Jack M. Gwaltney's research while affiliated with University of Virginia and other places

Publications (186)

Article
Full-text available
A prolonged course of antibiotic therapy is often initiated for chronic rhinosinusitis (CRS) based on symptomatology. We examined differences in clinical manifestations and underlying conditions in patients with symptoms typical for CRS. CT scan abnormality of the sinuses was the gold standard for diagnosis of CRS. We performed a prospective observ...
Article
Over the past 20 years, the use of zinc as an over-the-counter alternative therapy for the common cold has vastly grown in popularity. Recent reports of potentially permanent anosmia caused by intranasal zinc therapy warrant careful analysis of the therapeutic effects of zinc. A search of the Medline database (including articles published during 19...
Article
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Prospective surveillance for influenza was performed during the 2002 Salt Lake City Winter Olympics. Oseltamivir was administered to patients with influenza like illness and confirmed influenza, while their close contacts were given oseltamivir prophylactically. Influenza A/B was diagnosed in 36 of 188 patients, including 13 athletes. Prompt manage...
Article
Contrast dye in the nasopharynx reaches the middle ear during swallowing and yawning in normal adults. This suggests that displacement of bacteria in nasopharyngeal secretion to the middle ear may occur frequently during sleep. The middle ear is sterile under normal conditions. The purpose of this study was to examine by means of CT whether radiopa...
Article
Echinacea is a herbal preparation that is frequently used to treat the common cold. Spending on echinacea in the United States has risen to >300 million dollars annually. A total of 322 articles related to echinacea and colds, including 9 placebo-controlled clinical trials, were identified using the Medline and PubMed databases. Eleven features of...
Article
To determine whether healthy adult nasal carriers of Staphylococcus aureus can disperse S. aureus into the air after rhinovirus infection. We investigated the "cloud" phenomenon among adult nasal carriers of S. aureus experimentally infected with a rhinovirus. Eleven volunteers were studied for 16 days in an airtight chamber wearing street clothes,...
Article
Acute sinusitis is one of the most common infections seen in general clinical practice. The most common cause of acute sinusitis is viral; however, many patients receive a prescription for an antibiotic. Such injudicious prescribing habits have a major impact on health care costs, contribute to the increasing prevalence of drug-resistant strains of...
Article
The concentration of rhinovirus in nasal wash specimens from infected volunteers peaks at 48-72 h after inoculation. The volume of expelled nasal fluid peaks at the same time, raising the question of whether the viral concentration in nasal wash reflects viral replication in nasal cells or merely the production of an increased volume of nasal fluid...
Article
To investigate whether rhinovirus infection leads to increased airborne dispersal of coagulase-negative staphylococci (CoNS). Prospective nonrandomized intervention trial. Wake Forest University School of Medicine, Winston-Salem, North Carolina. Twelve nasal Staphylococcus aureus-CoNS carriers among 685 students screened for S. aureus nasal carriag...
Article
Two areas of investigation were reviewed: (1) placebo-controlled trials of antimicrobial treatment involving patients with a clinical diagnosis of acute community-acquired bacterial sinusitis (ACABS) for whom pre- and posttherapy sinus aspirate cultures were not performed, and (2) uncontrolled trials of antimicrobial treatment involving patients wi...
Article
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Human rhinovirus (HRV) infections are usually self-limited but may be associated with serious consequences, particularly in those with asthma and chronic respiratory disease. Effective antiviral agents are needed for preventing and treating HRV illnesses. Ruprintrivir (Agouron Pharmaceuticals, Inc., San Diego, Calif.) selectively inhibits HRV 3C pr...
Article
Although most children and young adults with asthma are atopic, exacerbations of asthma are frequently associated with viral respiratory tract infections, especially those caused by rhinovirus (HRV). Young atopic adults with mild asthma were evaluated before and during an experimental HRV infection to test the hypothesis that airway inflammation be...
Article
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Mean total symptom severity scores for subjects with experimental rhinovirus colds peak 48 h after viral inoculation. Also, total symptom scores for natural rhinovirus and nonrhinovirus colds peaked on day 2 of illness in a long-term, noncompensated epidemiology study. In contrast, the mean total symptom scores for compensated patients receiving pl...
Article
Attempts to relieve the misery of the common cold have been made since long before current understanding of its viral origin. Although current symptomatic therapies provide some relief, any effective treatment must incorporate an antiviral to address the infection. Symptom production is related not only to viral cytopathic effect but also to the ea...
Article
Viral respiratory tract infections, also known as colds, are the most common infection in humans. The majority of these infections are caused by rhinoviruses. Rhinovirus deposition in the nose or the eye initiates infection. The virus attaches to the host cell intercellular adhesion molecule-1 (ICAM-1) receptors in the back of the throat. Subsequen...
Article
The pathogenesis, bacteriology, diagnosis, and antimicrobial treatment of acute bacterial rhinosinusitis (ABRS) is reviewed. Most cases of ABRS arise as complications of the rhinosinusitis of colds and other acute viral respiratory infections. Nose blowing during colds may be a risk factor for ABRS by propelling bacteria-laden nasal fluid into the...
Article
Full-text available
A randomized, controlled, double-masked clinical trial was conducted with a combination antiviral-antimediator treatment for experimental rhinovirus colds. In all, 150 healthy men and women (aged 18–51 years) were randomly assigned to 1 of 3 groups: intranasal interferon (IFN)–α2b (6×106 U every 12 h × 3) plus oral chlorpheniramine (12 mg extended...
Article
Full-text available
The objective of this practice guideline is to provide recommendations for the accurate diagnosis and optimal treatment of group A streptococcal pharyngitis in children and adults. The desired outcomes are prevention of acute rheumatic fever, prevention of suppurative complications, improvement of clinical symptoms and signs, reduction in transmiss...
Article
Attempts to relieve the misery of the common cold have been made since long before current understanding of its viral origin. Although current symptomatic therapies provide some relief, any effective treatment must incorporate an antiviral to address the infection. Symptom production is related not only to viral cytopathic effect but also to the ea...
Article
Viral respiratory tract infections, also known as colds, are the most common infection in humans. The majority of these infections are caused by rhinoviruses. Rhinovirus deposition in the nose or the eye initiates infection. The virus attaches to the host cell intercellular adhesion molecule-1 (ICAM-1) receptors in the back of the throat. Subsequen...
Conference Paper
Attempts to relieve the misery of the common cold have been made since long before current understanding of its viral origin. Although current symptomatic therapies provide some relief, any effective treatment must incorporate an antiviral to address the infection. Symptom production is related not only to viral cytopathic effect but also to the ea...
Conference Paper
Viral respiratory tract infections, also known as colds, are the most common infection in humans. The majority of these infections are caused by rhinoviruses. Rhinovirus deposition in the nose or the eye initiates infection. The virus attaches to the host cell intercellular adhesion molecule-1 (ICAM-1) receptors in the back of the throat. Subsequen...
Article
Treatment with first-generation antihistamines reduces sneezing, rhinorrhea, nasal mucus weight, and, in some instances, cough in subjects with experimental or natural colds; however, treatment with second-generation antihistamines has not been effective for these complaints in trials in subjects with natural colds. This article reports the negativ...
Article
Objectives: To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis. Study design: Retrospective, nonrandomized study. Methods: Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30...
Article
We hypothesized that respiratory syncytial virus (RSV)-induced pathologies could be mediated, in part, by vascular active cytokines elaborated during virus infection. To address this hypothesis, we determined whether RSV stimulated vascular endothelial cell growth factor (VEGF)/vascular permeability factor (VPF) elaboration in vitro. Supernatants f...
Article
Little data exist on the cause and treatment of subfacial pain and pressure and other discomfort attributed to the paranasal sinuses that develop early during the course of the common cold. The purpose of this study was to determine the efficacy of the combination of pseudoephedrine hydrochloride with acetaminophen for the treatment of early sympto...
Article
Full-text available
To distinguish sinusitis from uncomplicated "colds," we examined lactoferrin and eosinophilic cationic protein (ECP) in nasal secretions. Lactoferrin titers were >/=1:400 in 4% of persons with uncomplicated colds and controls but in 79% of persons with sinusitis or purulent sputa. ECP levels were >200 ng/ml in 61% of persons with colds and >3,000 n...
Article
Viruses are the leading cause of respiratory infections in children and adults and are a major cause of morbidity and mortality worldwide. A variety of clinical syndromes and illness severity's result from viral respiratory infections reflecting the biologic differences of the various viruses as well as differences in host resistance. Infection wit...
Article
Full-text available
Intranasal pressures were measured in adults during nose blowing, sneezing, and coughing and were used for fluid dynamic modeling. Sinus CT scans were performed after instillation of radiopaque contrast medium into the nasopharynx followed by nose blowing, sneezing, and coughing. The mean (±SD) maximal intranasal pressure was 66 (±14) mm Hg during...
Article
This is the second in a series of practice guidelines commissioned by the Infectious Diseases Society of America (IDSA) through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians when malting decisions on treating the conditions specified in each guideline. The targeted providers are pediatrici...
Article
Full-text available
Rhinovirus (RV) upper respiratory tract infections are prototypic transient inflammatory responses. To address the mechanism of disease resolution in these infections, we determined if RV stimulated the production of the IL-1 receptor antagonist (IL-1ra) in vivo and in vitro. In contrast to IL-1alpha and IL-1beta, immunoreactive IL-1ra was readily...
Article
New recommendations regarding prophylaxis of healthcare workers exposed to human immunodeficiency virus (HIV) prompted us to examine the frequency and nature of percutaneous injuries at this hospital. Four previously defined risk factors for transmission of HIV were evaluated. Between 1993 and 1995, 1,070 percutaneous injuries were reported, includ...
Article
An estimated 20 million cases of acute community-acquired bacterial sinusitis occur each year in the United States. Antibiotic treatment shortens the duration of the illness, decreases mucosal damage that might lead to chronic sinusitis, and limits the spread of infection. Although complications are uncommon, they can be serious. However, the condi...
Article
Full-text available
This double-blind study determined the influence of serum neutralizing antibody titers on the rate of infection and magnitude of disease expression after experimental exposure of adult volunteers to rhinovirus strain Hanks (RV-H). A total of 133 healthy volunteers were tested for antibody status, cloistered for a 6-day period, and challenged with R...
Article
New recommendations regarding prophylaxis of healthcare workers exposed to human immunodeficiency virus (HIV) prompted us to examine the frequency and nature of percutaneous injuries at this hospital. Four previously defined risk factors for transmission of HIV were evaluated. Between 1993 and 1995, 1,070 percutaneous injuries were reported, includ...
Article
Full-text available
Two-hundred seventy-six volunteers completed a life stressor interview and psychological questionnaires and provided blood and urine samples. They were then inoculated with common cold viruses and monitored for the onset of disease. Although severe acute stressful life events (less than 1 month long) were not associated with developing colds, sever...
Article
Plasma levels of adrenocorticotropic hormone (ACTH) and cortisol were measured in young adults with influenza virus type A (H3N2) infection for whom cultures were positive and in comparable controls without symptoms or other evidence of illness. The mean plasma ACTH level ± SE in 19 patients with acute influenza was 13.5 ± 2.1 pg/mL compared with 2...
Article
Upper respiratory viruses cause self-limited illness characterized by acute rhinitis. In rhinovirus colds the symptoms are thought to be caused by the host response rather than viral damage of the nasal epithelium. Rhinovirus triggers an inflammatory cascade, evidenced by the presence of inflammatory mediators (e.g., IL-8) and proinflammatory cytok...
Article
Neutrophil infiltration is a well-documented early event in the pathogenesis of rhinovirus (RV) infections. To further understand the mechanisms responsible for this neutrophilia, we determined whether interleukin (IL)-8 was present at sites of experimental RV infection in vivo and characterized the mechanism(s) by which RV stimulates IL-8 producti...
Article
Limited data support the use of first-generation antihistamines for treatment of the common cold. The purpose of this study was to test the effectiveness of clemastine fumarate, a first-generation antihistamine, for treatment of sneezing and rhinorrhea associated with naturally occurring common colds. Four hundred three subjects (202 clemastine fum...
Article
We tested the efficacy of brompheniramine maleate in a large randomized, controlled trial of volunteers with experimental rhinovirus colds. Brompheniramine (12 mg) or placebo was administered at 8:00 a.m. and 8:00 p.m. for ⩽4 days after the onset of symptoms (24, 36, or 48 hours after virus challenge). During the first 3 days of treatment (the firs...
Article
In Reply. —Drs Edmunds, Medley, and O'Callaghan suggest that gregarious adults have more contacts with others and therefore would be exposed more often to rhinoviruses resulting in the development of protective immunity. They further argue that in our study, we only measure specific antibody to the challenge strains and that increased exposure to...
Article
This is the second in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians when making decisions on treating the conditions specified in each guideline. The targeted providers are pediatricians, fam...
Article
Full-text available
Cefdinir is an extended-spectrum oral cephalosporin that is active against pathogens commonly seen in acute community-acquired bacterial sinusitis (ACABS), including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Two randomized, investigator-blind, multicenter trials (one in the United States and one in Europe) compare...
Article
To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection. After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and moni...
Article
Objective: To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection. Design: After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2...
Article
Eleven young adults with experimental rhinovirus infection (cases) and six noninfected saline-challenged young adults (controls) underwent nasal washings and symptom evaluations at 2-hour intervals for 24 hours after intranasal challenge. The mean and median periods to the first recovery of virus were 11.3 hours and 10 hours, respectively. Geometri...
Article
Proof of effectiveness now exists for many health promotion and disease prevention practices, yet the importance of this knowledge is not widely appreciated, and a large percentage of the population does not receive this care. Universities with comprehensive academic medical centers are particularly appropriate places for providing health promotion...
Article
This study was designed to test the effects of oral steroid therapy on the kinin levels and symptoms of experimental rhinoviral colds. Forty-seven men were randomized to receive prednisone (20 mg) or placebo. Therapy was administered three times a day for 5 days, after one dose was given 11 hours before inoculation with rhinovirus. Viral titers, sy...
Article
Many groups are working on new and improved methods of common cold treatment that include antivirals, synthetic viral receptor, compounds which block symptom pathways, and combinations of these approaches. Because the common cold syndrome is in large part subjective, symptom measurement remains an important parameter in evaluating the effectiveness...
Article
The purpose of this study was to test the effectiveness of clemastine, a first generation antihistamine, for treatment of sneezing and rhinorrhea associated with common colds. Subjects who reported new onset (<24 hr.) of cold symptoms that included rhinorrhea and/or sneezing were treated with 1.34 mg of clemastine fumarate (N=202) or placebo (N=201...
Article
Nasal carriage of Staphylococcus aureus is common among health care workers, but outbreaks caused by such carriers are relatively uncommon. We previously reported outbreaks of S. aureus skin infections that affected newborn infants and were attributed to an S. aureus nasal carrier who had had an associated upper respiratory tract infection (UR) dur...
Article
Full-text available
To further understand the biology of rhinovirus (RV), we determined whether IL-6 was produced during RV infections and characterized the mechanism by which RV stimulates lung cell IL-6 production. In contrast to normals and minimally symptomatic volunteers, IL-6 was detected in the nasal washings from patients who developed colds after RV challenge...
Article
Selected events in rhinovirus infection of the normal human airway can be regarded as occurring sequentially. Initial steps in rhinovirus pathogenesis are believed to include viral entry into the nose, mucociliary transport of virus to the posterior pharynx, and initiation of infection in ciliated and non-ciliated epithelial cells of the upper airw...
Article
Full-text available
State and trait negative affect (NA) were measured in healthy people immediately before an illness was induced through exposure to a respiratory virus. State NA, disease-specific health complaints (e.g., runny nose, congestion, and sneezing), and an associated objective marker of disease severity (mucus secretion weights) were assessed daily during...
Article
For the past 3 decades, rhinovirus grown in cell culture and used to induce experimental infections has been assumed to produce illness comparable to natural rhinovirus illness. However, no studies have been conducted to compare the characteristics of these two illnesses. We have used two data bases, one from natural colds of proven rhinovirus etio...
Article
Episodes of acute otitis media are commonly associated with viral upper respiratory tract infections. Rhinoviruses account for approximately 40% of these infections, and were previously shown to alter eustachian tube function and middle ear pressures. However, progression to otitis media has not been prospectively documented. In the present study,...
Article
Nasal inhalation of steam has been proposed as treatment of viral colds on the assumption that increased intranasal temperature will inhibit replication of rhinovirus (RV). The effect of steam inhalation on RV shedding by infected volunteers was examined in this study. Randomized controlled trial. Volunteers experimentally infected with RV were tre...
Article
To determine whether a viral upper respiratory tract infection can alter the responsiveness of the nasal mucosa, paired intranasal histamine and cold air challenge sessions were performed before and after (8 to 13 days) experimental rhinovirus infection in 18 nonallergic subjects and 20 subjects with seasonal allergic rhinitis. The nasal response t...
Article
Full-text available
Colds are common, but the abnormalities they produce in the nasal passages and sinus cavities have not been well defined. We studied healthy adult volunteers with self-diagnosed colds of 48 to 96 hours' duration and obtained the following data: information on symptoms, computed tomographic (CT) studies of the nasal passages and sinuses, mucosal-tra...
Article
This study's objective was to determine if the combination of pseudoephedrine hydrochloride and atropine sulfate attenuates the symptomatic and pathophysiologic response of individuals to experimental rhinovirus infection when given after illness begins. Forty-three susceptible adult volunteers were challenged with rhinovirus type 39 and randomly a...
Article
In early 1985, the Parakana-Apiterewa, a small, primitive Indian tribe, was contacted in the southern Amazon Basin. The tribe was thought to have been totally isolated from civilization until recent development of their land. Blood specimens were collected in 1985, shortly after the discovery of the tribe, and analyzed for the presence of rhinoviru...
Article
An antiviral agent and two antiinflammatory compounds were used in a blinded, placebo-controlled study to treat experimental rhinovirus colds. Intranasal interferon-α2b and ipratropium and oral naproxen were begun 24 h after rhinovirus inoculation. Treatment was continued three times a day for 4 days. Viral shedding (mean ± SE) was 4.4 ± 0.3 days f...
Article
Pretreatment sinus puncture was performed on 339 patients with acute community-acquired sinusitis (ACAS) between 1975 and 1990. Bacterial species recovered in titers of greater than or equal to 10(4) colony-forming units per milliliter (CFU/ml) from 383 sinus aspirates included Streptococcus pneumoniae, 92 (41%); Haemophilus influenzae, 79 (35%); a...
Article
Six (18%) of 34 healthy, asymptomatic young adults had mucosal thickening or fluid in the paranasal sinuses on screening magnetic resonance imaging (MRI) examination. When 19 of these subjects were challenged with rhinovirus, 18 became infected. Twelve of the 18 infected subjects had technically satisfactory serial MRI examinations, and four (33%)...
Article
Full-text available
To determine whether naproxen, a propionic acid inhibitor of cyclooxygenase, alters the course of experimental rhinovirus colds. A randomized, double-blind, controlled trial. Rhinovirus challenge model in volunteers cloistered in individual hotel rooms. Eighty-seven healthy young adults with serum neutralizing antibody titers of less than or equal...
Article
To determine if individuals with allergic rhinitis are hyperresponsive to upper respiratory tract viral infections, 20 allergic and 18 nonallergic, susceptible, adult volunteers were challenged and infected with rhinovirus type 39 before the pollen seasons. Before challenge and on each of 6 days of cloister, all volunteers were interviewed for symp...
Article
Experimental rhinovirus infection in volunteers has provided important new knowledge on the pathogenesis and treatment of rhinovirus colds. However, the clinical parameters of this illness have not been well defined. In the current study, data on 151 young adult subjects in 14 previous studies were used to determine representative values for nasal...