Journal of Mucosal Immunology Research
Open Access

Lower respiratory tract infection; Community-Acquired pneumonia; Diagnosis; Antibiotic resistance; Overuse of antibiotics respiratory illness; Contributable percentage

Introduction

In 2015, 2.74 million people died from lower respiratory tract infections (LRI), which include community-acquired pneumonia (CAP), hospital-acquired pneumonia, bronchitis, bronchiolitis, and tracheitis (95 percent confidence interval: 2.50 million to 2.86 million). Numerous infections, including bacteria, viruses, mycoplasma, and fungi, all of which have similar clinical manifestations, are responsible for LRIs. Despite a thorough diagnostic workup, the causes of up to 62 percent of CAP cases are still unknown. Patients with severe LRIs are frequently initially treated with empirical broad-spectrum antibiotics to address their symptoms in the absence of a conclusive microbiological diagnosis. Once infections are discovered, clinicians should modify or discontinue such empirical treatment [1]. The overuse of broadspectrum antibiotics results from the fact that such treatments are frequently extended if the patient is responding favourably or if no contributing microorganisms have been found. Furthermore, lower respiratory tract infections (LRTIs) continue to be a major cause of hospitalisation for roughly 11.9 million children and mortality globally in the absence of a microbial aetiology, leading clinicians to mistakenly diagnose the symptoms as a non-infectious inflammatory condition and prescribe empiric corticosteroids for treatment. LRTIs are to blame for 6.8% of neonatal fatalities, 20% of deaths in children under the age of one, and 14% of deaths in children between the ages of one and four [2]. Exposure to indoor air pollution, poor nutrition, congestion, a low socioeconomic position, insufficient immunisation, or preterm birth is typical risk factors for LRTIs.

Individuals with immunological immaturity and immune impairment are more susceptible to HPIVs, which can lead to serious consequences and disease. Typically, it has been assumed that severe childhood illnesses are related to poor T cell responses, which are necessary to mediate viral clearance and ensure longlasting immunological memory. To understand the precise way in which the various respiratory viruses interact with the host immune system, the host T cells are being carefully investigated [3]. While a child who had a severe case of adenovirus pneumonia was shown to have an increase in CD8+ T lymphocytes, some respiratory viruses, such as respiratory syncytial virus (RSV), have been linked to a decrease in circulating lymphocytes. Due to the lack of antivirals or vaccines, HPIVs, respiratory viruses that cause serious infections of the lower respiratory tract, could pose a serious health risk, particularly to children. In addition, nothing is known about how T cells react to HPIV in connection with LRTIs. In order to analyse the peripheral blood T cells count in HPIV-associated LRTIs in children, this study was created [4].

A new way of thinking has emerged in the field of molecular microbiology thanks to syndrome molecular panels. A few manufacturers have created panels for the identification of pathogens linked to illnesses of the central nervous system, respiratory tract, and blood stream. Extended multiplex respiratory panels enable the simultaneous identification of a few bacterial as well as several prevalent viral culprits of respiratory tract illnesses. When compared to more established techniques like cell culture, these panels offer improved sensitivity for the laboratory diagnosis of respiratory tract infections. The Film Array panels (Bio Fire Diagnostics, Salt Lake City, UT), the ePlex RP (GenMark Diagnostics, Carlsbad, CA), and several panels provided by Luminex are the most frequently used US Food and Drug Administration (FDA) cleared respiratory panels (Northbrook, IL) [5].

One of the most prevalent infections in children is lower respiratory tract infection (CA-LRTI), which is acquired in the community. The main pathogens that cause CA-LRTI are bacteria and viruses, and many bacterial infections have been documented in kids who are being treated for pneumonia in hospitals. In individuals with pneumonia, appropriate antibiotic therapy has been advised following early bacterial infection differentiation. Serum C-reactive protein and procalcitonin, which are often utilised in clinical practise, have been shown to be useful for the differentiation of bacterial infection and the therapy evaluation in paediatric patients with pneumonia. Peripheral white blood cell (WBC) and neutrophil counts are additional conventional criteria to identify bacterial pneumonia from other types of pneumonia [6].

Numerous respiratory pathogens, including coronavirus and influenza, have continuously changed in wildlife. The Global Virome Project, which focuses on early detection of the pandemic-potential of viruses identified in wild animals, was formed to help stop future pandemics. Despite the substantial amount of labour and materials needed for this initiative, it was not possible to stop the SARS-CoV-2 pandemic on its own. Prior to these zoonotic viruses effectively spreading from human to human and reaching pandemic stage, viral adaptation to a human host is a rate-determining phase. If the majority of individuals suspected of having viral infections are consistently examined, it may be able to successfully detect new viruses at early stages of adaptation [7].

Materials and Methods

Using a national inpatient database in Japan, discharge records for kids with acute lower respiratory tract infections between the ages of 3 months and 15 years were extracted for the fiscal years 2010 through 2014. We used mixed effect regression models to examine antibiotic use trends, and we used unsupervised machine learning to identify variances and clusters in hospital practise patterns. 1000 respiratory specimens that were treated using standard microbiological methods were used in the current study. To evaluate the sensitivity, specificity, positive and negative predictive values, gramme stain smear and culture findings were statistically compared. Kappa statistics were used to determine how well gramme stain smear inspection and culture agreed [8].

All patients were prospectively and sequentially enrolled if their primary physician requested that their respiratory sample be tested for respiratory viral microarray. Both the upper and lower respiratory tracts were sampled, including the nose, nasopharynx, throat, sputum, trachea, and bronchoalveolar lavage. An amount of 0.5 ml from the total of 2 ml from each specimen in viral transport medium (2% foetal bovine serum, 10 units/ml penicillin, and 10 mcg/ml streptomycin in phosphate buffered saline) was secured and kept at 4 °C for additional anti-dsDNA immunofluorescence after specimens were delivered to the lab for routine detection of 19 subtypes of respiratory viruses with microarray. The microarray data were kept a secret from the scientists, and the specimens were labelled with random numbers [9].

Discussion

A significant improvement in the diagnosis of a wide variety of respiratory viruses in clinical microbiology laboratories is represented by molecular respiratory syndromic panels. Extended panels have largely superseded the traditional strategy of combining antigen testing, cell culture, and small panel molecular testing. The present upper respiratory tract molecular panels could identify up to 20 bacterial and viral infections [10].

Conclusion

The use of antibiotics with a limited spectrum has been trending somewhat upward. However, only 25% of hospitals had a treatment plan that adhered to the most recent guidelines. Paediatric inpatient antibiotic use may benefit from hospital-level measures to encourage and monitor antibiotic use. Despite decades of research, preventing and treating respiratory tract infections has remained a daunting scientific issue. The present COVID-19 crisis has underlined the need for novel approaches to protect airways and cardiovascular health in the general community, even though people with respiratory disease or immune system deficiencies are more susceptible to viral infections. In this article, we’ve suggested that increasing NO, which is reduced by mental stress and viral attack, might offer protection against viral multiplication and its numerous negative pulmonary and vascular effects. Focusing on dietary methods of raising nitrate levels, such as consumption of specific types of vegetables, may potentially be more affordable and provide extra benefits for general health. However, more research on the impact of NO donors on respiratory infections is required before such tactics are more widely used.

Acknowledgement

None

Conflict of interest

None

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