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Zhang Y, Huang X, Zhang J, Tao Z. Risk factors for hospitalization and pneumonia development of pediatric patients with seasonal influenza during February-April 2023. Front Public Health 2024; 11:1300228. [PMID: 38249383 PMCID: PMC10797015 DOI: 10.3389/fpubh.2023.1300228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives In China influenza remains a low activity for continuous 3 years due to COVID-19 controls. We here sought to study the clinical characteristics and risk factors of the influenza infection among children after the mandatory COVID-19 restrictions were lifted. Methods We included 1,006 pediatric patients with influenza A virus (IAV) infection, enrolled in one tertiary hospital in Zhenjiang, Jiangsu Province, China, during February to April 2023. Patients were divided into the outpatient (n = 798) and inpatient (n = 208) groups, and their baseline characteristics were compared between two groups to conclude the risk factors for pediatric hospitalization. Separately, pediatric inpatients (n = 208) were further divided into the pneumonia and non-pneumonia groups with comparison of their clinical characteristics, including their laboratory test results and representative radiological features, to derive the key determinants for pneumonia development after hospitalization. Results Compared to outpatients, IAV-infected pediatric inpatients exhibited younger age, higher female: male ratio, more co-infection of influenza B virus (IBV) and hematological abnormality. Multivariate regression analysis determined the independent risk factors of hospitalization to be the clinical symptom of abdominal pain (OR = 2.63, [95% CI, 1.05-6.57], p = 0.039), co-infection of IBV (OR = 44.33, [95% CI, 25.10-78.30], p = 0.001), elevated levels of lymphocytes (OR = 2.24, [95% CI,1.65-3.05], p = 0.001) and c-reactive proteins (CRPs) (OR = 1.06, [95% CI, 1.03-1.08], p = 0.001) upon hospital admission. Furthermore, the cough symptom (OR = 17.39, [95% CI, 3.51-86.13], p = 0.001) and hospitalization length (OR = 1.36, [95% CI, 1.12-1.67], p = 0.002) were determined to be risk factors of pneumonia acquirement for pediatric inpatients. Conclusion While the abdominal pain, viral co-infection and some hematological abnormality mainly contribute to hospitalization of pediatric patients with IAV infection, the length of hospital stay and clinical sign of coughing upon hospital admission constitute the key determinants for nosocomial pneumonia development.
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Affiliation(s)
- Yuqian Zhang
- Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xing Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianguo Zhang
- Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhimin Tao
- Department of Emergency Medicine, The Affiliated Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
- Jiangsu Province Key Laboratory of Medical Science and Laboratory Medicine, Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
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2
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Oey A, McClure M, Symons JA, Chanda S, Fry J, Smith PF, Luciani K, Fayon M, Chokephaibulkit K, Uppala R, Bernatoniene J, Furuno K, Stanley T, Huntjens D, Witek J. Lumicitabine, an orally administered nucleoside analog, in infants hospitalized with respiratory syncytial virus (RSV) infection: Safety, efficacy, and pharmacokinetic results. PLoS One 2023; 18:e0288271. [PMID: 37467213 PMCID: PMC10355467 DOI: 10.1371/journal.pone.0288271] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/25/2023] [Indexed: 07/21/2023] Open
Abstract
Respiratory syncytial virus (RSV) infection is the leading cause of infant hospitalizations and mortality. Lumicitabine, an oral nucleoside analog was studied for the treatment of RSV. The phase 1b and phase 2b studies reported here assessed the safety, pharmacokinetics, and pharmacodynamics of lumicitabine in infants/neonates hospitalized with RSV. In the phase 1b study, infants (≥1 to ≤12 months) and neonates (<28 days) received a single-ascending or multiple-ascending doses (single loading dose [LD] then 9 maintenance doses [MD] of lumicitabine, or placebo [3:1]). In the phase 2b study, infants/children (28 days to ≤36 months old) received lumicitabine 40/20 mg/kg, 60/40 mg/kg LD/MD twice-daily or placebo (1:1:1) for 5 days. Safety, pharmacokinetics, and efficacy parameters were assessed over 28 days. Lumicitabine was associated with a dose-related increase in the incidence and severity of reversible neutropenia. Plasma levels of ALS-008112, the active nucleoside analog, were dose-proportional with comparable mean exposure levels at the highest doses in both studies. There were no significant differences between the lumicitabine groups and placebo in reducing viral load, time to viral non-detectability, and symptom resolution. No emergent resistance-associated substitutions were observed at the RSV L-gene positions of interest. In summary, lumicitabine was associated with a dose-related increase in the incidence and severity of reversible neutropenia and failed to demonstrate antiviral activity in RSV-infected hospitalized infants. This contrasts with the findings of the previous RSV-A adult challenge study where significant antiviral activity was noted, without incidence of neutropenia. Trial registration ClinicalTrials.gov Identifier: NCT02202356 (phase 1b); NCT03333317 (phase 2b).
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Affiliation(s)
- Abbie Oey
- Janssen Research & Development, LLC, South San Francisco, California, United States of America
| | - Matthew McClure
- Janssen Research & Development, LLC, South San Francisco, California, United States of America
| | - Julian A. Symons
- Janssen Research & Development, LLC, South San Francisco, California, United States of America
| | - Sushmita Chanda
- Janssen Research & Development, LLC, South San Francisco, California, United States of America
| | - John Fry
- Janssen Research & Development, LLC, South San Francisco, California, United States of America
| | - Patrick F. Smith
- Certara Strategic Consulting, Parsippany, New Jersey, United States of America
| | - Kathia Luciani
- Department of Infectious Diseases Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Panama City, Panama
| | - Michael Fayon
- CHU de Bordeaux, Pneumologie pédiatrique, CIC 1401 (INSERM), Hôpital Pellegrin-Enfants, Bordeaux Cedex, France
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rattapon Uppala
- Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | - Jolanta Bernatoniene
- Paediatric Infectious Disease and Immunology Department, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Kenji Furuno
- General Pediatrics & Interdisciplinary Medicine Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Thorsten Stanley
- Department of Paediatrics, University of Otago, Wellington, New Zealand
| | | | - James Witek
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
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Helal MA, Shouman S, Abdelwaly A, Elmehrath AO, Essawy M, Sayed SM, Saleh AH, El-Badri N. Molecular basis of the potential interaction of SARS-CoV-2 spike protein to CD147 in COVID-19 associated-lymphopenia. J Biomol Struct Dyn 2022; 40:1109-1119. [PMID: 32936048 PMCID: PMC7544927 DOI: 10.1080/07391102.2020.1822208] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Abstract
Lymphopenia is considered one of the most characteristic clinical features of the coronavirus disease 2019 (COVID-19). SARS-CoV-2 infects host cells via the interaction of its spike protein with the human angiotensin-converting enzyme 2 (hACE2) receptor. Since T lymphocytes display a very low expression level of hACE2, a novel receptor might be involved in the entry of SARS-CoV-2 into T cells. The transmembrane glycoprotein CD147 is highly expressed by activated T lymphocytes, and was recently proposed as a probable route for SARS-CoV-2 invasion. To understand the molecular basis of the potential interaction of SARS-CoV-2 to CD147, we have investigated the binding of the viral spike protein to this receptor in-silico. The results showed that this binding is dominated by electrostatic interactions involving residues Arg403, Asn481, and the backbone of Gly502. The overall binding arrangement shows the CD147 C-terminal domain interacting with the spike external subdomain in the grove between the short antiparallel β strands, β1' and β2', and the small helix α1'. This proposed interaction was further confirmed using MD simulation and binding free energy calculation. These data contribute to a better understanding of the mechanism of infection of SARS-CoV-2 to T lymphocytes and could provide valuable insights for the rational design of adjuvant treatment for COVID-19. Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Mohamed A. Helal
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt
- Medicinal Chemistry Department, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Shaimaa Shouman
- Center of Excellence for Stem Cells and Regenerative Medicine, Zewail City of Science and Technology, Giza, Egypt
| | - Ahmad Abdelwaly
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt
| | - Ahmed O. Elmehrath
- Center of Excellence for Stem Cells and Regenerative Medicine, Zewail City of Science and Technology, Giza, Egypt
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Essawy
- Center of Excellence for Stem Cells and Regenerative Medicine, Zewail City of Science and Technology, Giza, Egypt
| | - Shireen M. Sayed
- Center of Excellence for Stem Cells and Regenerative Medicine, Zewail City of Science and Technology, Giza, Egypt
| | - Amr H. Saleh
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt
| | - Nagwa El-Badri
- Center of Excellence for Stem Cells and Regenerative Medicine, Zewail City of Science and Technology, Giza, Egypt
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4
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Ayuso B, Lalueza A, Arrieta E, Romay EM, Marchán-López Á, García-País MJ, Folgueira D, Gude MJ, Cueto C, Serrano A, Lumbreras C. Derivation and external validation of a simple prediction rule for the development of respiratory failure in hospitalized patients with influenza. Respir Res 2022; 23:323. [PMID: 36419130 PMCID: PMC9684757 DOI: 10.1186/s12931-022-02245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Influenza viruses cause seasonal epidemics worldwide with a significant morbimortality burden. Clinical spectrum of Influenza is wide, being respiratory failure (RF) one of its most severe complications. This study aims to elaborate a clinical prediction rule of RF in hospitalized Influenza patients. METHODS A prospective cohort study was conducted during two consecutive Influenza seasons (December 2016-March 2017 and December 2017-April 2018) including hospitalized adults with confirmed A or B Influenza infection. A prediction rule was derived using logistic regression and recursive partitioning, followed by internal cross-validation. External validation was performed on a retrospective cohort in a different hospital between December 2018 and May 2019. RESULTS Overall, 707 patients were included in the derivation cohort and 285 in the validation cohort. RF rate was 6.8% and 11.6%, respectively. Chronic obstructive pulmonary disease, immunosuppression, radiological abnormalities, respiratory rate, lymphopenia, lactate dehydrogenase and C-reactive protein at admission were associated with RF. A four category-grouped seven point-score was derived including radiological abnormalities, lymphopenia, respiratory rate and lactate dehydrogenase. Final model area under the curve was 0.796 (0.714-0.877) in the derivation cohort and 0.773 (0.687-0.859) in the validation cohort (p < 0.001 in both cases). The predicted model showed an adequate fit with the observed results (Fisher's test p > 0.43). CONCLUSION we present a simple, discriminating, well-calibrated rule for an early prediction of the development of RF in hospitalized Influenza patients, with proper performance in an external validation cohort. This tool can be helpful in patient's stratification during seasonal Influenza epidemics.
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Affiliation(s)
- Blanca Ayuso
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - Antonio Lalueza
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - Estibaliz Arrieta
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - Eva María Romay
- grid.414792.d0000 0004 0579 2350Infectious Diseases Unit, University Hospital Lucus Augusti, Lugo, Spain
| | - Álvaro Marchán-López
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - María José García-País
- grid.414792.d0000 0004 0579 2350Infectious Diseases Unit, University Hospital Lucus Augusti, Lugo, Spain
| | - Dolores Folgueira
- grid.144756.50000 0001 1945 5329Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain
| | - María José Gude
- grid.414792.d0000 0004 0579 2350Department of Microbiology, University Hospital Lucus Augusti, Lugo, Spain
| | - Cecilia Cueto
- grid.144756.50000 0001 1945 5329Department of Biochemistry, University Hospital 12 de Octubre, Madrid, Spain
| | - Antonio Serrano
- grid.144756.50000 0001 1945 5329Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - Carlos Lumbreras
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain ,grid.144756.50000 0001 1945 5329Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain
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5
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Wiltshire K, Kalff A, Morrissey CO, Griffin D, Patil S, Spring S, Spencer A, Kliman D. SARS-CoV-2 infection in autologous stem cell transplantation. Intern Med J 2021; 51:1352-1353. [PMID: 34423537 PMCID: PMC8653091 DOI: 10.1111/imj.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/31/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kaitlyn Wiltshire
- Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Anna Kalff
- Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Catherine O Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - David Griffin
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Sushrut Patil
- Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Stephanie Spring
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - David Kliman
- Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
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6
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Treatment and Mortality of Hemophagocytic Lymphohistiocytosis in Adult Critically Ill Patients: A Systematic Review With Pooled Analysis. Crit Care Med 2021; 48:e1137-e1146. [PMID: 32947471 DOI: 10.1097/ccm.0000000000004581] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Hemophagocytic lymphohistiocytosis is a cytokine release syndrome caused by uncontrolled immune activation resulting in multiple organ failure and death. In this systematic review, we aimed to analyze triggers, various treatment modalities, and mortality in critically ill adult hemophagocytic lymphohistiocytosis patients. DATA SOURCES MEDLINE database (PubMed) at October 20, 2019. STUDY SELECTION Studies and case series of patients greater than or equal to 18 years old, of whom at least one had to be diagnosed with hemophagocytic lymphohistiocytosis and admitted to an ICU. DATA EXTRACTION Source data of studies and case series were summarized and analyzed on an individual basis. Multivariable logistic regression analysis was performed adjusting for age, sex, and trigger groups. Each single treatment agent was entered as a dichotomous variable to determine treatments associated with survival, regardless if given alone or in combination. DATA SYNTHESIS In total, 661 patients from 65 studies and case series were included. Overall mortality was 57.8%. Infections were the most frequent trigger (49.9%), followed by malignancies (28.0%), autoimmune diseases (12.1%), unknown triggers (9.4%), and drugs (0.6%). Treatment with IV immunoglobulins was associated with improved survival (odds ratio, 0.548; 95% CI, 0.337-0.891; p = 0.015), while treatment with cyclosporine was associated with increased risk of death (odds ratio, 7.571; 95% CI, 3.702-15.483; p < 0.001). Considering different trigger groups separately, same results occurred only for infection-triggered hemophagocytic lymphohistiocytosis. No information was available on disease severity and other confounding factors. CONCLUSIONS Mortality of hemophagocytic lymphohistiocytosis in the ICU is high. Most common triggers were infections. Results of survival analyses may be biased by treatment indication and disease severity. Future studies prospectively investigating treatment tailored to critically ill hemophagocytic lymphohistiocytosis patients are highly warranted.
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7
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Lalueza A, Ayuso B, Arrieta E, Trujillo H, Folgueira D, Cueto C, Serrano A, Laureiro J, Arévalo-Cañas C, Castillo C, Díaz-Pedroche C, Lumbreras C. Elevation of serum ferritin levels for predicting a poor outcome in hospitalized patients with influenza infection. Clin Microbiol Infect 2020; 26:1557.e9-1557.e15. [PMID: 32120038 DOI: 10.1016/j.cmi.2020.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/05/2020] [Accepted: 02/14/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES There is increasing evidence that ferritin is a key marker of macrophage activation, but its potential role in influenza infection remains unexplored. Our aim was to assess whether hyperferritinaemia (ferritin ≥500 ng/mL) could be a marker of poor prognosis in hospitalized patients with confirmed influenza A infection. METHODS We prospectively recruited all hospitalized adult patients who tested positive for the influenza A rRT-PCR assay performed on respiratory samples in two consecutive influenza periods (2016-17 and 2017-18). Poor outcome was defined as the presence of at least one of the following: respiratory failure, admission to the intensive care unit, or in-hospital mortality. RESULTS Among 494 patients, 68 (14%) developed poor outcomes; 112 patients (23%) had hyperferritinaemia (39/68, 57% in the poor-outcome group versus 73/426, 17% in the remaining patients, p < 0.0001). Median serum ferritin levels were significantly higher in the subgroup of patients with poor outcomes (609 ng/mL, range 231-967 versus 217 ng/mL, range 140-394, p < 0.0001). In multivariate analysis, hyperferritinaemia was associated with a five-fold increase in the odds ratio of developing poor outcome. After adjusting for classic influenza risk factors, ferritin remained as a significant predictive factor in all exploratory models. Ferritin levels had a good discriminative capacity with an area under the ROC curve of 0.72 (95% confidence interval (CI) 0.65-0.8, p < 0.001) and an overall diagnostic accuracy for predicting poor outcome of 79.3% (95%CI 75.4-82.7%). CONCLUSIONS Serum ferritin may discriminate a subgroup of patients with influenza infection who have a higher risk of developing a poor outcome.
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Affiliation(s)
- A Lalueza
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain; Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain.
| | - B Ayuso
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - E Arrieta
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - H Trujillo
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - D Folgueira
- Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain; Department of Microbiology, School of Medicine, Complutense University, Madrid, Spain
| | - C Cueto
- Department of Biochemistry, University Hospital 12 de Octubre, Madrid, Spain
| | - A Serrano
- Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - J Laureiro
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - C Arévalo-Cañas
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - C Castillo
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - C Díaz-Pedroche
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain
| | - C Lumbreras
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain; Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain; Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain
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8
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Lalueza A, Folgueira D, Díaz-Pedroche C, Hernández-Jiménez P, Ayuso B, Castillo C, Laureiro J, Trujillo H, Torres M, Lumbreras C. Severe lymphopenia in hospitalized patients with influenza virus infection as a marker of a poor outcome. Infect Dis (Lond) 2019; 51:543-546. [PMID: 31012776 DOI: 10.1080/23744235.2019.1598572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Antonio Lalueza
- a Departamento de Medicina Interna , Hospital Universitario 12 de Octubre , Madrid , Spain.,b Departamento de Medicina. Facultad de Medicina , Universidad Complutense , Madrid , Spain.,c Instituto de Investigación Hospital 12 de Octubre (i + 12) , Madrid , Spain
| | - Dolores Folgueira
- b Departamento de Medicina. Facultad de Medicina , Universidad Complutense , Madrid , Spain.,c Instituto de Investigación Hospital 12 de Octubre (i + 12) , Madrid , Spain.,d Departamento de Microbiología , Hospital Universitario 12 de Octubre , Madrid , Spain
| | - Carmen Díaz-Pedroche
- a Departamento de Medicina Interna , Hospital Universitario 12 de Octubre , Madrid , Spain.,b Departamento de Medicina. Facultad de Medicina , Universidad Complutense , Madrid , Spain
| | | | - Blanca Ayuso
- a Departamento de Medicina Interna , Hospital Universitario 12 de Octubre , Madrid , Spain
| | - Cristina Castillo
- a Departamento de Medicina Interna , Hospital Universitario 12 de Octubre , Madrid , Spain
| | - Jaime Laureiro
- a Departamento de Medicina Interna , Hospital Universitario 12 de Octubre , Madrid , Spain
| | | | - Marta Torres
- a Departamento de Medicina Interna , Hospital Universitario 12 de Octubre , Madrid , Spain
| | - Carlos Lumbreras
- a Departamento de Medicina Interna , Hospital Universitario 12 de Octubre , Madrid , Spain.,b Departamento de Medicina. Facultad de Medicina , Universidad Complutense , Madrid , Spain.,c Instituto de Investigación Hospital 12 de Octubre (i + 12) , Madrid , Spain.,e Unidad de Enfermedades Infecciosas , Hospital Universitario 12 de Octubre , Madrid , Spain
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9
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Lalueza A, Folgueira D, Muñoz-Gallego I, Trujillo H, Laureiro J, Hernández-Jiménez P, Moral-Jiménez N, Castillo C, Ayuso B, Díaz-Pedroche C, Torres M, Arrieta E, Arévalo-Cañas C, Madrid O, Lumbreras C. Influence of viral load in the outcome of hospitalized patients with influenza virus infection. Eur J Clin Microbiol Infect Dis 2019; 38:667-673. [PMID: 30820840 PMCID: PMC7102091 DOI: 10.1007/s10096-019-03514-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/14/2019] [Indexed: 01/30/2023]
Abstract
The role of viral load in the outcome of patients requiring hospital admission due to influenza is not well established. We aim to assess if there is an association between the viral load and the outcome in hospitalized patients with a confirmed influenza virus infection. A retrospective observational study including all adult patients who were hospitalized in our center with a confirmed influenza virus infection from January to May 2016. Viral load was measured by real-time reverse-transcriptase–polymerase chain reaction (rRT-PCR) cycle threshold (Ct) value on upper respiratory tract samples. Its value was categorized into three groups (low Ct, ≤ 20; intermediate Ct, > 20–30; and high Ct, > 30). Two hundred thirty-nine patients were included. Influenza A/H1N1pdm09 was isolated in 207 cases (86.6%). The mean Ct value was 26.69 ± 5.81. The viral load was higher in the unvaccinated group when compared with the vaccinated patients (Ct 25.17 ± 5.55 vs. 27.58 ± 4.97, p = 0.004). Only 27 patients (11.29%) presented a high viral load. Patients with a high viral load more often showed abnormal findings on chest X-ray (p = 0.015) and lymphopenia (p = 0.097). By contrast, there were no differences between the three groups (according to viral load), in associated pneumonia, respiratory failure, need for mechanical ventilation, sepsis, or in-hospital mortality. Our findings suggest that in patients admitted to the hospital with confirmed influenza virus infection (mostly A/H1N1pdm09), a high viral load is associated with a higher presence of abnormal findings on chest X-ray but not with a significant worse prognosis. In these cases, standardized quantitative PCR could be useful.
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Affiliation(s)
- Antonio Lalueza
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain. .,Department of Medicine, School of Medicine, Complutense University, Madrid, Spain. .,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
| | - Dolores Folgueira
- Department of Medicine, School of Medicine, Complutense University, Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Irene Muñoz-Gallego
- Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Hernando Trujillo
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Jaime Laureiro
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Pilar Hernández-Jiménez
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | | | - Cristina Castillo
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Blanca Ayuso
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Carmen Díaz-Pedroche
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University, Madrid, Spain
| | - Marta Torres
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Estibaliz Arrieta
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Coral Arévalo-Cañas
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Olaya Madrid
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain
| | - Carlos Lumbreras
- Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5400, 28041, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University, Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain
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