How to Prevent the Common Cold

Avoid / Cure A Cold Fast

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Viral Infections Common Cold

Infectious rhinitis is typically viral and is often referred to as the common cold . It is more common in children than in adults, and the most frequently identified agents are rhinovirus, myxovirus, coronavirus and adenovirus 67, 271 . Swelling of the mucosa may cause obstruction of a sinus ostium, with subsequent secondary bacterial infection (acute bacterial sinusitis). The histologic findings include marked oedema and a non-specific mixed inflammatory infiltrate of the lamina propria.

Bacterial Infections of the Upper Respiratory System

A number of different species of bacteria can infect the upper respiratory system. Some, such as Haemophilus influenzae and -hemolytic streptococci of Lancefield group C, can cause sore throats but generally do not require treatment because the bacteria are quickly eliminated by the immune system. Other infections require treatment because they are not so easily eliminated and can cause serious complications.

Viral Infections of the Upper Respiratory System

The Common Cold Medical practitioners have been taught for generations that the symptoms of the common cold, if treated vigorously, will go away in seven days, whereas if left alone, they will disappear over the course of a week. This pessimistic outlook may now be changing with development of new antiviral medications. On average, a person in the United States has two to three colds per year. Colds are the leading cause of absences from school, and result in loss of about 150 million work days per year. Immunity generally lasts less than a few years.

Allergic Rhinitis

Allergic rhinitis (hay fever) is part of an inherited syndrome, which may also manifest as atopic eczema and asthma. In allergic rhinitis, airborne particles, such as grass pollens, moulds and animal allergens, are deposited on the nasal mucosa giving rise to acute and chronic reactions. Allergens combine with the IgE antibodies produced by the plasma cells of the nasal mucosa, which are avidly bound to the Fc-epsilon receptors on mast cells. This triggers degranulation of mast cells and releases the inflammatory mediators of the type I hyper-sensitivity reaction, causing rhinorrhoea and nasal obstruction. Microscopically, the nasal mucosa shows numerous eosinophils, abundant plasma and in some cases an increased number of mast cells. There is goblet cell

Nasal Congestion

Nasal congestion is a common side effect of CPAP therapy (53). Although most patients experience initial self-limiting nasal congestion, at least 10 complain of persistent nasal stuffiness of some degree after six months of therapy (54). There appear to be many possible reasons for nasal symptoms. CPAP may provoke pressure-sensitive mucosal receptors, leading to vasodilation and increased mucus production. In some patients, it may unmask allergic rhinitis by restoring the nasal route of breathing after years of mouth breathing. In others, fixed nasal obstruction with polyps or a deviated septum may produce symptoms. Mouth leaks also cause increased nasal resistance (55). Treatment of nasal congestion will depend on the exact cause. Mouth leak producing increased nasal flow may be minimized by ensuring that the mask interface selection is ideal and the correct CPAP pressure is used. Sometimes, it may be necessary to use chin straps. However, these may be uncomfortable and...

The Common Cold

The common cold is caused by the rhinovirus invading the nasopharyngeal tract. The rhinovirus is frequently accompanied by acute inflammation of the mucous membranes of the nose and increased nasal secretions. This is known as acute rhinitis. Adults have between two and four colds per year. Children are more susceptible to colds. The average child has between 4 and 12 colds each year. The rhinovirus is seasonable 50 of the infections occur in the winter and 25 during the summer. The other 25 occur anytime throughout the year. Although no one has directly died from the common cold, it does create both physical and mental discomfort for the person and leads to a loss of work and school. The rhinovirus is contagious one to four days before the patient notices the symptoms of the cold. This is referred to as the incubation period. During this time, the rhinovirus can be transmitted by touching contaminated surfaces and from contact with droplets from an infected patient who sneezes and...

Measurement of Total IgE

Several early studies evaluated the role of IgE in patients with a variety of allergic diseases ( 29,30 and 31). Adults and children with allergic rhinitis and extrinsic Total serum IgE has been found to be markedly elevated in atopic dermatitis, with the serum IgE concentration correlating with the severity of the eczema and with the presence of allergic rhinitis, asthma, or both. Patients with atopic dermatitis without severe skin disease or accompanying asthma or hay fever may have normal IgE concentrations (45). Total IgE concentrations have been found to be markedly elevated in allergic bronchopulmonary aspergillosis.

Other Hypersensitivity States

In type I, or immediate, hypersensitivity, allergen interacts with IgE antibody on the surface of mast cells and basophils, resulting in the cross-linking of IgE, FceRI receptor apposition, and mediator release from these cells. Only a few allergen molecules, interacting with cell-bound IgE, lead to the release of many mediator molecules, resulting in a major biologic amplification of the allergen-IgE antibody reaction. Clinical examples include anaphylaxis, allergic rhinitis, and allergic asthma.

Spasmogenic Mediators

Histamine, generated by decarboxylation of histidine, was the first mast cell mediator to be identified, and it is the sole preformed mediator in this functional class. It is bound to the proteoglycans of mast cell and basophil granules (5 and 1 mg 106 cells, respectively) (2.4,2.5). Histamine circulates at concentrations of about 300 pg mL with a circadian maximum in the early morning hours (26). Histamine excretion exceeds 10 mg 24 hours a small fraction is excreted as the native molecule, and the remainder as imidazole acetic acid or methyl histamine. Histamine interacts with specific H,, H2, and H3 receptors (2.7,28). H receptors predominate in the skin and smooth muscle H2 receptors are most prevalent in the skin, lungs, and stomach and on a variety of leukocytes and H 3 receptors predominate in the brain. The biologic response to histamine reflects the ratio of these receptors in a given tissue. H 1 histamine effects include contraction of bronchial and gut musculature, vascular...

Lipoxygenase Products

Leukotrienes are potent and possess a broad spectrum of biologic activity (43). They induce wheal-and-flare responses that are long lived and are accompanied histologically by endothelial activation and dermal edema. In the airway, they enhance mucus production and cause bronchoconstriction, especially by affecting peripheral units. In humans, LTD4 is most active, LTC4 is intermediate, and LTE4 is the least potent. LTE4 has been implicated as an inducer of nonspecific bronchial hyperreactivity. It has been suggested that LTD4 augments airway remodeling (44), possibly by stimulating matrix metalloproteinase release or activity. All depress cardiac muscle performance and diminish coronary flow rates. LTC4 and LTD4 have been recovered from nasal washings and bronchial lavage fluids of patients with allergic rhinitis or asthma, whereas LTE4 has been recovered from the urine.

Ragweed Pollen Antigens

Amb a 1 consists of two fragments, named A and B. These fragments are not bound covalently and are dissociated readily, which results in a significant loss of allergenic activity. Recombination of these polypeptide chains does not restore allergenic activity, presumably because the steric conformation is not readily restored. Amb a 1 is resistant to enzymatic degradation, suggesting that readily accessible amino or carboxyl groups are not the principal immunologic determinants. Interestingly, 10-fold more Amb a 1 is extractable in vitro at the pH of nasal secretions from patients with allergic rhinitis (pH 7 to 8), than at the pH of nasal secretions from nonatopic individuals (pH 6.3) (13). In addition to the short ragweed allergens just described, an allergen from giant ragweed (A trifida), Amb t V (Ra 5G), has been identified (58). Other allergens that cause allergic rhinitis have been purified from additional weeds. These include Sal p 1 from S pestifer (Russian thistle) (59), Par...

Other Plant And Animal Allergens

Glues and gums are occasional causes of human allergy. Impure gelatin is the adhesive obtained from the bones and hides of terrestrial animals and fish bones. Other natural glues are made from casein, rubber, and gum arabic. Synthetic adhesives recently have minimized the glue allergy problem, although the amine hardeners used in the manufacture of epoxies have caused asthma and rhinitis in factory workers. In addition to gum arabic, other vegetable gums (acacia, chicle, karaya, and tragacanth) have been reported to cause allergy by inhalation or ingestion. These are used in candies, chewing gum, baked goods, salad dressings, laxatives, and dentifrices. They also are used as excipients in medications. Guar gum is a vegetable gum that recently has been shown to induce IgE-mediated asthma. This gum is used in the carpet industry and affects about 2 of workers in carpet-manufacturing plants. The gum is used to fix colors to carpeting. It is also Enzymes used in laundry detergents to...

Industrial And Occupational Chemicals And Air Pollutants

Air pollution appears to have an impact on asthma and rhinitis. Multiple epidemiologic studies have demonstrated a correlation between levels of common outdoor air pollutants and hospital admissions or emergency room visits (277,278). However, these epidemiologic studies are limited by confounding factors, including air temperature and levels of other outdoor aeroallergens. For this reason, experiments also have been performed under controlled conditions involving short exposures to individual pollutants. The effects of ozone on lung function have been investigated extensively. Ozone is generated by the action of ultraviolet light on precursor pollutants from such sources as automobiles and power plants. Ozone causes decreased FEV-, and forced vital capacity as well as increases in bronchial hyperresponsiveness in both asthmatics and nonasthmatics at concentrations as low as the National Ambient Air Quality Standard of 0.12 ppm ( 277). A few studies have suggested that ozone increases...

Chapter References

H1 receptor antagonist treatment of chronic rhinitis. J Allergy Clin Immunol 1988 81 975. 36. Watson WTA, Simons KJ, Chen XY, et al. Cetirizine a pharmacokinetic and pharmacodynamic evaluation in children with seasonal allergic rhinitis. J Allergy Clin Immunol 1989 84 457. 46. Chu TJ, Yamate M, Biedermann AA, et al. One versus twice daily dosing of terfenadine in the treatment of seasonal allergic rhinitis US and European studies. Ann Allergy 1989 63 12. 67. Wong L, Hendeles L, Weinberger M. Pharmacologic prophylaxis of allergic rhinitis relative efficacy of hydroxyzine and chlorpheniramine. J Allergy Clin Immunol 1981 67 223. 68. Schaaf L, Hendeles L, Weinberger M. Suppression of seasonal allergic rhinitis symptoms with daily hydroxyzine. J Allergy Clin Immunol 1979 3 129. 69. Empey DW, Bye C, Hodder M, et al. A double-blind crossover trial of pseudoephedrine and triprolidine alone and in combination, for the treatment of allergic rhinitis. Ann Allergy 1975...

The Atopic State and the TH2 Paradigm

Allergic Rhinitis Th2

Extensive evidence has accumulated that may define the underlying immunologic basis for the atopic phenotype, that is, individuals with allergic asthma, allergic rhinitis, and atopic eczema (24). The atopic condition can be viewed as a TH2 lymphocyte-driven response to allergens of complex genetic and environmental origins (36). The reciprocal action of IL-4 and IFN-g on IgE production led to several studies on the T-cell origin of these cytokines. Mosmann and Coffman ( 37) described two distinct types of helper T cells in murine systems and defined them as TH1 or TH2 cells by the pattern of cytokine secretion. TH1 cells produced IL-2, IFN-g, and lymphotoxin. TH2 cells produced IL-4, IL-5, IL-6, and IL-10.

Documenting The History Of Infection

The number and types of infections and their individual and cumulative morbidity should be assessed. It is necessary to exclude carefully other causes of nonspecific symptoms for example, is sniffling or congestion due to recurrent upper respiratory infection, allergy, or other types of rhinitis If cough is a major complaint, it is important to determine whether this is due to sputum production, irritation, or other causes. Could it represent cough-equivalent asthma If failure to thrive and cough are both present, could the patient have cystic fibrosis Inflammatory bowel disease may mimic hypogammaglobulinemia in children with poor weight gain who also have recurrent rhinitis due to multiple mucosal viral infections, which by themselves would not be considered significant.


Second-generation antihistamines are available only as oral formulations. They all have convenient once- or twice-daily dosing ( 10,1.7) (Iab e.,5.,4). Studies have reported that a single dose of terfenadine (120 mg) or fexofenadine (180 mg) is equally effective as 60 mg given twice a day in improving allergic rhinitis symptom scores and suppressing histamine-induced wheal-and-flare responses (46,47). Astemizole and loratadine should be injected on an empty stomach to avoid problems with absorption. All three agents have comparable antihistaminic potency to each another and to first-generation antihistamines.


Tolerance to antihistamines is a common concern of patients taking these agents chronically. This phenomenon has been speculated to occur because of autoinduction of hepatic metabolism, resulting in an accelerated clearance rate of the antihistamine ( 103). However, studies have failed to confirm this hypothesis, and most reports of tolerance to antihistamines are now believed to be secondary to patient noncompliance because of intolerable drug side effects or breakthrough symptoms due to severity of disease (104,105,106 and 107). Short-term studies evaluating tolerance to second-generation agents have found no change in their therapeutic efficacy after 6 to 8 weeks of regular use (108,109). Studies up to 12 weeks found no evidence that second-generation agents cause autoinduction of hepatic metabolism leading to rapid excretion rates and drug tolerance (42). The clinical efficacy of these agents in the skin and treatment of allergic rhinitis does not decrease with chronic use.


The discovery of H-, receptor antagonists has proved to be a significant breakthrough in the treatment of allergic diseases. Chemical modifications of these early agents have yielded the second-generation antihistamines, which are of equal antagonistic efficacy but have fewer side effects because of their lipophobic structures. Newer nonsedating antihistamines, which are metabolites or isomers of existing agents, are now under development. H 2 receptor antagonists have been found extremely useful in the treatment of peptic ulcer disease. However, they have been disappointing in the treatment of allergic and immunologic disorders in humans. Newer selective nonsedating H-, antagonists and dual-action antihistamines, because of their lower side-effect profiles, have provided therapeutic advantages over first-generation agents for long-term management of allergic rhinitis.


Outdoor insects such as mayfly and caddis fly have been studied clinically and immunologically ( 227). These insects have an aquatic larval stage and therefore are found around large bodies of water such as the Great Lakes, particularly Lake Erie. These flies were reported to cause significant respiratory allergy in the summer months, but their numbers have declined, probably because of pollution of the lakes. Japanese investigators reported that 50 of asthmatics show sensitivity to the silkworm moth (Bombyx mori) caused by antigens found in the wings. These wing allergens cross-react almost completely on RAST inhibition with butterfly allergens, but not at all with mites (228). Finished silk products are not thought to be allergenic, but contamination of some products, such as silk-filled bed quilts, with waste products of B. mori and the Antheraea pernyi can cause asthma and rhinitis. Occupational exposure to insects may cause respiratory allergy. Chironomid larvae are used as fish...

Trees Gymnosperms

Most of these trees are dioecious and produce large quantities of round pollen grains 20 to 30 mm in diameter with a thick intine (internal membrane). The mountain cedar is an important cause of allergic rhinitis in certain parts of Texas and has proliferated where the ecosystem has been disturbed by overgrazing of the grasslands. The bald cypress may be a minor cause of allergic rhinitis in Florida. Trees Angiosperms These trees produce large amounts of highly allergenic pollen. Pecan trees in particular are important in the etiology of allergic rhinitis where they grow or are cultivated. The pollen grains are 40 to 50 pm in diameter and usually contain three germinal pores.

Grasses Poaceae

Sweet vernal grass (Anthoxanthum odoratum) is an important cause of allergic rhinitis in areas where it is indigenous. In the total picture of grass allergy, however, it is not as important as the species previously mentioned. The pollen grains are 38 to 45 pm in diameter.

What Else May Be Important In Causing Multiple Sclerosis

Emotional stress, common infections such as colds or sinusitis, and trauma to the CNS also have been studied as possible causes both of MS and of periodic exacerbations. Except for the observation that common viral infections often precede exacerbations, no cause-and-effect relationship has been validated in scientifically controlled studies.

Trematodes Trichobilharzia spp

Pinworm or Enterobius vermicularis is the most common human helminth infection. Indeed, the Guinness Book of Records claims that it is the second most-common human infection, after the common cold. Interestingly, the prevalence is higher in temperate than in tropical climates and it is more common in developed than in underdeveloped countries.

Clinical evaluation

The cause of the atrial fibrillation should be identified. Precipitating causes, such as hyperthyroidism, electrolyte abnormalities, and drug toxicity, should be excluded. Stimulant abuse, excess tobacco, alcohol, caffeine, chocolate, over-the-counter cold remedies, and street drugs should be sought. AF may be associated with a recent acute illness, such as pneumonia.

Roots In Intervention And Manipulation

For example, most people would say that research relating to HIV or genetics involves greater privacy risk than research on the common cold. This perceived difference in the risk of the research is an illusion. Assume that a single database, maintained under tight security arrangements, is made available to two different researchers under confidentiality agreements that bind the two investigators to the same obligations regarding use and protection of the data. One is studying HIV infection and the other is studying staphylococcus infection. The privacy risks in both cases are the same they stem from the adequacy of data security arrangements and the obligations imposed on the investigators. The appearance of differential risk stems from the current cultural perceptions of HIV, and the fact that people or institutions other than the researcher might misuse the information to embarrass or harm the data subject, if they were to gain access to the information. Similarly, test results...

What Constitutes Disease Natural History

A chief goal of natural history research is to understand the spectrum of the disease, the different manifestations, patterns of recognition and care. It is critical for differentiating self-limiting illnesses (e.g. acute infection) from chronic states (e.g. heart disease, cancer, diabetes, chronic respiratory illness) and distinguishing underlying disease from the exacerbations of chronic illness (e.g. multiple sclerosis, pain syndromes). There is often talk of confounding by indication'' where our concern is determining events that may be attributable to the indication or disorder for which the therapy is prescribed rather than the therapy itself disease natural history is the indication side of this dilemma.

Problems And Side Effects See Also Chapter

Side effects reported by the patient are usually, but not exclusively, related to pressure or airflow or the mask-face interface. The minimization of side effects is important for effective CPAP usage patients who complain of side effects use CPAP less frequently than those without side effects (51). A nonspecific claustrophobic feeling may be reported by patients but this often involves either mask interface problems, nasal congestion, or exhalation difficulties that are discussed below. Dangerous complications of nasal CPAP therapy are extremely rare and represent isolated case reports in the literature including pulmonary barotrauma, pneumocephalus, increased intraocular pressure, tympanic membrane rupture, cerebrospinal fluid (CSF) leak and meningitis (52), massive epistaxis, and subcutaneous emphysema after facial trauma (53). It is clear that caution should be used when implementing CPAP therapy post-neuro, -airway, or -facial surgery. Irritating side effects such as aerophagy...

General Comments

The only significant human exposure to bismuth involves pharmaceutical uses. A number of trivalent and, rarely, pentavalent salts of bismuth have been used orally or intramuscularly over the past two centuries for the treatment of a number of conditions syphilis, malaria, hypertension, warts, stomatitis, upper respiratory tract infections, amebiasis, dyspepsia and diarrhea. Bismuth compounds have also been used as radiocontrast agents in diagnostic testing and as topical astringents having slight antiseptic action (1). With the introduction of more effective therapeutic agents, primarily antibiotics and antimicrobials, the internal use of certain trivalent bismuth salts (subnitrates, subcarbonates, subgallates, tartrates, subcitrates, and subsalicylates) is now limited primarily to oral preparations for the prevention and treatment of gastric and intestinal disorders, such as ulcers and diarrhea. Available as over-the-counter products, the (presumed) insoluble bismuth salts were long...

Juxtaoral Organ of Chievitz

Herpes simplex virus can persist in a latent form in the trigeminal ganglion and when re-activated causes recurrent infections. These are typically seen at the mucocutaneous junctions of the mouth or nasal cavity, and involvement of the lips, the most common site, is called herpes labialis. A variety of apparently disparate factors can trigger re-activation, including the common cold ( fever blister ), exposure to sunlight, menstruation, stress and others. There is usually a brief prodromal burning or prickling sensation in the

Forms of Herbal Therapies

Herbal therapy can also take the form of syrup. Syrups are made by drying the herb and soaking it in water or oil and then adding a sweetener to the mix. The sweetener is usually honey or sugar. The sweetened mixture is then heated until the syrup forms. Herbal syrups are used to treat colds, cough, and sore throat.

Immediate Questions

Was there trauma to the nose Allergic rhinitis can cause itching and subsequent rubbing of the nose, traumatizing mucosa. Prior trauma from a direct blow on the nose may cause septal injury and bleeding. A dry environment causes crusting, and young children may be prone to picking the nose, irritating septal mucosa. Unilateral foul or purulent nasal discharge suggests a foreign body. In hospitalized patients, indwelling nasal tubes or suction trauma may injure mucosa and promote bleeding.

Examination of the eye

Adenovirus is the most common cause of viral conjunctivitis. Viral conjunctivitis often occurs in epidemics, typically presenting with an acutely red eye, watery discharge, conjunctival swelling, a tender preauricular node, photophobia and a foreign-body sensation. Some patients have an associated upper respiratory tract infection.

Differential Diagnosis

Infectious processes can directly affect the GI tract, with resultant vomiting or diarrhea that decreases oral intake. Likewise, symptoms of upper respiratory tract infection, streptococcal pharyngitis, or pneumonia can affect child's oral intake.

Fluorescence Scanning

SARS is a serious respiratory illness with significant morbidity and mortality rate (31-37). Its diagnosis depends mainly on the clinical findings of an atypical pneumonia not attributed to any other cause and a history of exposure to a suspect or probable case of SARS, or to the respiratory secretions and other bodily fluids of individuals with SARS. Definitive diagnosis of this novel CoV relies on classic tissue culture isolation, followed by electron microscopy studies to identify the virus in cell culture, which is technically very demanding. Serological testing for increasing titer against SARS-associated CoV was shown to be highly sensitive and specific (32) but was not suitable for quick and early laboratory diagnosis. Molecular tests have also been attempted for the detection of this virus or to confirm infection (48,49). However, only one target was detected in one test using the existing methods, so a higher risk of false negatives was inevitably encountered. Our method is...

Pharmacokinetics in humans

After oral administration of a 100 mg dose to healthy fasting subjects, a mean Cmax of 2.86-6.50 mg L was achieved within 1.22-2.75 h 19, 23-30 . Nimesulide concentrations of approximately 25-80 of the Cmax appeared at the first sampling time, 30 min after administration. Pharmacological effectiveness appears to be exhibited earlier than time to Cmax, from 30 to 60 min after administration 31, 32 . In 100 hospitalised children with acute upper respiratory tract infections and fever (body temperature 38.5 C), the mean body temperature was decreased significantly 1 h after administration of a single dose of nimesulide suspension 5 mg kg 31 . In the same study, the tmax in paediatric patients receiving nimesulide 50 mg (granules) was close to 2 h.

Human Fungal Diseases

Serious fungal diseases that involve the internal organs are often caused by dimorphic fungi such as Histoplasma capsulatum, Paracoccidiodes brasiliensis, Coccidioides immitis, and Blastomyces dermatitidis. If the spores of these fungi are inhaled, they can cause severe respiratory illness and spread to other organs, sometimes resulting in death. They grow as a mold in soil, but at human body temperature (37 C or 98.6 F), they become unicellular. H. capsulatum often grows as a mold in the feces of birds and can become airborne and inhaled when feces dry out. In some people, the mold causes histoplasmosis, which is characterized by fever and respiratory problems that resemble those of tuberculosis.

Correction Of Other Medical Disorders

Treatment of hypothyroidism, acromegaly, and nasal congestion may improve the severity of OSA. OSA is common in patients with hypothyroidism, and it is believed that hypothyroidism predisposes to the development of OSA (50). The mechanism for this association may include weight gain, tongue enlargement, muscle dysfunction, and changes in respiratory drive. In patients with sleep apnea, the prevalence of undiagnosed hypothyroidism has been reported in the range of 3.1 to 11.5 (51,52). Whether all patients with OSA should be screened for hypothyroidism is controversial (53). Nevertheless, treatment of hypothyroid-ism may lead to an improvement of OSA (54), and is likely to improve symptoms of daytime fatigue and promote weight loss (55). Treatment of hypothyroidism masquerading as OSA so called secondary sleep apnea may result in resolution of symptoms (56). Having a low threshold for testing thyroid function in patients with OSA is recommended. Nasal pathology is associated with OSA...

Principles of Epidemiology

Diseases that can be transmitted from one host to another, such as measles, colds, and influenza, are communicable diseases. In order for a communicable disease to spread, a specific chain of events must occur. First, the pathogen must have a suitable environment in which to live. That natural habitat, the reservoir, may be on or in an animal, including humans, or in an environment such as soil or water (figure 20.1a). A pathogen must then leave its reservoir in order to be transmitted to the susceptible host. If the reservoir is an animal, the body orifice or surface from which a microbe is shed is called the portal of exit. Disease-causing organisms must then be transmitted to the next host, usually through direct contact or via contaminated food, water, or air (figure 20.1b). They enter the next host through a body surface or orifice called the portal of entry (figure 20.1c). Diseases that are constantly present in a given population are called endemic. For example, both the common...

Treatment of barotrauma

Preventive measures are essential in order to avoid barotrauma of the external and middle ear, the labyrinth, and the sinus. Repetitive Valsalva and or Frenzel maneuvers help to keep open the Eustachian tube which equalizes middle-ear and ambient pressure. Individuals suffering from upper respiratory infections or allergic rhinitis, which cause dysfunction of the Eustachian tube and produce edema of the mucosa around the sinus orifices, should avoid scuba diving. Treatment involves the use of analgesics, antihistamines, and vasoconstrictors. Antibiotics should be used if the tympanic membrane is ruptured ( Kizer.1995).

Bioaerosols and Disease Donald E Gardner PhD

The large and heterogeneous group of microorganisms called viruses are alike in that they are all obligate intracellular parasites that live in cells of their selected hosts. Viruses, the smallest parasites (0.02 to 0.3 mm), are intracellular molecular particles, in some instances crystallizable. The virus particle consists of a central core of a nucleic acid for its reproduction. The nucleic acid core may be made up of either RNA (ribonucleic acid) or DNA (deoxyribonucleic acid), which represents the basic infectious material. When viruses invade a host cell, the genetic material takes over the host cell's own reproduction process and causes the cell to produce more viruses. Viruses cannot replicate themselves in the extracellular state and are highly specific in selecting cells that they will infect. Some viruses replicate within the cytoplasm of the host cells, and others replicate within the nucleus of the cell. Viruses can be released from the host cell when the cell ruptures, a...

Irritable bowel syndrome

Irritable bowel syndrome ranks second only to the common cold as a cause of absenteeism from work,(39) affecting between 8 and 17 per cent of the general population in the United States.(4 4 and 42 Symptoms include abdominal pain (relieved by defecation), and various forms of disturbed defecation such as altered stool frequency, altered stool form, altered stool passage, passage of mucus, and bloating. Symptoms must be continuous or recur within 3 months to meet the criteria for a diagnosis of irritable bowel syndrome. The severity of this syndrome frequently correlates with periods of emotional stress the sympathetic nervous system inhibits gastric motility.

Cited Publications

In S. L. Gorbach, J. G. Bartlett, and N. R. Blacklow, eds., Infectious Diseases, 2nd ed., Saunders, Philadelphia, PA, 1998, pp. 548-559. 91 C. B. Hall and J. T. McBride, Upper respiratory tract infections The common cold, pharyngitis, bacterial tracheitis and epiglottitis. In J. E. Pennington, eds., Respiratory Infections Diagnosis and Management, Raven Press, New York, 1989, pp. 97-118.

Positive Stranded RNA Viruses Make Polyproteins

Picornaviruses are small, spherical single-stranded RNA viruses. They include polio, common cold, hepatitis A, and foot and mouth disease. Their genome is long enough for about a dozen genes. Since they are positive-strand RNA viruses, their RNA can be directly used as mRNA. The viral RNA does have a poly(A) tail attached to its 3'-end but has no cap. Instead a protein, the Vpg protein, is attached covalently to the 5'-

Consumer Fear Of Germs

Historically, consumers have relied on cleanliness to reduce bacterial contamination. We wash to remove as many pathogens as possible. With food poisonings, viruses, and the common cold, health care concerns on are the rise. This germ phobia has resulted in an outburst of antibacterial products soaps, lotions, facial cleansers, cutting board products, dishwashing soaps, kitchen and bathroom cleaners, countertops, kitchen appliances, pillows, sheets, mattress pads, kitty litter, children's toys, socks, athletic shoes, toothbrushes, sponges, and even toothpaste. Many people have an irrational fear of germs, and they are demanding better and safer products. The market is responding with a wide range of antibacterial products. Parents want to protect their children from the dangers of bacteria. Let us not forget the growing contingent of baby boomers and the Gen Xers, pursuing their quest for health and fitness. With more travel, day care, and public transportation, today's consumer is...

Prevention and Treatment

Since such a large number of immunologically different viruses cause colds, vaccines are impractical. Rhinoviruses, like all other viruses, are not affected by antibiotics and other antibacterial medications. Prevention of the spread of rhinoviruses includes handwashing, even in plain water, which readily removes rhinoviruses, and keeping hands away from the face. In addition, one should avoid crowds and crowded places such as commercial airplanes when respiratory diseases are prevalent, and especially avoid people with colds during the first couple of days of their symptoms. Except for the estimated 10 of colds caused by bacteria where an antibiotic might be helpful, only the antiviral medication pleconaril shortens the duration of symptoms. In experimental rhinovirus infections, aspirin and acetaminophen, commonly present in cold remedies, both somewhat prolonged symptoms, antibody production, and duration of virus excretion. Table 23.5 summarizes some facts about the common cold....

Physiological Variables

The physicochemical properties of the mucus are known to change during various pathological conditions such as the common cold, bacterial and fungal infections, and inflammatory conditions of the eye (45-47). The exact structural changes taking place in mucus under these conditions are not clearly understood. The problems presented by

Exercise And Infections

Without doubt exercise and training influence natural immunity. An important question is, however, to what degree are these cellular changes of clinical significance, especially with respect to resistance to infectious diseases. From animal studies 197-199 it is clear that effects of exercise on disease lethality vary with the type and time that it is performed. In general, exercise or training before infection has either no effect or decreases morbidity and mortality. Exercise during the incubation period of the infection appears to have either no effect or to increase severity of infection. In contrast to the limited experimental evidence, there are several epidemiological studies on exercise and upper respiratory tract infections (URTI). These studies are based on self-reported symptoms rather than clinical verification. In general, increased numbers of URTI

Ascorbic Acid and Immune Function

The observation that high concentrations of vitamin C are found in phagocytic cells has underpinned the concept that ascorbic acid is an important nutrient for optimal immune function. However, although the role of vitamin C as a key component of antioxidant defense is well established, most studies have shown only minor effects on a range of immune functions, except in cases where the vitamin may be acting by interacting with GSH metabolism. Unlike deficiencies in vitamins B6, E, and riboflavin, deficiency of vitamin C does not cause atrophy of lymphoid tissue. In a study of ultra marathon runners, dietary supplementation with 600mg day of ascorbic acid reduced the incidence of upper respiratory tract infections after a race by 50 (62). It is interesting to note that strenuous exercise has been shown to deplete tissue glutathione content. The interrelationship between gluta-thione and ascorbic acid may therefore play a role in the effect of exercise on immune function.

Clinical Features

Spontaneous hemorrhage is the most dreaded occurrence in a lymphangioma and may lead to eyelid ecchymosis, subconjunctival hemorrhage, and acute proptosis (Figure 14.6). This may create diagnostic difficulty in a patient with a previously undiagnosed asymptomatic lymphangioma. Acute increase in intraorbital pressure can result in compressive optic neuropathy and vision loss.37,39 In the clinical differential diagnosis of spontaneous orbital hemorrhage, the following possibilities should be considered in addition to lymphangioma trauma, bleeding disorder, orbital varix, and, rarely, cavernous hemangioma. One characteristic feature of lymphangioma is that the proptosis is exacerbated after trauma or upper respiratory tract infection.38,40 Under these circumstances, hemorrhage into the channels of the tumor may lead to the development of chocolate cysts.

Primary and Secondary Immune Responses

The first time the body encounters an antigen, the immune response is called a primary immune response. The response of memory cells to a later infection by the same pathogen is called a secondary immune response. The secondary immune response is much faster and more powerful, producing many more antibodies, as shown in the graph above. Recall that memory cells protect only against pathogens already encountered. Colds and flu are an exception, because rhinoviruses and flu viruses mutate at a high rate. Therefore, these viruses are always presenting new antigens.

Sickness Behaviour As Behavioural Defence

According to Hart, these sickness behaviours are adaptive because they enhance illness-induced fever, which may aid the animal to combat pathogens. In fact, Kluger and colleagues have shown that animals not allowed to express the typical febrile response associated with illness have a greater risk of dying. Higher mortality rates were observed in lizards forced to remain in a cold environment after exposure to a bacterial infection than those placed in a warm environment 43 . Moreover, lizards in the warm environment that were treated with an antipyretic (salicylate), experienced higher mortality rates than untreated animals 44 . Likewise in humans, the use of antipyretics (aspirin and acetaminophen) has been shown to extend the duration and symptoms of chicken pox 45 and common colds L46 , although we cannot be certain these effects of the drugs are attributable to the absence of a fever. The work of others has shown that a behavioural fever (moving to a warmer environment) increases...

Specific micronutrient deficiencies

Vitamin C is a free radical scavenger that serves as an important antioxidant. Vitamin C concentrations in the plasma and leukocytes decline during infections and stress. Supplementation with antioxidant vitamins including vitamin C has been shown to improve immune response to group A streptococcal infection compared to penicillin alone 83 . Supplementation may enhance phagocytosis and NK cell activity 84 , increase levels of the antioxidant plasma glutathione levels, and inhibit Fas-induced apoptosis of monocytes. H. pylori infection is associated with a decrease in gastric juice ascorbic acid concentration, and this effect is greater in children with the CagA-positive strain A 67 . Both vitamin C and astaxanthin, a carotenoid, show antimicrobial activity against H. pylori that may be mediated through immune mechanisms 85 . Vitamin C is used to treat recurrent furunculosis in patients with deficient neutrophil function, and may lower the incidence of colds associated with acute...

Cromolyn and Nedocromil

Although cromolyn sodium (Intal) and nedocromil sodium (Tilade) are widely known for their ability to prevent the release of histamine and other inflammatory mediators by mast cells during the early response to antigen challenge, these drugs have a wide variety of inhibitory effects on many cell types, including eosinophils, neutrophils, monocytes, and neurons. Cromolyn sodium and nedocromil sodium are used as pulmonary inhalants in the treatment of asthma. Nasal (Nasalcrom) and ophthalmic (Opticrom) preparations of cromolyn sodium can be used to reduce the symptoms of allergic rhinitis and conjunctivitis. More detailed information on these compounds may be found in Chapter 39.

Viruses Are the Ultimate Parasites

Virus-caused diseases are numerous and all too familiar chicken pox, influenza, some types of pneumonia, polio, measles, rabies, hepatitis, the common cold, and many others. Smallpox, once a worldwide scourge, was eradicated by a decade-long global immunization effort beginning in the mid-1960s. Viral infections in plants (e.g., dwarf mosaic virus in corn) have a major economic impact on crop production. Planting of virus-resistant varieties, developed by traditional breeding methods and more recently by genetic engineering techniques, can reduce crop losses significantly. Most viruses have a rather limited host range, infecting certain bacteria, plants, or animals (Figure 1-6).

Drugs That Interfere With Norepinephrine Storage

Peripheral nervous system side effects are the result of a reserpine-induced reduction of sympathetic function and unopposed parasympathetic activity symptoms include nasal congestion, postural hypotension, diarrhea, bradycardia, increased gastric secretion, and occasionally impotence. Because of the increased gastric secretion, reserpine is contraindicated for patients

Clinical characteristics

University hospital, indicated that the prevalence and clinical severity due to hMPV infections are slightly lower than those of RSV infections during the winter season 32 . Most of the hMPV-positive patients were children 2 years old without any underlying illnesses. hMPV was found significantly less frequently than RSV in children 2 months old. Of the 31 hMPV-posi-tive children 2 years old, only 4 (31 ) were 2 months old, whereas 43 (35 ) of the 122 hRSV-positive children 2 years old were also 2 months old. Others have found that the mean age of patients infected with hMPV was slightly lower than that compared to RSV 39 . Of the hMPV-posi-tive patients who were 5 years old, most had other diseases (e.g., cystic fibrosis, leukemia, and non-Hodgkin lymphoma) or had recently received bone marrow or kidney transplantation, indicating an association with immunosuppression. Two severely immunocompromised patients died due to progressive respiratory failure with hMPV as the sole pathogen...

Drugs That Interfere With Norepinephrine Synthesis

Sedation is the most common adverse effect of metyrosine. Other CNS disturbances, such as anxiety, confusion, and disorientation, have also been reported. Symptoms of sympathetic nervous system depression in general, such as nasal congestion and dryness of mouth, can also occur.

Examples Of Naturally Emerging Viruses

In May 1993, a clinician reported a cluster of cases presenting with nonspecific illness, fever, headache, and cough that rapidly progressed to respiratory distress. The patients were young, previously healthy, and lived in rural areas in the four-corners region bordering Arizona, Colorado, New Mexico, and Utah. By early June 1993, 24 cases had been reported with a mortality rate approximately 75 .11,12 Patient blood and autopsy tissues were sent to the Centers for Disease Control (CDC) for investigation. Diagnostic assays failed to identify known causes of respiratory illness however, patient samples cross-reactived with antibodies to four different hantaviruses. Using hantavirus sera, immunohistochemistry detected hantavirus antigen in autopsy tissue from the lung and other involved organs.13 Hantaviruses are RNA viruses with a genome in three segments and a member of the family Bunyaviridae. Previous outbreaks of hantaviruses involved patients with renal disease leading to...

Pharmacogenetics of NSAIDs

Addition of aspirin or other NSAIDs, which inhibit COX-1, results in rapid depletion of PGE2 and worsening of asthma and rhinitis symptoms. The enzyme, leukotriene C synthase (LTC4S) is upregulated in the bronchial mucosa of asthmatics. Patients with asthma who have an A-C transversion of nucleotide 444 in the LTC4S enzyme have increased expression of this enzyme in peripheral blood eosinophils. The C444 allele is also observed more commonly in patients with aspirin-induced asthma, compared with the healthy controls or asthmatics who are not aspirin-sensitive (23). For a full discussion of this topic see Chapter 6.

Side Effects And Limitations

Side effects from CPAP therapy tend to be minor though can often be a significant barrier between long-term adherence (113) and tend to be related either due to problems with the interface or due to positive pressure. Common complaints include nasal congestion, rhinorrhea, skin abrasion, difficulty with exhalation, chest discomfort, dry mouth, claustrophobia, conjunctivitis due to air leak, and or aerophagia (114). Reports document up to 10 of all CPAP users complaining of some degree of persistent nasal congestion at six months after initiation of CPAP therapy (115). This finding is likely related to reduced humidification of the inspired air causing release of inflammatory mediators (116). Extremely rare are reports of serious complications including pulmonary barotrauma, pneumocephalus (subsequent to base of skull fracture), tympanic membrane rupture, massive epistaxis, subcutaneous emphysema, decreased cardiac output at high pressure, and increased intraocular pressure, Mask...

Slowing the Emergence and Spread of Antimicrobial Resistance

A greater effort must also be made to educate the public about the appropriateness and limitations of antibiotics in order to ensure that they are utilized wisely. First and foremost, people need to understand that antibiotics are not effective against viruses. Taking antibiotics will not cure the common cold or any other viral illness. A few antiviral drugs are available, but they are effective against only a limited group of viruses such as HIV and herpesviruses. Unfortunately, surveys indicate that far too many people erroneously believe that antibiotics are effective against viruses and often seek prescriptions to cure viral infections. This misuse only selects for antibiotic-resistant bacteria in the normal flora. Even though these organisms are not pathogenic themselves, they can serve as a reservoir for R plasmids, eventually transferring their resistance genes to an infecting pathogen.

Analgesic Antiinflammatory And Antispasmodic Activity

Only a few reports on the topical anti-inflammatory effects of O. vulgare refer to oregano-herbal mixtures or their decoctions, used in the treatment of inflammation as supporting therapies (Deryabin, 1990 Deryabin, 1991). Podkolzin etal. (1986) report on the favourable local effect of insufflation of fine powder mixture of Hypericum perforatum and O. vulgare (1 1) on the course of rhinitis, that was induced in an animal (rabbit) experiment. In the control animals the rhinitis symptoms were more pronounced and of longer duration, so the powder was proposed as an adjuvant therapy in treatment of rhinitis.

On Adult Presentations

Nasal obstruction contributes to the worsening of sleep-disordered breathing, but the extent to which this might be related to allergic rhinitis is not known. One case-control study did show that sleep apnea patients had a higher rate of perennial allergic rhinitis and atopy than controls (104).

Adverse Effects and Contraindications

Care should be taken in transferring patients from systemic to aerosol corticosteroids, as deaths due to adrenal insufficiency have been reported. In addition, allergic conditions, such as rhinitis, conjunctivitis, and eczema, previously controlled by systemic corticos-teroids, may be unmasked when asthmatic patients are switched from systemic to inhaled corticosteroids. Caution should be exercised when taking cortico-steroids during pregnancy, as glucocorticoids are terato-genic. Systemic corticosteroids are contraindicated in patients with systemic fungal infections.

Classification of Viruses

Examples of DNA viruses and the diseases that they produce include adenoviruses (colds, conjunctivitis) hepadnaviruses (hepatitis B) herpesviruses (cytomega-lovirus, chickenpox, shingles) papillomaviruses (warts) and poxviruses (smallpox). Pathogenic RNA viruses include arborviruses (tick-borne encephalitis, yellow fever) arenaviruses (Lassa fever, meningitis) or-thomyxoviruses (influenza) paramyxoviruses (measles, mumps) picornaviruses (polio, meningitis, colds) rhab-doviruses (rabies) rubella virus (German measles) and retroviruses (AIDS).

Human Viral Diseases Are Common

Many common childhood diseases such as measles, mumps and chickenpox are caused by viruses, as are the common cold and flu. More dangerous viral diseases include polio, smallpox, herpes, Lassa fever, Ebola and AIDS. Do viruses ever do anything useful Yes infection by a mild virus can provide resistance against a related but more dangerous virus (see Ch. 17). Viruses may carry genes from one host organism to another, in a process known as transduction (see Ch. 18), and have thereby played a major role in molecular evolution (see Ch. 20). The ability of viruses to carry genes between organisms may be put to good use by genetic engineers. All the same, about the best that can be said for the natural role of viruses is that most of them do relatively little damage and only a few cause highly virulent diseases. Antibiotics are of no use against viruses they only kill bacteria. So why do doctors often prescribe antibiotics for viral diseases like flu or colds There are two main reasons. The...

Pathogenesis and host response

Experimental animal models of hMPV infection have been reported, including both primates and rodents. The first published experimental hMPV infection model in cynomolgus macaques (Macaca fascicularis) confirmed that hMPV is a primary pathogen of the respiratory tract in primates 45 . The hMPV-infected macaques showed mild clinical signs of rhinorrhea corresponding with a suppurative rhinitis at pathological examination. In addition, mild erosive and inflammatory changes in the mucosa and submucosa of conducting airways, and an increased number of alveolar macrophages in bronchioles and pulmonary alveoli were observed. A close association between these lesions and the specific expression of hMPV antigen was shown by immunohistochemistry. Based on the antigen expression, viral replication mainly took place at the apical surface of ciliated epithelial cells throughout the respiratory tract. Pharyngeal excretion of hMPV showed a peak at day 4 post infection (p.i.) decreasing to zero by...

Positivesense Rna Viruses

Picornaviruses are a family of small stable viruses, most of which can survive the harsh environment of the gut and be recovered from stool samples. There are five key genera of picornaviruses. Poliovirus, a rather ineffective pathogen that can infect the central nervous system (CNS) and cause poliomyelitis, is eradicated in many parts of the world due to the use of highly effective killed and attenuated vaccines. Select members of the 30+ serotypes of echoviruses are among the most commonly isolated viruses from stools, and cause a variety of disease symptoms including meningitis, encephalitis, rashes, diarrhea, upper respiratory infections, and conjunctivitis. Coxsackieviruses (29 serotypes) are also rather commonly isolated from humans and cause hand, foot, and mouth disease (which is distinct from the animal virus that wreaked havoc on British livestock in 2000), herpangina, pleurodynia, and myocarditis in addition to a variety of nonspecific symptoms. Hepatitis A virus, the agent...

Causes Of Kidney Failure

According to the 1998 USRDS, the annual incidence of pediatric ESRD is 1,087, or 13 per million.1 Many causes of pediatric ESRD are unique (Table 13B.1). Alport's syndrome is the association of nephropathy, deafness, and cataracts. Infantile polycystic kidney disease (ARPKD) is autosomal recessive, occurs one in 10,000 to one in 40,000 live births, and involves both kidneys and liver. Adult or autosomal dominant polycystic kidney disease (AKPDK) occurs one in 250 live births, but only 10 present in the first two decades of life. Hemolytic uremic syndrome (HUS) is a disease of infancy characterized by microangiopathic hemolytic anemia, renal cortical necrosis, renal failure, and thrombocytopenia. IgA nephropa-thy (Berger's disease) presents as a respiratory illness, hematuria, and glomerular mesangial IgA deposits. Henoch Schonlein syndrome (HSP) is characterized by purpuric skin lesions, abdominal pain, arthralgia, and renal dysfunction. Cysti-nosis is a rare, autosomal recessive,...

Allergic angiitis and granulomatosis

Pulmonary features in allergic angiitis and granulomatosis are related to underlying asthma which is present in all patients. A phasic pattern of allergic angiitis and granulomatosis syndrome has been described initial allergic rhinitis, evolving into asthma and followed by peripheral blood eosinophilia, eosinophilic tissue infiltrates, and ultimately vasculitis. A study of 154 patients with allergic angiitis and granulomatosis revealed the following 84 males, average age of 28 years at onset of allergic rhinitis, average age of 35 years at onset of asthma, and average age of 38 years when vasculitis was diagnosed. Other observations included a mean peak eosinophil count of 12.9 * 109 l, anemia in 83 per cent, granulomas in 40 per cent, tissue eosinophilia in 50 per cent, and vasculitis in more than 70 per cent. Chest radiograph abnormalities are present in over 60 per cent of patients and include patchy and occasionally diffuse alveolar-interstitial infiltrates in the perihilar area....

Anatomy and Physiology

Structures commonly involved in infections of the upper respiratory system (figure 23.1) are the nose. Infection of the nose is called rhinitis Figure 23.1 Anatomy and infections of the Respiratory System (a) Lateral view, upper respiratory system, showing the inside of the nasal chamber and its connections with the eyes, middle ears, and sinuses, and details of the respiratory epithelium. (b) Frontal view of the upper and lower respiratory system, including details of the alveoli. Common cold

Effect of Modulation of Immune System on Sleep 831 Overview

It is well known that nearly all infectious diseases and chronic inflammatory disorders affect sleep. Most individual have experienced the almost irresistible desire for sleep with the onset of flu. Further, altered of sleep were described in infected rabbits (Toth and Krueger 1988) and rats (Kent, Price, and Satinoff 1988). These changes in sleep in response to infectious challenge are facet of the acute phase response (APR) (Krueger and Majde 1990 Krueger et al. 1994 Majde and Krueger 2005). Many kind of infection like viral, bacterial, fungal, or parasitic, have changes in amount of non-rapid eye movement sleep (NREMS) or rapid eye movement sleep (REMS) (Toth 1999). Excess sleep is reported in patients with infectious mononucleosis (Lambore, McSherry, and Kraus 1991), HIV-1 (Norman et al. 1992), rhinovirus-induced common cold (Drake, Roehrs, Royer, Koshorek, Turner, and Roth 2000). The degree of sleep alteration is depending on kind of infection. For example, sleep pattern in...

Management of Complications

Nasal Dryness, Congestion, and Rhinitis With reference to the CPAP literature, the side effects of nasal dryness, congestion, and rhinitis are related to a defect of humidification promoted by air leaks (120). For patients with nasal and mouth dryness, a cold passover or a heated humidifier (the latter is more effective) (121) can be used. Heat moisture exchangers are not well adapted to the case of leaks since the dry flow from the ventilator is higher than the dampened flow returning from the patient. In a large series, a minority of patients needed humidifiers (10).

Medical Research On Latex Aller

The aerosolized latex allergen is readily inhaled and has been associated with conjunctivitis, rhinitis, cough, hoarse voice, chest tightness and bronchospasm. Baur et al. have demonstrated a direct relationship between the development of allergy-related symptoms in hospital workers and latex allergen concentrations in their work area. Airborne allergens have also been shown to affect individuals who are in the immediate vicinity but not themselves using latex products.36 Replacing high-allergen gloves with powderless low-allergen gloves can reduce ambient allergen levels 10-fold.34 4. Individuals with a history of atopy, hay fever, rhinitis, asthma or eczema. In a number of reports examining latex allergy in various populations, atopy was one of the significant predisposing risk factors. In a study of latex sensitization in a low-risk pediatric population, Bernardini et al. reported that all the children with latex sensitization were atopic whereas only 29 percent of non-sensitized...

Ophthalmic therapy

Allergen immunotherapy is effective in patients with allergic rhinitis. Allergy treatment begins with identification of allergens, institution of avoidance procedures and administration of medication. Immunotherapy may be considered if other measures fail.


Chiropractic treatment has been used for the neuromusculoskeletal (nerve, muscle, and skeleton) system, lower back, upper back, neck and head pain, and for extremity, joint, and muscle problems. It has also been beneficial for respiratory illnesses, the common cold, sinusitis, bronchial asthma, gastrointestinal disorders, high blood pressure, heart trouble, menstrual difficulties, and emotional problems such as depression and schizophrenia.


Bacterial rhinosinusitis usually follows a viral infection or allergic rhinitis, and the most commonly involved agents are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis 11, 34 . A dense inflammatory infiltrate mainly made of neutrophils occupies the lamina propria. Acute bacterial rhinosinusitis usually resolves with antibiotic therapy. Complications are rare and include contiguous infectious involvement of the orbit or central nervous system.


Atrophic rhinitis is a chronic inflammation of the nasal mucosa of unknown aetiology characterised by progressive nasal mucosal atrophy and by a thick, dense secretion, with a foetid smell and crusting 178 . Multiple factors may be involved in the pathogenesis, including chronic bacterial infections and nutritional deficiencies. Its incidence has markedly decreased in the last century, and nowadays most cases are secondary to trauma, surgery, granulomatous diseases, infection and radiation exposure 178 . Histologically, there is non-specific chronic inflammatory infiltrate, squamous metaplasia of the surface epithelium and of glandular excretory ducts, and atrophy of mucoserous glands 1, 69 . Chronic sinusitis is a complex, multifactorial disorder resulting from persistent acute inflammation or repeated episodes of acute or subacute sinusitis. There are usually predisposing factors like small sinus ostia, repeated episodes of common cold, allergy or acute sinusitis determining...

The First Night

Considering the length of time CPAP has been used to treat patients with sleep apnea, there are surprisingly little published data on the variability in CPAP pressure with posture or sleep stage. Some evidence exists for higher pressure requirements with the supine posture (35) and REM sleep (36). It appears that a CPAP level accurately set on one night is generally effective on subsequent nights (37). Early work and clinical experience suggested this was the case, but the use of auto-titrating CPAP (auto-CPAP) technology in the home has provided the research methodology to support this view (38). Clinically, in patients who respond immediately to CPAP but then report continued daytime sleepiness on home treatment, it may be appropriate to empirically increase CPAP pressure, assuming that the laboratory study underestimated the subsequent domiciliary CPAP pressure requirement. However, this has not been specifically studied. There is also a range of factors which may have an impact on...

Factorial Anova

To illustrate, let's examine that mainstay of midwinter television, the cough and cold remedy. Colds seem to come in two varieties, runny noses and hacking coughs. Some remedies like to take a broad-spectrum approach at last count, Driptame was supposed to knock out 26 symptoms. Other brands try for specificity Try-a-mine-ic eats up about 6 feet of drugstore shelf space with all the permutations to make you dry up or drip more, cough less or cough loose. All in all, an ideal situation for factorial ANOVA. The original question remains Is there any difference overall among brands But some other testable questions come to mind, for example, Do broad-spectrum remedies work better or worse than specific ones Which kind of cold is more uncomfortable and Do remedies work better or worse on runny noses or hacking cough Believe it or not, it's possible to have a swing at all of these questions at one time, using factorial ANOVA. Experimental Design for Cold Remedy Study Experimental Design...

Sources Of Drugs

For thousands of years, plants have served as sources of drugs. Ephedrine, a drug used to treat nasal congestion, was used by the Chinese long before western man visited the Orient. Belladonna (or Deadly Nightshade), the source of atropine and scopolamine was used in the Middle Ages. Its name means beautiful woman in Italian. A solution obtained by soaking the belladonna plant in water caused the pupils of the eye to dilate and appear black. These were symbols of beauty at the time. Belladonna was a favorite poison. Opium, a product obtained from the poppy plant, is mentioned in early Greek mythology as a sleep producer.

J Drug Interaction

Drugs administered by inhalation have either may a local or systemic effect. Anesthetics, like nitrous oxide, are inhaled and exert their effect after absorption into the circulatory system. Sprays for nasal congestion have their effect on the tissue in the nose and do not necessarily enter the general circulation.


Itching is highly suggestive of allergic conjunctivitis. A history of recurrent itching or a personal or family history of hay fever, allergic rhinitis, asthma or atopic dermatitis is also consistent with ocular allergy. F. Recent contact with an individual with an upper respiratory tract infection suggests adenoviral conjunctivitis. Chlamydial or gonococcal infection may be suggested by the patient's sexual history, including a history of urethral discharge.


Keys to locating an active source of anterior bleeding or intranasal foreign body are adequate light, appropriate instruments, cooperative patient, and skilled assistance. Assess color and texture of mucosa. Clear secretions, boggy turbinates, and bluish mucosa are seen in patients with allergic rhinitis.

Oral Antihistamines

Orally administered antihistamines can be beneficial for patients with moderate to severe allergic conjunctivitis, rhinitis, and sinusitis. There are many products available both OTC and by prescription. The most common OTC oral antihistamines are diphenhydramine (ie, Benadryl )


A history should elicit what may have precipitated this diabetic crisis. The most common causes are infection, upper respiratory tract infection and gastroenteritis, or inadequate insulin therapy (Berger,aQd.,Kel er,.1992). Check the patient's recent oral food and fluid intake, as well as his or her insulin and oral hypoglycemic drug use. Ask about other drugs, particularly illicit drugs and alcohol. Discuss the patient's normal diabetic control and diabetic complications such as nephropathy, neuropathy, and retinopathy. A history may be available from relatives or ambulance officers if the patient is unconscious.


The two most common viral vectors currently being used are retroviruses, which include the HIV virus, and adenoviruses, a common cause of colds. The former results in integration of nucleic acid into the host cells, whereas the latter leads only to expression of the viral genes for a short period of time while the virus replicates, referred to as transient expression.


Overdosage with benzodiazepines is common deaths are not. Although fatal-overdose statistics contain deaths ascribed to benzodiazepines alone, (24) many such attributions are suspect. Only in children and the physically frail, especially those with respiratory illness, are the benzodiazepines on their own hazardous. However, they can markedly potentiate other central nervous system depressant drugs such as alcohol. Typically, persons who take an overdose, say 100 mg of diazepam, become drowsy and fall deeply asleep. Some develop dysarthria, rigidity or clonus of limbs, or a bullous eruption. Sleep lasts from 24 to 48 h but patients are generally rousable.(24) Plasma benzodiazepine concentrations are often high on admission to hospital and are still very high even when the patient wakes up and is conscious presumably this reflects acute short-term tissue tolerance.

Causative Agents

Between 30 and 50 of colds are caused by the 100 or more types of rhinoviruses (rhino means nose, as in rhinoceros, or horny nose ), members ofthe picornavirus family (pico is Italian for small and rna is ribonucleic acid RNA thus, small RNA viruses ) (figure 23.8). The viruses are non-enveloped and their RNA is single-stranded, positive sense. The rhinoviruses were initially difficult to cultivate in the laboratory, since most failed to infect laboratory animals or cell cultures. In the 1950s, researchers in England accidentally discovered that if cell cultures were incubated at 33 C instead of at body temperature (37 C) and at a slightly acid pH instead of at the alkaline pH of body tissues, many rhinovirus strains would infect them. These conditions of lower temperature and pH normally exist in the upper respiratory tract. Rhinoviruses, however, are killed if the pH drops below 5.3, and therefore, they are usually destroyed in the human stomach. Many other viruses and some...

Microcheck 234

Many different kinds of infectious agents can produce the same symptoms and signs of respiratory disease. Emotional stress significantly increases the risk of contracting a cold, but exposure to cold temperatures probably does not. Persons suffering a cold are most likely to transmit it if symptoms are severe, and during the first few days of illness. Adenovirus infections can mimic colds, pinkeye, strep throat, and whooping cough. People who staff polar ice stations where they are isolated from other human contact for long periods often do not develop colds. Is this an expected observation Why or why not


Patient presents with fever, sore throat, and tender cervical adenopathy. Headache, nausea, vomiting, and abdominal pain are common. Marked erythema of throat is present, with hyperemic, exudative tonsils and palatal petechi-ae. Nasal congestion and rhinorrhea is usually absent. More common in late winter and early spring.

Thymic Factors

By promoting the formation of T lymphocytes, thymic factors are used to enhance T-lymphocytic functions. Thymic factors have been used with some success in clinical trials in patients with severe combined immunodeficiency, DiGeorge's or Nezelof's syndrome, and viral disorders. Studies with thymodulin show promise in treating symptoms in asthmatics and patients with allergic rhinitis. The primary consideration in the use of thymic factors for immunodeficiency states is the presence of T-lymphocyte precursors.

Survival skills

In my humble opinion, surviving and enjoying life as a parent is all about prioritizing. As parents ofchildren with autism, AS, AD HD or any other special needs, our priorities need to be slightly different from those ofother parents. As my boys have been so very ill at many times in their lives, I tend not to worry about coughs and colds and minor ailments. Whilst I feel sorry for them and do all I can to alleviate their symptoms, my priorities are slightly different and in the main, I deal with most ailments myselfunless I consider them life threatening.

Regulatory Issues

The explosion in popularity of herbs dates to the Dietary Supplement Health and Education Act of 1994 (DSHEA), in which the FDA recognized herbal preparations as dietary supplements outside of its direct regulatory control. The act was a compromise between the FDA and manufacturing lobbies brought about in large measure by increased public demand for herbal products. Instead of FDA regulation, these products now fall under the far less stringent Current Good Manufacturing Practice in Manufacturing, Packaging or Holding Human Food regulations. Unlike prescription pharmaceuticals, which must be proved safe and effective before being marketed, supplements do not have to be either safe or effective as long as they avoid therapeutic claims on the label. Neither are they policed in regard to delivering accurate doses, although some consumer-oriented organizations, such as Consumer Lab (, are starting to hold manufacturers more accountable through random testing and...


The purple coneflower Echinacea purpura, and its close relatives, E. angustifolia and E. pallida, are the source of the herb Echinacea, which is widely popular as a nonspecific immune stimulant. These perennials are native to the prairies of North America and are now widely grown garden ornamentals. The root and aerial parts of the plant are the portions used, and the preparation's potency can be verified by the transient tingling sensation produced when it is tasted. Echinacea contains alkamides, caffeic acid esters (echinacoside, cichoric acid, caftaric acid), polysaccharides (heteroxylan), and an essential oil. Some echinacea products are standardized for their echinacoside content. In the past, adulteration with American feverfew (Parthenium integri-folium) was common. Echinacea is now sold either by itself or in combination with golden seal or zinc for the treatment of colds and influenza.


There are numerous studies on echinacea in the literature, many of which indicate either an in vitro immune stimulation or a significant clinical reduction in the severity and duration of upper respiratory viral symptoms, especially when taken early in the onset of symptoms. Despite several of these meta-analyses concluding that echinacea is an effective immunomodulator of acute infection, there is still controversy as to the extent of its clinical effectiveness. A number of trials now clearly indicate that echinacea is unlikely to be effective in the prevention of colds, even if it may slightly shorten their course.

Viral Tonsillitis

The most common causes of upper respiratory tract infections and pharyngo-tonsillitis in the general population, including infants and young children, are viruses such as influenza virus, Coxsackie's virus (group A), adenovirus, and the ubiquitous herpes virus Ep-stein-Barr virus 205 . EBV infects epithelial cells and B-lymphocytes of Waldeyer's ring, which represent the reservoir for life-long viral persistence 104, 186 . Primary infections with EBV occur early in infancy and childhood in developing countries and are generally asymptomatic. In contrast, in developed countries, primary infection occurs in adolescents and young adults. EBV infections may cause the mostly self-limiting acute disease infectious mononucleosis, affecting adolescents and young adults in the western world. In Japan, however, an endemic area for EBV, acute cases of infectious mononucleosis are commonly diagnosed in children less than 4 years of age 100 . The symptoms include enlarged swollen palatine tonsils,...

Lupus pneumonitis

Lupus pneumonitis may present as either an acute or a chronic illness. Lupus pneumonitis is rarer than pulmonary hemorrhage, with an incidence ranging from 1.5 to 9 per cent. In several reported cases, lupus pneumonitis has been the first manifestation of the disease. The pathophysiology of both acute and chronic lupus pneumonitis involves deposition of immune complexes in the blood vessels and alveolar walls with or without associated vasculitis. Acute lupus pneumonitis is reported to occur more frequently during the immediate postpartum period in women who have SLE. It is usually accompanied by other manifestations of SLE. It mimics acute lung infection so that an infectious etiology for respiratory illness should be excluded. Acute lupus pneumonitis is characterized by the acute onset of dyspnea, high fever, and cough, with occasional hemoptysis. Physical findings are minimal unless hypoxia is severe enough to cause cyanosis. A slightly elevated

Glucocorticoids GC

Recent studies have shown that intact budesonide (25) after inhalation binds primarily to available steroid receptors, and mainly excess unbound budesonide is esterified 76,77 . Esterification of budesonide is a rapid process. Thus, in the rat, within 20 minutes of inhalation of radiolabeled budesonide, approximately 80 of the radioactivity within the trachea and main bronchi was associated with budesonide esters, primarily budesonide oleate 78 . The efficacy of topical glucocorticoids in rhinitis and asthma is likely to depend on drug retention in the airway mucosa. With fluticasone propionate (28), retention may be achieved exclusively by its inherent lipophilicity, whereas for budesonide an additional possibility may be provided by its ability to form fatty acid esters in the airway mucosa that release the active drug 79 . Recent studies have investigated the role of inhaled corticosteroids in the long-term management of chronic obstructive pulmonary disease (COPD) 80,81 . This...