Acute airway obstruction due to necrotizing tracheobronchial aspergillosis in immunocompromised patients: a new clinical entity

Two immunocompromised patients with severe neutropenia developed acute airway obstruction due to Aspergillus mycetoma formation in the trachea and main bronchi. The mycetomas caused transmural necrosis of the airway. In one patient, the necrosis extended through the bronchus intermedius into the pulmonary artery, resulting in a fatal hemorrhage during bronchoscopy.

Inhibition of neutral endopeptidase potentiates neurogenic inflammation in the rat trachea

The present study was performed to determine whether neurogenic inflammation in the rat trachea can be exaggerated by inhibiting neutral endopeptidase, an enzyme that degrades tachykinins that are believed to mediate neurogenic inflammation. Neurogenic inflammation was produced by antidromic electrical stimulation of one vagus nerve (2.5 Hz, 1 ms, 5 V for 5 min) in the presence of atropine or by an intravenous injection of capsaicin (100 micrograms/kg). Neutrophils that adhered to the endothelium of venules were visualized and counted in tracheal whole mounts that were stained by a histochemical reaction for myeloperoxidase. Neural inflammation increased the number of adherent neutrophils. Pretreatment with the neutral endopeptidase inhibitor phosphoramidon (1.0 or 2.5 mg/kg iv) increased neutrophil adhesion induced by neural inflammation. As assessed by the amount of extravasation of Monastral blue pigment, neural inflammation also increased vascular permeability, and this change was potentiated by phosphoramidon. These results are consistent with the concept that neuropeptides released from sensory nerves in the tracheal mucosa cause neutrophils to adhere to venules and increase vascular permeability and that these effects are modulated by neutral endopeptidase.

Necrotizing tracheobronchitis following mechanical ventilation of the newborn

Mechanical ventilation of newborn infants with respiratory distress is associated with diverse pathology of the lung. Recent reports have focused on a distinct lesion pattern of the tracheobronchial system--necrotizing tracheobronchitis. While many advanced cases of the disease proved fatal secondary to airway obstruction, others were successfully treated by removal of the occlusion. We describe two neonates with necrotizing tracheobronchitis, one of whom had a complete occlusion of the right main stem bronchus that was relieved by curettage during bronchoscopic examination.

Bacterial tracheitis in children

Bacterial tracheitis is a relatively rare cause of respiratory distress in children and is associated with a high morbidity and mortality rate. Three children who have survived this affliction are presented: one developed toxic shock syndrome in the acute phase and two developed late complications. The authors review the pediatric literature and postulate possible etiological factors. Prompt diagnosis and aggressive airway management are essential to survival. Early tracheotomy is recommended as the primary form of airway management.

Bacterial tracheitis in children

We examined the records of 14 patients aged 7 months to 10 1/4 years who were treated for bacterial tracheitis from May 1982 to December 1987; the management protocol for 13 of the patients included the use of nasotracheal intubation. The infection was caused by Staphylococcus aureus in seven, Haemophilus influenzae in three, Branhamella catarrhalis in one and Streptococcus pneumoniae in one. Both H. influenzae and B. catarrhalis were isolated in another patient, and no organism was found in the remaining patient. In addition to the bacteria, viruses were cultured from the tracheal secretions of two patients. The mean duration of intubation was 7.6 days and of hospital stay 9.2 days. Twelve of the cases occurred during the cold months of the year (October to March). Of the three deaths only one occurred in the pediatric intensive care unit and was due to severe bronchospasm and an air leak that caused bilateral pneumothorax and pneumomediastinum. In one patient subglottic stenosis developed that necessitated tracheostomy. Healing began 5 to 9 days after the onset of symptoms, as demonstrated with the use of repeated fibreoptic bronchoscopy. We found that the airway could be safely managed with the use of a nasotracheal tube. Bronchoscopy helped to confirm the diagnosis, to remove adherent secretions and to monitor the course of the disease. The ventilation tube can be removed after the patient's temperature returns to normal, if there is an air leak around the tube, if the quantity and viscosity of the secretions decrease and if healing is observed at bronchoscopy.

Necrotizing tracheobronchitis. An ischemic lesion

Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction. A retrospective clinicopathologic study of 206 neonatal autopsy reports spanning a three-year period yielded 122 cases of necrotizing tracheobronchitis with an incidence of 59%. All study patients received treatment prior to the development of high-frequency ventilator jet, oscillator, or interruption. The site and submucosal depth of airway involvement was variable. The most commonly affected anatomic site was the middle or thoracic trachea (56%). The common cause identified was severe ischemia to the airway mucosa and submucosa, occurring with profound birth asphyxia and/or shock. The presence of ischemia supports the concept that decreased tracheoperfusion may be an important factor in the development of tracheobronchial abnormalities.

Respiratory tract infections increase susceptibility to neurogenic inflammation in the rat trachea

This study reveals that respiratory tract infections make the tracheal mucosa of rats more susceptible to neurogenic inflammation, which is a type of inflammation mediated by neuropeptides released from sensory nerves. Neurogenic inflammation was produced in the tracheas of 2 groups of Long-Evans rats by electrical stimulation of the vagus nerve (5 V, 1 ms, 20 Hz for 5 min) or by an injection of capsaicin (15 to 200 micrograms/kg i.v.) or substance P (0.05 to 5.0 micrograms/kg i.v.). Rats of one group were pathogen-free; the others had serologic evidence of naturally occurring airway infections caused by Sendai virus, coronavirus, and Mycoplasma pulmonis. The stimuli produced neurogenic inflammation in both groups of rats, but the magnitude of this inflammation was much greater in the infected rats. The susceptibility of the infected rats to neurogenic inflammation was manifested by a 2.0 to 3.1 times larger increase in vascular permeability to Monastral blue, 5 times larger increase in number of neutrophils adhering to the endothelium of venules, and conspicuous morphologic changes in the tracheal epithelium. When pathogen-free rats acquired respiratory tract infections, they too became susceptible to neurogenic inflammation. Other experiments showed that infection by Sendai virus was essential for the change, although infection by M. pulmonis or coronavirus may also be necessary. The susceptibility to neurogenic inflammation outlasted the transient pathologic changes caused in the airway mucosa by the viral infections and may have been permanent.

Diffuse necrotizing tracheobronchitis: an acute and chronic disease

Necrotizing tracheobronchitis (NTB) is characterized by acute episodes of airway obstruction, hypercarbia, and lack of chest movement in mechanically ventilated neonates. Emergency bronchoscopic removal of necrotic tissue is essential for survival. Although postmortem lesions extend into smaller bronchi, survivors have not demonstrated residual tracheobronchial abnormalities. Two infants were treated successfully for NTB but succumbed to diffuse tracheobronchial strictures with progressive pulmonary hyperinflation. A third neonate with esophageal atresia and left pulmonary agenesis developed NTB. Despite initial postbronchoscopic improvement, the infant died at age 6 weeks with diffuse obstructing NTB. All three infants required endotracheal intubation and mechanical ventilation. High-frequency jet ventilation was not used. Tracheal cultures for fungi, bacteria and viruses were negative. Successful treatment of NTB may be followed acutely by recurrence of NTB and chronically by diffuse tracheobronchial strictures and emphysema.

Endotracheal mass resulting from a transtracheal oxygen catheter

A 50 percent or greater savings in oxygen usage and aesthetic benefits leading to increased compliance are reasons for increasing use of the transtracheal catheter for administration of home supplemental oxygen. Minor complications of the procedure are common and include catheter dislodgement, bronchospasm, subcutaneous emphysema, bleeding at the catheter site, as well as hemoptysis and wound infections. Rare complications include retroflexion of the catheter into the upper trachea from coughing, and fracture of the catheter with loss in the trachea. New, improved catheters and detailed descriptions for operator use may reduce the frequency of these complications. This report describes a potentially serious complication of a transtracheal catheter system which resulted despite appropriate use and care of the catheter.

Necrotizing tracheobronchitis following high-frequency ventilation: effect of lung deflation

A piglet model of acute respiratory failure was used to determine whether necrotizing tracheobronchitis (NTB) reported during high-frequency pneumatic flow interrupter (HFFI) ventilation could be minimized by a different ventilatory strategy. Twenty-one piglets (mean age 3.8 days, average weight 1.4 kg) were anesthetized with ketamine and given Pavulon prior to saline lung lavage. Femoral vessels were cannulated for measurements of blood pressures, arterial blood gases (ABG), and fluid administration. Airway pressures were measured 5 mm above the endotracheal tube tip. To allow for lung deflation, HFFI (10 Hz) was programmed to pause for 1 sec either 5 (HFFI5) or 12 times per min (HFFI12). Seven animals were assigned to each of the treatment groups and to a conventional mechanical ventilation (CMV) control. All animals were kept on 1.0 FIO2 with ventilators adjusted to maintain ABG (pO2 = 50-100 mmHg and pCO2 = 30-40 mmHg). After 6 h of ventilation, the animals were sacrificed and their lungs inflated with formalin to 40 cm H2O. Sections were obtained from trachea, carina, mainstem, and hilar bronchi. An airway injury score (AIS) was calculated after "blinded" microscopic evaluation. There was no difference in total AIS between CMV (2.4) and HFFI12 (8.6) but a statistically significant difference (p less than 0.05) existed between CMV and HFFI5 (14.1). NTB was limited to the trachea during HFFI12 but extended down to the hilar bronchi during HFFI5. More frequent lung deflations reduce the severity and distribution of NTB during HFFI ventilation.

Necrotizing tracheobronchitis: a complication of high frequency jet ventilation

The tracheal and bronchial lesions observed are described in seven patients, presenting with respiratory distress syndrome and receiving both conventional and high frequency jet ventilation for various periods. The histological findings are related to the duration of the exposure as well as the number of pulsations administered to the tracheobronchial tree. Severe damage to the mucosa leading to acute tracheobronchitis, hyperplasia and hypersecretion of the mucosal glands may explain some of the clinical symptoms observed, especially the upper respiratory obstruction. Care should be taken to limit these changes which may lead to various degrees of stenosis in survivors receiving this mode of therapy.

Surgical complications of bedside tracheotomy in an otolaryngology residency program

A prospective analysis of 124 consecutive adult patients undergoing tracheotomy was performed to examine the incidence of resulting complications. All tracheotomies were performed by a junior otolaryngology resident under the supervision of a member of the attending staff or a chief resident. The vast majority were performed at the bedside in an intensive care unit. The complications were divided into two groups: early (within 2 days) and late (2 to 14 days). Seven patients had complications directly related to tracheotomy. Four of these complications occurred in three patients and were considered significant. There were no mortalities. Despite the fact that our tracheotomies were routinely performed by residents at the bedside, our complication rate was comparable to those reported from other centers. We believe that bedside tracheotomy, properly supervised and performed, is a safe procedure.

Bacterial tracheitis in Down's syndrome

Four children with Down's syndrome and bacterial tracheitis are described. In three the infection was due to Haemophilus influenza. In patients with Down's syndrome presenting with stridor tracheitis should be considered and appropriate treatment started.

Necrotizing tracheobronchitis: a newly recognized cause of acute obstruction in mechanically ventilated neonates

Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high-frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long-term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evaluation of the airway revealed a characteristic picture consisting of necrosis, neutrophil infiltration, epithelial erosion, and intraluminal obstruction.

Bacterial tracheitis in adults

Bacterial tracheitis is characterized by acute upper airway obstruction in which indirect laryngoscopy is normal. Roentgenograms reveal an irregular tracheal air column. Endoscopic evaluation demonstrates a normal supraglottic and glottic larynx with purulent debris, mucosal ulcerations, and edema of the subglottic larynx and trachea. To our knowledge, this entity has not been previously described in an adult. We report herein three cases of bacterial tracheitis in adults.

Necrotizing tracheobronchitis in intubated newborns: a complication of assisted ventilation

This report describes a newly recognized iatrogenic lesion in newborns that we have termed necrotizing tracheobronchitis (NTB). Although it is related to assisted ventilation, it is different from previously described tracheal lesions in that it is most severe distal to the tip of the endotracheal tube and manifests a characteristic basophilic necrosis of the tracheal mucosa. Sloughing of tracheal mucosa, which occurs in the later stages, can cause respiratory obstruction. The lesion occurs over a wide range of gestational ages and birth weights as well as ventilatory rates, pressures, and supplemental oxygen concentrations. The severity of the lesion is related to the duration of ventilation. We believe NTB to be related to airflow through the endotracheal tube rather than to the effects of the tube itself because the lesion is worst beyond the end of the tube and extends into the major bronchi. A grading system is presented.

Laryngotracheitis outbreak limited to a part of a chicken flock exposed to smoke and chemicals

Laryngotracheitis was diagnosed in a flock of molted, caged table-egg-layers. Morbidity was restricted to an area of the house in which the birds had been exposed to smoke from a fire in the house and to a powdered chemical fire-extinguisher used on the fire. Mortality in this group began to rise 6 days after the fire and continued to be above normal for about 3 weeks. Feed consumption dropped for about 1 1/2 weeks after the fire but was normal or above normal during the rest of the disease outbreak. Egg production dropped slightly for 1 week after the fire, then returned to normal. Microscopic tracheitis in the exposed birds continued for 11 weeks after the fire. Hens outside of the smoke-affected area did not show histopathological changes or shed laryngotracheitis virus.

[Long-term intubation following tracheotomy]

Between 1981 and 1983 tracheotomy was performed on 61 patients in the Surgical University Clinic of Tübingen. The dominant factors in indication of tracheotomy was for 49% of patients the persistingly necessary artificial respiration, for 26% a better bronchial toilet and other reasons for 25%. With 40.5% of all cases pneumonia was the most frequent complication encountered with our patients. The most frequent bacteria was Pseudomonas aeruginosa. Because of the decisive advantage constituted by the possibility of unproved bronchial toilet an earlier realisation of tracheotomy is to be recommended.

Necrotizing tracheobronchitis: a complication of high-frequency ventilation

The tracheobronchial histopathologic findings in eight neonates who died after treatment with high-frequency jet ventilation (HFJV) were compared with those in eight similar infants who died after treatment with conventional mechanical ventilation. The HFJV and conventionally treated groups were matched as closely as possible for birth weight, gestational age, and duration of mechanical ventilation. A 4-point, nine-variable histologic scoring system was used to grade tissue changes in the trachea, carina, and mainstem bronchi. The patients who received HFJV had significantly more histologic damage in their tracheas, carinas, and right and left mainstem bronchi. At all levels of the airway examined, HFJV was associated with more inflammation, greater losses of ciliated epithelium, and more mucus within the lumen of the airway than was conventional mechanical ventilation.

A case report of tracheobronchitis by herpes simplex virus, type I

Herpes simplex virus (HSV) infection of the lung and lower respiratory tract has been thought to be a rare and fatal disease, usually in patients with immunosuppression, severe burns, or prolonged intubation. However, recently, increasing numbers of patients have been reported to have a localized infection and some of them have recovered without specific therapy.

In Korea, there has been yet no proven case of HSV infection of the lower respiratory tract. Recently, we saw a case of localized HSV infection of the tracheobronchus. A 78-year-old male patient was admitted in acute respiratory failure, with COPD and old pulmonary trberculosis. After the clinical condition improved, a bronchoscopy was done which revealed a localized area of swelling, hyperemia, and mucosal irregularity at the lower trachea and right upper lobar bronchus. Bronchial brushing and biopsy showed typical cytologic changes including intranuclear inclusion body. Viral culture of a bronchial washing revealed a growth of HSV, type I. The patient died of unrelated, acute myocardial linfarction.

[Aggressive pulmonary paracoccidioidomycosis, stenosing endotracheitis and subacute cor pulmonale. Description of a case]

A paracoccidioidomicose (Pbmicose) atinge os pulmões pela via inalatória, onde se estabelece o complexo primário semelhante ao da tuberculose. A traquéia comprometida pela via tubohemolinfática desenvolveria reação inflamatória em processo granulomatoso levando à obstrução estenosante com asíixia. Acompanhou-se um doente, masculino, 32 anos, branco, natural de Sarutaiá (SP), lavrador, que há 8 meses desenvolveu tosse expectorativa branco-amarelada, diária, sem fatores de melhora ou piora e dispnéia inicial discreta. Há 4 meses, anorexia, fraqueza e astenia. Há 1 mês a dispneia se agravou. Perdeu 15 kg. Tabagista e etilista há 16 anos. Exame físico revelou: PA — 10/7 mmHg, FR = 28 bpm, peso 31 kg, hipocratismo digital e hipotrofia muscular Tórax enfisematoso e síndrome obstrutivo aos testes de função pulmonar. Coração: P2 desdobrada e hiperfonética. Hepatesplenomegalia. Desenvolveu cor-pulmonale e insuficiência adrenal à internação, evoluindo após 45 dias para óbito em insuficiência respiratória aguda asfixiante, apesar da terapia antifúngica ter sido completa. A literatura médica revista não mostrou registro de caso semelhante de cor-pulmonale e insuficiência adrenal de evolução subaguda.

Antibiotic activity in sputum

Pulmonary infection in cystic fibrosis (CF) is primarily a purulent tracheobronchitis. Antibiotics are available that are active in vitro against bacteria isolated from sputum from patients with CF. Despite efficacious antibiotic concentrations in serum, however, the results of treatment are frequently suboptimal. A widely accepted explanation for this limited efficacy is poor penetration of orally or intravenously administered antibiotics into respiratory secretions. The bioactivity of antibiotics in respiratory secretions is not identical to that found in vitro. Laboratory conditions are standardized and selected to approximate serum. Deviations from these conditions can markedly influence the results. Differences in composition between sputum and laboratory culture media, as well as variation in growth and metabolism of the pathogen in respiratory secretions, must be considered when predicting in vivo activity in sputum. Thus, when defining criteria for antibiotic susceptibility or resistance in the treatment of pulmonary infection in patients with CF, the concentrations achievable in bronchial secretions as well as the bioactivity in this environment should be considered.

Tracheobronchial tree: expandable metallic stents used in experimental and clinical applications. Work in progress

An expandable stainless steel stent was formulated for use in the treatment of tracheobronchial stenosis, tracheomalacia, and airway collapse following tracheal reconstruction. The stents were placed through an endotracheal tube into the trachea and bronchi of 11 healthy dogs. The stents expanded over time, substantially increasing the diameter of the lumen. Slight migration occasionally occurred, while an inflammatory reaction was noted in each animal. The stents were successfully used in the treatment of two cancer patients to dilate a postoperative bronchial stenosis that caused pneumonia and to support a tracheal graft that collapsed with respiration. Because of the stent migration in experimental studies, designs are being tested to develop stents with greater stability. These stents may be effective in overcoming stenosis caused by scarring, extrinsic compression, and collapse of reconstructed tracheobronchial structures.

Membranous laryngotracheobronchitis, a complication of measles

Membranous laryngotracheobronchitis is a very serious infection which affects the larynx, trachea and bronchi, requiring aggressive therapeutic measures. It has been recently rediscovered as a cause of disease in children. However, it is a very unusual complication of measles. Two infants with measles and membranous laryngotracheobronchitis are reported.

Congenital glottic webs in children. A retrospective review of 51 patients

This study is a retrospective review of congenital glottic webs in children. Its purpose is to clarify the controversial aspects of this lesion and to offer a more definitive approach to its treatment. The study includes discussions of embryology and anatomy, a thorough literature review, and a detailed statistical analysis of patient data. Fifty-one pediatric cases are reported, with symptoms and endoscopic findings described in detail. Treatment with dilatations, incisions (knife, scissors, laser), stenting, and external laryngeal surgery with keel insertion are evaluated, and results of therapy, both before and after the development of laser surgery, are reported. Of the 51 patients, 22 required tracheotomy and all who completed therapy were ultimately decannulated. Vocal dysfunction was the most difficult symptom to treat, and perfection of the voice was attained only infrequently. However, the ultimate results of therapy, as noted in this series of patients, should counter the pessimistic viewpoints expressed in the literature.

Diagnosis and therapy of necrotizing tracheobronchitis in ventilated neonates

From January 1983 to September 1984 our neonatal ICU (NICU) treated eight endotracheally intubated infants who had suspected airway obstruction characterized by hypercarbia dissonant with severity of lung disease and difficulty in ventilation with lack of chest movement, both on conventional intermittent mandatory ventilation and high-frequency oscillation. Bronchoscopic removal of necrotic tissue was possible in six infants, two of whom survived. Bronchoscopy showed desquamation of epithelial surfaces, leaving encrusted exudations considered to be characteristic of necrotizing tracheobronchitis (NTB). The four nonsurvivors of bronchoscopy and one of the infants not submitted to bronchoscopy had NTB confirmed at autopsy. NTB was not associated with any specific lung disease, humidifier, or ventilator. The autopsy frequency of NTB during this period was 5 per 160 NICU admissions. A separate chart review of unselected autopsied cases in 1981 and 1982 showed that 12 of 284 neonates admitted to the NICU had NTB. NTB appears to be a rediscovered condition related to endotracheal intubation and mechanical ventilation using high mean airway pressures.

Herpetic tracheobronchitis detected at bronchoscopy: cytologic diagnosis by the immunoperoxidase method

Herpes simplex virus (HSV) infection of the respiratory tract requires rapid specific diagnosis to avoid late complications and maximize the efficacy of available drug therapy. We report a method of accomplishing this that was tested in 33 cytologic specimens derived from sputum, washings, or brushings from 25 debilitated elderly males suffering from a variety of underlying neoplastic and nonneoplastic chronic diseases. All specimens had shown either single cells (54%), multinucleated groups (8%), or both (38%); they displayed the ground-glass appearance (86%), discrete nuclear inclusions (4%), or both (10%), as appreciated by the Papanicolaou stain. The specimens were processed by the peroxidase-antiperoxidase technique utilizing anti-HSV-1 antibody and 3,3'-diaminobenzidine (DAB) as the chromogen. In six cases, aminoethylcarbazol (AEC) was used for comparison. Twenty-nine of the 33 specimens (88%) stained positively for HSV-1 as did control sections of herpetic encephalitis and esophagitis; there were no false positives with appropriate negative controls. All 12 bronchoscopic specimens revealed virocytes with HSV immunopositivity; in contrast, 17 of 21 (80%) sputum specimens were positive for HSV. The strongest positivity was noted in bronchial brushings and washings whereas the only four negative smears were from sputum specimens. The DAB immunostain was coarser and stronger at the periphery of the cytoplasm, and the hematoxylin counterstain permitted a clear identification of nuclear viral changes. With AEC, the immunostain was more vivid and evenly distributed, but counterstaining was impaired due to the greater solubility of the chromogen. The technique is sensitive, reproducible, and less expensive and time-consuming than electron microscopy (EM) or viral cultures.

Selective primary health care: strategies for control of disease in the developing world. XXI. Acute respiratory infections

Acute respiratory infections represent an important cause of mortality in developing countries, especially among malnourished infants. The microbial etiologies are numerous and complex. Since vaccines effective against the likely major pathogens in the youngest children are not available, the acute respiratory infection control programs designed by the World Health Organization are based on simple schemes to classify illness according to severity and to treat bacterial infections early, thus preventing severe complications. These programs require careful planning to anticipate and circumvent local problems, and their efficacy should be monitored with care. In addition, research is needed in many areas: definition of the spectrum of organisms involved and the pathogenesis of severe infection; delineation of markers that will accurately identify patients needing antibiotics or hospitalization; performance of controlled trials of intervention strategies that will unequivocally identify effective methods; design and production of new, simple, and inexpensive diagnostic tools; and development of vaccines that will be effective in the target populations.

Viral respiratory diseases

An overview of the more commonly encountered viral diseases of the dog and cat is presented. The reader is acquainted with the principles of antiviral therapy and the drugs that have been studied for use in animal viral respiratory diseases. An update on vaccination principles and guidelines is provided.

An Alcaligenes faecalis isolate from turkeys: pathogenicity in selected avian and mammalian species

An Alcaligenes faecalis isolate of known pathogenicity for turkeys was examined for adherence and cytotoxicity in tracheal organ cultures of turkeys, chickens, Japanese quail, guinea pigs, hamsters, and mice, and for colonization and pathogenicity in these 6 species. Adherence and colonization were detected by fluorescent antibody staining. Infected and noninfected tracheal rings were examined by phase-contrast microscopy for cytotoxicity (ciliostasis, blebing of the cell membrane, and sloughing of the ciliated epithelium). Alcaligenes faecalis adhered to the tracheal rings of all species examined. Cytotoxicity was apparent in the tracheal rings of turkeys, quail, and chickens. Cytotoxicity was not detected in tracheal rings from the mammalian species. Alcaligenes faecalis colonization of turbinates and tracheas of intact turkeys and quail was detected. Clinical signs of alcaligenes rhinotracheitis were observed and histopathologic characteristics of the disease were detected. Chickens, guinea pigs, hamsters, and mice were refractory to infection with this isolate of A faecalis.

Fatal aspiration pneumonia caused by an esophageal foreign body

Esophageal foreign body accompanied by respiratory complications is a rare condition. A few cases have been reported, only two of them in adults. We describe the case of a 34-year-old mentally retarded patient who was hospitalized for aspiration pneumonia and died 48 hours after admission. At autopsy, the prominent finding was a 3 X 3-cm stone impacted into the upper esophagus and compressing the trachea from behind. The possibility of an esophageal foreign body should be included in the differential diagnosis of unexplained respiratory distress or aspiration pneumonia in adults.

Involuntary smoking and incidence of respiratory illness during the first year of life

A prospective study of 1,144 infants and their families was performed. Smoking and family histories were evaluated with respect to the incidence of lower respiratory disease during the first year of life. It was found that (1) tracheitis and bronchitis occurred significantly more frequently in infants exposed to cigarette smoke in the home, (2) maternal smoking imposed greater risks upon the infant than paternal smoking, (3) occurrence of neither tracheitis nor bronchitis showed a consistent relationship to the number of cigarettes smoked, (4) a family history that was positive for respiratory illness (chronic cough or bronchitis) significantly influenced the incidence of bronchitis, (5) too few cases of laryngitis and pneumonia were seen to warrant any opinions regarding the adverse influence of either smoking or a family history that was positive for respiratory illness, and (6) occurrence of bronchiolitis was not affected by the presence of a smoker nor influenced by a family history that was positive for respiratory illness. It is concluded that passive smoking is dangerous to the health of infants and that infants born to families with a history that is positive for respiratory illness (chronic cough or bronchitis) are at risk of developing bronchitis.

Reactivity of cat tracheal smooth muscle to histamine under conditions of experimentally induced inflammation

The reactivity of cat tracheal smooth muscle to histamine in vitro was studied at various degrees of inflammation of the airways induced experimentally by the intratracheal administration of turpentine oil or Staphylococcus aureus, both in aerosol form. Tracheal smooth muscle preparations from the control animals did not respond to histamine in doses of 10(-9)-10(-3) mol X 1(-1). In tracheal preparations from three groups of cats with turpentine oil inflammation induced 24 h, 48 h and 15 days previously, histamine caused contractions in 20, 70 and 24% of the cats, respectively, according to the degree of inflammation. All tracheal preparations from cats with staphylococcal inflammation responded to histamine by contraction. Atropine, acetylosalicylic acid and phentolamine did not abolish histamine contractions in tracheal preparations, but clemastine did.

Respiratory disease (rhinotracheitis) in turkeys in Brittany, France, 1981-1982. II. Laboratory findings

After discovering that numerous turkey flocks experiencing rhinotracheitis in Brittany, France, had antibodies against chlamydia, laboratory studies were conducted to determine whether chlamydia and/or viruses would explain the respiratory disease observed. Although both lentogenic paramyxoviruses of type 1 (Newcastle disease virus) and Chlamydia psittaci were isolated, it was concluded, based on epidemiologic and other laboratory findings, that C. psittaci was the primary cause of the disease.