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Inadequate nutrition and acute lower respiratory infection (ALRI) are overlapping and interrelated health problems affecting children in developing countries. Based on a critical review of randomized trials of the effect of nutritional interventions on ALRI morbidity and mortality, we concluded that: (1) zinc supplementation in zinc-deficient populations prevents about one-quarter of episodes of ALRI, which may translate into a modest reduction in ALRI mortality; (2) breastfeeding promotion reduces ALRI morbidity; (3) iron supplementation alone does not reduce ALRI incidence; and (4) vitamin A supplementation beyond the neonatal period does not reduce ALRI incidence or mortality. There was insufficient evidence regarding other potentially beneficial nutritional interventions. For strategies with a strong theoretical rationale and probable operational feasibility, rigorous trials with active clinical case-finding and adequate sample sizes should be undertaken. At present, a reduction in the burden of ALRI can be expected from the continued promotion of breastfeeding and scale-up of zinc supplementation or fortification strategies in target populations. La malnutrition et les infections aigues des voies respiratoires inferieures (ALRI) sont des problemes sanitaires interdependants et imbriques, qui affectent les enfants des pays en developpement. Sur la base d'une analyse critique d'essais randomises etudiant les effets d'interventions nutritionnelles sur la morbidite et la mortalite par ALRI, nous avons conclu que (1) la supplementation en zinc des populations deficitaires en ce metal previent environ un quart des episodes d'ALRI, d'ou eventuellement une diminution modeste de la mortalite associee ; (2)la promotion de l'allaitement fait baisser la morbidite due aux ALRI ; (3) la supplementation en fer ne suffit pas seule a reduire l'incidence des ALRI ; et (4) la supplementation en vitamine A au-dela de la periode neonatale ne diminue ni l'incidence des ALRI, ni la mortalite qui leur est imputable. Les elements disponibles a propos des autres interventions nutritionnelles potentiellement benefiques etaient insuffisants. Concernant les strategies beneficiant d'une justification theorique solide et probablement realisables sur le plan operationnel, il conviendrait d'entreprendre des essais rigoureux, avec une recherche des cas active et des echantillons de taille appropriee. On pourrait a present s'attendre a une baisse de la charge d'ALRI comme consequence de la promotion permanente de l'allaitement et du passage a l'echelle superieure des strategies de supplementation ou d'enrichissement en zinc, menees parmi les populations cibles. Problemas interrelacionados que se solapan, la mala nutricion y las infecciones agudas de las vias respiratorias inferiores (IAVRI) afectan a los ninos de los paises en desarrollo. A partir de una resena critica de los ensayos aleatorizados sobre el efecto de las intervenciones nutricionales en la morbilidad y mortalidad por IAVRI, Ilegamos a la conclusion de que: (1) la administracion de suplementos de zinc en las poblaciones con deficit de ese elemento previene aproximadamente una cuarta parte de los episodios de IAVRI, lo que puede traducirse en una reduccion moderada de la mortalidad por IAVRI; (2) el fomento de la lactancia materna reduce la morbilidad por IAVRI; (3) la administracien de suplementos de hierro por si sola no reduce la incidencia de IAVRI; y (4) los suplementos de vitamina A superado el periodo neonatal no reducen la incidencia de IAVRI ni la mortalidad por esa causa. La evidencia respecto a otras intervenciones nutricionales potencialmente beneficiosas era insuficiente. Cuando las estrategias tengan una justificacion teerica solida y probabilidades de ser operacionalmente viables, deberian emprenderse ensayos rigurosos con procedimientos de busqueda activa de casos clinicos y tamanos de muestra adecuados. Por el momento, cabe prever una reduccion de la carga de IAVRI como consecuencia del fomento continuo de la lactancia materna y de la extension masiva de las estrategias de uso de zinc como suplemento o como enriquecimiento de los alimentos en las poblaciones objetivo. [TEXT NOT REPRODUCIBLE IN ASCII], Introduction Estimation of the global burden of child mortality attributable to undernutrition has played a crucial role in refocusing the attention of researchers and policy-makers on the importance of optimal [...]

Human metapneumovirus (hMPV) is an important cause of lower respiratory tract infections in hospitalized children, but the age-related incidence and effect of hMPV in unselected children in the community have [...]

During the fall/winter season of 2004-05, we found 9 respiratory specimens positive for human parainfluenza virus type 4 (HPIV-4) in our laboratory (43% of all HPIVs) from patients with mild [...]

We examined 10,025 respiratory samples collected for 4 years (2001-2004) and found a 7.1% average annual incidence of human metapneumovirus. The epidemic peak of infection was late winter to spring, [...]

BACKGROUND AND OBJECTIVES. Environmental tobacco smoke (ETS) exposure is probably one of the most important public health hazards in our community. Our aim with this article is to (1) review the prevalence of ETS exposure in the United States and how this prevalence is often measured in practice and (2) summarize current thinking concerning the mechanism by which this exposure may cause infections in young children. METHODS. We conducted a Medline search to obtain data published mainly in peer-reviewed journals. RESULTS. There is still a very high prevalence of ETS exposure among US children ranging from 35% to 80% depending on the method of measurement used and the population studied. The mechanism by which ETS may be related to these infections is not entirely clear but may be through suppression or modulation of the immune system, enhancement of bacterial adherence factors, or impairment of the mucociliary apparatus of the respiratory tract, or possibly through enhancement of toxicity of low levels of certain toxins that are not easily detected by conventional means. CONCLUSIONS. The prevalence of ETS exposure in the United States is still very high, and its role in causing infections in children is no longer in doubt even if still poorly understood. Research, therefore, should continue to focus on the various mechanisms of causation of these infections and how to best reduce the exposure levels. Key Words environmental tobacco smoke exposure, prevalence, environmental tobacco smoke and infections, Abbreviations ETS--environmental tobacco smoke SIDS--sudden infant death syndrome NHANES--National Health and Nutrition Examination Survey Th--T helper Ig--immunoglobulin IL--interleukin ET--eustachian tube POD--periodontal disease PAR--population attributable risk ENVIRONMENTAL TOBACCO SMOKE (ETS) exposure [...]

Diesel exhaust (DE) is a major component of airborne particulate matter. In previous studies we have described the acute inflammatory response of the human airway to inhaled DE. This was characterized by neutrophil, mast cell, and lymphocyte infiltration into the bronchial mucosa with enhanced epithelial expression of IL-8, Gro-[alpha], and IL-13. In the present study, we investigated whether redox-sensitive transcription factors were activated as a consequence of DE exposure, consistent with oxidative stress triggering airway inflammation. In archived biopsies from 15 healthy subjects exposed to DE [particulates with a mass median diameter of particulate matter

The opportunistic human pathogen Pseudomonas aeruginosa causes persistent airway infections in patients with cystic fibrosis (CF). To establish these chronic infections, P. aeruginosa must grow and proliferate within the highly viscous sputum in the lungs of CF patients. In this study, we used Affymetrix GeneChip microarrays to investigate the physiology of P. aeruginosa grown using CF sputum as the sole source of carbon and energy. Our results indicate that CF sputum readily supports high-density P. aeruginosa growth. Furthermore, multiple signals, which reduce swimming motility and prematurely activate the Pseudomonas quinolone signal cell-to-cell signaling cascade in P. aeruginosa, are present in CF sputum. P. aeruginosa factors critical for lysis of the common CF lung inhabitant Staphylococcus aureus were also induced in CF sputum and increased the competitiveness of P. aeruginosa during polymicrobial growth in CF sputum.

A case of 35-year-old man is presented who was admitted in the emergency department of Massachusetts General Hospital because of nasal congestion, swelling, and pain in his right nostril. The patient had the signs and symptoms of nasal ulceration and inflammation whose potential causes involve a broad range of both infectious and noninfectious causes.

Adaptive immune responses in mice against Actinobacillus pleuropneumoniae are discussed with emphasis on adjuvant contribution. Mice are susceptible to A. pleuropneumoniae infection, a quality makes investigation of adjuvant-mediated differences in adaptive responses against outer-membrane proteins (OMP) at the serololgical level possible, as is extension to look at responses to live infection.

Byline: Britt-Marie Larsson (1), Kjell Larsson (1), Per Malmberg (1), Lena Palmberg (1) Abstract: Background and Objective: Inhalation of dust from swine confinement buildings results in an acute inflammatory reaction in the respiratory tract. The dust has a high microbial content, dominated by Gram positive bacteria. The aim of the present study was to evaluate the significance of bacteria in the induction of IL-6 and IL-8 release from respiratory epithelial cells and alveolar macrophages. The results would give an indication to what extent the bacteria contribute to the toxic inflammation following exposure to swine dust. Methods: Epithelial cells from a human lung carcinoma cell line (A549) and human alveolar macrophages obtained from healthy subjects by bronchoalveolar lavage, were stimulated with swine dust, LPS, one Gram negative and four Gram positive bacteria strains. The dose-response release of IL-6 and IL-8 were studied. In addition, a bacteria-free supernatant was prepared from each strain and used for stimulation. Results: With a few exceptions, a dose-dependent IL-6 and IL-8 release was demonstrated from both cell types after stimulation with bacteria. In epithelial cells, Escherichia coli was the most potent bacteria at the highest concentration of 400 bacteria/cell regarding secretion of both IL-6 and IL-8 (P &lt 0.001), followed by Staphylococcus hominis and Staphylococcus lentus. In alveolar macrophages, S. lentus was the most potent strain (P &lt 0.001) in inducing cytokine release (P &lt 0.001), followed by S. hominis and E. coli concerning IL-6 secretion or Micrococcus luteus and E. coli with respect to IL-8 secretion (P &lt 0.001). Differences in potency between the various bacteria could be demonstrated, both within the two cell types as well as between the epithelial cells and macrophages. Bacteria-free supernatants were also able to induce cytokine release in both cell types. In macrophages the supernatants were even more potent stimuli than whole bacteria. Conclusions: The results indicate that bacteria or bacterial products could be an important contributing factor to the inflammatory reaction following exposure to swine dust. Author Affiliation: (1) Department of Occupational Medicine, National Institute for Working Life, S-171 84, Solna, Sweden Article History: Registration Date: 30/09/2004

To the Editor: Before 2007, two human polyomaviruses were known to infect humans: BK virus and JC virus (1,2). Recently, 2 novel polyomaviruses, KI polyomavirus (KIPyV) and WU polyomavirus (WUPyV), [...]

To the Editor: Human rhinovirus (HRV) is a common etiologic agent of upper respiratory tract infections and is associated with symptoms such as asthma and wheezing. HRV has >100 serotypes, [...]

Acute lower respiratory tract infections (ALRI), which include pneumonia and bronchiolitis, are a frequent cause of illness in children. However, many of the underlying causes of ALRI are unclear. This limits vaccine development and knowledge of the best treatment. To better determine causes of ALRI, 121 urban children (50 female) who were hospitalized with ALRI were evaluated using newly available laboratory tests. Evidence for causes of ALRI was found in 84 patients (70 percent), which included 30 bacterial infections, 30 viral infections, and 24 mixed infections. Haemophilus influenzae and Streptococcus pneumoniae were the most common bacteria. Respiratory syncytial virus was the most common virus, with adenovirus infection detected half as often. The frequency of H. influenzae infection, especially in children under three years, has not previously been considered this high. Viral ALRI, alone or with bacteria, occurred most often in younger patients, and the proportion of bacterial ALRI increased with age. Use of the new tests allowed identification of more ALRI causes and of more bacterial infections than has previously been possible. The causes of infection in the remaining 30 percent of children may not have been identified due to microbes not tested for, lack of responses measurable by tests, or due to the effectiveness of drug therapy in eliminating infective agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

A longitudinal study in 2004 and 2005 detected polyomaviruses WU and KI in 44% and 17% of children with and without respiratory symptoms, respectively, in the Netherlands. In some children [...]

To the Editor: Human rhinoviruses (HRVs), members of the family Picornaviridae, were first isolated in 1956 (1); to date, >100 serotypes have been identified on the basis of nucleotide sequence [...]

Acute otitis media, or inflammation of the middle ear, is common in children, and two-thirds of the cases are caused by bacterial infections. Generally, viral respiratory infections are thought to precede otitis media. Up to 42 percent of children with otitis media have been found to have viral infections, which may have symptoms similar to those of otitis media, including fever, irritability, and loss of appetite. Because the effect of a concomitant respiratory virus infection on the course of otitis media is unclear, 363 children (181 female) from 0.02 to 11.6 years of age (average 2.52 years) were evaluated over a one-year period. Pathogenic (disease-causing) bacteria were found in airway samples from 82 percent of the children. Although respiratory viruses were found in 42 percent, that figure is probably an underestimate of the incidence of viral infection; 94 percent of patients and family members of 57 percent of patients had signs of viral respiratory infection. Rhinovirus infection was the most dominant virus, present in 24 percent of virally-infected children. Respiratory syncytial virus was the second most common viral infection. The presence of bacterial infections did not correlate with viral infections, and the appearance of the eardrum (tympanic membrane) did not differ in children with either type of infection. Earache was significantly more common as a symptom of otitis media in children older than two years. Half of the children were feverish, and similar numbers were irritable, restless, and had a poor appetite. Acute otitis media usually developed three to seven days after respiratory symptoms began. If a patient was examined by a physician shortly after symptom onset, it may not have been possible to diagnose otitis media. Patients usually recovered well from acute otitis media when given antibiotics, but symptoms of viral respiratory infections often persisted, sometimes necessitating further evaluation and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)