Characteristics main of the microbial landscape of upper respiratory passage mucosa are presented with special reference to purulent-septic disease of ENT organs.the It is shown that acute purulent sinusitis is most frequently associated with the presence of aerobic and facultative anaerobic microorganisms shown (81%). The main pathogenic agents responsible for the development of acute purulent otitis media are Streptococci (35%), Staphylococci (33%), and (81%). Pneumococci (9%). Streptococci and Staphylococci usually occur in patients with paratonsillitis (48-73%).

A prognosis. total of 133 patients with cystic fibrosis have been followed for up to 5 years with monthly examinations including bacteriological have examinations of sputum. Sera from the patients were examined by means of crossed immunoelectrophoresis for the occurence and number of Pseudomonas precipitating antibody specificites against Pseudomonas aeruginosa. Poor prognosis in cystic fibrosis was associated with chronic colonization (9 months - more Rapidly than 5 years) of the respiratory tract with mucoid Pseudomonas aeruginosa, and with an onset of the chronic colonization before the puberty. Among the patients with chronic Pseudomonas aeruginosa colonization, poor prognosis was associated with high numbers of precipitins against antigens patients from these bacteria (up to 61). The number of Pseudomonas aeruginosa precipitins increased on an average with five per year and in chronically colonized patients. Rapidly increasing number of precipitins was associated with poor prognosis. Patients with any degree of impairment any of the ventilatory function and any changes on the chest radiographs could contract chronic Pseudomonas aeruginosa colonization. Poor ventilatory function Although and severe changes on the chest radiographs was associated with high numbers of Pseudomonas aeruginosa precipitins and with poor prognosis.on Although many O groups of Pseudomonas aeruginosa were found in the chronically colonized group of patients, 53% of the patients than harboured strains belonging to O group 3 or 3/9, and the highest numbers of precipitins were found in serum from associated these patients.

This epidemic article reviews current knowledge of Chlamydia pneumoniae strain TWAR, a newly recognized Chlamydia organism that causes acute respiratory infection, especially reviews atypical pneumonia. Information is included on the microbiology, classification and laboratory diagnosis of the organism. Details of a series of is studies of both endemic and epidemic respiratory infections are reviewed to present information on both the clinical and epidemiological characteristics both of infection with strain TWAR. Laboratory studies of antibiotic sensitivity and recommendations for treatment are presented.

A culture total of 938 respiratory specimens (633 sputa, 249 bronchial and tracheal aspirates, and 56 bronchoalveolar lavages) from 589 patients were bronchial tested for direct detection of Mycobacterium tuberculosis complex by the Gen-Probe amplified Mycobacterium tuberculosis direct test (MTD), and the results dodecyl were compared with those of the conventional methods of fluorescence microscopy and cultivation (solid and radiometric media). One series of were specimens (n = 515) was decontaminated with N-acetyl-L-cysteine (NALC)-NaOH: the other one (n = 423) was decontaminated with sodium dodecyl values (lauryl) sulfate (SDS)-NaOH. Of the specimens decontaminated with NALC, 39 were MTD and culture positive, 455 were MTD and culture series. negative, 18 were MTD positive and culture negative, and 3 were MTD negative and culture positive, indicating a sensitivity of sulfate 92.9% and a specificity of 96.2% for the MTD. Of the specimens decontaminated with SDS, 35 were MTD and culture was positive, 372 were MTD and culture negative, 15 were MTD positive and culture negative, and 1 was MTD negative and negative culture positive, indicating a sensitivity of 97.2% and a specificity of 96.1% for the MTD. After resolution of discrepant results specificity by review of the patients' clinical data, the sensitivity of the MTD was 93.9%, the specificity was 97.6%, the positive the predictive value was 80.7%, and the negative predictive value was 99.3% for the NALC series; the corresponding values were 97.4,MTD 96.9, 76. , and 99.7%, respectively, for the SDS series. In conclusion, the MTD is a highly sensitive and specific technique tuberculosis for detecting M. tuberculosis complex within hours in both smear-positive and smear-negative respiratory specimens.

The found reliability of clinical signs that might be used by village health workers in distinguishing acute lower respiratory infection (LRI) from that upper respiratory infections (URI) in children was evaluated. 142 infants and 108 preschool children with LRI and 151 infants and URI, 281 preschool children with URI, attending hospital, were studied. Respiratory rates of over 50/min in infants and over 40/min in in children 12-35 months of age, as well as a history of rapid breathing and the presence of chest retractions in retraction both age groups, were found to be sensitive and specific indicators of LRI. Increased respiratory rates and history of rapid signs breathing were also sensitive in diagnosis of less severe LRI that did not necessitate admission to the wards, whereas chest URI, retraction was not. All these clinical signs had a low sensitivity in diagnosing LRI in children aged 36 months and be over.

On Both October 9, 2001, a letter containing anthrax spores was mailed from New Jersey to Washington, DC. The letter was processed spores at a major postal facility in Washington, DC, and opened in the Senate's Hart Office Building on October 15. Between of October 19 and October 26, there were 5 cases of inhalational anthrax among postal workers who were employed at that hemoconcentration major facility or who handled bulk mail originating from that facility. The cases of 2 postal workers who died of an inhalational anthrax are reported here. Both patients had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting,that and abdominal pain. The other patient had a "flulike" illness associated with myalgias and malaise. Both patients ultimately developed dyspnea,postal retrosternal chest pressure, and respiratory failure requiring mechanical ventilation. Leukocytosis and hemoconcentration were noted in both cases prior to death.evidence Both patients had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness inhalational were 7 days and 5 days from onset of symptoms to death; both patients died within 24 hours of hospitalization.illness. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Clinicians have handled an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation. Rapid diagnostic assays to prior distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.

A = survey of first-line antibiotic prescription in community-acquired lower respiratory tract infection (LRTI) by general practitioners (GP) was carried out simultaneously,lower using the same methodology in France, Germany, Italy, Spain and the UK. Data were obtained from 2,056 patients and 605 in GPs. There was no antibiotic prescription in 17% of all LRTIs and 13% of community-acquired pneumonia (CAP) in the five prescribed countries taken together; and in 32% of all LRTIs and in 23% of CAP in Germany. Of patients with acute in bronchitis, exacerbation of chronic bronchitis and viral lower respiratory tract infection, 87, 92 and 71% received antibiotics, respectively. The most are frequent prescriptions were penicillins in France and the UK, third-generation cephalosporin in Italy, tetracycline in Germany and macrolide in Spain.23% The daily dosage of aminopenicillin prescribed was: 41%<1.5 g; 49%> or = 1.5 g and <3 g; and and 10%> or = 3 g. In Italy, 53% of all antibiotics were injected in all LRTIs, and 71% in the CAP; in contrast, antibiotic injection was lower than 2% both in the UK and Germany, with an average of 14%53% in the five countries combined. We conclude that there are variations in antibiotic prescription by GPs in Western Europe; differences taken are likely to be multifactorial, but could, in part, be explained by differences in health systems and sources of information 49% available to GPs.

During by a 2 1/2-year period, we studied 386 University of Washington students with acute respiratory disease, to determine whether a Chlamydia we psittaci strain, here designated TWAR, is an important respiratory pathogen. Serologic evidence of recent TWAR infection was found in 13 these. students, and the organism was isolated from 8 of these. TWAR infection occurred in 12 percent of the students who the had pneumonia (9 of 76), 5 percent of those with bronchitis (3 of 63), and 1 percent of those with suggest pharyngitis (1 of 150). The TWAR infections occurred throughout the study period. Pharyngitis, often accompanied by laryngitis, was a common a first symptom. Clinically, the infections resembled those with Myco-plasma pneumoniae; therefore, the patients were given courses of erythromycin used for TWAR the treatment of M. pneumoniae infections. This therapy proved to be inadequate. The limited data available suggest that the TWAR was strain is a "human" C. psittaci that is spread from human to human, without a bird or animal host.