin currently is recommended by the American Academy of Pediatrics and American Heart Association as first-line therapy for GABHS infections; erythromycin is recommended for those allergic to penicillin. Virtually all patients improve clinically with penicillin and other antibiotics. However, penicillin treatment failures do occur, especially in tonsillopharyngitis in which 5% to 35% of patients do not experience bacteriologic eradication. Penicillin treatment failures are more common among patients who have been treated recently with the drug. Cephalosporins or azithromycin are preferred following penicillin treatment failures in selected patients as first-line therapy, based on a history of penicillin failures or lack of compliance and for impetigo. GABHS remain exquisitely sensitive to penicillin in vitro. There are several explanations for penicillin treatment failures, but the possibility of copathogen co-colonization in vivo has received the most attention. Treatment duration with penicillin should be 10 days to optimize cure in GABHS infections. A 5-day regimen is possible and approved by the United States Food and Drug Administration for cefpodoxime (a cephalosporin) and azithromycin (a macrolide). Prevention of rheumatic fever is the primary objective for antibiotic therapy of GABHS infections, but a reduction in contagion and faster clinical improvement also can be achieved. Development of streptococcal toxic shock syndrome and necrotizing fasciitis ("flesh-eating bacteria") are rising concerns. The portal of entry for these invasive GABHS strains is far more often skin and soft tissue than the tonsillopharynx.
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PMID:Group A beta-hemolytic streptococcal infections. 974 11

A prospective study was conducted over a 3-month winter period in three general practice clinics in an urban population in southern Israel to identify the etiological agents of respiratory tract infections (RTI) in adults. RTI was defined as an acute febrile illness with cough, coryza, sore throat or hoarseness. Serum samples were taken from all patients in both the acute and convalescent phases of their illness. Tests were conducted for detection of 17 microorganisms known to cause RTI, including serological tests for 16 known pathogens. An etiological diagnosis was established in 80 (66%) of the 122 patients who participated in the study. The distribution of the etiological agents was as follows: influenza B virus in 27 (22%) patients. Chlamydia pneumoniae in 22 (18%), Legionella spp. in 15 (12%), Mycoplasma pneumoniae in 13 (11%), influenza A virus in 11 (9%), Bordetella pertussis in 9 (7%), adenovirus in 4, Epstein Barr virus in 4, Haemophilus influenzae in 3, beta-hemolytic streptococci in 3, Streptococcus pneumoniae in 2, respiratory syncytial virus in 2, parainfluenza 1 virus in 2 and parainfluenza 2 virus in 1. No patients were found to be infected with Coxiella burnetii, Moraxella catarrhalis or parainfluenza 3 virus. More than one pathogen was identified in 27 (34%) patients in whom an etiological diagnosis was established. It is concluded that RTI is caused by a broad spectrum of etiological agents, a considerable number of patients having evidence of infection with more than one pathogen. The therapeutic significance of these findings should be elucidated in further studies.
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PMID:Etiology of respiratory tract infection in adults in a general practice setting. 986 80

Mycoplasma pneumoniae (primary atypical or Eatons' agent) is a common cause of walking or atypical pneumonia in young adults. It is responsible for approximately 43% of the cases of community-acquired pneumonia in patients between the ages of 17 and 44. Patients with Mycoplasma pneumonia typically present with the gradual onset of a nonproductive cough, sore throat, fever, and pulmonary infiltrates on chest x-ray. The diagnosis is based on symptomatology and on radiographic findings such as interstitial infiltrates, patchy infiltrates, plate-like atelectasis, nodular infiltration, or hilar adenopathy. The primary treatment for Mycoplasma pneumoniae is a macrolide antibiotic, preferably azithromycin: 500 mg initially and then 250 mg daily for 4 days.
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PMID:Mycoplasma pneumoniae in women. 1102 66

Acute respiratory disease is one of the most common reasons to consult a general practitioner. A substantial part of these diseases cannot be explained by an infection with a virus or a common pathogenic bacterium. To study this diagnostic deficit, the prevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae infections was determined in two groups of patients consulting a general practitioner. DNA of C. pneumoniae and M. pneumoniae was detected by a polymerase chain reaction (PCR) in nose/throat swabs from six (1.1%), and from seven (1.3%) patients, respectively, of 557 patients consulting a general practitioner for complaints suggestive for a virus infection during the 1994/1995 respiratory infections season. Two patients remained C. pneumoniae PCR-positive for at least 4 weeks. All others were negative within 3 weeks. Double infections of C. pneumoniae and influenza virus (3/6), and of M. pneumoniae and respiratory syncytial virus (1/7) or rhinovirus (1/7) were diagnosed. During the 1992/1993 season, attempts to isolate C. pneumoniae in cell culture or to detect C. pneumoniae DNA by PCR using throat swabs were all negative for 80 patients with a sore throat, although serological data suggested a C. pneumoniae infection in 13 (16%) patients. A specimen from another patient of this group was M. pneumoniae PCR-positive and the corresponding serum specimens showed a persistent high antibody titre. In summary, the prevalence of acute C. pneumoniae and M. pneumoniae infections was less than 2% in patients consulting a general practitioner.
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PMID:Low prevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae among patients with symptoms of respiratory tract infections in Dutch general practices. 1148 97


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