ArticleLiterature Review

Probiotics for preventing acute upper respiratory tract infections

Authors:
  • West China Hosipital, Sichuan University
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Abstract

Background: Probiotics may improve a person's health by regulating their immune function. Some trials have shown that probiotic strains can prevent respiratory infections. Even though the previous version of our review showed benefits of probiotics for acute upper respiratory tract infections (URTIs), several new studies have been published. Objectives: To assess the effectiveness and safety of probiotics (any specified strain or dose), compared with placebo, in the prevention of acute URTIs in people of all ages, at risk of acute URTIs. Search methods: We searched CENTRAL (2014, Issue 6), MEDLINE (1950 to July week 3, 2014), EMBASE (1974 to July 2014), Web of Science (1900 to July 2014), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to July 2014), the Chinese Medicine Popular Science Literature Database (from 2000 to July 2014) and the Masters Degree Dissertation of Beijing Union Medical College Database (from 1981 to July 2014). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for completed and ongoing trials on 31 July 2014. Selection criteria: Randomised controlled trials (RCTs) comparing probiotics with placebo to prevent acute URTIs. Data collection and analysis: Two review authors independently assessed the eligibility and quality of trials, and extracted data using the standard methodological procedures expected by The Cochrane Collaboration. Main results: We included 13 RCTs, although we could only extract data to meta-analyse 12 trials, which involved 3720 participants including children, adults (aged around 40 years) and older people. We found that probiotics were better than placebo when measuring the number of participants experiencing episodes of acute URTI (at least one episode: odds ratio (OR) 0.53; 95% confidence interval (CI) 0.37 to 0.76, P value < 0.001, low quality evidence; at least three episodes: OR 0.53; 95% CI 0.36 to 0.80, P value = 0.002, low quality evidence); the mean duration of an episode of acute URTI (mean difference (MD) -1.89; 95% CI -2.03 to -1.75, P value < 0.001, low quality evidence); reduced antibiotic prescription rates for acute URTIs (OR 0.65; 95% CI 0.45 to 0.94, moderate quality evidence) and cold-related school absence (OR 0.10; 95% CI 0.02 to 0.47, very low quality evidence). Probiotics and placebo were similar when measuring the rate ratio of episodes of acute URTI (rate ratio 0.83; 95% CI 0.66 to 1.05, P value = 0.12, very low quality evidence) and adverse events (OR 0.88; 95% CI 0.65 to 1.19, P value = 0.40, low quality evidence). Side effects of probiotics were minor and gastrointestinal symptoms were the most common. We found that some subgroups had a high level of heterogeneity when we conducted pooled analyses and the evidence level was low or very low quality. Authors' conclusions: Probiotics were better than placebo in reducing the number of participants experiencing episodes of acute URTI, the mean duration of an episode of acute URTI, antibiotic use and cold-related school absence. This indicates that probiotics may be more beneficial than placebo for preventing acute URTIs. However, the quality of the evidence was low or very low.

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... They might improve immune function in several ways, including enhancing gut barrier function, increasing immunoglobulin production, inhibiting viral replication, and enhancing the phagocytic activity of white blood cells. However, the mechanisms of their potential effects on immune function are unclear [17,175,176]. In addition, research findings for one probiotic strain cannot be extrapolated to others [17,177]. ...
... Efficacy: Several systematic reviews and meta-analyses published before the emergence of COVID-19 evaluated probiotic use to prevent or treat respiratory tract infections in children and adults. All of these studies found that probiotics have beneficial effects on some, but not all, outcomes [176,[178][179][180][181]. Several studies have also suggested that probiotics improve outcomes in patients who have ventilator-associated pneumonia and other infections, although the evidence is of low quality and high heterogeneity [182,183]. ...
... indicating that probiotic supplements are safe for most people [175]. Side effects, which are usually minor, include gastrointestinal symptoms, such as gas [17,176]. However, potential safety concerns can include systemic infections, especially in individuals who are immunocompromised [175]. ...
Article
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COVID-19, the disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in 2019 and has infected over 230 million people worldwide as of October 1, 2021. Common initial signs and symptoms include cough, fever, fatigue, headache, muscle aches and pain, and diarrhea [2]. Some individuals with COVID-19 become severely ill, usually starting about 1 week after symptom onset; severe COVID-19 often involves progressive respiratory failure and may also result in life-threatening pneumonia, multiorgan failure, and death. In addition, thousands of individuals-possibly 10% to 75%-who have had COVID-19 report symptoms of “long COVID” (including fatigue, muscle weakness, sleep difficulties, and cognitive dysfunction) for several months after the acute stage of illness has passed. Currently, data are insufficient to support recommendations for or against the use of any vitamin, mineral, herb or other botanical, fatty acid, or other dietary supplement ingredient to prevent or treat COVID-19. And by law, dietary supplements are not allowed to be marketed as a treatment, prevention, or cure for any disease; only drugs can legally make such claims. Nevertheless, sales of dietary supplements marketed for immune health increased after the emergence of COVID-19 because many people hoped that these products might provide some protection from SARS-CoV-2 infection and, for those who develop COVID-19, help reduce disease severity. The immune system defends the body against pathogens that cause disease and is comprised of innate responses, which are the first line of defense, and adaptive responses, which become engaged later.
... The results of studies using probiotics for the treatment or prevention of viral respiratory illnesses have; however, been inconsistent [5,7]. These inconsistent results may be due to the variable quality of the study designs and results reporting of the clinical trials [2]. These trials have generally not addressed potential mechanisms of action in humans, and the proposed mechanism of action of probiotics as treatment for viral respiratory disease have been based primarily on animal models [8,9]. ...
... Many clinical trials have explored the effect of probiotics on URTI. However, most clinical trials have been conducted in children and the low number of studies in adults have made systematic comparison challenging [2,19]. Although some of these trials have reported beneficial effects, the results have been inconsistent. ...
... Furthermore, there is little information about probiotic strain-specific effects, optimal dose, and potential mechanisms of action. Reviews of these studies have concluded that the usefulness of probiotics in viral upper respiratory disease is uncertain and more studies are needed to clarify the effectiveness of probiotics in healthy adults [2,7]. Our study was designed to address some of the deficiencies in the earlier studies by using a well-defined and well-controlled model involving documented infection with single pathogen and an adequate sample size to detect a meaningful effect. ...
Article
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Background This study was designed to assess the efficacy of Bifidobacterium animalis ssp. lactis (Bl-04) for prevention of rhinovirus colds and to explore the interactions between the probiotic, the viral infection, the host response and the host microbiome. Methods The effect of ingestion of the probiotic Bl-04 was evaluated in a randomized, double-blinded rhinovirus (RV) challenge study. Healthy volunteers recruited from a university community in USA were randomized 1:1 using a computer generated code to ingest either Bl-04 (n=165) or placebo (n=169) for 28 days and were then challenged with RV-A39, and followed for 14 days. All study interactions and sample collection occurred in dedicated clinical research space. The primary analysis was the effect of the probiotic on the incidence of RV-associated illness. (Trial registration: NCT02679807, study complete). Findings The first cohort of volunteers was randomized on March 14, 2016 and the last (5th) cohort was randomized on March 12, 2018. Sixty-three (56%, 95% CI [47%; 66%]) of the 112 subjects in the active group and 60 (50%,95% CI [41%; 59%]) of the 120 subjects in the placebo group had a protocol-defined rhinovirus-associated illness (χ²=0·91, p=0·34). The point estimate of the difference in illness (active-placebo) is 6.3% (95% CI -6.7;19.1). There were no adverse events that were judged as definitely or probably related to the study product. Interpretation In this study there was no effect of orally administered Bl-04 on the occurrence of RV-associated illness. Funding Danisco Sweeteners Oy (now IFF Health & Biosciences).
... Some orally delivered probiotics, including bacteria derived from the human microbiota, have shown promising results for prevention or treatment of disease in both the gut and at other body sites (Hungin et al., 2018;Guo et al., 2019;Di Pierro et al., 2021). There is also some evidence that oral probiotics can help prevent or reduce the severity of URT infections (Hao et al., 2015;Wang et al., 2016). URT commensal bacteria have shown promise in vitro and may have potential as locally applied probiotics for the prevention and management of URT viral infections. ...
... and Bifidobacterium spp. This approach is predicated on the idea that gastrointestinal microbiota can influence the URT via systemic effects such as immune modulation, however, the evidence from these studies for influence on the URT is mixed (Hao et al., 2015;Li et al., 2020). ...
Article
Full-text available
There is a high incidence of upper respiratory viral infections in the human population, with infection severity being unique to each individual. Upper respiratory viruses have been associated previously with secondary bacterial infection, however, several cross-sectional studies analyzed in the literature indicate that an inverse relationship can also occur. Pathobiont abundance and/or bacterial dysbiosis can impair epithelial integrity and predispose an individual to viral infection. In this review we describe common commensal microorganisms that have the capacity to reduce the abundance of pathobionts and maintain bacterial symbiosis in the upper respiratory tract and discuss the potential and limitations of localized probiotic formulations of commensal bacteria to reduce the incidence and severity of viral infections.
... In the past two decades the effect of probiotics on immune function and respiratory viral infections have been studied in numerous clinical studies, but with variable quality. Although meta-analyses indicate efficacy of probiotics against acute upper respiratory tract (URT) infections in general (Hao et al., 2015;King et al., 2014;Shi et al., 2021), the results per strain vary, and accordingly probiotic effects on immunity should be investigated on a per strain or consortia basis (Hill et al., 2014). ...
... As many COVID-19 patients suffer from gastrointestinal symptoms, these probiotic consortia could potentially support intestinal health and immune function. Probiotics in general have shown efficacy in meta-analyses against respiratory tract infections (Hao et al., 2015;King et al., 2014), however, the results between the strains or their combinations vary. Thus, it is warranted to use specific strains or consortia of probiotics for immune stimulation (Hill et al., 2014). ...
Article
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Probiotics have been suggested as one solution to counter detrimental health effects by SARS-CoV-2, however, data so far is scarce. We tested the effect of two probiotic consortia, OL-1 and OL-2, against SARS-CoV-2 in ferrets and assessed their effect on cytokine production and transcriptome in a human monocyte-derived macrophage (Mf) and dendritic cell (DC) model.The results showed that the consortia significantly reduced the viral load, modulated immune response, and regulated viral receptor expression in ferrets compared to placebo. In human Mf and DC model, OL-1 and OL-2 induced cytokine production and genes related to SARS-CoV-2 anti-viral immunity. The study results indicate that probiotic stimulation of the ferret immune system leads to improved anti-viral immunity against SARS-COV-2 and that genes and cytokines associated with anti-SARS-CoV-2 immunity are stimulated in human immune cells in vitro. The effect of the consortia against SARS-CoV-2 warrants further investigations in human clinical trials.
... [102] Studies have shown that probiotics are effective in preventing and treating many disorders, such as acute gastroenteritis, [103] inflammatory bowel diseases and irritable bowel syndrome, [104,105] Clostridium difficile-associated diarrhea, [106] allergies, [107] neonatal sepsis, [108] and respiratory tract infections. [109] Hu et al [110] also reported that probiotics might exert their beneficial effects on coronavirus and have a positive effect on host immune functions during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In recent years, probiotics have also been used to prevent various oral diseases, such as dental caries, [111] gingivitis, [112] and periodontitis. ...
Article
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A massive depletion of CD4+ T lymphocytes has been described in early and acute human immunodeficiency virus (HIV) infection, leading to an imbalance between the human microbiome and immune responses. In recent years, a growing interest in the alterations in gut microbiota in HIV infection has led to many studies; however, only few studies have been conducted to explore the importance of oral microbiome in HIV-infected individuals. Evidence has indicated the dysbiosis of oral microbiota in people living with HIV (PLWH). Potential mechanisms might be related to the immunodeficiency in the oral cavity of HIV-infected individuals, including changes in secretory components such as reduced levels of enzymes and proteins in saliva and altered cellular components involved in the reduction and dysfunction of innate and adaptive immune cells. As a result, disrupted oral immunity in HIV-infected individuals leads to an imbalance between the oral microbiome and local immune responses, which may contribute to the development of HIV-related diseases and HIV-associated non-acquired immunodeficiency syndrome comorbidities. Although the introduction of antiretroviral therapy (ART) has led to a significant decrease in occurrence of the opportunistic oral infections in HIV-infected individuals, the dysbiosis in oral microbiome persists. Furthermore, several studies with the aim to investigate the ability of probiotics to regulate the dysbiosis of oral microbiota in HIV-infected individuals are ongoing. However, the effects of ART and probiotics on oral microbiome in HIV-infected individuals remain unclear. In this article, we review the composition of the oral microbiome in healthy and HIV-infected individuals and the possible effect of oral microbiome on HIV-associated oral diseases. We also discuss how ART and probiotics influence the oral microbiome in HIV infection. We believe that a deeper understanding of composition and function of the oral microbiome is critical for the development of effective preventive and therapeutic strategies for HIV infection.
... Clinical and experimental studies have demonstrated that probiotics exert a protective activity against respiratory viruses. Indeed, a Cochrane meta-analysis of 12 randomized control trials including 3,720 adults and children reported a 2-fold lower risk of developing upper respiratory tract infections (over 90% of them caused by viral pathogens) in subjects taking probiotics and a small but significant reduction in disease severity in those infected 39 . The possible mechanisms involved in the probiotic protection against viruses are increased levels of type I interferons, the number and activity of antigen-presenting cells, NK cells, T cells, and the levels of systemic and mucosal specific antibodies in the lungs 40,41 . ...
Article
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Abstract Before eliciting an adaptive immune response, SARS-CoV-2 must overcome seven constitutive respiratory defense barriers. The first is the mucus covering the respiratory tract’s luminal surface, which entraps inhaled particles, including infectious agents, and eliminates them by mucociliary clearance. The second barrier comprises various components present in the airway lining fluid, the surfactants. Besides providing low surface tension that allows efficient gas exchange at the alveoli, surfactants inhibit the invasion of epithelial cells by respiratory viruses, enhance pathogen uptake by phagocytes, and regulate immune cells’ functions. The respiratory tract microbiota constitutes the third defense barrier against SARS-CoV-2. It activates the innate and adaptive immune cells and elicits anti-infectious molecules such as secretory IgA antibodies, defensins, and interferons. The fourth defense barrier comprises the antimicrobial peptides defensins, and lactoferrin. They show direct antiviral activity, inhibit viral fusion, and modulate the innate and adaptive immune responses. Secretory IgA antibodies, the fifth defense barrier, besides protecting the local microbiota against noxious agents, also inhibit SARS-CoV-2 cell invasion. If the virus overcomes this barrier, it reaches its target, the respiratory epithelial cells. However, these cells also act as a defense barrier, the sixth one, since they hinder the virus’ access to receptors and produce antiviral and immunomodulatory molecules such as interferons, lactoferrin, and defensins. Finally, the sensing of the virus by the cells of innate immunity, the last constitutive defense barrier, elicits a cascade of signals that activate adaptive immune cells and may inhibit the development of productive infection. The subject of the present essay is discussing these mechanisms.
... When it comes to probiotics safety in RTIs, the evidence obtained from meta-analyses and reviews gives the conclusion that the side effects upon probiotic consumption are minor (Hao et al., 2015;King et al., 2014). ...
Chapter
Nowadays, respiratory infections are one of the main causes of death worldwide. It was always thought that the respiratory tract was devoid of its microbiota, but it was a few years ago when this changed. It has not only been described but also the pulmonary microbial community is altered in the context of various respiratory disorders. Despite the lack of knowledge about its role in health and disease, there is evidence indicating that the use of probiotics may have beneficial effects during respiratory disorders since they can modulate the immune system both directly and indirectly.
... The main advantages of probiotic ingestion reported in systematic reviews are related to several different conditions. Those include prevention and treatment of necrotizing enterocolitis [2]; decreased incidence of diarrhea associated with antibiotic use [3] ; decreased duration of infectious and in ammatory diseases [4]; regulation of intestinal transit [5]; relief of irritable bowel syndrome symptoms [6] ; decrease in the incidence of upper respiratory tract diseases [7], reduction in allergy symptoms, serum cholesterol concentration, stmulation and modulation of the immune system and modulation of gene expression [8]. ...
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Aim: The study evaluated the effects of supplementation with three different probiotic strains B. lactis (LACT GBTM), L. rhamnosus (RHAM GBTM) and L. reuteri (REUT GBTM) on brain-intestinal immunomodulation in an animal model of LPS-induced inflammation. Methods: 50 mice Balb/C were distributed into five groups: Control; lipopolysaccharide (LPS); LPS + B. lactis (LACT GBTM); LPS + L. rhamnosus (RHAM GBTM); LPS + L. reuteri (REUT GBTM). The animals were supplemented with their respective probiotic microorganisms daily, for 30 days, at a concentration of 1x10⁹ CFU/animal/day. After 30 days of supplementation, animals received the inflammatory insult by LPS (15mg/kg). Behavioral tests, oxidative stress and inflammation were performed, as well as gut and brain histology. Results: In the behavioral test, LPS+ B. lactis group was less anxious than the other groups. Serum interleukin IL-1β and IL-6 levels increased in all groups that received the LPS insult and there was a reduction in inflammation in the supplemented groups when compared to the LPS group in brain and gut. A reduction in myeloperoxidase activity and oxidative stress in groups supplemented with probiotics. Intestine histological analysis, damage to tissue integrity in the LPS group and preservation of integrity in the supplemented animals. In the brain, infiltrates of perivascular inflammatory cells can be seen in the LPS group. Conclusion: The three probiotic studies showed efficient immunomodulating activity and ensured integrity of the intestinal barrier function, even after the severe insult by LPS. These results show the important role of probiotics in the gut-brain axis.
... It reduces the duration of an episode of URTI and antibiotic prescription rate. [105] Evaluation of possible effects of probiotics on RTI associated expenses in USA primary care settings. ...
Article
Rapid infectivity of SARS-CoV2 with recent viral variants is posing a challenge in the development of robust therapeutic strategies. On the other hand, microbiota is debated for its involvement in SARS-CoV2 infection with varied opinions. Although ample data about the role of microbiota and probiotics in respiratory viral infections are available, their role in COVID-19 is limited albeit emerging rapidly. The utilization of probiotics for the management of COVID-19 is still under investigation in many clinical trials. Existing information coupled with recent COVID-19 related studies can suggest various ways to use microbiota modulation and probiotics for managing this pandemic. Present article indicates the role of microbiota modulation and probiotics in respiratory infections. In addition, scattered evidence was gathered to understand the potential of microbiota and probiotics in the management of SARS-CoV2. Gut-airway microbiota connection is already apparent in respiratory tract viral infections, including SARS-CoV2. Though few clinical trials are evaluating microbiota and probiotics for COVID-19 management, the safety evaluation must be given more serious consideration because of the possibility of opportunistic infections among COVID-19 patients. Nevertheless, the information about microbiota modulation using probiotics and prebiotics can be helpful to manage this outbreak and this review presents different aspects of this idea.
... It reduces the duration of an episode of URTI and antibiotic prescription rate. [105] Evaluation of possible effects of probiotics on RTI associated expenses in USA primary care settings. ...
Article
Rapid infectivity of SARS-CoV2 with recent viral variants is posing a challenge in the development of robust therapeutic strategies. On the other hand, microbiota is debated for its involvement in SARS-CoV2 infection with varied opinions. Although ample data about the role of microbiota and probiotics in respiratory viral infections are available, their role in COVID-19 is limited albeit emerging rapidly. The utilization of probiotics for the management of COVID-19 is still under investigation in many clinical trials. Existing information coupled with recent COVID-19 related studies can suggest various ways to use microbiota modulation and probiotics for managing this pandemic. Present article indicates the role of microbiota modulation and probiotics in respiratory infections. In addition, scattered evidence was gathered to understand the potential of microbiota and probiotics in the management of SARS-CoV2. Gut-airway microbiota connection is already apparent in respiratory tract viral infections, including SARS-CoV2. Though few clinical trials are evaluating microbiota and probiotics for COVID-19 management, the safety evaluation must be given more serious consideration because of the possibility of opportunistic infections among COVID-19 patients. Nevertheless, the information about microbiota modulation using probiotics and prebiotics can be helpful to manage this outbreak and this review presents different aspects of this idea.
... Probiotics are defined as "live microorganisms which, when administered in adequate amounts, confer health benefits to the host" (Gerritsen, Smidt, Rijkers, & de Vos, 2011). Some of the commonly associated health benefits of probiotics include hypocholesterolemic effects (Guo et al., 2011), and therapeutic treatment of respiratory tract infections (Hao, Dong, & Wu, 2015). The main source of probiotics for most consumers is dairy products as the protective food matrix is capable of supporting probiotic viability during storage and gastrointestinal transit (Vijaya Kumar, Vijayendra, & Reddy, 2015). ...
Article
In this study, a bilayer probiotic edible coating was developed for fresh-cut apple slices. Lactobacillus plantarum 299v-containing carboxymethyl cellulose solution was applied to the apple slices as the primary coating, followed by a secondary coating with zein. As a result, the probiotic bacteria L. plantarum 299v remained stable on the coated apple slices during 7 days storage at 4 °C (>6 log CFU/g) and only manifested a drop of 2.24 ± 0.08 log CFU/g during simulated digestion. The bilayer probiotic edible coating was able to induce significantly less weight loss of the apple slices, suppress yeasts and moulds, and inhibit the proliferation of spiked Listeria monocytogenes during the chilled storage (P < 0.05). Taken together, our results demonstrated that the bilayer probiotic edible coating with stabilized L. plantarum 299v as developed in this study was able to improve the shelf life and safety quality of fresh-cut apple slices.
... Probiotics have been prescribed for patients with gastrointestinal disease and complaints (Williams et al., 2010). There is a set of cumulative evidence that supports the use of probiotics, both in food products and supplements to provide protection against infectious diseases including respiratory infections (Hao et al., 2011;Ozen et al., 2015). Lactobacilli, Enterococci, and Bifidobacteria are families of Lactic Acid Bacteria (LAB) and they constitute the most frequently used strains of probiotics (Fijan, 2014). ...
Article
The aim of current study was to isolate and identify naturally occurring probiotic Lactobacillus species in buffalo milk, camel milk, and camel urine to investigate their susceptibility to antibiotics and their antibacterial activity against pathogenic bacteria. A total number of seven samples which included three milk samples from buffalo, three milk samples from camel, and one urine sample from camel were collected and used in this study. The samples were cultured, and 18 isolated strains were identified by using 16S rRNA multiplex Polymerase Chain Reaction analysis, which was performed following DNA extraction from the isolated bacteria. Buffalo and camel milk were different in their Lactobacilli content. All Lactobacilli strains that were found in both camel milk and camel urine, were also found in buffalo milk, Lactobacilli strains in camel milk and urine were generally more resistant to the antibiotic. Lactobacilli isolated from buffalo milk, camel milk, and also camel urine presented variable degrees of antibacterial activity against pathogenic bacteria. Further studies should be conducted with more samples to gain more information in the field of antibacterial activity of probiotic lactobacilli and to understand the mechanisms of their activity. Hopefully, they can be used as natural alternatives instead of synthetic antibiotics.
... The main advantages of probiotic ingestion reported in systematic reviews are related to several different conditions. Those include prevention and treatment of necrotizing enterocolitis [2]; decreased incidence of diarrhea associated with antibiotic use [3] ; decreased duration of infectious and in ammatory diseases [4]; regulation of intestinal transit [5]; relief of irritable bowel syndrome symptoms [6] ; decrease in the incidence of upper respiratory tract diseases [7], reduction in allergy symptoms, serum cholesterol concentration, stmulation and modulation of the immune system and modulation of gene expression [8]. ...
Preprint
Full-text available
Aim: The study evaluated the effects of supplementation with three different probiotic strains B. lactis (LACT GBTM), L. rhamnosus (RHAM GBTM) and L. reuteri (REUT GBTM) on brain-intestinal immunomodulation in an animal model of LPS-induced inflammation. Methods: 50 mice Balb/C were distributed into five groups: Control; lipopolysaccharide (LPS); LPS + B. lactis (LACT GBTM); LPS + L. rhamnosus (RHAM GBTM); LPS + L. reuteri (REUT GBTM). The animals were supplemented with their respective probiotic microorganisms daily, for 30 days, at a concentration of 1x10⁹ CFU/animal/day. After 30 days of supplementation, animals received the inflammatory insult by LPS (15mg/kg). Behavioral tests, oxidative stress and inflammation were performed, as well as gut and brain histology. Results: In the behavioral test, LPS+ B. lactis group was less anxious than the other groups. Serum interleukin IL-1β and IL-6 levels increased in all groups that received the LPS insult and there was a reduction in inflammation in the supplemented groups when compared to the LPS group in brain and gut. A reduction in myeloperoxidase activity and oxidative stress in groups supplemented with probiotics. Intestine histological analysis, damage to tissue integrity in the LPS group and preservation of integrity in the supplemented animals. In the brain, infiltrates of perivascular inflammatory cells can be seen in the LPS group. Conclusion: The three probiotic studies showed efficient immunomodulating activity and ensured integrity of the intestinal barrier function, even after the severe insult by LPS. These results show the important role of probiotics in the gut-brain axis.
... On the skin, mucosa and in the gut, healthy communities of beneficial microbes can suppress the proliferation of harmful bacteria through resource competition and the production of antimicrobial compounds (Dethlefsen et al., 2007;Ng et al., 2013). Applying an ecosystem perspective to the microbial infections we host has led to clinical trials and commercialization of some natural enemy-based therapeutics, including probiotics for use against Salmonella enterica serovar Typhimurium, Clostridium difficile and upper respiratory infections (Bernaola Aponte et al., 2013;Goldenberg et al., 2017;Hao et al., 2015;Kassam et al., 2013;Koretz & Rotblatt, 2004). More recently, bacteriophages (naturally occurring viruses that infect and kill bacteria and archaea) have received increased attention as a promising alternative to antibiotics for multidrug-resistant infections (Dedrick et al., 2019;Nobrega et al., 2015). ...
Article
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Many infectious pathogens spend a significant portion of their life cycles in the environment or in animal hosts, where ecological interactions with natural enemies may influence pathogen transmission to people. Yet, our understanding of natural enemy opportunities for human disease control is lacking, despite widespread uptake and success of natural enemy solutions for pest and parasite management in agriculture. Here we explore three reasons why conserving, restoring or augmenting specific natural enemies in the environment could offer a promising complement to conventional clinical strategies to fight environmentally mediated pathogens and parasites. (a) Natural enemies of human infections abound in nature, largely understudied and undiscovered; (b) natural enemy solutions could provide ecological options for infectious disease control where conventional interventions are lacking; and, (c) many natural enemy solutions could provide important co‐benefits for conservation and human well‐being. We illustrate these three arguments with a broad set of examples whereby natural enemies of human infections have been used or proposed to curb human disease burden, with some clear successes. However, the evidence base for most proposed solutions is sparse, and many opportunities likely remain undiscovered, highlighting opportunities for future research. A free Plain Language Summary can be found within the Supporting Information of this article. A free Plain Language Summary can be found within the Supporting Information of this article.
... Systematic reviews have demonstrated that probioticsincluding lactobacilli (LBs) and strains of alpha haemolytic streptococci (AHS)-can reduce the number and duration of acute upper respiratory (URT) tract infections (URTIs), reduce episodes of acute OM (AOM), antibiotic use and school absence (Hoa et al., 2015;Scott et al., 2019). There was significant benefit found in otitis-prone children (Scott et al., 2019). ...
Article
Aims: To explore the in vitro ability of alpha haemolytic streptococcus (AHS) and lactobacilli, from Indigenous Australian children, to inhibit the growth of respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis), also from Indigenous Australian children. Methods and results: The bacterial interference of 91 isolates, from Indigenous Australian children both with and without otitis media (OM) or rhinorrhoea, was investigated using agar overlay and cell-free supernatant. Promising isolates underwent whole genome sequencing to investigate upper respiratory tract tropism, antibiotic resistance and virulence. Antibiotic susceptibility was examined for ampicillin, amoxicillin + clavulanic acid, and azithromycin. Differences in the strength of bacterial inferences in relation to OM was examined using a case series of 3 healthy and 3 children with OM. Lactobacilli readily inhibited the growth of pathogens. AHS were less effective, although several isolates inhibited S. pneumoniae. One L. rhamnosus had genes coding for pili to adhere to epithelial cells. We detected antibiotic resistance genes coding for antibiotic efflux pump and ribosomal protection protein. Lactobacilli were susceptible to antimicrobials in vitro. Screening for virulence detected genes encoding for two putative capsule proteins. Healthy children had AHS and lactobacillus that were more potent inhibitors of respiratory pathogens in vitro than children with OM. Conclusions: L. rhamnosus from remote Indigenous Australian children are potent inhibitors of respiratory pathogens in vitro. Significance and impact of study: Respiratory/ear disease are endemic in Indigenous Australians. There is an urgent call for more effective treatment/prevention; beneficial microbes have not been explored. L. rhamnosus investigated in this study are potent inhibitors of respiratory pathogens in vitro and require further investigation.
... Akciğerde immünomodülasyon, antiviral aktivitede artış ile respiratuvar virüslere karşı koruma sağlamaktadırlar [69] . Probiyotik desteğinin üst solunum yolu infeksiyonlarına etkisini inceleyen derleme bir çalışmada probiyotik alanlarda üst solunum yolu infeksiyonunun, antibiyotik kullanımının ve hastalık nedenli iş gücü kaybının daha az olduğu görülmüştür [70] . COVID-19 gastrointestinal sistem-akciğer yolağında değişikliklerle disbiozise neden olabilmektedir. ...
... Una elevada presencia de LDLox, es un indicador de importancia en la enfermedad cardiovascular.Otros marcadores bioquímicos de importancia son aquellos relacionados con el proceso inflamatorio, como es el caso de las citoquinas proinflamatorias, proteína C-reactiva y el ácido úrico. Este último se eleva en respuesta a una sobreproducción de la xantina oxidasa (enzima reguladora de la síntesis de ácido úrico), como producto de un ambiente oxidativo celular(61).La diseminación sistémica de ERO y RL, conlleva a alteración orgánica de otros tejidos, siendo uno de los más susceptibles el sistema nervioso, personas con estrés oxidativo crónico es común que presenten manifestaciones clínicas tales como trastornos del sueño (insomnio), Estos marcadores bioquímicos y clínicos van de la mano con la calidadde a dieta. Estudios como los realizados por Monteiro et al. (63), Pagliai et al. (64) y Askari et al. (65), asocian el consumo elevado y prolongado de alimentos ultraprocesados con el desarrollo de enfermedades crónico notransmisibles. ...
Book
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El presente libro es la suma de esfuerzos de investigadores que están comprometidos con una visión diferente y actualizada de la nutrición. Los cambios globales del siglo XXI han conducido al desarrollo de acciones enfocadas a erradicar la pobreza, promover la prosperidad y el bienestar para todos, proteger el medio ambiente y luchar contra el cambio climático. La nutrición, como una ciencia dinámica y creciente, se ve en la necesidad de rediseñar sus modelos de intervención hacia un desarrollo sostenible, que promueva una alimentación que salvaguarde el medio ambiente; por tal motivo, en el presente libro el lector podrá encontrar la suma de proyectos e investigaciones encaminados a una visión de la nutrición sostenible con el objetivo de ser una herramienta sólida y basada en la evidencia científica y clínica para el nutricionista en el diseño de estrategias nutricionales sustentables.
... [7 ] for references), but there is also evidence that they reduce the incidence of respiratory infections and promote a better outcome, particularly in children [63][64][65][66][67][68][69]. This effect is likely due to the so-called gut-lung axis [70 ], whereby altered gut microbiota affects cells that are part of the gut-associated immune system and these cells move to the lung-associated immune system to elicit beneficial actions. ...
Article
Purpose of review: This article will briefly describe the role of specific dietary components, mainly micronutrients, in supporting the immune response and summarise the literature regarding foods and dietary patterns in the context of immunity and infectious illness. Literature on SARS-COV-2 infection and COVID-19 is referred to where appropriate. Recent findings: Micronutrients, other nutrients and plant bioactives have roles in supporting the immune response. Low status of a number of micronutrients is associated with increased risk and severity of COVID-19. Recent studies report associations of plant-based diets with lower risk of, and less severe, COVID-19. Summary: In order to support the immune response, sufficient amounts of a range of essential and non-essential nutrients and other bioactives, mainly from a plant-based diet should be consumed. Further research should define cause-and-effect relationships of intakes of individual dietary components and foods, and of dietary patterns with susceptibility to, and severity of, viral infections.
... Several studies demonstrate the beneficial effect of probiotic bacteria against enteric virus infections and many other diseases [66][67][68][69]. Probiotics protect the host from viral infection by modulating gut microbiota composition, enhancing intestinal barrier function and promoting mucosal immunity [70], as well as interfering with the binding of virus to their target cells by competitive exclusion by blocking viral receptors and binding viruses on the surface to promote their elimination in faeces [71]. ...
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Rotavirus (RV) and norovirus (NoV) are the leading cause of acute gastroenteritis (AGE) worldwide. Several studies have demonstrated that histo-blood group antigens (HBGAs) have a role in NoV and RV infections, since their presence on the gut epithelial surfaces is essential for the susceptibility to many NoV and RV genotypes. Polymorphisms in genes that code for enzymes required for HBGAs synthesis lead to secretor or non-secretor and Lewis positive and Lewis negative individuals. While secretor individuals appear to be more susceptible to RV infections, regarding NoVs infections there are too many discrepancies that prevent drawing conclusions. A second factor that influences enteric viral infections is the gut microbiota of the host. In vitro and animal studies have determined that the gut microbiota limits, but in some cases enhances, enteric viral infection. The ways microbiota can enhance NoV or RV infection include virion stabilization and promotion of virus attachment to host cells, whereas experiments with microbiota-depleted and germ-free animals point to immunoregulation as the mechanism by which the microbiota restricts infection. Human trials with live, attenuated RV vaccines and analysis of the microbiota in responders and non-responders individuals also allowed the identification of bacterial taxa linked to vaccine efficacy. As more information is gained on the complex relationships that are established between the host (glycobiology and immune system), the gut microbiota and the intestinal viruses, new avenues will be open for the development of novel anti-NoV and anti-RV therapies.
... While probiotics are primarily associated with gastrointestinal health, some studies have found that diversity in gut microflora is associated with respiratory diseases, indicating crosstalk between the intestinal tract and lungs via the gut-lung axis to modulate immune responses [152]. Three meta-analyses that assessed a total of 57 randomized controlled trials found that probiotic use decreased the incidence, severity, and duration of respiratory tract infections [153,154]. ...
Article
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The coronavirus disease 2019 (COVID-19) has caused a pandemic and upheaval that health authorities and citizens around the globe are still grappling with to this day. While public health measures, vaccine development, and new therapeutics have made great strides in understanding and managing the pandemic, there has been an increasing focus on the potential roles of diet and supplementation in disease prevention and adjuvant treatment. In the literature, the impact of nutrition on other respiratory illnesses, including the common cold, pneumonia, and influenza, has been widely demonstrated in both animal and human models. However, there is much less research on the impact related to COVID-19. The present study discusses the potential uses of diets, vitamins, and supplements, including the Mediterranean diet, glutathione, zinc, and traditional Chinese medicine, in the prevention of infection and severe illness. The evidence demonstrating the efficacy of diet supplementation on infection risk, disease duration, severity, and recovery is mixed and inconsistent. More clinical trials are necessary in order to clearly demonstrate the contribution of nutrition and to guide potential therapeutic protocols.
... To enhance clarity, only those ASVs with p-adj < 0:0001 are shown. 10 BioMed Research International innate (like phagocytic or natural killer cell activity), adaptive (immunoglobulins production), and local (improved gut barrier and cytokine production) immune functions [63,64]. It is also well known that through the same mechanisms, probiotics have been indicated to enhance vaccine effect [65]. ...
Article
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The decline of the immune system with aging leads elderly people to be more susceptible to infections, posing high risk for their health. Vaccination is thus important to cope with this risk, even though not always effective. As a strategy to improve protection, adjuvants are used in concomitance with vaccines, however, occasionally producing important side effects. The use of probiotics has been proposed as an alternative to adjuvants due to their efficacy in reducing the risk of common infections through the interactions with the immune system and the gut microbiota. A placebo-controlled, randomized, double-blind, clinical trial was carried out on fifty elderly subjects, vaccinated for influenza, to determine the efficacy of a probiotic mixture in reducing common infection symptoms. The incidence of symptoms was evaluated after 28 days of probiotic intake (namely, T28) and after further 28 days of follow-up (namely, T56). The number of subjects, as well as the number of days with symptoms, was remarkably reduced at T28, and even more at T56 in the probiotic group. Furthermore, the influence of probiotics on immunological parameters was investigated, showing a significant positive improvement of total antioxidant capacity and β-defensin2 levels. Finally, faecal samples collected from participants were used to assess variations in the gut microbiota composition during the study, showing that probiotic intake enhanced the presence of genera related to a healthy status. Therefore, the collected results suggested that the treatment with the selected probiotic mixture could help in reducing common infectious disease symptom incidence through the stimulation of the immune system, improving vaccine efficacy, and modulating the composition of the resident gut microbiota by enhancing beneficial genera.
... Если говорить о клинических исследованиях, то наиболее цитируема публикация Q. Hao и et al., которые проанализировали 14 рандомизированных контролируемых исследований, сравниваю щих назначение пробиотиков с плацебо для профилактики острых инфекций верхних дыхательных путей. Было обнаружено, что применение пробиотиков достоверно снижало частоту острых респираторных вирусных инфекций (ОРВИ) и использование антибиотиков по сравнению с группой пациентов, получавших плацебо [2]. ...
Article
The problem of prevention and treatment of acute respiratory infections of the upper respiratory tract remains extremely at the top. Although viruses are the etiological factor in more than 90% of acute respiratory infections, the fact of the active use of antibiotics in the treatment of patients with this patology, along with the lack of effective antiviral agents can cause increasing concern, since this is assocatied with an increase in bacterial resistance, sensitization and inflammatory diseases and therefore requires the development of completely different alternative methods of treatment. Since the discovery of the human microbiome over the past two decades, not only the microbiota as a participant in the infectious process, but also probiotics as a factor in managing the immune responses of the macroorganism in viral infections have been actively studied. In addition, the antiviral activity of different probiotic strains has been demonstrated in the scientific literature, which explains the interest of the scientific community in the use of probiotics in acute respiratory infections, especially since probiotics have shown not only efficacy, but aalso high safety in patients of different age groups, including infants. Thus, the literature review showed that the currently available data both from clinical studies and experimental work on the use of probiotics in acute respiratory infections indicate the potential of such an innovative strategy not only for the prevention but also for the treatment of the acute period of the disease, which should be the basis for its wider use in real practice.
... The only way to prevent RTIs is to improve the immune function [19]. URTIs are infection in the mucosal surfaces of upper airways, such as the nose, sinuses, pharynx, or larynx, resulting in non-allergic rhinitis, acute sinusitis, acute pharyngitis/laryngitis, acute epiglottis, and acute otitis media [26][27][28]. Some of the viruses responsible for common respiratory infections are the influenza virus, respiratory syncytial virus, parainfluenza virus, rhinovirus, enterovirus, adenovirus, coronavirus, and others [28][29][30]. ...
Article
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Fermented foods (FFs) hold global attention because of their huge advantages. Their health benefits, palatability, preserved, tasteful, and aromatic properties impart potential importance in the comprehensive evaluation of FFs. The bioactive components, such as minerals, vitamins , fatty acids, amino acids, and other phytochemicals synthesized during fermentation, provide consumers with several health benefits. Fermentation of food is an ancient process that has met with many remarkable changes owing to the development of scientific technologies over the years. Initially , fermentation relied on back-slapping. Nowadays, starter cultures strains are specifically chosen for the type of fermentation process. Modern biotechnological methods are being implemented in the fermentation process to achieve the desired product in high quality. Respiratory and gastro-intestinal tract infections are the most severe health issues affecting human beings of all age groups, especially children and older adults, during this COVID-19 pandemic period. Studies suggest that the consumption of probiotic Lactobacillus strains containing fermented foods protects the subjects from common infectious diseases (CIDs, which is classified as upper respiratory tract infections, lower respiratory tract infections and gastrointestinal infections) by improving the host's immune system. Further studies are obligatory to develop probiotic-based functional FFs that are effective against CIDs. Presently, we are urged to find alternative, safe, and cost-effective prevention measures against CIDs. The current manuscript briefs the production of FFs, functional properties of FFs, and their beneficial effects against respiratory tract infections. It summarizes the outcomes of clinical trials using human subjects on the effects of supplementation of FFs.
... For COVID-19 infection prevention and treatment approaches, prebiotics and probiotics have been proposed as possible ingredients [147][148][149]. In addition to their ability to alter immunological responses, probiotics are also renowned for their ability to reduce inflammation [150], were found to be effective in preventing illnesses in the past [151], and lowering the likelihood of ventilator-associated pneumonia [149]. One study demonstrated that adding a multi-strain probiotic formulation to conventional treatment decreased morbidity and death in a small cohort of hospitalized COVID-19 patients [152]. ...
Article
Coronavirus disease (COVID-19), a coronavirus-induced illness attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, is thought to have first emerged on November 17, 2019. According to World Health Organization (WHO). COVID-19 has been linked to 379,223,560 documented occurrences and 5,693,245 fatalities globally as of 1st Feb 2022. Influenza A virus that has also been discovered diarrhea and gastrointestinal discomfort was found in the infected person, highlighting the need of monitoring them for gastro intestinal tract (GIT) symptoms regardless of whether the sickness is respiration related. The majority of the microbiome in the intestines is Firmicutes and Bacteroidetes, while Bacteroidetes, Proteobacteria, and Firmicutes are found in the lungs. Although most people overcome SARS-CoV-2 infections, many people continue to have symptoms months after the original sickness, called Long-COVID or Post COVID. The term “post-COVID-19 symptoms” refers to those that occur with or after COVID-19 and last for more than 12 weeks (long-COVID-19). The possible understanding of biological components such as inflammatory, immunological, metabolic activity biomarkers in peripheral blood is needed to evaluate the study. Therefore, this article aims to review the informative data that supports the idea underlying the disruption mechanisms of the microbiome of the gastrointestinal tract in the acute COVID-19 or post-COVID-mediated elevation of severity biomarkers.
... Probiotics were found to be advantageous for reducing both the episodes of acute respiratory tract infections and antibiotic use (Hao et al., 2011). A systematic review also showed that the oropharyngeal probiotic Streptococcus salivarius K12 that colonizes the oropharyngeal mucosa may be useful in reducing the occurrence and/or severity of acute otitis media and secretory otitis media in children, as middle ear infections typically occur after the spread of nasopharyngeal bacteria through the Eustachian tube (Zupancic et al., 2017). ...
Article
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Probiotics play an important role against infectious pathogens via their effects on the epithelium, the production of antimicrobial compounds, and competitive exclusion. Administration of probiotic supplements may reduce the risk of infectious diseases and the use of antibiotics, hence contributing to a reduction or a delay of the development of multi-resistant bacteria. Infection is a constant concern for people who experience recurrent infections, and antibiotic treatment usually fails due to antibiotic resistance. Therefore, an infection can lead to severe illness and hospitalization if left untreated. A growing number of studies have demonstrated promising results for a variety of probiotic strains used to prevent or treat acute and recurrent infectious diseases, but additional standardized clinical research is needed.
... In addition, the gut microbiota can act directly on viruses through its structural components or metabolites or indirectly influence the body's immune response, ultimately affecting the outcome of viral infection [122]. Probiotics can enhance the antiviral ability of the body by regulating innate immunity, maintaining the integrity of the intestinal wall, and activating adaptive immune responses [123]. ...
Article
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Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and it has become a public health concern worldwide. In addition to respiratory symptoms, some COVID‑19 patients also show various gastrointestinal symptoms and even consider gastrointestinal symptoms to be the first manifestation. A large amount of evidence has shown that SARS-CoV-2 infection could disrupt the gut microbiota balance, and disorders of the gut microbiota could aggravate the condition of COVID-19 patients. Therefore, maintaining the gut microbiota balance is expected to become a potential new therapeutic target for treating COVID-19. Traditional Chinese medicine (TCM) has significant effects in all stages of the prevention and treatment of COVID-19. It can adjust the gut microbiota and is an ideal intestinal microecological regulator. This review summarizes the advantages and clinical efficacy of TCM in the treatment of COVID-19 and expounds on the relationship between TCM and the gut microbiota, the relationship between COVID-19 and the gut microbiota, the mechanism of gut microbiota disorders induced by SARS-CoV-2, the relationship between cytokine storms and the gut microbiota, and the role and mechanism of TCM in preventing and treating COVID-19 by regulating the gut microbiota to provide new research ideas for TCM in the prevention and treatment of COVID-19.
... 52 Bu konu ile ilgili yapılan meta-analizlerde, viral kaynaklı solunum yolu enfeksiyonlarının insidansının ve süresinin azaltılmasında probiyotiklerin ılımlı bir etkisinin olduğu belirtilmiştir. 53,54 COVID-19 tanısı almış hastaların %2-47'sinde mekanik ventilasyon gerektiği bildirilmiştir. 50,51 Bu konu ile ilgili yapılan randomize kontrollü çalışmalarda, mekanik ventilasyona bağlı probiyotik verilen (Lactobacillus rhamnosus GG, Bacillus subtilis, and Enterococcus faecalis) kritik hastalarda probiyotik verilmeyen gruba göre ventilatöre bağlı pnömoninin daha az geliştiği saptanmıştır. ...
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ÖZET Dünya Sağlık Örgütü’nün pandemi olarak kabul ettiği koronovirüs hastalığı (COVID-19) ülkemizde de önemli bir halk sağlığı sorunu haline gelmiştir. COVID-19’u da içeren viral enfeksiyonlardan korunmada ve tedavisinde yeterli ve dengeli bir diyete ek olarak A, C ve D vitamini ile çinko ve selenyum suplementasyonunun yararlı etkilerinin olabileceği belirtilmiştir. Ayrıca, probiyotiklerin viral enfeksiyonlara karşı bağışıklığı arttırabileceği bildirilmiştir. Sağlıklı bir bağışıklık sistemi, bugün için koruyucu ve tedavi edici ilacın mevcut olmadığı COVID-19 pandemisinde en önemli silahtır. Besinler, besin ögeleri veya ilaçlar ile birlikte yürütülecek anti-inflamatuar strateji, COVID-19 yönetimi için uygun bir seçenektir.
... В настоящем исследовании не ставили задачу интегральной оценки микробиоценозов, поэтому оценку состояния микробиоценозов ротоглотки и кишечника при сравнении двух препаратов не проводили, а оценивали только частоту встречаемости условно-патогенной микрофлоры. В публикациях, посвященных изучению влияния антисептических средств и фитопрепаратов на состояние микробиоценозов ротоглотки и кишечника, показано, что фитопрепараты оказывают более мягкое воздействие на индигенную микрофлору ротоглотки и кишечника, чем антисептики [18,19,20]. Известно, что многие виды кишечных микроорганизмов имеют оральное происхождение, что указывает на возможность транслокации микроорганизмов, участвующих в передаче генов антибиотикорезистентности, а также ответственных за антилизоцимную, антиинтерфероновую и антицитокиновую активность, из ротоглотки в кишечник [21]. ...
Article
The widespread use of antibacterial drugs for the treatment of respiratory diseases causes antimicrobial resistance in opportunistic microorganisms, which leads to the chronic forms of respiratory diseases and contributes to the risk of repeated respiratory infections. One of the new therapeutic solutions is the use of multicomponent water-soluble plant extracts. The goal of this study was to evaluate the antibacterial efficacy of extracts of multicomponent herbal remedies versus the synthetic antiseptic for the treatment of the oropharyngeal and gut opportunistic microflora in children with chronic tonsillitis. In a retrospective study, we compared the effectiveness of the plant extract Tonsinal (experimental group, 100 patients) versus the Miramistin antiseptic agent (control group, 40 patients) for the treatment of chronic tonsillitis in children 5 to 15 years old using various treatment regimens. The oropharyngeal microbiocenosis was investigated by bacteriological analysis of smears from the posterior wall of the pharynx and tonsils. Bacterial strains were isolated by inoculation on liquid agar media with subsequent identification of Staphylococcus aureus , Streptococcus pyogenes , Candida spp. , Moraxela cataralis , and Mycoplasma pneumonie according to the morphological and biochemical characteristics. For bacteriological analysis of gut microbiocenosis, Staphylococcus aureus , Streptococcus spp. , Candida spp. , Klebsiella spp. , Clostridiums spp. , and Proteus spp. were isolated from coprofiltrate and identified by the same methods. The occurrence rate of microorganisms with the contamination intensity of more than 10 ⁴ CFU/g was compared for the experimental and control groups before and after a 10-day course of therapy. The statistically significant decrease in the incidence of Staphylococcus aureus (from 25% to 0%, p<0.01) and Candida spp. (from 18% to 0%, p<0.01) in oropharynx of patients in the experimental group and from 20% to 7.5% and from 5% to 0% (p<0.01), respectively in the control group was observed. The statistically significant decrease in the occurrence rate of Streptococcus pyogenes was observed only in the experimental group (from 30% to 0%, p<0.01). Treatment with Tonsinal or Miramistin did not lead to the statistically significant changes in the occurrence rate of opportunistic microorganisms in the gut microflora of the patients in both groups. Thus, we have shown a higher antimicrobial efficacy of Tonsinal versus the Miramistin antiseptic for the treatment of the oropharyngeal opportunistic microorganisms in children with chronic tonsillitis.
... Probiotics also show promise as dietary interventions to prevent and treat lung infections, including URTIs and ARIs (Hill et al., 2014), which might be triggered by air pollution as well. A 2015 Cochrane review (Hao et al., 2015) evaluating 12 randomized controlled trials in both paediatric and adult populations concluded that probiotics were better than placebo in preventing ARIs; the number of subject experiencing episodes of ARIs was about 47% lower in the probiotic group. Also in relation to the treatment of ARIs, probiotics provide a benefit compared to placebo treatment, with a shortened episode duration by about 1.89 days. ...
Article
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Air pollution exposure is a public health emergency, which attributes globally to an estimated seven million deaths on a yearly basis We are all exposed to air pollutants, varying from ambient air pollution hanging over cities to dust inside the home. It is a mixture of airborne particulate matter and gases that can be subdivided into three categories based on particle diameter. The smallest category called PM0.1 is the most abundant. A fraction of the particles included in this category might enter the blood stream spreading to other parts of the body. As air pollutants can enter the body via the lungs and gut, growing evidence links its exposure to gastrointestinal and respiratory impairments and diseases, like asthma, rhinitis, respiratory tract infections, Crohn's disease, ulcerative colitis, and abdominal pain. It has become evident that there exists a crosstalk between the respiratory and gastrointestinal tracts, commonly referred to as the gut-lung axis. Via microbial secretions, metabolites, immune mediators and lipid profiles, these two separate organ systems can influence each other. Well-known immunomodulators and gut health stimulators are probiotics, prebiotics, together called synbiotics. They might combat air pollution-induced systemic inflammation and oxidative stress by optimizing the microbiota composition and microbial metabolites, thereby stimulating anti-inflammatory pathways and strengthening mucosal and epithelial barriers. Although clinical studies investigating the role of probiotics, prebiotics, and synbiotics in an air pollution setting are lacking, these interventions show promising health promoting effects by affecting the gastrointestinal- and respiratory tract. This review summarizes the current data on how air pollution can affect the gut-lung axis and might impact gut and lung health. It will further elaborate on the potential role of probiotics, prebiotics and synbiotics on the gut-lung axis, and gut and lung health.
Chapter
Probiotics may provide support for athletes to counter the stresses of high physical activity levels by enhancing gut barrier function, immune function, antioxidant defenses, energy harvest, and other potential benefits. These impacts have the potential to increase the tolerable training load and resultant benefits as well as competition performance. Probiotic single and multistrain cocktails from the genera Lactobacillus and Bifidobacterium have demonstrated benefits of modest attenuation of both upper respiratory tract symptoms during high-level training and gastrointestinal tract symptoms during exercise. Multistrain probiotic cocktails for periods of at least 12 weeks appear to be most efficacious. Available research does not support probiotic efficacy for enhanced barrier function, attenuation of exercise-induced muscle damage, and exercise performance for athletes during training or competition. Evidence regarding the use of probiotics to limit the negative impacts of oxidative stress and to enhance absorption of some nutrients is promising but further research is needed.
Article
Many studies have shown that the use of probiotics acts positively on a disturbed intestinal ecosystem. Probiotics are defined as living, non-pathogenic microorganisms (usually bacteria), which confer a health benefit on the host when administrated in adequate amounts. Probiotics mechanisms described so far include adhesion to the surface of intestinal epithelium, competition with pathogens for receptors and nutrients, improvement of mucosal barrier function and maintenance of intestinal integrity, promotion of innate and acquired immune response, elaboration of bactericins and modulation of cellular kinetics. Dysbiosis of endogenous microbiota can lead to compromised immune responses and manifestations of various autoimmune diseases. Even some local and systemic metabolites of probiotic have been identified to have anti-inflammatory activity and may modify autoimmune diseases. The list of diseases that can benefit from the use of probiotics is long and includes acute diarrhea, urogenital infections, allergies, lactose intolerance, cystic fibrosis, carcinoma, inflammatory bowel disease, teeth and mouth disease, etc. The aim of this paper is to summarize the latest information from the currently available scientific literature on the role of probiotics in human health and disease.
Article
COVID-19, first reported in December 2019 in Wuhan, China, quickly spread worldwide and was announced as a pandemic in March 2020. As symptoms and outcomes are varied, the elderly and those who have at least one comorbidity (diabetes, cardiovascular disorders or other chronic diseases) are considered to be at high risk and are generally have lower immunity. An optimal immune system is critical for survival, as it protects the body against infectious agents. Nutrition is an essential factor in the immune system, contributing to components in physical barriers, biochemical, innate and adaptive immunity. Research advances show that nutritional deficiencies, namely the inadequacy of energy, macronutrients and micronutrients, affect the immune system and increase infection risk. The following discussion explains the comprehensive role of nutrition in the immune system, nutrition recommendations that can be used as precautions and the need for supplementation during this outbreak.
Article
Purpose of review: The respiratory microbiota has a role in respiratory tract infection (RTI) pathogenesis. On the mucosa, the respiratory microbiota interacts with potential pathogenic viruses, bacteria and the host immune system, including secretory IgA (sIgA). This review discusses the role of the respiratory microbiota and its interaction with the (mucosal) immune system in RTI susceptibility, as well as the potential to exploit the microbiota to promote health and prevent RTIs. Recent findings: Recent studies confirm that specific microbiota profiles are associated with RTI susceptibility and during susceptibility and found accompanying RTIs, although clear associations have not yet been found for SARS-CoV-2 infection. sIgA plays a central role in RTI pathogenesis: it stands under control of the local microbiota, while at the same time influencing bacterial gene expression, metabolism and defense mechanisms. Respiratory microbiota interventions are still newly emerging but promising candidates for probiotics to prevent RTIs, such as Corynebacterium and Dolosigranulum species, have been identified. Summary: Improved understanding of the respiratory microbiota in RTIs and its interplay with the immune system is of importance for early identification and follow-up of individuals at risk of infection. It also opens doors for future microbiota interventions by altering the microbiota towards a healthier state to prevent and/or adjunctively treat RTIs.
Article
Multiple sclerosis in children and adolescents (PedMS) presents a significant challenge both in diagnostic and therapeutic terms. Developmental specificities are the cause of numerous differences in PedMS in relation to the adult form of multiple sclerosis (AoMS). In the field of basic and clinical neurological research, researchers' opinions are conflicted creating many questions and dilemmas, which suggest that PedMS is distinguished as a different and specific disease compared to AoMS. Having in mind the ability of the developing brain to compensate for damage, leading to partial recovery, the imperative of adequate treatment is the early diagnosis and early administration of immunomodulatory therapy.
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Objective To evaluate the benefits and risks of zinc formulations compared with controls for prevention or treatment of acute viral respiratory tract infections (RTIs) in adults. Method Seventeen English and Chinese databases were searched in April/May 2020 for randomised controlled trials (RCTs), and from April/May 2020 to August 2020 for SARS-CoV-2 RCTs. Cochrane rapid review methods were applied. Quality appraisals used the Risk of Bias 2.0 and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Twenty-eight RCTs with 5446 participants were identified. None were specific to SARS-CoV-2. Compared with placebo, oral or intranasal zinc prevented 5 RTIs per 100 person-months (95% CI 1 to 8, numbers needed to treat (NNT)=20, moderate-certainty/quality). Sublingual zinc did not prevent clinical colds following human rhinovirus inoculations (relative risk, RR 0.96, 95% CI 0.77 to 1.21, moderate-certainty/quality). On average, symptoms resolved 2 days earlier with sublingual or intranasal zinc compared with placebo (95% CI 0.61 to 3.50, very low-certainty/quality) and 19 more adults per 100 were likely to remain symptomatic on day 7 without zinc (95% CI 2 to 38, NNT=5, low-certainty/quality). There were clinically significant reductions in day 3 symptom severity scores (mean difference, MD −1.20 points, 95% CI −0.66 to −1.74, low-certainty/quality), but not average daily symptom severity scores (standardised MD −0.15, 95% CI −0.43 to 0.13, low-certainty/quality). Non-serious adverse events (AEs) (eg, nausea, mouth/nasal irritation) were higher (RR 1.41, 95% CI 1.17 to 1.69, NNHarm=7, moderate-certainty/quality). Compared with active controls, there were no differences in illness duration or AEs (low-certainty/quality). No serious AEs were reported in the 25 RCTs that monitored them (low-certainty/quality). Conclusions In adult populations unlikely to be zinc deficient, there was some evidence suggesting zinc might prevent RTIs symptoms and shorten duration. Non-serious AEs may limit tolerability for some. The comparative efficacy/effectiveness of different zinc formulations and doses were unclear. The GRADE-certainty/quality of the evidence was limited by a high risk of bias, small sample sizes and/or heterogeneity. Further research, including SARS-CoV-2 clinical trials is warranted. PROSPERO registration number CRD42020182044.
Chapter
Probiotics are live bacterial or yeast-derived products, that when administered in adequate amounts, confer a health benefit on the host and are created using production techniques that are consistent with quality standards [1, 2]. The use of probiotics in infectious diseases started years prior to microbiota studies, and their efficacy in the treatment of acute diarrhea and antibiotic-associated diarrhea has been demonstrated in many meta-analyses and is a recommendation in many international guidelines [3–8] diseases have been largely discussed. The effects of probiotics on microbiota restoration are evaluated through the next-generation sequencing technologies and bioinformatics assessments.
Article
Current literature related to the impact of probiotics on the incidence of gastrointestinal tract infections (GITIs) has shown mixed results and no systematic review available with pooled analysis exists. Thus, the aim of this systematic review is to provide contemporary evidence regarding the overall and strain‐specific influence of probiotics in preventing GITIs among infants and children attending childcare centres. The review shortlisted 18 RCTs after screening through the initial search results of 779 articles. However, only 15 trials were deemed eligible, addressing at least one outcome in the pooled analysis. It is concluded that the supplementation of probiotics (overall effect) may reduce the risk of GITI episode by 26%, with Lacticaseibacillus paracasei , Limosilactobacillus reuteri and Lacticaseibacillus rhamnosus GG being specifically potent probiotic strains in reducing GITI episode, duration of infection, and absence from childcare, respectively. There is insufficient evidence to determine the effect of Bifidobacterium animalis subsp. lactis BB‐12 based on the findings of the trials included in this review.
Chapter
The health benefits of probiotics in children have been the subject of thorough research. Probiotics are supplements containing viable microorganisms that confer health benefits on the host. Beneficial effects of select probiotic strains for the management or prevention of select pediatric conditions have been extensively proven. The best documented efficacy of certain probiotics is for the treatment of acute gastroenteritis, for the prevention of antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, and nosocomial diarrhea. Unfortunately, due to the different study designs, currently a broad consensus for the majority of indications, for specific strains, dosages, and treatment regimens is lacking. More well-designed, large, strain-specific, and dedicated dose–response studies are needed. However, some evidence to support the use of certain probiotics in select pediatric conditions is often available. In addition, the administration of probiotics only carries a low risk of adverse events and is generally well tolerated. The purpose of this chapter is to provide an overview of current available evidence on the specific efficacy of probiotics in select conditions to guide pediatricians in decision-making on the therapeutic or prophylactic use of probiotic strains in children, possibly also outside applicable directives. The use of probiotic strains without proven efficacy should not be considered.
Chapter
Upper respiratory tract infections (URTIs), otitis media, and tonsillopharyngitis are the most common pediatric otolaryngological infections during childhood. URTIs refer to any infectious diseases involving the nose, sinuses, pharynx, or larynx and they are usually caused by viral agents. Although these infections are mostly caused by viruses, diseases that last more than 7–10 days generally refer to secondary bacterial infections. Whether caused by viral or bacterial agents, pediatric otolaryngological infections constitute one of the most common reasons for doctor visits and cause considerable socioeconomic burden for the community.
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Objectives Public health institutions have alerted consumers about advertising for dietary supplements with false claims of preventing or treating COVID-19. We quantitatively and qualitatively examined newspaper advertisements for dietary supplements before and after the COVID-19 spread. Design Content analysis. Participants We analysed advertisements for dietary supplements in two major Japanese newspapers in February–July 2019 and February–July 2020. Our analysis covered 2167 advertisements. Results The number of advertisements for dietary supplements that claimed to be effective in infection prevention (p=0.009) and improving joint (p=0.002) and digestive functions (p=0.002) significantly increased after the spread of COVID-19 compared with before. Dietary supplements that claimed to be effective in preventing infection were advertised in combination with recommendations for gargling and handwashing. Such terms as ‘defence’ and ‘prevent’ were used to promote the preventive effect. Conclusions False and misleading claims in advertising for dietary supplements may result in consumer harm, such as overdosing and failure to take preventive behaviour. While the pandemic continues, there will be an increasing need for disseminating accessible information about the appropriate use of dietary supplements, consumer education and warnings to manufacturers.
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Fermented food and beverages constitute a significant part of the human diet (5%–40%) worldwide. Fermentation has been used for preservation and to augment the flavor, texture, and nutritional qualities of the food, since antiquity. During fermentation, the bioavailability of vitamins, minerals, and other constituents increases due to the microorganisms’ metabolic activities. Besides enhancing nutritional quality, fermented foods contain live organisms reported to prevent/treat many health disorders. Types of the fermentation process are also classified based on these microorganisms. In developing countries, fermented foods were usually prepared using traditional methods without any standardized techniques. Considering the beneficial effects of fermented foods, industrial-level production requires consistent specific microorganisms, fermentation methods, evaluation of nutritional compositions, and food safety testing. This chapter discusses the fermented foods and associated organisms, different sources available for the consumption of fermented foods, and food component’s effect on microorganism’s efficacy.
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This chapter provides an overview of the definitions of probiotics, prebiotics, and synbiotics as noted by the International Scientific Association for Probiotics and Prebiotics and the interpretation of live biotherapeutic agents, psychobiotics, immunobiotics as well as postbiotics, parabiotics, and pharmabiotics with regard to health and regulations. The most common regulation bodies that mention probiotics are also outlined. Reviews and meta-analyses of clinical studies on the efficacy of probiotics and the supporting regulations on the use of probiotics for the most common gastrointestinal diseases, including acute gastroenteritis, inflammatory bowel diseases, irritable bowel syndrome, antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea, and Helicobacter pylori infections, were assessed. The efficacy of strain-specific probiotics for allergies, anxiety, depression and other mood disorders, wound healing and wound infections, and common acute infections were also assessed and, where applicable, regulations were mentioned. These studies also show that the efficacy of probiotics is strain specific and that clinical studies clearly show the diverse health effects of probiotics; however, several studies do not succeed in proving statistically significant benefits. Therefore more well-designed, multicenter, randomized, double-blind placebo-controlled clinical studies with clearly defined probiotics strains are warranted to scientifically prove the knowledge of these important beneficial microbes for selected clinical outcomes.
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Probiotics are live microbes that are beneficial and bring health benefits when consumed. The probiotics consumption boosts our immune system by maintaining healthy gut microflora; whereas, the use of antibiotics and inappropriate foods disturb our gut microbiota and raise the risk of allergic diseases, especially in children. These food allergies are now considered pediatric diseases. The food allergy symptoms include stomach upsets like gas, bloating, constipation, diarrhea, and heartburn. The unhealthy gut symptoms include sleep disturbances, skin irritation, food intolerances, and unintentional weight changes. Lactose intolerance is another common gastrointestinal condition; it arises due to the inability of lactose digestion and intake of essential dietary lactose required for normal function. This chapter covers the role of probiotics in the mitigation of food allergies and lactose intolerances and discusses the influence of major factors associated with intake of probiotics as well as dietary management strategies.
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The present chapter shows an overview of the production of bioactive peptides (BAPs) obtained from food matrices, using fermentation processes. It shows that it is possible to obtain BAPs from milk, meat, and vegetable proteins and emphasizes scientific production and the proven benefits that milk protein-derived BAPs provide to health. It also emphasizes a promising outlook in BAP production by fully using meat and vegetable proteins using food industry by-products, which also helps to mitigate waste environmental issue. For viable and safe BAPs industrial production, advances about in vivo research and adaptations of biotechnological processes for this scale of production are required.
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Currently, the world is facing a coronavirus pandemic with a grave deficiency of specific therapy for coronavirus disease (COVID-19). Moreover, scientists attempt to discover the most refined approach to prevent this condition. Regarding COVID-19 infection, herbal medicines with immunomodulatory effects may offer patients a promising preventive treatment option. Several ayurvedic and traditional Chinese medicines (TCM) are effective during this worrisome coronavirus pandemic i.e. Tinospora cordifolia (Willd.) Miers, Withania somnifera (L.) Dunal, Scutellaria baicalensis Georgi, Curcuma longa L. etc. TCM was shown to be utilized with over 90% efficacy when the COVID-19 pandemic broke out in early 2020. In addition to herbal treatments and nutraceutical drugs, dietary supplements such as vitamins and amino acid derivatives also play a significant part in COVID-19 management. Diet can assist in regulating inflammation, while nutraceuticals can aid in the prevention of viral invasion. Functional amino acids (e.g., arginine, cysteine, glutamate, glutamine, glycine, taurine and tryptophan) and glutathione, which are all abundant in animal-sourced foodstuffs, are crucial for optimum immunity and health in humans and animals. The goal of this article is to thoroughly evaluate recent statistics on the effectiveness of herbal medicines in COVID-19, the antiviral activity of nutraceuticals, and the significance of these results in creating dietary supplements that would enhance innate immunity and contribute as preventive measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Probiotics and prebiotics have been the subject of extensive investigations into their role in human health including their effects on risk of age-related chronic diseases. There is good evidence that probiotics and, to a lesser extent prebiotics, can influence immune function in older subjects and counteract immunosenescence and increased inflammation. Probiotics have also been shown to increase the effectiveness of influenza vaccination in the elderly and reduce risk and/or duration of upper respiratory tract infections. Prebiotics and probiotics have been shown to have benefits for common gastrointestinal disorders that are common in older people, especially constipation, and there is some evidence that symptoms of metabolic syndrome can be alleviated by certain probiotics.
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Probiotics are live microorganisms, which provide beneficial health effects to animals and humans. Their use in prevention and, in some cases, in the treatment of various organic dysfunctions have been studied for decades. Nowadays, it is believed that the effects and benefits of these microorganisms are dependent on the probiotic strain, which implies that studies with several species must be carried out in humans and animals. The application of probiotics is increasing due to the recognition of their importance by the consumers and health professionals and, even, due to the economic return. The benefits to the economy can occurs because of the prevention of common diseases such as the flu, reduction in the number of days at hospital, reduction of absenteeism and the replacement of synthetic antimicrobials (such as antibiotics) in the breeding of animals. In this chapter, data from scientific articles on the effects of probiotics on human (obesity, respiratory tract, and gut-brain axis) and animal health, and the challenges to be faced in the next years will be discussed.
Chapter
Nutraceuticals are products manufactured from both food and non-food sources that provide health benefits in support of structure or function of the body, prevention or mitigation of diseases, delay of the aging process, and promotion of wellbeing. The most widely used functional ingredients in nutraceuticals include cranberry, garcinia, ginkgo biloba, ginseng, green tea, omega-3 fatty acids, probiotics, red yeast rice, St. John's Wort, and turmeric. A wide range of health indications which lead to use of netraceuticals include hyperglycemia, dyslipidemia, obesity, hypertension, cognition, immunity, vision, osteoporosis, sleep, and sarcopenia. Most importantly, health benefits of nutraceuticals must be substantiated repeatedly by clinical evidence from human studies, particularly with positive effects reported by meta-analysis.
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The intestine, the largest immune organ in the human body, harbors approximately 1013 microorganisms, including bacteria, fungi, viruses, and other unknown microbes. The intestine is a most important crosstalk anatomic structure between the first (the host) and second (the microorganisms) genomes. The imbalance of the intestinal microecology, especially dysbiosis of the composition, structure, and function of gut microbiota, is linked to human diseases. In this review, we investigated the roles and underlying mechanisms of gut microecology in the development, progression, and prognosis of infectious diseases. Furthermore, we discussed potential new strategies of prevention and treatment for infectious diseases based on manipulating the composition, structure, and function of intestinal microorganisms in the future. This article is categorized under: Infectious Diseases > Molecular and Cellular Physiology.
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Background: There is no clear evidence-based medicine that points to the most effective drug treatments for the common cold. In view of its ability to relieve symptoms and shorten the disease course, as well as its minimal side effects, traditional Chinese medicine (TCM) has been widely used to treat the common cold. However, there is a lack of strong evidence to support the clinical efficacy of TCM. This study aimed to evaluate the efficacy and safety of Ganduqing granules in the treatment of the common cold based on the network pharmacology analysis. Methods: In this multicenter, randomized, double-blind, placebo-controlled trial, 60 eligible subjects will be randomly assigned to either the intervention group or the placebo group. The intervention group will be treated with Ganduqing granules, while the placebo group will be treated with placebo. After 5 days of intervention, the efficacy and safety of Ganduqing granules in the treatment of the common cold will be observed. The primary outcome is the time to clearance of all symptoms. The secondary outcomes included the levels of IL-6, TNF-α, SOD, and MDA in the peripheral blood, time to disappearance of primary symptoms and secondary symptoms, clinical symptom remission rate, and change in TCM syndrome score. Results: Sixty participants completed the study. Ganduqing granules showed a greater effect on the time to clearance of all symptoms (P < 0.0001), nasal discharge (P=0.0124), fatigue and lack of strength (P=0.0138), dryness of the pharynx (P < 0.0001), pharyngalgia or dysphagia (P < 0.0001), and expectoration (P < 0.0431) compared with the placebo group. Participants in the intervention group had a greater decrease of IL-6 levels compared with the placebo group (P < 0.007); similar results were observed for the SOD (P < 0.033). However, the change in TNF-α and MDA levels in the intervention group was not significantly different from the placebo group. In addition, participants in the intervention group had a greater decrease of TCM syndrome score compared with the placebo group (P < 0.040). Conclusion: Ganduqing granules could improve common cold symptoms, shorten the disease course, attenuated inflammation and oxidative stress, and provided objective evidence for the efficacy and safety of a Chinese herbal medicine in treating the common cold.
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Gastrointestinal and respiratory infections are common among children attending day-care, particularly among younger children. The aim of the present randomized, double-blind and placebo-controlled study was to investigate whether Biola, a commercial milk product with a combination of three different probiotic strains (Lactobacillus rhamnosus GG (LGG), L. acidophilus LA-5, and Bifidobacterium Bb-12) given daily to 240 children younger than 3 years, during 7 winter months of their first year in a day-care centre, could prevent such infections. Information about symptoms of respiratory and gastrointestinal infections was collected by use of a diary completed by the parents and the number of days with respiratory and gastrointestinal symptoms and absences from day-care because of illness were studied. There was no significant difference between the two groups when analysing the total number of days with gastrointestinal and/or respiratory symptoms (26.5 days for the Biola group versus 26.9 days for the placebo group, p=0.52). However, the results indicate that Biola may reduce the number of days with gastrointestinal symptoms only (1.7 days for the Biola group versus 3.0 days for placebo, p=0.02). No significant difference between treatments was seen with respect to respiratory symptoms alone.
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We examined whether exercise-induced lymphocytosis and lymphocytopenia are impaired with high-intensity training. Eight trained cyclists (VO(2max) = 64.2 ± 6.5 mL · kg(-1) · min(-1)) undertook 1 wk of normal-intensity training and a second week of high-intensity training. On day 7 of each week, participants performed a cycling task, consisting of 120 min of submaximal exercise followed by a 45-min time trial. Blood was collected before, during, and after exercise. CD8(+) T lymphocytes (CD8(+)TLs) were identified, as well as CD8(+)TL subpopulations on the basis of CD45RA and CD27 expression. High-intensity training (18,577 ± 10,984 cells per microliter × ~165 min) was associated with a smaller exercise-induced mobilization of CD8(+)TLs compared with normal-intensity training (28,473 ± 16,163 cells per microliter × ~165 min, P = 0.09). The response of highly cytotoxic CD8(+)TLs (CD45RA(+)CD27(-)) to exercise was smaller after 1 wk of high-intensity training (3144 ± 924 cells per microliter × ~165 min) compared with normal-intensity training (6417 ± 2143 cells per microliter × ~165 min, P < 0.05). High-intensity training reduced postexercise CD8(+)TL lymphocytopenia (-436 ± 234 cells per microliter) compared with normal-intensity training (-630 ± 320 cells per microliter, P < 0.05). This was driven by a reduced egress of naive CD8(+)TLs (CD27(+)CD45RA(+)). High-intensity training was associated with reduced plasma epinephrine (-37%) and cortisol (-15%) responses (P < 0.05). High-intensity training impaired CD8(+)TL mobilization and egress in response to exercise. Highly cytotoxic CD8(+)TLs were primarily responsible for the reduced mobilization of CD8(+)TLs, which occurred in parallel with smaller neuroendocrine responses. The reduced capacity for CD8(+)TLs to leave blood after exercise with high-intensity training was accounted for primarily by naive, and also, highly cytotoxic CD8(+)TLs. This impaired CD8(+)TL redistribution in athletes undertaking intensified training may imply reduced immune surveillance.
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Probiotics purportedly reduce symptoms of gastrointestinal and upper respiratory-tract illness by modulating commensal microflora. Preventing and reducing symptoms of respiratory and gastrointestinal illness are the primary reason that dietary supplementation with probiotics are becoming increasingly popular with healthy active individuals. There is a paucity of data regarding the effectiveness of probiotics in this cohort. The aim of this study was to evaluate the effectiveness of a probiotic on faecal microbiology, self-reported illness symptoms and immunity in healthy well trained individuals. Competitive cyclists (64 males and 35 females; age 35 ± 9 and 36 ± 9 y, VO2max 56 ± 6 and 52 ± 6 ml.kg-1.min-1, mean ± SD) were randomised to either probiotic (minimum 1 × 109 Lactobacillus fermentum (PCC®) per day) or placebo treatment for 11 weeks in a double-blind, randomised, controlled trial. The outcome measures were faecal L. fermentum counts, self-reported symptoms of illness and serum cytokines. Lactobacillus numbers increased 7.7-fold (90% confidence limits 2.1- to 28-fold) more in males on the probiotic, while there was an unclear 2.2-fold (0.2- to 18-fold) increase in females taking the probiotic. The number and duration of mild gastrointestinal symptoms were ~2-fold greater in the probiotic group. However, there was a substantial 0.7 (0.2 to 1.2) of a scale step reduction in the severity of gastrointestinal illness at the mean training load in males, which became more pronounced as training load increased. The load (duration×severity) of lower respiratory illness symptoms was less by a factor of 0.31 (99%CI; 0.07 to 0.96) in males taking the probiotic compared with placebo but increased by a factor of 2.2 (0.41 to 27) in females. Differences in use of cold and flu medication mirrored these symptoms. The observed effects on URTI had too much uncertainty for a decisive outcome. There were clear reductions in the magnitude of acute exercise-induced changes in some cytokines. L. fermentum may be a useful nutritional adjunct for healthy exercising males. However, uncertainty in the effects of supplementation on URTI and on symptoms in females needs to be resolved. The trial was registered in the Australia and New Zealand Clinical Trials Registry (ACTRN12611000006943).
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The purpose of this study was to examine the effects of a probiotic supplement during 4 mo of winter training in men and women engaged in endurance-based physical activities on incidence of upper respiratory-tract infections (URTIs) and immune markers. Eighty-four highly active individuals were randomized to probiotic (n = 42) or placebo (n = 42) groups and, under double-blind procedures, received probiotic (PRO: Lactobacillus casei Shirota [LcS]) or placebo (PLA) daily for 16 wk. Resting blood and saliva samples were collected at baseline and after 8 and 16 wk. Weekly training and illness logs were kept. Fifty-eight subjects completed the study (n = 32 PRO, n = 26 PLA). The proportion of subjects on PLA who experienced 1 or more weeks with URTI symptoms was 36% higher than those on PRO (PLA 0.90, PRO 0.66; p = .021). The number of URTI episodes was significantly higher (p < .01) in the PLA group (2.1 ± 1.2) than in the PRO group (1.2 ± 1.0). Severity and duration of symptoms were not significantly different between treatments. Saliva IgA concentration was higher on PRO than PLA, significant treatment effect F(1, 54) = 5.1, p = .03; this difference was not evident at baseline but was significant after 8 and 16 wk of supplementation. Regular ingestion of LcS appears to be beneficial in reducing the frequency of URTI in an athletic cohort, which may be related to better maintenance of saliva IgA levels during a winter period of training and competition.
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Immune senescence potentially leads to an increased risk of infections. It is desirable to augment the immune system and protect against infections by daily consumption of immunostimulatory food. The present study evaluated whether the intake of yoghurt fermented with Lactobacillus delbrueckii ssp. bulgaricus (L. bulgaricus) OLL1073R-1 has an effect on resistance to the common cold. We conducted two independent studies, in which fifty-seven (median age 74.5 years) and eighty-five healthy elderly individuals (median age 67.7 years) were participants. In each study, the subjects were divided into two groups based on age and sex and instructed to eat 90 g yoghurt or drink 100 ml milk once per d over an 8- or 12-week period. A meta-analysis of the results of these two independent studies showed the risk of catching the common cold was about 2.6 times lower (OR 0.39; P = 0.019) in the yoghurt group than in the milk group and the increase of natural killer cell activity was significantly higher in the yoghurt group than in the milk group (P = 0.028). In addition, the quality of life score for the 'eye/nose/throat' system after intake was significantly higher in the yoghurt group than in the milk group and the improvement of the score was correlated with the promotion of natural killer cell activity. In conclusion, consumption of yoghurt fermented with L. bulgaricus OLL1073R-1 augmented natural killer cell activity and reduced the risk of catching the common cold in elderly individuals.
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To evaluate whether a fermented dairy drink containing the probiotic strain Lactobacillus casei DN-114 001 could reduce the incidence of common infectious diseases (CIDs) and the change of behavior because of illness in children. We conducted a double-blinded, randomized, placebo-controlled allocation concealment clinical trial in the Washington, DC metropolitan area. Participants were 638 children 3-6 years old in daycare/schools. The intervention was a fermented dairy drink containing a specific probiotic strain or matching placebo with no live cultures for 90 consecutive days. Two primary outcomes were assessed: incidence of CIDs and change of behavior because of illness (both assessed by parental report). The rate of change of behavior because of illness was similar among active and control groups. However, the incidence rate for CIDs in the active group (0.0782) is 19% lower than that of the control group (0.0986) (incidence rate ratio=0.81, 95% CI: 0.65, 099) P=0.046. Daily intake of a fermented dairy drink containing the probiotic strain L. casei DN-114 001 showed some promise in reducing overall incidence of illness, but was primarily driven by gastrointestinal infections and there were no differences in change of behavior.
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The incidence of nosocomial infections, predominantly gastrointestinal and respiratory, in children in developed countries is high, ranging from 5% to 44%. There is no effective strategy for preventing these infections. The objective of our study was to investigate the role of Lactobacillus GG (LGG) in preventing nosocomial gastrointestinal and respiratory tract infections at a pediatric hospital. We conducted a randomized, double-blind, placebo-controlled trial of 742 hospitalized children. They were randomly allocated to receive for their hospitalization LGG at a dose of 10(9) colony-forming units in 100 mL of a fermented milk product (LGG group, n = 376) or placebo that was the same postpasteurized fermented milk product without LGG (placebo group, n = 366). In the LGG group, compared with the placebo group, we found a significantly reduced risk for gastrointestinal infections (relative risk [RR]: 0.40 [95% confidence interval (CI): 0.25-0.70]; number needed to treat: 15 [95% CI: 9-34)], respiratory tract infections (RR: 0.38 [95% CI: 0.18-0.85]; number needed to treat: 30 [95% CI: 16-159]), vomiting episodes (RR: 0.5 [95% CI: 0.3-0.9]), diarrheal episodes (RR: 0.24 [95% CI: 0.10-0.50]), episodes of gastrointestinal infections that lasted >2 days (RR: 0.40 [95% CI: 0.25-0.70]), and episodes of respiratory tract infections that lasted >3 days (RR: 0.4 [95% CI: 0.2-0.9]). Groups did not differ in hospitalization duration (P = .1). LGG administration can be recommended as a valid measure for decreasing the risk for nosocomial gastrointestinal and respiratory tract infections in pediatric facilities.
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The common cold has a profound impact on employee attendance and productivity. Seasonal influenza is responsible for approximately 200,000 hospitalizations and 36,000 deaths per year in the United States alone. Over-the-counter medication efficacy has been questioned, and seasonal vaccination compliance issues abound. Our previously reported randomized trial of an oral fermentation product found an adjuvant benefit for vaccinated individuals in terms of a significantly reduced incidence and duration of cold and flu-like symptoms. A concurrent 12-week, randomized, double-blind, placebo-controlled clinical trial of 116 subjects with no recent history of seasonal influenza vaccination was conducted. Participants received once-daily supplementation with 500 mg of a dried modified Saccharomyces cerevisiae oral fermentate (EpiCor) or placebo. Clinical outcome measurements included periodic interval-based in-clinic examinations and serologic analysis at baseline, 6 weeks, and 12 weeks. Participants utilized a standardized self-report symptom diary. Subjects receiving the intervention experienced a statistically significant reduction in the incidence (p = 0.01), a nonsignificant reduction in duration (p = 0.10), and no impact on the severity (p = 0.90) of colds or flu-like symptoms, but a more favorable safety profile compared with subjects receiving placebo. This nutritional-based fermentate appeared to be safe and efficacious in a unique at-risk population and should receive more clinical research as a potential method to reduce the incidence of cold and flu-like symptoms, in individuals with and without a history of influenza vaccination.
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Probiotic consumption effects on cold and influenza-like symptom incidence and duration were evaluated in healthy children during the winter season. In this double-blind, placebo-controlled study, 326 eligible children (3-5 years of age) were assigned randomly to receive placebo (N = 104), Lactobacillus acidophilus NCFM (N = 110), or L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07 (N = 112). Children were treated twice daily for 6 months. Relative to the placebo group, single and combination probiotics reduced fever incidence by 53.0% (P = .0085) and 72.7% (P = .0009), coughing incidence by 41.4% (P = .027) and 62.1% (P = .005), and rhinorrhea incidence by 28.2% (P = .68) and 58.8% (P = .03), respectively. Fever, coughing, and rhinorrhea duration was decreased significantly, relative to placebo, by 32% (single strain; P = .0023) and 48% (strain combination; P < .001). Antibiotic use incidence was reduced, relative to placebo, by 68.4% (single strain; P = .0002) and 84.2% (strain combination; P < .0001). Subjects receiving probiotic products had significant reductions in days absent from group child care, by 31.8% (single strain; P = .002) and 27.7% (strain combination; P < .001), compared with subjects receiving placebo treatment. Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age.
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A randomised, double-blind, placebo-controlled study was conducted to determine whether probiotics might be effective in reducing the risk of infections in infancy. Infants requiring formula before the age of 2 months were recruited from community well-baby clinics. Infant formula supplemented with the probiotics Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb-12 or placebo was administered daily until the age of 12 months. Incidence of early infections (before the age of 7 months) and incidence of recurrent (three or more) infections during the first year of life were recorded as the main outcome measures of the study. During the first 7 months of life, seven out of thirty-two (22 %) infants receiving probiotics and twenty out of forty (50 %) infants receiving placebo experienced acute otitis media (risk ratio (RR) 0.44 (95 % CI 0.21, 0.90); P = 0.014) and antibiotics were prescribed for ten out of thirty-two (31 %) infants receiving probiotics and twenty-four out of forty (60 %) infants receiving placebo (RR 0.52 (95 % CI 0.29, 0.92); P = 0.015). During the first year of life, nine out of thirty-two (28 %) infants receiving probiotics and twenty-two out of forty (55 %) infants receiving placebo encountered recurrent respiratory infections (RR 0.51 (95 % CI 0.27, 0.95); P = 0.022). These data suggest that probiotics may offer a safe means of reducing the risk of early acute otitis media and antibiotic use and the risk of recurrent respiratory infections during the first year of life. Further clinical trials are warranted.
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Resistance is an emerging problem in human medicine and the effects of resistance are being noted on an ever-increasing scale. Whether it is treatment of nosocomial bacteremia in New York City or community-acquired dysentery in Central Africa, multiresistant organisms are diminishing our ability to control the spread of infectious diseases. Clearly, the rate at which resistant organisms develop is not solely a function of the use of antimicrobials in humans, but is also highly influenced by the use of these agents in veterinary medicine, animal husbandry, agriculture, and aquaculture, as has been emphasized at recent meetings sponsored by organizations such as Rockefeller University and the American Society for Microbiology, and in the report on bacterial resistance recently issued by the US Office of Technology Assessment. We have entered an era where both physicians and patients must take on the responsibility to use antimicrobials wisely and judiciously. Just as in the days at the turn of the century when the public was an integral part of establishing quarantines for infectious diseases, now again the public's cooperation must be sought for this latest threat to public health. The multiresistant organisms of the 1990s are a grim warning of the possibility of the postantibiotic era.
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Mice fed Bifidobacterium breve YIT4064 and immunized orally with influenza virus were more strongly protected against influenza virus infection of the lower respiratory tract than ones immunized with influenza virus only. The number of mice with enhanced anti-influenza virus immunoglobulin G (IgG) in serum upon oral administration of B. breve YIT4064 and oral immunization with influenza virus was significantly greater than that upon oral immunization with influenza virus only. These findings demonstrated that the oral administration of B. breve YIT4064 increased anti-influenza virus IgG antibodies in serum and protected against influenza virus infection. The oral administration of B. breve YIT4064 may enhance antigen-specific IgG against various pathogenic antigens taken orally and induce protection against various virus infections.
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To determine the effects of dietary consumption of Bifidobacterium lactis (strain HN019, DR10TM) on natural immunity. A randomized, double blind, placebo-controlled clinical trial. Janeway Medical Centre, Memorial University, St Johns, Newfoundland. Twenty-five healthy elderly volunteers (median age 69 y; range 60-83 y). Twelve control subjects consumed 180 ml low-fat/low-lactose milk twice daily for a period of 6 weeks; 13 test subjects consumed milk supplemented with 1.5x1011 colony-forming units of B. lactis twice daily. Indices of natural immunity, including interferon production, phagocytic capacity and phagocyte-mediated bactericidal activity, were determined via peripheral blood at 0, 3, 6 and 12 weeks post-trial commencement. Subjects who consumed milk containing B. lactis for 6 weeks produced significantly enhanced levels of interferon-alpha, upon stimulation of their peripheral blood mononuclear cells in culture, in comparison to the placebo control group who received milk alone. There were also significant increases in polymorphonuclear cell phagocytic capacity among test group subjects, following consumption of milk supplemented with B. lactis, while individuals who consumed B. lactis-supplemented milk or milk alone showed enhanced phagocyte-mediated bactericidal activity. The results demonstrate that dietary consumption of B. lactis HN019 can enhance natural immunity in healthy elderly subjects, and that a relatively short-term dietary regime (6 weeks) is sufficient to impart measurable improvements in immunity that may offer significant health benefits to consumers. Financial support for this project was provided by the New Zealand Dairy Board.
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Many investigators have studied the therapeutic and preventive effects of yogurt and lactic acid bacteria, which are commonly used in yogurt production, on diseases such as cancer, infection, gastrointestinal disorders, and asthma. Because the immune system is an important contributor to all of these diseases, an immunostimulatory effect of yogurt has been proposed and investigated by using mainly animal models and, occasionally, human subjects. Although the results of these studies, in general, support the notion that yogurt has immunostimulatory effects, problems with study design, lack of appropriate controls, inappropriate route of administration, sole use of in vitro indicators of the immune response, and short duration of most of the studies limit the interpretation of the results and the conclusions drawn from them. Nevertheless, these studies in toto provide a strong rationale for the hypothesis that increased yogurt consumption, particularly in immunocompromised populations such as the elderly, may enhance the immune response, which would in turn increase resistance to immune-related diseases. This hypothesis, however, needs to be substantiated by well-designed randomized, double-blind, placebo-controlled human studies of an adequate duration in which several in vivo and in vitro indexes of peripheral and gut-associated immune response are tested.
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Many investigators have studied the therapeutic and preventive effects of yogurt and lactic acid bacteria, which are commonly used in yogurt production, on diseases such as cancer, infection, gastrointestinal disorders, and asthma. Because the immune system is an important contributor to all of these diseases, an immunostimulatory effect of yogurt has been proposed and investigated by using mainly animal models and, occasionally, human subjects. Although the results of these studies, in general, support the notion that yogurt has immunostimulatory effects, problems with study design, lack of appropriate controls, inappropriate route of administration, sole use of in vitro indicators of the immune response, and short duration of most of the studies limit the interpretation of the results and the conclusions drawn from them. Nevertheless, these studies in toto provide a strong rationale for the hypothesis that increased yogurt consumption, particularly in immunocompromised populations such as the elderly, may enhance the immune response, which would in turn increase resistance to immune-related diseases. This hypothesis, however, needs to be substantiated by well-designed randomized, double-blind, placebo-controlled human studies of an adequate duration in which several in vivo and in vitro indexes of peripheral and gut-associated immune response are tested.
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The original meaning of "allocation concealment" is that the statistician and the trial designer who generated the random sequence and allocation sequence should not recruit and allocate the participants for the purpose of avoiding selection bias. In the process of generating allocation sequence, combined blinding measures are so called "setting blinding", for instance, by using "double simulation". We use a example to describe how to perform an adequate allocation and conceal the sequence, and setting blinding. Another example is used to describe how to report the methods of randomization, allocation concealment and the effect of blinding, etc.
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Acute respiratory infections (ARI) are one of the main health problems in children, particularly in those under 5 years of age. The aim of this study was to evaluate whether the regular intake of the probiotic Lactobacillus rhamnosus HN001 affects the frequency, severity or duration of ARI in children attending day care centers during the winter season. A double-blind, placebo-controlled trial was carried out in 398 children (1 to 5 years old) who were randomized into two groups to receive daily for 3 months either 100 mL of a product containing HN001 (10^{10} bacteria/day) or a control without the probiotic. ARI episodes and symptoms, absenteeism and antibiotic administration were registered. In a sub-group of children, oropharyngeal and fecal samples were obtained to detect pathogens, total Lactobacillus counts and secretory IgA, respectively. When comparing groups, neither the number nor the duration of the ARI, nor the days of absenteeism or antibiotic administration were statistically different. No differences between the groups in the detection rates of Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes in the oropharyngeal samples were observed along the study. Fecal Lactobacillus counts as well as sIgA levels increased significantly during the study in the HN001 group, compared to the control (P=0.027 and P=0.048, respectively). In the conditions in which this study was carried out, the regular intake of L. rhamnosus HN001 modulated the intestinal immune responses without affecting the frequency or severity of ARI in children.
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Objective: To evaluate efficacy of probiotics in prevention and treatment of diarrhoea associated with the use of antibiotics. Design: Meta-analysis; outcome data (proportion of patients not getting diarrhoea) were analysed, pooled, and compared to determine odds ratios in treated and control groups. Identification: Studies identified by searching Medline between 1966 and 2000 and the Cochrane Library. Studies reviewed Nine randomised, double blind, placebo controlled trials of probiotics. Results: Two of the nine studies investigated the effects of probiotics in children. Four trials used a yeast (Saccharomyces boulardii), four used lactobacilli, and one used a strain of enterococcus that produced lactic acid. Three trials used a combination of probiotic strains of bacteria. In all nine trials, the probiotics were given in combination with antibiotics and the control groups received placebo and antibiotics. The odds ratio in favour of active treatment over placebo in preventing diarrhoea associated with antibiotics was 0.39 (95% confidence interval 0.25 to 0.62; P<0.001) for the yeast and 0.34 (0.19 to 0.61; P<0.01 for lactobacilli. The combined odds ratio was 0.37 (0.26 to 0.53; P<0.001) in favour of active treatment over placebo. Conclusions: The meta-analysis suggests that probiotics can be used to prevent antibiotic associated diarrhoea and that S boulardii and lactobacilli have the potential to be used in this situation. The efficacy of probiotics in treating antibiotic associated diarrhoea remains to be proved. A further large trial in which probiotics are used as preventive agents should look at the costs of and need for routine use of these agents.
Article
Objective: To examine whether long term consumption of a probiotic milk could reduce gastrointestinal and respiratory infections in children in day care centres. Design: Randomised, double blind, placebo controlled study over seven months. Setting: 18 day care centres in Helsinki, Finland. Participants: 571 healthy children aged 1-6 years: 282 (mean (SD) age 4.6 (1.5) years) in the intervention group and 289 (mean (SD) age 4.4 (1.5) years) in the control group. Intervention: Milk with or without Lactobacillus GG. Average daily consumption of milk in both groups was 260 ml. Main outcome measures: Number of days with respiratory and gastrointestinal symptoms, absences from day care because of illness, respiratory tract infections diagnosed by a doctor, and course of antibiotics. Results: Children in the Lactobacillus group had fewer days of absence from day care because of illness (4.9 (95% confidence interval 4.4 to 5.5) v 5.8 (5.3 to 6.4) days, 16% difference, P=0.03; age adjusted 5.1 (4.6 to 5.6) v 5.7 (5.2 to 6.3) days, 11% difference, P=0.09). There was also a relative reduction of 17% in the number of children suffering from respiratory infections with complications and lower respiratory tract infections (unadjusted absolute % reduction −8.6 (−17.2 to −0.1), P=0.05; age adjusted odds ratio 0.75 (0.52 to 1.09), P=0.13) and a 19% relative reduction in antibiotic treatments for respiratory infection (unadjusted absolute % reduction −9.6 (−18.2 to −1.0), P=0.03; adjusted odds ratio 0.72 (0.50 to 1.03), P=0.08) in the Lactobacillus group. Conclusions: Lactobacillus GG may reduce respiratory infections and their severity among children in day care. The effects of the probiotic Lactobacillus GG were modest but consistently in the same direction. What is already known on this topic What is already known on this topic Children attending day care centres are at high risk of respiratory and gastrointestinal infection The successful prevention of respiratory infections could be extremely useful for families and for society in general Short term use of probiotic bacteria has been shown to reduce the severity of rotavirus diarrhoea and the incidence of diarrhoea associated with the use of antibiotics
Article
These changes partially reflect a decrease in visits for common infectious conditions, which declined from 19% to 16% of total outpatient visits (P < 0.001). In addition, fewer common infectious conditions were treated with an antibiotic (Figures 1 and 2). Among adults, the frequency of antibiotic prescribing decreased from 1991–1992 to 1998–1999 for the common cold and unspecified upper respiratory tract infections (56% vs. 43% of patient visits; P = 0.011), pharyngitis (78% vs. 64% of patient visits; P = 0.02), and acute bronchitis (76% vs. 59% of patient visits; P < 0.001). Among children, the frequency of antibiotic prescribing decreased for the common cold and unspecified upper respiratory tract infections (41% vs. 21% of patient visits; P < 0.001) and pharyngitis (73% vs. 54%; P = 0.002) and trended toward a decrease for otitis media (78% vs. 72%; P = 0.08) and acute bronchitis (78% vs. 68%; P = 0.091). However, despite decreases in the frequency of antibiotic treatment of these conditions, nonpneumonic acute respiratory tract infections (the common cold and nonspecific upper respiratory tract infections, pharyngitis, otitis media, sinusitis, acute bronchitis, laryngitis, acute tonsillitis, and tracheitis) accounted for 47% to 56% of adult and 75% to 80% of pediatric antibiotic prescriptions in each study period. Our study can only raise, not answer, questions about the factors that influence prescribing behavior. Moreover, our results should be interpreted in light of our study's limitations. Inaccurate survey completion, including failure to record antibiotics prescribed after the visit (for example, after chest radiography or throat culture results became available), may have led us to underestimate antibiotic use. We were also unable to distinguish initial visits from follow-up visits that may have occurred after a course of antibiotics was completed. Together, these factors may explain why patients with illnesses such as pneumonia and urinary tract infections received fewer antibiotics than would be expected. Data were collected on prescribed medications and therefore may not reflect which medications were actually taken. Finally, some patient diagnoses may have been inaccurately or imprecisely reported. This may include diagnosis shifting, in which physicians implicitly justify their choice of antibiotics by recording a modified diagnosis. However, because use of newer antibiotics increased across a wide variety of diagnoses, only extreme degrees of random misclassification would change our conclusions. Moreover, diagnosis shifting would probably underestimate the use of broad-spectrum antibiotics in clinically inappropriate settings.
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THE LIST of emerging infectious diseases is an intriguing constellation of new entities (a previously unrecognized Hantavirus), recognized pathogens that have caused recent outbreaks of unprecedented size (Cryptosporidium in municipal water supplies), outbreaks that have culminated in a reassessment of the issue of food safety (Escherichia coli O157:H7), and traditional nosocomial and community-acquired infections that, due to their resistance to multiple antimicrobial agents, have suggested the possibility of a postantibiotic era.1,2Enterococcus faecium, Streptococcus pneumoniae, and Mycobacterium tuberculosis are just a few of the organisms that have become considerably more difficult to treat due to increasing drug resistance. Examples of the types of resistant bacteria that have emerged around the world are shown in Figure 1, while specific examples of emerging resistance problems in the United States are shown in Figure 2. Clearly, the emergence of resistant organisms has been a global phenomenon. A recent Institute of Medicine report
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An optimally functioning immune system is essential for protection against infectious diseases and cancers. Deficiency in any component of the immune system can predispose an individual to a greater risk of infection or may enhance the severity of disease. Several studies have shown that dietary supplementation with lactic acid bacteria (LAB) can be used to promote health and well-being; LAB are normal components of the human intestinal flora and are commonly used as starter cultures in dairy products. Consumption of LAB has been associated with a variety of health benefits including enhanced immune performance, increased resistance to infectious diseases, alleviation of food allergies and the suppression of cancer development. The precise mechanisms by which LAB act on the immune system are not fully understood. However, there is sufficient evidence to suggest that LAB exert their immunity enhancing effects by augmenting both non-specific (e.g. phagocyte function, NK-cell activity) and specific (e.g. antibody production, cytokine production, lymphocyte proliferation, delayed-type hypersensitivity) host immune responses. It is important to note that most of the evidence supporting these immunoenhancing effects is derived from in vitro or animal studies and there is a scarcity of carefully designed and properly controlled clinical studies demonstrating immune health benefits for humans, especially healthy human subjects. This article discusses the impact of LAB on different immune functions, the role of LAB-induced immunoenhancement in disease resistance, and highlights gaps in our knowledge that need further research.
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Human bocavirus (HBoV) is frequently identified in children with respiratory tract infections, and its role in acute otitis media (AOM) has been suggested. The disease associations for the closely related bocaviruses HBoV2-4 remain unknown. Increasing evidence shows that probiotics may reduce the risk of AOM of viral origin. Objectives of the study was to examine the prevalence and persistence of bocaviruses in consecutive nasopharyngeal samples (NPS) of otitis-prone children, and whether an association exists between HBoV and the child's characteristics, respiratory symptoms, and AOM pathogens, and whether probiotics reduce the occurrence of HBoV. In a double-blind, placebo-controlled, randomized, 6-month intervention study, 269 otitis-prone children (aged 9 months to 5.6 years), consumed daily either one capsule of probiotics (Lactobacillus rhamnosus GG, L. rhamnosus Lc705, Bifidobacterium breve 99 and Propionibacterium freudenreichii JS) or placebo. After a clinical examination and NPS collected at three-time points, the presence and persistence of HBoV1-4 DNA in NPS was determined by RT-qPCR at the baseline, after 3, and 6 months. A high load (>10,000 copies/ml) of HBoV DNA was detected in 26 (17.1%) of 152 children, and 16 (10.5%) showed a prolonged presence of HBoV for at least 3 months. None had DNA of HBoV2-4. Higher number of siblings associated with increased HBoV prevalence (p=0.029). Prevalence or persistence of HBoV was not significantly associated with other characteristics, respiratory symptoms, or AOM pathogens. Probiotic intervention significantly reduced the number of HBoV DNA-positive samples (probiotic vs. placebo: 6.4% vs. 19.0%, OR=0.25, CI 95%=0.07-0.94, p=0.039). HBoV, but not HBoV2-4, DNA occurs often in the nasopharynx of otitis-prone children, and may persist for 3-6 months. Probiotic treatment possibly reduced the presence of HBoV.
Article
The aim of the study was to examine the effects of a follow-on formula containing Lactobacillus fermentum CECT5716 (L. fermentum) on the incidence of infections in infants between the ages of 6 and 12 months. A randomized double-blinded controlled study including infants at the age of 6 months was conducted. Infants were assigned randomly to either follow-on formula supplemented with L. fermentum plus galactooligosaccharide (experimental group, EG), or the same formula supplemented with only galactooligosaccharide (control group, CG). The main outcome was the incidence of infections for the 6-month duration of the study. The EG showed a significant 46% reduction in the incidence rate (IR) of gastrointestinal infections (EG: 0.196 ± 0.51, CG: 0.363 ± 0.53, IR ratio 0.54, 95% confidence interval [CI] 0.307-0.950, P = 0.032), 27% reduction in the incidence of upper respiratory tract infections (EG: 0.969 ± 0.96, CG: 1.330 ± 1.23, IR ratio 0.729, 95% CI 0.46-1.38, P = 0.026), and 30% reduction in the total number of infections (EG: 1.464 ± 1.15, CG: 2.077 ± 1.59, IR ratio 0.70, 95% CI 0.46-1.38, P = 0.003), at the end of the study period compared with CG. Administration of a follow-on formula with L. fermentum CECT5716 may be useful for the prevention of community-acquired gastrointestinal and upper respiratory infections.
Article
Persistent diarrhoea (diarrhoea lasting more than 14 days) accounts for one third of all diarrhoea related deaths in developing countries in some studies. Probiotics may help treatment. To evaluate probiotics for treating persistent diarrhoea in children. In August 2010, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, and LILACS. We also contacted authors of included trials and organizations working in the field, and checked reference lists. Randomized controlled trials comparing a specified probiotic agent with placebo or no probiotic in children with persistent diarrhoea. Two review authors assessed the eligibility, risk of bias, extracted and analysed data. Differences were resolved by discussion. Statistical analysis were performed using the fixed-effect model and the results were expressed as mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). Four trials were included, with a total number of 464 participants; one trial had a low risk of bias. Meta-analysis showed that probiotics reduced the duration of persistent diarrhoea (mean difference 4.02 days, 95% CI 4.61 to 3.43 days, n=324, 2 trials). Stool frequency was reduced with probiotics in two trials. One trial reported a shorter hospital stay, which was significant, but numbers were small. No adverse events were reported. There is limited evidence suggesting probiotics may be effective in treating persistent diarrhoea in children.
Article
Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness. To assess the effects of probiotics in proven or presumed acute infectious diarrhoea. We searched the Cochrane Infectious Diseases Group's trials register (July 2010), the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2010), MEDLINE (1966 to July 2010), EMBASE (1988 to July 2010), and reference lists from studies and reviews. We also contacted organizations and individuals working in the field, and pharmaceutical companies manufacturing probiotic agents. Randomized and quasi-randomized controlled trials comparing a specified probiotic agent with a placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent. Two reviewers independently assessed the methodological quality of the trial and extracted data. Primary outcomes were the mean duration of diarrhoea, stool frequency on day 2 after intervention and ongoing diarrhoea on day 4. A random-effects model was used. Sixty-three studies met the inclusion criteria with a total of 8014 participants. Of these, 56 trials recruited infants and young children. The trials varied in the definition used for acute diarrhoea and the end of the diarrhoeal illness, as well as in the risk of bias. The trials were undertaken in a wide range of different settings and also varied greatly in organisms tested, dosage, and participants' characteristics. No adverse events were attributed to the probiotic intervention.Probiotics reduced the duration of diarrhoea, although the size of the effect varied considerably between studies.The average of the effect was significant for mean duration of diarrhoea (mean difference 24.76 hours; 95% confidence interval 15.9 to 33.6 hours; n=4555, trials=35) diarrhoea lasting ≥4 days (risk ratio 0.41; 0.32 to 0.53; n=2853, trials=29) and stool frequency on day 2 (mean difference 0.80; 0.45 to 1.14; n=2751, trials=20).The differences in effect size between studies was not explained by study quality, probiotic strain, the number of different strains, the viability of the organisms, dosage of organisms, the causes of diarrhoea, or the severity of the diarrhoea, or whether the studies were done in developed or developing countries. Used alongside rehydration therapy, probiotics appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea. However, more research is needed to guide the use of particular probiotic regimens in specific patient groups.
Article
Acute upper respiratory tract infections (URTIs) are infections of the upper airways that can cause symptoms for up to four weeks. Acute URTIs include colds, influenza and infections of the throat, nose or sinuses. The symptoms are often treated with painkillers and decongestants. Sometimes antibiotics are prescribed, although most acute URTIs are caused by viruses. Nasal saline sprays or irrigation have been used to treat symptoms of chronic airway infections, and sometimes for acute infections. This review is limited by the differences in the characteristics of the included studies, including study populations and outcome measures. However, it found little research to support the use of nasal saline for acute URTIs. Included studies showed limited benefit for symptoms relief with nasal saline irrigation in adults. Nasal saline is safe and may reduce time off work but may cause minor adverse effects such as dry nose or irritation in less than half of users. Future studies are needed to establish the use of nasal saline irrigation as a way of reducing acute URTI symptoms safely while keeping people at work and reducing antibiotic use.
Article
The aim of this study was to investigate whether consumption of Lactobacillus plantarum HEAL 9 (DSM 15312) and Lactobacillus paracasei 8700:2 (DSM 13434) could affect naturally acquired common cold infections in healthy subjects. A randomised, parallel, double-blind placebo-controlled study was performed to investigate whether intake of this probiotic mixture could reduce the risk of common cold episodes, number of days with common cold symptoms, frequency and severity of symptoms, and cellular immune response in common cold infections. A total of 272 subjects were supplemented daily with either 10(9) cfu (colony forming units) of probiotics (N = 135) or control (N = 137) for a 12-week period. The incidence of acquiring one or more common cold episode was reduced from 67% in the control group to 55% in the probiotic group (p < 0.05). Also, the number of days with common cold symptoms were significantly (p < 0.05) reduced from 8.6 days in the control group to 6.2 days, in the probiotic group, during the 12-week period. The total symptom score was reduced during the study period from a mean of 44.4 for the control group to 33.6 for the probiotic group. The reduction in pharyngeal symptoms was significant (p < 0.05). In addition, the proliferation of B lymphocytes was significantly counteracted in the probiotic group (p < 0.05) in comparison with the control group. In conclusion, intake of the probiotic strains Lactobacillus plantarum HEAL 9 (DSM 15312) and Lactobacillus paracasei 8700:2 (DSM 13434) reduces the risk of acquiring common cold infections.
Article
Aging is associated with a decline in immune function. This may contribute to decreased ability of an elderly patient to mount an appropriate innate inflammatory response when injured. This study examined elderly trauma patients to determine whether there was a difference in neutrophil response to injury when compared with controls. This prospective, observational, cohort study compared neutrophil function in 24 injured elderly (older than 65 years) patients admitted to our trauma center to control groups of noninjured individuals (11 elderly and 17 young). Blood samples were also taken from the injured elderly group within 48 hours of trauma and subsequently at two periods during their hospital stay. A single blood sample was obtained from the noninjured control groups. Neutrophils were analyzed for CD18 expression, stimulated oxidative burst, apoptosis, and IL-10. Results were compared using one-way analysis of variance (alpha 0.05). This study was approved by the Institutional Review Board. Twenty-four injured elderly subjects were enrolled: mean injury severity score 15.3, average age 74.6 years, 92% survival, 100% blunt trauma. CD18 levels in the elderly injured subjects for all three time periods were significantly higher than both control groups. When evaluated between controls, CD18 for the noninjured elderly (NIE) was also significantly higher than the noninjured young (NIY). The neutrophil stimulated oxidative burst in the injured elderly subjects at time periods 1, 2, and 3 was not significantly different from the NIY controls. However, the injured elderly had a significantly higher oxidative burst at time period 3 than the NIE controls. Apoptosis in the injured elderly subjects was significantly lower in all three time periods than the NIY. There was no difference in apoptosis between the injured elderly subjects when compared with the NIE controls. There was no significant difference in IL-10 expression among g