Rhinitis Ebook

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Uncomplicated Upper Respiratory Infectioncommon Cold

Uncomplicated upper respiratory infections (URIs) are characterized by rhinorrhea, nasal congestion, sneezing, sore or scratchy throat, and cough (1). The incubation period varies between 48 and 72 h. In some cases a low-grade fever is present, but temperature elevation in adults is rare. The early symptoms may be minimal and limited to malaise and nasal symptoms. The nasal discharge is initially clear and watery. There is a subsequent transition period where the nasal discharge becomes viscous, opaque, and discolored (white, yellow, green) (2). The color of the secretions is not predictive of a bacterial infection. The clinical presentation is similar in both adults and children. The episode tends to be self-limited. The median duration of a cold is 1 wk, with most patients improving by the 10th day, but lingering symptoms may last up to 2 wk. URIs, or the common cold, are exactly as the name implies common. URIs are consistently one of the five most common diagnoses in ambulatory...

Immunoglobulin E Cytokines and Chemokines in Rhinitis

Several workers have reported the local production of IgE in patients with a negative skin-prick test (Huggins and Brostoff, 1975), and in a proportion of people who are now classified as having nonallergic or idiopathic rhinitis (Powe et al., 2001, 2003). Several groups have proposed that the nasal mucosa has the ability to produce allergen-specific IgE locally (Huggins and Brostoff, 1975 Kleinjan et al., 2000 Powe et al., 2001).There may be mechanisms other than allergy that can produce eosinophilia. For example, the common cold has been shown to produce a prolonged influx of IgE receptor-bearing eosinophils in patients with allergic rhinitis (Van Benton et al., 2001). Are the mucosal changes the aftermath of an infection that has upregulated cy-tokines (Kramer et al., 2000), resulted in chemokines such as eotaxin-2 (Jahnsen et al., 1999 Murdoch and Finn, 2000), and altered the genetic expression of mucus (Voynow et al., 1998) or the production of proteoglycans (Lee et al., 2001)...

Rhinitis Common Cold

The classic common cold (coryza) is marked by copious watery nasal discharge and obstruction, sneezing, and perhaps a mild sore throat or cough, but little or no fever. All colds are viral. Rhinoviruses are the major cause, several serotypes being prevalent year-round and accounting for about half of all colds. Coronaviruses are responsible for about another 15 , mainly those occurring m the winter months. Certain enteroviruses, particularly coxsackieviruses A21 and A24 and echoviruses 11 and 20, cause febrile colds and sore throats, especially in the summer. In children, respiratory syncytial virus (RSV), parainfluenza viruses, and the low-numbered adenoviruses are between them responsible for up to half of all upper respiratory tract infections (URTJ).

Nonprescription Drugs

Nonprescription drugs are drugs that are designated by the FDA to be safe (if taken as directed) and obtained without a prescription. These drugs are also referred to as over-the-counter (OTC) drugs and may be purchased in a variety of settings, such as a pharmacy, drugstore, or in the local supermarket. OTC drugs include those given for symptoms of the common cold, headaches, constipation, diarrhea, and upset stomach.

Viruses and the immune system

Viruses come in many different forms, and the Baltimore Classification identifies viruses according to the nature of the genetic material they contain. Viruses can contain, for example, (a) double-stranded DNA (typically 5000 base pairs (bp) to 300 000 bp), (b) single-stranded DNA, (c) double-stranded RNA, (d) positive sense single-stranded RNA, and (e) negative sense single-stranded RNA. Of these, the positive sense single-stranded RNA class is the best known to humans, causing the common cold (rhinoviruses) and meningitis (enterovirus). A viral infection is dangerous to an organism because, if the infection goes unchecked, a sufficiently large number of cells can be killed which leads to the organism as a whole dying. An example of HIV (human immunodeficiency virus, considered to be the main cause of AIDS (Acquired Immunodeficiency Syndrome)), is provided in Figure 2.10.

Display 72 Lactamase Inhibitor Combinations

Goldenseal, also called Hydrastis canadensis, is an herb found growing in the certain areas of the northeastern United States, particularly the Ohio River Valley. Goldenseal has long been used alone or in combination with echinacea for colds and influenza. However, there is no scientific evidence to support the use of goldenseal for cold and influenza or as a stimulant as there is for the use of echinacea (see Chap. 54). Similarly, goldenseal is touted as an herbal antibiotic,although there is no scientific evidence to support this use either. Another myth surrounding goldenseal's use is that taking the herb masks the presence of illicit drugs in the urine.

Local Spread on Epithelial Surfaces

Restriction of infection to an epithelial surface cannot be equated with lack of severity of clinical disease. Large areas of intestinal epithelium may be damaged by rotaviruses, lor example, causing severe diarrhea. The severity of localized infections of the respiratory tract depends on their location infections of the upper respiratory tract may produce rhinitis but few other signs infection of the bronchioles or alveoli produces more severe respiratory distress and may predispose to secondary bacterial invasion.

Optimize the Immediate Preoperative Condition

Check that the patient has had maximum preoperative medical treatment. It is surprising how often this is overlooked. Reducing the amount of inflammation at the time of surgery will make the operative field easier work in and will enable the surgeon do a safer and better job. The patient with infective rhinosinusitis should have had at least a minimum of 2 weeks of a broad-spectrum antibiotic with anaerobic cover for example, coamoxiclav or cefuroxime and metronida-zole (Fig. 8.4). For allergic rhinitis, the current ARIA guidelines summarize the best medical treatment (see Chapter 3, Table 3.1). It is particularly important to check compliance with topical nasal steroids. In severe nasal polyposis, and in particular when polyps lie medial to the middle turbinate and there is a reduction or absence of sense of smell, a course of oral steroids in the week before surgery should help reduce surgical damage to the olfactory mucosa. Oral steroids should be given as long as there are no...

Defect in CD40L Protein

Mutation in the gene coding for CD40L causes hyper-IgM syndrome (X-HIM), a severe immunodeficiency. Subjects have low levels oflgG, IgA, and IgE in serum but normal levels of IgM. Other anatomic defects are also present in humans and knock-out mice (Table 4). Patients suffer from increased upper respiratory tract infections and increased susceptibility to Pneumocystis and Cryptosporidium. Recurrent infections with these organisms are typically associated with T-cell defects (Fischer and Arnaiz-Villena, 1995).

How To Communicate the Benefits and Risks of Surgery to the Patient

It is very helpful to have the patient's CT scans with you to illustrate what is happening in their sinuses and what procedure is planned, and to show the proximity of the orbit and brain when discussing possible complications (Fig. 9.1). An alternative is to have a diagram of the sinuses available. We normally describe sinus surgery to patients who have little medical knowledge as plumbing of the sinuses. Another analogy that patients understand is describing the sinuses as 14 little rooms connected by corridors on either side, and sinus surgery as like these being converted into a big hall on each side (Fig.9.2a, b). We say that surgery helps drainage, reduces the surface area from which polyps can form, and allows access to topical nasal medication. However, it is important to emphasize that surgery is not always a cure for all of the patient's symptoms, particularly in the presence of allergic rhinitis or when the patient also has late-onset asthma.

Classic Infectious Disease

Infecting most individuals in early and late childhood, respectively (Gardner, 1973 Padgett and Walker, 1973 Taguchi et al., 1982). BKV is thought to cause mild respiratory illness, which would correlate with its appearance in the population at early ages (Goudsmit et al., 1981, 1982 Hashida et al., 1976 Min-inberg et al., 1982 Padgett et al., 1983). Indeed, both viruses can be detected in tonsillar tissue, and JCV has been shown to infect tonsillar lymphocytes and stromal cells (Goudsmit et al., 1982 Monaco et al., 1998a,b). The viruses then disseminate and establish a subclinical, persistent infection in the urinary tract and lymphocytes (and, for JCV, the brain). To obtain overt disease, the individual usually must be immunocompromised. Most commonly affected are patients with AIDS or transplant recipients taking immunosuppressive drugs. The pathology of the disease is thought to be due to destruction of the infected tissue due to viral replication. The molecular mechanisms of...

Vasculitis cutaneous See also Cha Eter32

Henoch-Schonlein purpura occurs primarily in children and young adults following an upper respiratory tract infection. Purpuric lesions develop over the extensor surfaces and buttocks. Edema of the lower legs is common edema of the hands, scalp, and periorbital areas occurs in young children. Arthritis, abdominal pain, gastrointestinal bleeding, and renal involvement presenting as proteinuria and hematuria are other features. Serum complement levels are usually normal. Immunofluorescent staining of skin biopsy specimens of early lesions reveals mainly immunoglobulin A and complement deposition in the walls of affected vessels.

Preadministration Assessment

When a patient is to have nose drops instilled for nasal congestion, the nurse examines the nasal passages and describes the type of secretions present in the nose. The nurse also should obtain the blood pressure because nose drops that contain adrenergic drugs are not given to those with high blood pressure.

Educating the Patient and Family

When a nasal decongestant (drops or spray) containing an adrenergic drug has been recommended or prescribed, the nurse shows the patient or family member the correct method of instillation. The nurse explains possible adverse effects and the importance of adherence to the dose regimen prescribed by the primary health care provider. Because many nasal deconges-tants are over-the-counter (OTC) drugs, the nurse advises patients using them that these drugs are con-traindicated in those with high blood pressure and that overuse can increase nasal congestion (rebound congestion).

Preoperative Considerations Patient Selection

A medical history should focus on the patient's urologic history along with surgical risks and concomitant medical problems. Urologic history should include a history of sexually transmitted diseases, kidney stones, trauma, previous catheterizations, genitourinary cancer, renal insufficiency, neurologic disease, and neurogenic bladder. Medical conditions that may influence bladder functioning include diabetes and neurologic diseases. Surgical risks predominantly are the result of renal failure, coronary artery disease, and cerebrovascular disease. Medicines containing a-sympathomimetics, including over-the-counter cold remedies, enhance bladder outlet obstruction. A family history should focus on a history of urologic cancer, and a social history should focus on risks for cancer such as smoking and occupational exposure.

Blocking Attachment or Uncoating of Virion

X-Ray crystallography has provided detailed information on the binding site of a wide range of antiviral agents that block uncoating of picornaviruses. Many of the studies to date have used human rhinovirus type 14 (HRV-14) as a model. Most of the drugs, in spite of their diversity of chemical structure, bind to the same site on HRV-14, namely, a hydrophobic pocket which lies immediately beneath the floor of the canyon that comprises the ligand (receptor-binding site) on the viral capsid protein VP1. Hydrophobic interactions result in deformation of the canyon floor which may inhibit attachment of the virion to its cell receptor but, more importantly, inhibits uncoating of the virion. This is thought to occur by locking VP I into a position that prevents the disassembly of the virion which normally occurs in the acidic environment of the endosome. When administered prophylactically, but not therapeutically, some such antivirals have been claimed to reduce the symptoms of the common...

Summary Drug Table Antidepressants

Effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea effects (dry mouth, dry eyes, urinary retention), nausea, nasal congestion, blurred vision, orthostatic hypotension, lethargy, confusion, constipation, diarrhea urinary retention), nausea, nasal congestion, blurred vision,...

Adverse Reactions

Administration of these drugs may result in a wide variety of adverse reactions. The adverse reactions seen with the use of some of these drugs may include sedation, hypotension, postural hypotension, dry mouth, nasal congestion, photophobia (an intolerance to light), urticaria, photosensitivity (abnormal response or sensitivity when exposed to light), behavioral changes, and headache. Photosensitivity can result in severe sunburn when patients taking antipsychotic drugs are exposed to the sun or ultraviolet light.

And Laboratory Investigations

Most children with Hurler syndrome manage to walk, but develop only limited language skills. They have a characteristic appearance. Prominent features are relative macrocephaly, a prominent forehead, coarse facial features, hypertelorism, flat nasal bridge, prominent bushy eyebrows, thick and dry hair, hir-sutism, thick skin, enlarged tongue, hypertrophic gums, short and broad hands with stubby fingers, short and broad feet, exaggerated lumbar lordosis, thoracic kyphosis, and a protuberant abdomen, frequently with umbilical and inguinal hernias. On physical examination hepatosplenomegaly is found. Patients experience increasing joint stiffness and limitation of joint mobility, which may begin in early infancy. The preferentially affected joints are shoulders, fingers, and wrists. Deformities become apparent with claw hands and flexion contractures of elbows and knees. Vision becomes impaired due to progressive corneal clouding. Glaucoma, optic atrophy, and pigmentary retinal...

Specific Forms Of Human Allergy

Descriptions of what is almost certainly hay fever (allergic rhinitis) date almost as far back as the beginning of written history. But despite its name, hay fever is not a fever, and only rarely is it caused by hay It is most often caused by pollens or other plant-associated products carried by wind allergies truly can be due to something in the air. In North America, one of the most serious offenders is ragweed, a plant that spreads its pollen throughout much of the summer and early autumn. But allergic rhinitis can be caused by any airborne allergen chemicals, dust, microbial spores, animal dander, fibers, or insect parts in addition to pollen. As the term allergic rhinitis implies, the nose is a particularly sensitive target. The nose is unusually rich in small blood vessels and secretory glands, related to its role in warming and moistening incoming air. Even in the absence of an allergic reaction, the nose may secrete as much as a quart of water Hay fever-like symptoms caused by...

Contraindications

A decongestant is a drug that reduces swelling of the nasal passages, which, in turn, opens clogged nasal passages and enhances drainage of the sinuses. These drugs are used for the temporary relief of nasal congestion caused by the common cold, hay fever, sinusitis, and other respiratory allergies.

Specific Immunotherapy

Specific immunotherapy to specific allergens induces allergen-specific anergy in peripheral T lymphocytes and this appears to be due to IL-10 production by Tr1 cells, followed by its production from monocytes.78 Endogenous IL-10 switches off the production of specific IgE and IgG4. IL-10 acts directly T cells by suppressing the CD28 co-stimulation signal transduction via tyrosine phosphorylation of CD28. Immunotherapy results in increased numbers ofTr1 cells that secrete both IL-10 and TGF-P, resulting in suppression of Th2-driven allergic inflammation.80 Grass pollen immunotherapy in seasonal rhinitis results in increased IL-10 production and this is expressed predominantly in CD4+CD25+ T cells that are a variant of regulatory T cells.81

Antibody Responses Against Different Pathogenic Fungi

H. capsulatum is a dimorphic fungus and is the most prevalent cause of fungal respiratory disease, infecting approximately 500,000 individuals in the US each year (Cano and Hajjeh, 2001). Infection usually results in a mild, often asymptomatic respiratory illness, but may progress to life-threatening systemic disease, especially in individuals with AIDS (Graybill, 1988). The clinical manifestations are principally caused by intracellular yeast forms that parasitize mammalian phagocytes.

Treatment Of Sleep Apnoea And Snoring

Nasal CPAP is an effective treatment, but compliance is variable (94,95), ranging between 40 and 80 . Problems affecting compliance with nasal CPAP include a sense of claustrophobia, mask air leaks, nasal congestion and dryness of the mouth and throat (usually associated with mask or mouth air leaks), and the inconvenience of using a machine. Patients with mild disease or those requiring high pressures are most likely to be non-compliant. Obese patients generally require higher CPAP pressures (96).

Iral Diseases of the Respiratory Tract

Respiratory infections are the most common afflictions of humans, and most are caused by viruses. Children contract on average about half a dozen respiratory illnesses each year, and adults perhaps two or three. Admittedly these are mainly trivial colds and sore throats, but they account for millions of lost working hours and a significant proportion of all visits to family physicians. More serious lower respiratory tract infections tend to occur at the extremes of life, and in those with preexisting pulmonary conditions. The most important human respiratory viruses are influenza and respiratory syncytial viruses (RSV), the former killing mainly the aged and the latter the very young. Of the estimated 5 million deaths from respiratory infections in children annually worldwide, at least 1 million are viral in origin. Whereas some viruses have a predilection for one particular part of the respiratory tract, most are capable of causing disease at any level, and the syndromes to be...

Branchedchain Fatty Acids

Dihydrosterculic Acid

Echinacea consists of the dried roots of Echinacea purpurea, E. angustifolia, or E. pallida (Compositae Asteraceae), herbaceous perennial plants indigenous to North America, and widely cultivated for their large daisy-like flowers, which are usually purple or pink. Herbal preparations containing the dried root, or extracts derived from it, are promoted as immunostimulants, particularly as prophylactics and treatments for bacterial and viral infections, e.g. the common cold. Tests have validated stimulation of the immune response, though the origins of this activity cannot be ascribed to any specific substance. Activity has variously been assigned to lipophilic alkylamides, polar caffeic acid derivatives, high molecular weight polysaccharide material, or to a combination of these. Compounds in each group have been demonstrated to possess some pertinent activity, e.g. immunostimulatory, anti-inflammatory, antibacterial or antiviral effects. The alkylamides comprise a complex mixture of...

In A Study Of Intraobserver Variablity In The Assessment Of Cervical Smears3325 Slides Were Screened

3.13 Medical research has concluded that people experience a common cold roughly two times per year. Assume that the time between colds is normally distributed with a mean of 160 days and a standard deviation of 40 days. (a) What is the probability of going 200 or more days between colds Of going 365 or more days

The Laurel Family Lauraceae

Camphor has been used since ancient times. This evergreen tree, native to China, Japan, and Taiwan, is the main source of camphor essence still used in cold remedies and inhalants, insecticides, and perfumes. The essence is distilled from wood chips. Camphor trees are smog resistant, and some American cities and towns with milder climates have been using them as street trees.

Severe Congenital Neutropenia and Kostmann Disease

During the first year of life, omphalitis, otitis media, upper respiratory tract infections, pneumonitis, skin abscesses, and liver abscesses occur commonly with positive cultures for staphylococci, streptococci, Pseudomonas, Peptostreptococcus, and fungi. Splenomegaly may be present. Other manifestations include the following

Human Relevance of Viruses

Nuclear Polyhedrosis Virus

The economic impact of viruses in both third-world and industrialized countries is enormous. The annual loss in work time due to common cold and influenza viruses alone amounts to millions of hours. While discomfort, adverse effects on employment, and even deaths due to viral diseases, such as chicken pox, measles, German measles, mumps, and yellow fever, have declined dramatically since immunizations against the diseases became widespread, they still take their toll. Another viral disease, infectious hepatitis, periodically still claims victims. Guillain-Barre syndrome and Epstein-Barr are debilitating diseases caused by viruses that are apparently carried by nearly everybody, but what triggers them into action is as yet still unknown.

The role of unconscious phantasy

Klein placed great emphasis on the person's subjective experience over the impact of real events. A central tenet of her theory is the notion of unconscious phantasy. An unconscious phantasy is the mental representation of an experience or need. Klein maintained that from birth all our bodily impulses and emotional experiences have a mental representation in the form of phantasies, which colour our evolving inner life, that is, our internal world, and affect our experience of the external world. For example, one of my patients experienced any physical ill health, however minor, in a very paranoid manner. When she became ill, she often attributed the cause of her colds or flu, for example, to her careless manager who was not monitoring the office water supply or her partner who had prepared food that she believed was past its sell-by date. In other words, whenever she was ill the underlying phantasy that was activated was that she was being poisoned by another person rather than that...

Case Study for Chapter

A 6-year-old boy is brought to the pediatrician by his mother because of a puffy face and lethargy. A few weeks before, he had an upper respiratory tract infection, probably caused by a virus. Body temperature is 36.8 C blood pressure, 95 65 and heart rate, 90 beats min. Puffiness around the eyes, abdominal swelling, and pitting edema in the legs are observed. A urine sample (dipstick) is negative for glucose but reveals 3+ protein. Microscopic examination of the urine reveals no cellular elements or casts. Plasma Na+ is 140 mEq L BUN, 10 mg dL glucose , 100 mg dL creatinine, 0.8 mg dL serum albumin, 2.3 g dL (normal, 3.0 to 4.5 g dL) and cholesterol, 330 mg dL. A 24-hour urine sample has a volume of 1.10 L and contains 10 mEq L Na+, 60 mg dL creatinine, and 0.8 g dL protein.

Isolated angiitis of the central nervous systen is a recently recognized vasculitic disorder primarily involving the

Churg-Strauss syndrome is a rare disorder characterized by hypereosinophilia, systemic vasculitis, and necrotizing granulomatous inflammation that occurs in people with asthma and allergic rhinitis. Pulmonary infiltrates occur in up to 90 of patients, and a cutaneous eruption is seen in 70 . Cardiac manifestations (pericarditis, cardiomyopathy, and myocardial infarction) account for about half of deaths. Peripheral neuropathy is found in 70 of patients its occurrence in susceptible patients is highly suggestive of CSS. Renal disease, seldom seen, is generally mild. XVI. Henoch-Schonlein purpura is the most common vasculitis of childhood. Half of the time, it is preceded by an upper respiratory tract infection, but the etiology remains unknown. Boys and girls are affected equally. The median age of onset is 4 years. It follows a self-limiting course in most patients. HSP can accompany familial Mediterranean fever in those regions where the latter is endemic.

Clinical Aspects of PPHN

As described above, autopsy studies of fatal PPHN demonstrate severe hypertensive structural remodeling even in newborns who die shortly after birth, suggesting that many cases of severe disease are associated with chronic intrauterine stress (Fig. 3B). However, the exact intrauterine events that alter pulmonary vascular reactivity and structure are poorly understood. Epidemiologic studies have demonstrated strong associations between PPHN and maternal smoking and ingestion of cold remedies that include aspirin or other non-steroidal anti-inflammatory products (83). Since these agents can induce partial constriction of the DA ), it is possible that pulmonary hypertension due to DA narrowing contributes to PPHN (see below). Other perinatal stresses, including placenta previa and abruption, and asymmetric growth restriction, are associated with PPHN however, most neonates who are exposed to these prenatal stresses do not develop PPHN. Circulating levels of L-arginine, the substrate for...

Immediate Hypersensitivity

Wheel And Flare Allergy Skin Test

Immediate hypersensitivity can produce allergic rhinitis (chronic runny or stuffy nose) conjunctivitis (red eyes) allergic asthma atopic dermatitis (urticaria, or hives) and other symptoms. These symptoms result from the immune response to the allergen. In people who are not allergic, the allergen stimulates one type of helper T lymphocyte, the TH1 cells, to secrete interferon-y and inter-leukin-2. In people who are allergic, dendritic cells stimulate the other type of helper T lymphocytes, the TH2 cells, to secrete other lymphokines, including interleukin-4 and interleukin-13. These, in Allergens that provoke immediate hypersensitivity include various foods, bee stings, and pollen grains. The most common allergy of this type is seasonal hay fever, which may be provoked by ragweed (Ambrosia) pollen grains (fig. 15.28a). People who have chronic allergic rhinitis and asthma because of an allergy to dust or feathers are usually allergic to a tiny mite (fig. 15.28b) that lives in dust and...

Respiratory Syncytial Virus

Oxygen Tent For Infant 1960s

The commonest manifestation of RSV infection in all age groups is a febrile rhinitis and or pharyngitis with limited involvement of bronchi However, the consequences may be much more serious in certain babies between the second and sixth months of life. Almost 1 of all babies develop an RSV infection severe enough to require admission to hospital, and of these about 1 die, particularly those with congenital heart defects, bronchopulmonary dysplasia, very low birth weight, or immunodeficiency. Characteristically, an infant with rhinorrhea develops a pronounced cough and wheezing, progressing to dyspnea with a markedly elevated respiratory rate and hypoxemia (Fig. 28-7). Death may occur very rapidly and may account for a proportion of cases of the so-called sudden infant death syndrome (SIDS). RSV infections in children also frequently involve the middle ear, making this virus the most important causal agent of otitis media. Of the children who recover from a severe pulmonary infection...

Early Asthmatic Reactions in the Lung

Asthma is a disease characterized by partial airway obstruction that is reversible either spontaneously or with treatment. Up to 80 of patients with asthma have positive skin tests to common aeroallergens such as pollens or grasses. Over 75 of asthmatic patients have associated rhinitis (Nelson, 1985).

Clinical Aspects Immunity

Hypersensitivity is a harmful overreaction of the immune system, commonly known as allergy. In cases of allergy, a person is more sensitive to a particular antigen than the average individual. Common allergens are pollen, animal dander, dust, and foods, but there are many more. A seasonal allergy to inhaled pollens is commonly called hay fever. Responses may include itching, redness or tearing of the eyes (conjunctivitis), skin rash, asthma, runny nose (rhinitis), sneezing, urticaria (hives), and angioedema, a reaction similar to hives but involving deeper layers of tissue.

Clinical Symptoms And Occurrence Of Complement Activationrelated Pseudoallergy

Common allergic symptoms Anaphylactic shock, angioedema, asthma attack, bronchospasm, chest pain, chill, choking, confusion, conjunctivitis, coughing, cyanosis, death, dermatitis, diaphoresis, dyspnoea, edema, erythema, feeling of imminent death, fever, flush, headache, hypertension, hypotension, hypoxemia, low back pain, lumbar pain, metabolic acidosis, nausea, pruritus, rash, rhinitis, skin eruptions, sneezing, tachypnea, tingling sensations, urticaria, and wheezing Unique symptoms

Respiratory Syncytial Virus Infection Control Guidelines

Include nasal congestion and cough with a more severe and prolonged course as compared to colds caused by other respiratory viruses. RSV appears to be an increasing cause of respiratory disease in this population, especially those in nursing care facilities. During outbreaks, the attack rate ranges from 10 to 40 and accounts for 5-27 of all respiratory tract infections in long-term care facilities. Individuals over the age of 60, typically, present with mild nasal congestion, but fever, anorexia, pneumonia, or bronchitis may develop (55-57).

Advances in Medical Management

It is said that to be a good surgeon you also have to be a good physician. Surgical maneuvers cannot cure the majority of patients with noninfective nasal polyps, any more than they can cure allergic rhinitis. Advances in instrumentation, computer-aided surgery, and optics may refine surgical techniques, but it seems likely that the main advances will come through research into the etiology and pathological mechanisms of allergic and idiopathic rhinitis and nasal polyposis, and the development of new medical therapies.

Localized Anaphylaxis Atopy

In localized anaphylaxis, the reaction is limited to a specific target tissue or organ, often involving epithelial surfaces at the site of allergen entry. The tendency to manifest localized anaphylactic reactions is inherited and is called atopy. Atopic allergies, which afflict at least 20 of the population in developed countries, include a wide range of IgE-mediated disorders, including allergic rhinitis (hay fever), asthma, atopic dermatitis (eczema), and food allergies. ALLERGIC RHINITIS The most common atopic disorder, affecting 10 of the U.S. population, is allergic rhinitis, commonly known as hay fever. This results from the reaction of airborne allergens with sensitized mast cells in the conjuncti-vae and nasal mucosa to induce the release of pharmacologically active mediators from mast cells these mediators then cause localized vasodilation and increased capillary permeability. The symptoms include watery exudation of the con-junctivae, nasal mucosa, and upper respiratory...

Families of RNA Viruses

Picornavirus Shape

The Picornavirtdae (pica, micro-micro rrn, sigla for ribonucleic acid) comprise small nonenveloped icosahedral viruses 25-30 nm in diameter, which contain a single molecule of plus sense ssRNA (7.5-8.5 kb), and replicate in the cytoplasm (see Table 2-2). The genus Enterovirus includes 3 polio-viruses, 32 human echoviruses, 29 coxsackieviruses, and a few other human enteroviruses. Most of these viruses usually produce inapparent enteric infections, but the polioviruses may also cause paralysis other enteroviruses are sometimes associated with meningoencephalitis, rashes, carditis, myositis, conjunctivitis, and mild upper respiratory tract disease. The only human pathogen in the genus Hepatovirus is human hepatitis A virus. The genus Rhhiovirus includes well over 100 serotypes that affect humans they are the most frequent viruses causing the common cold. The coronaviruses (coraim, crown) are somewhat pleomorphic viruses 75-160 nm in diameter, with widely spaced, pear-shaped peplomers...

Overuse And Misuse Of Antibiotics

Patient expectations for receiving antibiotics play an important role in the overuse of antibiotics. For example, discolored nasal discharge is a normal self-limited phase of a viral upper respiratory tract infection (URI). Randomized placebo-controlled trials have shown no significant effect of antibiotics on purulent rhinitis or discolored nasal discharge (2). The color of sputum is not related to the effectiveness of antibiotics in the treatment of acute bronchitis (3). However, when patients were presented with a scenario of a clinical syndrome that was consistent with, although not labeled as, a common cold that was 5 d in duration and accompanied by sore throat, cough, and runny nose with discolored (yellow, green, brown) nasal discharge, 79 thought that antibiotics would be effective (4).

Novel Therapeutic Strategies

Mucociliary Transport Rhinitis

It has been suggested that there is a balance in an individual's helper T-cell response between TH1 cells and Th2 cells (Berger, 2000). TH1 cells produce cytokines that produce the pro-inflammatory responses responsible for killing intracellular parasites and for perpetuating autoimmune responses. TH2 cells produce cytokines associated with the promotion of IgE and eosinophilic responses in atopy (Fig. 16.2). It has been suggested that in allergic rhinitis and seasonal asthma, an individual with a genetic predisposition toward a TH2-biased immune system could move away from this bias if exposed to certain environmental stimuli early in life (Openshaw and Walzl, 1999 Openshaw and Hewitt, 2000). Early exposure to microbial agents may be the appropriate stimulus causing the immune system in these individuals to move toward a TH1-depend-ent system (Strachan et al., 2000). Without this biological programming, the bias would persist and the individual would tend toward a TH2-dependent...

Mast Cells And Basophils

Mast Cells Fungi

Mast cells and basophils are responsible for the initiation of IgE-mediated hypersensitivity responses. Many fungal organisms produce allergens that result in allergic fungal diseases including rhinitis, fungal sinusitis, asthma, and allergic bronchopulmonary mycosis (ABPM). These diseases are associated with elevated serum and fungal specific IgE, and by implication, type-1 hypersensitivity (Horner et al. 1995 Bush et al. 2004 Khun and Swain 2003 Kurup 2000). Although it is presumed that IgE-mediated mast cell and basophil reactions are central to fungal allergy, the strict requirement for IgE-mediated reactions is still debated. There is even more limited information on the contribution of mast cells or basophils to host defense against fungal pathogens, though there is the potential to regulate immune responses. Overall, in the host response to fungi, mast cells and basophils make versatile contributions to allergy, inflammation and host defense (Figure 1).

Viruses Bacteria and Fungi

Viruses are known chiefly for their capacity to produce disease. A number of human ailments are caused by viruses polio, influenza, chicken pox, smallpox, measles, mumps, yellow fever, warts, and the common cold are among these. Much evidence points to viruses as also causing some cancers.

Mechanisms of Survival of Viruses in Nature

Seasonal differences in social activities may also markedly influence the opportunities for transmission of viruses, especially by the respiratory route. Although experience in the Arctic and Antarctic show that cold weather alone is not enough to cause colds and other respiratory infections, the crowding into restricted areas and ill-ventilated vehicles and buildings that occurs in temperate climates in winter promotes the exchange of respiratory viruses. In places subject to monsoonal rains, the onset of the rains early in summer is accompanied by greatly reduced movement of people, both in daily affairs The situation is different with viral infections that are localized to mucosal surfaces such as the respiratory tract, since mucosal immunity is relatively short-lived. A large number of serotypes of rhinoviruses and a few serotypes of corona viruses and enteroviruses can produce superficial infections of the mucous membrane of the upper respiratory tract. The seemingly endless...

Specific Inanimate And Animate Vectors

Colonized bum wounds with multiply resistant S. aureus (MRSA) heavily contaminate their immediate environment (48,49), leading to cross-infections in other patients in the unit. Similarly patients having pneumonia with MRSA can heavily contaminate their surroundings (14). While health care worker colonization with MRSA is infrequently a source of patient infections, certain health care workers do seem to have a tendency toward shedding the organism into the environment and transmitting the resistant bacteria to patients (50,51). Such transmission appears to be more likely when the health care worker has an upper respiratory tract infection or chronic dermatitis.

Viral Damage to Tissues and Organs

Diarrhea Rotavirus

As well as having direct adverse effects, viral infections olten predispose epithelia to secondary bacterial infections, increasing the susceptibility of the respiratory tract, for example, to bacteria that are normal commensals in the nose and throat (see Fig. 9-1). Thus, infections with influenza virus may destroy ciliated epithelia and cause exudation, allowing pneumococci and other bacteria to invade the lungs and cause secondary bacterial pneumonia, which is often the cause of death in elderly people suffering from influenza. Conversely, proteases secreted by bacteria may activate influenza virus infec-tivity by proteolytic cleavage of the hemagglutinin. Rhinoviruses and respiratory syncytial virus damage the mucosa of the nasopharynx and sinuses, predisposing to bacterial superinfection which commonly leads to purulent rhinitis, pharyngitis, sinusitis, and sometimes otitis media. Similarly, in the intestinal tract, rotavirus infections may lead to an increase in susceptibility...

Diseases of the respiratory system J00J99

_ Vasomotor and allergic rhinitis Includes spasmodic rhinorrhoea Excludes allergic rhinitis with asthma ( J45.0 ) rhinitis NOS ( J31.0 ) J30.0 Vasomotor rhinitis J30.1 Allergic rhinitis due to pollen J30.2 Other seasonal allergic rhinitis J30.3 Other allergic rhinitis Perennial allergic rhinitis J30.4 Allergic rhinitis, unspecified _ Chronic rhinitis, nasopharyngitis and pharyngitis J31.0 Chronic rhinitis Rhinitis (chronic) Excludes rhinitis

Parainfluenza Viruses

Parainfluenza viruses are common human respiratory pathogens, in the main they produce relatively harmless upper respiratory tract infections (URTI), but they are also the commonest cause of a more serious condition in young children known as croup and occasionally cause pneumonia. Human parainfluenza virus types 1 and 3 belong to the genus Paramyxovirus, whereas types 2, 4a, and 4b are now classified with mumps virus in the genus Rubulavirus.

Confirm the Diagnosis

Turbinate Hypertrophy

Patients with genuine chronic bacterial rhinosinusitis who do not respond to medical treatment are often helped by surgery, unless they are immuno-suppressed, when caution is needed (Fig. 8.1). It is important to make sure as far as possible that your patient has a diagnosis that is likely to respond, at least in part, to surgical intervention. Operating on a patient who has only allergic rhinitis is very unlikely to help them (Fig. 8.2). If their CT is normal or shows turbinate hypertrophy without evidence of sinus disease, retake

Coronavirus Replication and Viral Maturation

Common cold-coronaviruses cause an everyday variety of respiratory infections, which are restricted to the ciliated epithelia of the nose and trachea. They are responsible for about 30 of common cold infections. Diagnosis.The common-cold coronavirus can be grown in organ cultures of human tracheal tissue or in human diploid cells. Isolating the viruses for diagnostic purposes is not routine. Serodiagnosis (complement-binding reaction, immunofluorescence or enzyme immunoassay) and electron microscopy are feasible methods.

The Mint Family Lamiaceae

Mint oils have been used medicinally and as an antiseptic in different parts of the world. Mohegan Indians used catnip tea for colds, and dairy farmers in parts of the midwestern United States used local mint oils to wash their milking equipment before antibiotics became popular for this purpose. As a result, mastitis, a common disease of dairy cattle, was seldom encountered in their herds. Horehound, a common mint weed of Europe, has become naturalized on other continents and is cultivated in France. A leaf extract is still used in horehound candy and cough medicines. In England, it is a basic ingredient of horehound beer. Vinegar weed, also known as blue curls, is a common fall-flowering plant of western North America. Native Americans of the area used it in cold remedies, for the relief of toothaches, and in a bath for the treatment of smallpox. It was also used to stupefy fish.

Chlamydia psittaci Ornithosis Psittacosis

After an incubation period of one to three weeks, ornithosis presents with fever, headache, and a pneumonia that often takes an atypical clinical course. The infection may, however, also show no more than the symptoms of a common cold, or even remain clinically silent. Infected persons are not usually sources of infection.

Vaccine May Be the Only Way to Stop the Hivaids Epidemic

Most vaccines prevent infection by viruses that show little variation. The instability of its genome differentiates HIV-1 from most viruses for which successful vaccines have been developed. With the exception of influenza, for which the vaccines must be changed periodically, most viruses that can be controlled by immunization show only minor variability in structure. For comparison, consider that the rhinoviruses that cause the common cold have more than 100 subtypes therefore no effective vaccine has been developed. HIV-1 shows variation in most viral antigens and the rate of replication may be as high as 109 viruses per day. This variability along with the high rate of replication allows the production of viruses with multiple mutations some of these allow escape from immunity. The fact that significant differences in viral-envelope protein sequences have been seen in viral iso

Type I Hypersensitivities Can Be Controlled Medically

Eliminate them completely, in a significant number of individuals suffering from allergic rhinitis. Such repeated introduction of allergen by subcutaneous injections appears to cause a shift toward IgG production or to induce T-cell-mediated suppression (possibly by a shift to the TH1 subset and IFN-7 production) that turns off the IgE response (Figure 16-12). In this situation, the IgG antibody is referred to as blocking antibody because it competes for the allergen, binds to it, and forms a complex that can be removed by phagocytosis as a result, the allergen is not available to crosslink the fixed IgE on the mast-cell membranes, and allergic symptoms decrease. Knowledge of the mechanism of mast-cell degranulation and the mediators involved in type I reactions opened the way to drug therapy for allergies. Antihistamines have been the most useful drugs for symptoms of allergic rhinitis. These drugs act by binding to the histamine receptors on target cells and blocking the binding of...

Role in Allergic Diseases

Ciclon Flora Cuba

Asthma, however53 and IL-10 release from peripheral blood monocytes is increased during the late response to allergen54 and in bronchoalveolar lavage after allergen challenge.53 Nasal allergen challenge in patients with seasonal allergic rhinitis reduces the concentrations of IL-10 in nasal lavage, however, in line with most of the studies in asthma.55 In atopic dermatitis an increase in IL-10 expression in the epidermis has been described.56

Peter J Barnes Abstract

IL-10 plays a key regulatory role in allergic diseases. It is produced by many of the inflammatory cells involved in allergic inflammation, including macrophages, regulatory T lymphocytes, dendritic cells, mast cells and eosinophils. IL-10 suppresses allergic inflammation by inhibiting the expression of inflammatory cytokines, Th2 cell-derived cytokines, chemokines and inflammatory mediator enzymes. In addition, it suppresses antigen presentation and increases the production of endogenous anti-inflammatory molecules. There is increasing evidence for defective production of IL-10 in allergic diseases, including asthma and rhinitis and this is associated with disease severity. This may lead to amplification of the inflammatory response in allergic diseases. It may be determined by polymorphisms of the IL-10 promoter linked to low endogenous IL-10 production. IL-10 itself may be a therapeutic approach to allergic disease, but because of side effects stimulation of endogenous IL-10...

Mast Cells And Basophils In Allergic Fungal Disease

Mast cell and basophil activation by fungal allergens and organisms is evidenced by the release of histamine in response to fungi. This activity, often attributable to immediate hypersensitivity, is associated with a number of fungal diseases, specifically, rhinitis, asthma, cutaneous hypersensitivity and ABPM. Fungal rhinitis is characterized by immediate hypersensitivity to fungal allergens. As such, the cross-linking of allergen-specific IgE on sensitized mast cells or basophils, is a proximal event in this typically mild pathology (Bush, 2004). This may be caused by allergens derived from many different fungal species, and up to 6 of the population may exhibit this form of hypersensitivity (Horner et al. 1995). (For an excellent review of fungal allergens see Kurup, 2002).

Promoting an Optimal Response to Therapy

Decongestants are used only occasionally in the clinical setting. Because some of these products are available without a prescription, their use may be discovered during a patient history for other medical disorders. Nonprescription nasal decongestants should not be used by those with hypertension or heart disease unless such use is approved by the primary health care provider. After administering a topical nasal decongestant, some patients may experience a mild, transient stinging sensation. This usually disappears with continued use. To minimize the occurrence of rebound nasal congestion, the drug therapy should be discontinued gradually by initially discontinuing the medication in one nostril, followed by withdrawal from the other nostril.

Vernal and Atopic Keratoconjunctivitis

GPC is a chronic inflammatory process leading to the production of giant papillae (> 0.3 mm) on the tarsal conjunctiva lining the upper eye lids (fig. 1). The condition occurs in patients who wear soft contact lenses, an ocular prosthesis or have unburied sutures after surgery 37 . The etiology is uncertain and probably multifactorial, but the clinical picture resembles that of VKC 38 . It seems to be a delayed-type hypersensitivity reaction. The symptoms are pseudoptosis, redness, irritation, mucoid discharge, blurring of vision, tearing and photophobia. The eye is dry and the upper eye lid will show the characteristic giant papillae on the tarsal, and sometimes in the forniceal, conjunctiva (fig. 1). Mucous, cell debris and microorganisms are frequently found on the lenses and play a pathogenic role in GPC 39 . The immune privilege of the eye may reduce the incidence of intraocular inflammation. However, the lens produces a continuous antigenic stimulus evoking a localized...

Conclusion

Antimicrobial resistance is widespread and growing in scope. Understanding the specific resistance mechanism present in a particular pathogen can help clinicians manage individual patients and can help public health practitioners conduct appropriate surveillance of populations. Few resistant infections are completely untreatable in 2000, but many are associated with increased morbidity and mortality. Efforts to decrease inappropriate use of antimicrobial agents, decreasing the antimicrobial pressure that drives natural selection for resistance, hold promise for prolonging the lifespan of currently available antimicrobial agents. The main measures to control resistance depend on the type of pathogen. The key measures for foodborne pathogens are irradiation and reducing antibiotics in animal feed for nosocomial pathogens, formulary controls and infection control programs and for community-acquired pathogens, promoting appropriate use of antibiotics for upper respiratory tract...

Hunger

A great deal of the interest in symptoms of hypoglycaemia has been stimulated by concerns about patient education. It is helpful to let patients know the range of symptoms found in hypoglycaemia and to inform them of the early warning symptoms reported by other people with diabetes, much as we all tend to know the range of symptoms that are experienced with the common cold. Many surveys and laboratory studies have shown that people differ considerably in the symptoms of hypoglycaemia they experience (Cox et al., 1993a). In addition to learning the generally reported symptoms, individuals with diabetes should be encouraged to learn about their own typical symptoms of hypoglycaemia.

Treatment

Low back pain is an extremely common condition, affecting 80 of persons at some point in their lifetime, which makes this complaint second only to the common cold as a reason for outpatient physician visits. Most episodes of acute low back pain resolve spontaneously, regardless of the type of therapy chosen. However, a small percentage of these acute cases, 5 to 10 in most series, progress to chronic low back pain. It is this latter group of patients that primarily accounts for the enormous amount of disability caused by low back pain, estimated to cost more than 20 billion annually and completely disable more than 2.5 million persons in the United States alone.

Summary

Mast cells and basophils are important cells in the proximal events associated with immediate hypersensitivity. Many fungal diseases are associated with this type of hypersensitivity however, literature establishing a firm role for immediate hypersensitivity in fungal disease, with the exception of mast cell and basophil degranulation in rhinitis and ABPM is lacking. Future work will be required to define a role in candidiasis. Information on the contribution of mast cells and basophils to host defense against fungi is also lacking, though future investigation of mast cells in the innate response to fungi and host defense is likely to be very fruitful.

Tropical Fruits

Many species of the genus Citrus (including sweet orange, tangerine, grapefruit, lemon, and lime) are grown for their edible fruits. Sweet oranges (Citrus sinensis) are the most widely grown fruit in the world, but in the nineteenth century they were considered luxuries and prescribed as cold remedies by physicians. Like other citrus fruits, the fruit of an orange is technically a hesperidium, a berry with a leathery rind and a juicy pulp that is formed of juice sacks borne on the inner layer of the fruit wall. The juice sacks fill the sections of the fruit and surround the seeds. The watery solution in the sacks is high in vitamin C. There are three main classes of oranges Valencias, navels, and blood oranges. Valencias, with their deep orange color and rich flavor, are the source of most or

The History

In an acute respiratory illness it is important to enquire carefully about the onset of the illness. For example, in pneumococcal pneumonia systemic disturbance (rigor, pyrexia, malaise) seldom precedes the first respiratory symptom (often pleural pain) by more than a few hours, while in viral pneumonia the patient may be generally unwell for several days before there are any symptoms or signs to suggest pulmonary involvement. Pleural pain may be a manifestation of pneumonia, but pulmonary thromboembolic disease should always be considered. Acute breathlessness often demands urgent treatment, and an error in diagnosis, for example between tension pneumothorax, an acute attack of bronchial asthma and left heart failure may have catastrophic consequences. If the patient is loo breathless to give a coherent account of the illness, a carefully taken history from a relative may be very important. The nature and effect of any treatment taken before the patient is seen should also he...

Clinical Application

Diseases against which no satisfactory vaccine is available, including those with a large number of different etiologic agents, are prime targets for antiviral chemotherapy. The common cold is an admirable example on both counts, but there are so many serotypes that chemotherapeutic agents, to be sufficiently broad spectrum, will need to be directed at molecules (or ligands) that are conserved across the genus Rhinovirus. Other respiratory infections, gastroenteritis, hepatitis, and infectious mononucleosis must also be high on the list of priorities. Effective chemotherapy is also needed to treat reactivation of latent infections such as herpes simplex and zoster, even though the latent infection itself will not be eliminated. Reactivation of herpesvirus infections is a particular problem in immunocompromised individuals, such as AIDS patients or transplant recipients. Chronic infections, for example, hepatitis B and C, AIDS, congenital rubella, or cytomegalovirus infections, may be...

Social history

A full social history should be taken as described on page 11 including enquiry about pets (mammals and birds) which may be the cause of rhinitis, asthma, allergic alveolitis and pneumonia (psittacosis). Information which should be obtained from all patients with chronic breathlcssncss includes the physical effort involved in any employment. With the more severely disabled it is vital to know about hills and steps leading to the home and stairs within it.

Pain Management

Transsphenoidal surgery is unquestionably painful. The majority of patients find the initial postoperative pain and blocked nose distressing. As a consequence, it is routine to give the patients morphine for pain. It will be interesting to see if endoscopic surgery will reduce this need, because our initial observations suggest that this is a much less painful procedure. Patients who have undergone a craniotomy are also given morphine for pain. Codeine, when given as an alternative, is idiosyncratic in effectiveness and pain control more haphazard.

Lcms Hiv1 and HCV

The SELDI ProteinChip approach has been employed to study the protein profiles of cells infected with viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV), HIV-1, and chronic hepatitis B virus infection (CHB) 31 . SARS is a viral respiratory illness caused by SARS-CoV. SARS was recognized as a global threat in March 2003, after first appearing in Southern China in November 2002 (http www.cdc.gov 20 ). Current serological methods used for laboratory diagnosis of SARS fail to guarantee early diagnosis since most are based on the detection of antibodies that are produced 17-20 days after the onset of symptoms. ELISA-based antigen detection tests offer high specificity and reproducibility, but they lack sensitivity. On the contrary, PCR-based methods, including reverse transcription-PCR, lack sensitivity and specificity 112 . For this reason, there is a need to develop a diagnostic methodology that can detect SARS before the onset of the symptoms to allow for...

Nasal Obstruction

Patients with allergic rhinitis, whether they have hay fever within season or perennial allergic rhinitis, will be helped by taking antihistamines up to and after surgery, in order to reduce the amount of secretions they produce and the amount of mucosal swelling following surgery.

Coincidences

Why do 'coincidences' matter They matter because, when you are trying to determine if an event is statistically significant or not, the seemingly logical 'expected' answer can be very misleading - events which might seem very unlikely to occur by chance can do precisely that if enough cases are involved. Consider a statistical analysis of whether banging your head against a hard surface can cure the common cold. Many studies of this problem are conducted, each with 95 confidence limit (P 0.05). As soon as 20 studies have been performed, there will be, on average, at least one scientific paper published which proves that banging your head against a wall cures colds. Yet if you had a cold, what would you do

Antihistamines

Given in spray form ipratropium bromide reduces the watery discharge in autonomic rhinitis. This is a condition where the glands secrete more mucus. It is normally found in people over 60 years old and there are few other symptoms except a clear discharge. Ipratropium bromide has little effect on improving nasal blockage, a symptom that is rarely troublesome in autonomic rhinitis.

Associated Causes

The majority of problems follow a cold or viral upper respiratory tract infection. The infection causes the lining at the opening of the sinus to swell, and leads to a build-up of mucus in the sinuses. The mucus can then become infected with bacteria. Fungal infections are very rare and occur sporadically.

Symptoms

Acute sinusitis causes pain over the affected sinus, usually the cheek, or on one side of the forehead, a blocked nose and or a discharge, feeling unwell, and a temperature. Facial pain alone without any nasal symptoms is rarely due to sinus disease and is often caused by other types of pain such as midfacial segment pain, tension-type headaches, migraine, dental pain, or trigeminal neuralgia. Sinusitis is chronic when the symptoms have persisted for longer than three months. The features are mainly of nasal congestion, and there is a mucky nasal discharge that is often painless in a patient who feels quite well.

Size and Structure

Ebola Protein Coat

We know now that smallpox was caused by something considerably smaller in size than bacteria. During Pasteur's time, virtually all infectious agents, including bacteria, protozoans, and yeast, were called viruses. One of Pasteur's associates, Charles Chamberland, discovered that porcelain filters would block out bacteria but would not keep an unseen agent from passing through. The agent caused rabies, another serious disease of both animals and humans. Agents of disease that could pass through filters became known as filterable viruses, although the word filterable is no longer used. Today, we know that not only smallpox and rabies are caused by these viruses but also measles, mumps, chicken pox, polio, yellow fever, influenza, fever blisters, warts, and the common cold.

Osteoma

Endoscopic Osteoma

Approximately 3 of people have paranasal sinus osteomas according to Earwacker (1993). In his series of 1500 CT scans, only two patients were symptomatic. This is the authors' experience. Many osteomas are found incidentally and are blamed for causing headaches or excision is recommended before they cause symptoms (Hehar and Jones, 1997). In practice, osteomas rarely cause any problems other than cosmetic. If they do cause symptoms by obstructing the frontal recess, their history should include symptoms that are worse after upper respiratory tract infections and there should be endoscopic and CT scan signs of mucosal disease (Fig. 15.38a-c). All too often tension-

Rhinoviruses

In this era of organ transplantation, genetic engineering, and other dramatic demonstrations of the wonders of medical science, the man in the street perceives a certain irony in the inability of modern medicine to make the slightest impact on that most trivial of all human ailments, the common cold. An even greater irony is the fact that years of searching for the elusive common cold virus have led us finally not to one, but to over 100 separate rhino- viruses. Moreover, it is now evident that rhinoviruses cause only about 50 of all colds. A vaccine for the common cold is further away than ever. We are all too familiar with the symptomatology of the common cold profuse watery nasal discharge (rhinorrhea) and congestion, sneezing, and quite often a headache, mildly sore throat, and or cough. There is little or no fever. Resolution generally occurs within a week, but sinusitis or otitis media may supervene, particularly if secondary bacterial infection occurs. Rhinoviruses may also...

Nasal Septum Cocaine

Cocaine Lesions

85 and 68 of patients suffering from sinusitis and rhinitis, respectively. The most common complaints are epistaxis, crusting, and nasal obstruction. Nasal mucosa appears covered by crusts, with superficial hemorrhages. Especially in advanced stages and or in the presence of an aggressive form of the disease, it is possible to identify necrosis and resorption of the septal cartilage, turbinates, and lateral bony walls of the nasal cavities mucosa is even more friable and inclined to hemorrhage (Fig. 6.23). Patients with an extensive septal perforation may present a typical deformity of the nasal pyramid called saddle nose. When the granuloma-tous process directly involves the lacrimal pathway or the presence of abundant scar tissue obstructs the nasolacrimal duct, chronic dacryocystitis with epiphora may be observed.

Simmend Disease

Adelroth E, Rak S, Haahtela T, Aasand G, Rosenhall L, Zetterstrom O, Byrne A, Champain K, Thirlwell J, Della C (2000) Recombinant humanised mAb-E25, an anti-IgE mAb, in birch pollen-induced seasonal allergic rhinitis. Journal of Allergy and Clinical Immunology 106(2) 253-259. Carney S, Jones NS (1996) Idiopathic rhinitis idiopathic or not Clinical Otolaryngology 21 198-202. Huggins K, Brostoff J (1975) Local production of specific IgE antibodies in allergic rhinitis patients with negative skin tests. Lancet 2 148-150. Jones NS (1999 c) Current best treatment in children with allergic rhinitis. Current Medical Literature - Allergy 7(3) 4956. Jones NS (2004) Midfacial segment pain implications for rhinitis and sinusitis. Curr Allergy Asthma Rep. 4 187-92. Kleinjan AJK, Vinke JG, Severijnen LW, Fokkens WJ (2000) Local production and detection of (specific) IgE in nasal B-cell and plasma cells of allergic rhinitis patients. European Respiratory Journal 15 491-497. Kramer MF, Ostertag P,...

Sinusitis

Scan Sinus Abnormality

It is estimated that sinusitis affects 16 of the United States population annually, leading to approx 16 million office visits and a yearly expenditure of approx 2 billion dollars on its medical therapy (29). Sinusitis, an infection of one or more of the paranasal sinuses, usually begins as a complication of viral upper respiratory tract infection in the elderly population. Obstruction of sinus drainage and retention of secretions are the fundamental events in sinus infection. Geriatric patients may be predisposed to sinusitis by several conditions that compromise the integrity of the sinus ostia, thereby interfering with aeration of the sinuses and creating a closed space that is susceptible to bacterial infection. Sinusitis is, therefore, more likely in the elderly with allergic rhinitis, nasal septal deviation, nasal fractures, nasal polyps or tumors. About 5-10 of cases of bacterial maxillary sinusitis are secondary to dental root infection. Sinusitis is generally subdivided into...

Etanercept Enbrel

Reactions at the local injection site occur in more than a third of patients but may respond to topical corticosteroids and generally do not result in discontinuation of the drug. Some controlled data suggest that minor upper respiratory tract infections may be increased, and there are few anecdotal cases of sepsis and death in patients taking etanercept. As with other immunomodulatory agents, vigilance for infections should be maintained, and discontinuation of the drug is recommended when severe infections are identified. The effects of etanercept in patients with a history of malignancies or on the risk for new malignancies are not known. The development of antibodies against etanercept are common, but only non-neutralizing antibodies have been detected and are not associated with clinical response or adverse effects.

Southren Tshangshu

Root flavonoid extracts used to relieve menopausal problems Root extracts used to boost the immune system said to be good for colds, flu, and immune-deficiency disorders also lowers blood pressure. (Caution Some Astragalus spp. sequester toxic amounts of selenium should not be taken if a fever is present) Tea of root drunk by Native Americans and early settlers a week or two before giving birth to promote rapid parturition Water infusion of dried plant tops widely used to treat fevers and colds Oil from seeds contains gamma linoleic acid (GLA) and other oils beneficial in human nutrition

Acute Otitis Media

Because otitis media is a complication of URI, it has a peak incidence in the winter when colds are most likely to occur. Unlike sinusitis, which is more likely to affect adults, otitis media is predominantly a disease of younger children, with a peak incidence between 6 and 36 mo of age (51). Otitis media occurs with varying frequency in children. In a large population study, it was found that during the first 3 yr of life about a third of children never had otitis media, another third had one or two episodes, and the remaining third had three or more episodes. Otitis media arises from eustachian tube dysfunction that accompanies URIs or allergic rhinitis. Inflammation of the eustachian tube and middle ear results in tube occlusion and fluid accumulation in the middle ear space. Eustachian tube obstruction is more common in younger children because of less cartilage support of the tube, making collapse more likely. The Eustachian tube obstruction not only causes entrapment of...

Medical Management

Patients with allergic rhinitis are advised to continue their topical nasal steroid therapy after douching and to follow their preoperative treatment strategy (e.g., allergen avoidance, antihistamines). Nasal drops enter the frontal sinus best if they are given with the patient lying flat and with their head cocked back over the edge of the bed. It is often difficult for a patient to gauge how many drops they have instilled in this position and it can be helpful to keep the drops in the fridge, so as to provide more sensation when they are put in. As with all patients with allergic rhinitis, the importance of compliance should be explained. In patients with nasal polyposis, topical nasal steroids are given for 3 months and then reduced if the mucosa looks healthy (Fig. 13.4). In patients with allergic aspergillosis or invasive aspergillosis, itraconazole is preferable to amphotericin as it is associated with fewer side effects. Nevertheless, liver function and morning cortisol levels...

Other Enteroviruses

Most enterovirus infections are subclinical, particularly in young children. Nevertheless, they can cause a wide range of clinical syndromes involving many of the body systems (Table 23-3). It should be noted that each syndrome can be caused by several viruses, and that each virus can cause several syndromes even during the same epidemic. Rashes, upper respiratory tract infection (URT1), and undifferentiated summer febrile illnesses are common. Moreover, enteroviruses are the commonest cause of meningitis, albeit a relatively mild form. In general, coxsackieviruses tend to be more pathogenic than echoviruses they cause a number of diseases rarely seen with echo-viruses, for example, carditis, pleurodynia, herpangina, hand-foot-and-mouth disease, and occasionally paralysis. Colds Enteroviruses are not major causes of respiratory disease but can produce a range of febrile colds and sore throats during summer epidemics. These come under the umbrella label of URTI or undifferentiated...

Allergy Tests

Skin Prick Test Chart

Total IgE is not very specific or sensitive, being positive in only approximately 60 of patients with allergic rhinitis. It has a role as an adjunct to history, clini- As the upper and lower respiratory tract are in continuity, it is worth having a peak flow meter (and in children a height-peak flow chart) to check for possible asthma. It is pertinent to remember that 16 of those with rhinosinusitis have asthma and that 80 of asthmatics have rhinosinusitis. Cytology of the nasal mucosa has not been standardized, and what is termed eosinophilia varies from study to study. It is said that those with eosinophils will respond better to topical nasal steroids, but it is simpler to do a trial of medical treatment than do nasal cytology, particularly as this is the clinical strategy that will be used whatever the result of cytology. Cytology does not differentiate reliably between eosinophilic and noneosinophilic rhinitis, if there is indeed such a distinction to be made. Rhinomanometry and...

Acute Sinusitis

Because sinusitis is most often a complication of upper respiratory viral infections, it follows the same seasonal pattern as colds. This produces a winter peak with more cases seen in those exposed to upper respiratory tract infections. In children seen in a large health system, sinusitis is frequently found as a co-morbidity with otitis media. Nearly half of all children with sinusitis also had otitis media (40). Children are also more likely to have posterior ethmoidal and sphenoid inflammation while adults have mainly maxillary and anterior ethmoidal sinusitis (41). Some medical conditions may increase the risk for sinusitis. These include cystic fibrosis, asthma, immunosuppression, and allergic rhinitis (42). Cigarette smoking may also increase the risk of bacterial sinusitis during a cold because of reduced mucociliary clearance. previously, many cases of the common cold have concomitant sinus inflammation. The inflammation associated with viral infections clears without...

Coronaviridae

The family Coronaviridae embraces over a dozen major host-specific pathogens of mammals and birds, displaying tropism for the respiratory tract (e.g., avian infectious bronchitis virus), the enteric tract (transmissible gastroenteritis virus of swine), or the liver and brain (murine hepatitis virus). No convincing evidence has yet been obtained to link human coronaviruses with serious disease affecting any of these systems, but they are an important cause of that trivial but annoying disease, the common cold. In addition, particles morphologically resembling coronaviruses are often seen by electron microscopy in feces, but it has yet to be established whether they cause gastroenteritis in humans. Coronaviruses have the largest genome of all the RNA viruses and exhibits a unique transcription strategy of considerable interest to molecular biologists.

Immunotherapy

The use of immunotherapy in grass pollen allergic rhinitis has been proven in the short- and long-term (Durham et al., 1999). However, if there is cross-reactivity to a range of inhaled allergens, then im-munotherapy directed at one allergen is less effective. Similarly, the evidence to support allergen avoidance is mixed. The results of house dust mite desensitiza-tion have been equivocal. Fungal immunotherapy following surgery for allergic fungal sinusitis has helped prevent recurrence and it has been postulated that this may help patients with eosinophilic mucin rhi-nosinusitis (Ferguson, 2000). The benefits of allergen avoidance are contentious. When there is a marked single allergen, for example, to house dust mite, then going to great lengths to avoid this allergen has been shown to help. However, it is debatable how well these studies can be extrapolated into day-to-day practice, and whether patients are ready to comply with these measures. It appears that half-measures to...

The Markers of Atopy

In allergic rhinitis there is good epidemiological and basic scientific evidence that there is an inherited genetic component that is responsible (Moffat et al., 1994 Jones et al., 1998b). However, why do 15.5 of asymptomatic people who have a positive skin-prick test not develop any allergic symptoms (Droste et al., 1996) (Fig. 16.3), and not all those with a raised IgE have symptoms of rhinitis (Panzani et al., 1993) (Fig. 16.4) In another study of skin-prick tests, 18 of children changed over a 2-year period (Droste et al., 1996). An understanding of the normal course of these processes may help us to influence our immune status and suppress the excessive response to some foreign antigens that leads to the symptoms of allergic rhinitis.

History

This involves the duration of the lymphadenopathy fever recent upper respiratory tract infection sore throat skin lesions or abrasions, or other infections in the lymphatic region drained by the enlarged lymph nodes immunizations medications previous cat scratches, rodent bites, or tick bites arthralgia sexual history transfusion history travel history and consumption of unpasteurized milk. Significant weight loss, night sweats, or other systemic symptoms should also be recorded as part of the patient's history.

Nitric Oxide

Nitric oxide, a potent biological mediator synthesized from L-arginine by the enzyme NO synthase (NOS), is a small lipophilic molecule that can diffuse rapidly across cell membranes. One form of NOS is neuronal NO synthase found in the nonadrenergic, noncholiner-gic nerves of the peripheral nervous system a second is endothelial NO synthase and the third is inducible NO synthase (Conboy and Jones, 2000). Inducible NO synthase can be induced by inflammation or infection and a range of cell types, by pro-inflammatory cy-tokines such as IFN-y, IL-1 (3 and TNF-y, by IgE immune complexes, or by bacterial products such as lipopoly-saccharide and lipotechoic acid, and by viral infections. In animal models, inducible NO synthase inhibitors reduce the late-phase response after allergen challenge. Inducible NO synthase knockout mice appear to have an enhanced TH1 phenotype with an increase in IFN-y and a decrease in IL-4. Inducible NO synthase inhibitors, therefore, have potential as...