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Méroc E, Liang C, Iantomasi R, Onwuchekwa C, Innocenti GP, d'Angela D, Molalign S, Tran TMP, Basu S, Gessner BD, Bruyndonckx R, Polkowska-Kramek A, Begier E. A Model-Based Estimation of RSV-Attributable Incidence of Hospitalizations and Deaths in Italy Between 2015 and 2019. Infect Dis Ther 2024:10.1007/s40121-024-01041-x. [PMID: 39289329 DOI: 10.1007/s40121-024-01041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/30/2024] [Indexed: 09/19/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) incidence is known to be underestimated in adults due to its infrequent diagnostic testing and lower sensitivity of single nasal/nasopharyngeal swab PCR testing outside of the early childhood period. RSV can trigger acute cardiac events as well as cause respiratory disease. Consequently, we used a model-based study to estimate RSV-attributable hospitalization and mortality incidence among adults in Italy between 2015 and 2019. METHODS Through a database predisposed by CREA Sanità, by extracting monthly data from the Italian hospitalization collection data of the Ministry of Health and the Italian National Institute of Statistics (ISTAT) data (mortality), we estimated yearly RSV-attributable incidence of events for different cardiorespiratory outcomes. We used a quasi-Poisson regression model, which accounted for periodic and aperiodic time trends and viral activity proxies. RESULTS The yearly RSV-attributable cardiorespiratory hospitalization incidence increased with age and was highest among adults aged ≥ 75 years (1064-1527 cases per 100,000 person-years). Similarly, the RSV-attributable cardiorespiratory mortality rate was highest among persons aged ≥ 75 years (59-85 deaths per 100,000 person-years). Incidence rates for RSV-attributable hospitalizations and RSV-attributable mortality were on average 2-3 times higher for cardiorespiratory than respiratory disease alone. Incidence rate based on RSV-specific ICD codes only were 405-1729 times lower than modeled estimates accounting for untested events. CONCLUSION RSV causes a substantial disease burden among adults in Italy and contributes to both respiratory and cardiovascular conditions. Our results emphasize the need for effective RSV prevention strategies, particularly among older adults.
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Affiliation(s)
- Estelle Méroc
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Caihua Liang
- Pfizer Inc, Milan, Italy.
- Pfizer Inc, Dublin, Ireland.
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA.
| | - Raffaella Iantomasi
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
| | | | - Giuseppe Pietro Innocenti
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
| | - Daniela d'Angela
- Centro Per La Ricerca Economica Applicanta in Sanita, Rome, Italy
| | | | | | - Somsuvro Basu
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Bradford D Gessner
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
| | | | | | - Elizabeth Begier
- Pfizer Inc, Milan, Italy
- Pfizer Inc, Dublin, Ireland
- Pfizer Inc, 66 Hudson Blvd E, New York, NY, 10001, USA
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2
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Singh S, Josan E, Kovacs C. Clinical Impact of Community-Acquired Respiratory Viruses in Patients With Solid Organ Transplants. Transplant Proc 2024; 56:1702-1704. [PMID: 39181762 DOI: 10.1016/j.transproceed.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Community-acquired respiratory viruses (CARVs) are associated with poor outcome in solid organ transplant recipients. We reviewed some of these outcomes such as respiratory support, length of stay, admission to the intensive care unit, steroid use, and 30-day all-cause mortality. METHODS Multihospital, single center, retrospective review of electronic health records from January 1, 2014, to December 31, 2019. RESULTS Twenty-three solid organ transplant recipients (20 male and 3 female) who tested positive for CARVs were identified. The mean age at admission was 60 years, average length of stay was 8 days with 2 patients needing >2 weeks. Six patients required intensive care unit and 8 required supplemental oxygen support. CARV distribution was rhinovirus in 48%, parainfluenza in 29%, metapneumovirus in 12%, respiratory syncytial virus in 0.03%, adenovirus in 0.03%, and non-novel coronavirus in 0.06%. All patients were immunosuppressed, intravenous immunoglobulins were used in 3 patients, antivirals in 7 patients (ribavirin in 6 and oseltamivir in 1), and steroids in 10 patients. Twelve patients had transplant organ biopsy with 5 showing acute cellular rejection. Thirty-five percent of patients died within 1 year (2 during the same admission). CONCLUSION Transplant recipients are at a high risk of infections, especially CARVs, which may increase morbidity and mortality. In our observational study, we assessed patients with solid organ transplants who were admitted and tested positive for CARVs, and the associated impact on their clinical course. Careful analysis of the results will help us to emphasize the importance of timely diagnosis and treatment in specific populations.
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Affiliation(s)
- Supriya Singh
- Department of Infectious Diseases, The Cleveland Clinic Foundation, Cleveland, Ohio; Department of Infectious Diseases, The University of Tennessee Medical Center, Knoxville, Tennessee.
| | - Enambir Josan
- Department of Pulmonary Disease and Critical Care Medicine, The University of Tennessee Medical Center, Knoxville, Tennessee
| | - Christopher Kovacs
- Department of Infectious Diseases, The Cleveland Clinic Foundation, Cleveland, Ohio
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3
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Cilloniz C, Dy-Agra G, Pagcatipunan RS, Torres A. Viral Pneumonia: From Influenza to COVID-19. Semin Respir Crit Care Med 2024; 45:207-224. [PMID: 38228165 DOI: 10.1055/s-0043-1777796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.
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Affiliation(s)
- Catia Cilloniz
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Guinevere Dy-Agra
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Rodolfo S Pagcatipunan
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Antoni Torres
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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4
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Domnich A, Calabrò GE. Epidemiology and burden of respiratory syncytial virus in Italian adults: A systematic review and meta-analysis. PLoS One 2024; 19:e0297608. [PMID: 38442123 PMCID: PMC10914269 DOI: 10.1371/journal.pone.0297608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Respiratory syncytial virus (RSV) is a common respiratory pathogen not only in children, but also in adults. In view of a recent authorization of adult RSV vaccines in Italy, our research question was to quantify the epidemiology and burden of RSV in Italian adults. METHODS Observational studies on the epidemiology and clinical burden of laboratory-confirmed or record-coded RSV infection in Italian adults of any age were eligible. Studies with no separate data for Italian adults, modeling and other secondary publications were excluded. A literature search was performed in MEDLINE, Biological Abstracts, Global Health, Scopus and Web of Science on 22 November 2023. Critical appraisal was performed by means of a Joanna Briggs Institute checklist. Random-effects (RE) meta-analysis was performed to obtain pooled estimates and the observed heterogeneity was investigated by subgroup and meta-regression analyses. The protocol was prospectively registered (doi.org/10.17504/protocols.io.5qpvo32odv4o/v1). RESULTS Thirty-five studies were identified, most of which had at least one possible quality concern. RSV seasonal attack rates ranged from 0.8 ‰ in community-dwelling older adults to 10.9% in hematological outpatients. In the RE model, 4.5% (95% CI: 3.2-5.9%) of respiratory samples tested positive for RSV. This positivity prevalence was higher in older adults (4.4%) than in working-age adults (3.5%) and in outpatient (4.9%) than inpatient (2.9%) settings. According to the meta-regression, study location and sample size were also significant predictors of RSV detection frequency. The pooled estimate of in-hospital mortality was as high as 7.2% (95% CI: 4.7-10.3%). Data on other indicators of the diseases burden, such as complication and hospitalization rates, were unavailable. CONCLUSION RSV poses a measurable burden on Italian adults, especially those of older age and with some co-morbidities. However, several data on the natural history of RSV disease are missing and should be established by future large-scale studies.
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Affiliation(s)
- Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Giovanna Elisa Calabrò
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Avgoustou E, Spyridaki A, Pothitos G, Papadopoulos A, Kois S, Vassilara F. Enterovirus-Rhinovirus-Induced Acute Respiratory Distress Syndrome in Adults: A Case Report and Short Literature Review. Case Rep Infect Dis 2023; 2023:8887955. [PMID: 37954984 PMCID: PMC10637844 DOI: 10.1155/2023/8887955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Enteroviruses and rhinoviruses (EV-RV) are small RNA viruses that usually cause the common cold and asthma exacerbations. Although EV-RV-induced acute respiratory distress syndrome (ARDS) is common in children, only scattered reports of ARDS in adults have been published. The diagnosis has been greatly facilitated by the advent of molecular techniques, namely, real-time polymerase chain reaction (RT-PCR). EV-RV can cause ARDS by stimulating a cytokine cascade. No antiviral therapy has yet been approved, and treatment is entirely supportive. Herein, we report a rare case of EV-RV infection in an afebrile adult with dyspnea that rapidly progressed to acute lung injury and ARDS. EV-RV was isolated with multiple real-time PCR in nasopharyngeal and bronchial specimens, while no other pathogen was detected. We also present an up-to-date review of relevant literature, in an attempt to stress the importance of the early identification of viral culprits, which can minimize the use of invasive diagnostic procedures and antibiotic agents.
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Affiliation(s)
- Eirini Avgoustou
- 5 Department of Internal Medicine, Hygeia Hospital, Athens, Greece
| | - Aikaterini Spyridaki
- Department of Internal Medicine, Sismanoglio-Amalia Fleming General Hospital, Athens, Greece
| | - Giorgos Pothitos
- 5 Department of Internal Medicine, Hygeia Hospital, Athens, Greece
| | - Antonios Papadopoulos
- 4 Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Kois
- 5 Department of Internal Medicine, Hygeia Hospital, Athens, Greece
| | - Foula Vassilara
- 5 Department of Internal Medicine, Hygeia Hospital, Athens, Greece
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O'Grady NP, Alexander E, Alhazzani W, Alshamsi F, Cuellar-Rodriguez J, Jefferson BK, Kalil AC, Pastores SM, Patel R, van Duin D, Weber DJ, Deresinski S. Society of Critical Care Medicine and the Infectious Diseases Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Med 2023; 51:1570-1586. [PMID: 37902340 DOI: 10.1097/ccm.0000000000006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
RATIONALE Fever is frequently an early indicator of infection and often requires rigorous diagnostic evaluation. OBJECTIVES This is an update of the 2008 Infectious Diseases Society of America and Society (IDSA) and Society of Critical Care Medicine (SCCM) guideline for the evaluation of new-onset fever in adult ICU patients without severe immunocompromise, now using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. PANEL DESIGN The SCCM and IDSA convened a taskforce to update the 2008 version of the guideline for the evaluation of new fever in critically ill adult patients, which included expert clinicians as well as methodologists from the Guidelines in Intensive Care, Development and Evaluation Group. The guidelines committee consisted of 12 experts in critical care, infectious diseases, clinical microbiology, organ transplantation, public health, clinical research, and health policy and administration. All task force members followed all conflict-of-interest procedures as documented in the American College of Critical Care Medicine/SCCM Standard Operating Procedures Manual and the IDSA. There was no industry input or funding to produce this guideline. METHODS We conducted a systematic review for each population, intervention, comparison, and outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as best-practice statements. RESULTS The panel issued 12 recommendations and 9 best practice statements. The panel recommended using central temperature monitoring methods, including thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors when these devices are in place or accurate temperature measurements are critical for diagnosis and management. For patients without these devices in place, oral or rectal temperatures over other temperature measurement methods that are less reliable such as axillary or tympanic membrane temperatures, noninvasive temporal artery thermometers, or chemical dot thermometers were recommended. Imaging studies including ultrasonography were recommended in addition to microbiological evaluation using rapid diagnostic testing strategies. Biomarkers were recommended to assist in guiding the discontinuation of antimicrobial therapy. All recommendations issued were weak based on the quality of data. CONCLUSIONS The guidelines panel was able to formulate several recommendations for the evaluation of new fever in a critically ill adult patient, acknowledging that most recommendations were based on weak evidence. This highlights the need for the rapid advancement of research in all aspects of this issue-including better noninvasive methods to measure core body temperature, the use of diagnostic imaging, advances in microbiology including molecular testing, and the use of biomarkers.
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Affiliation(s)
- Naomi P O'Grady
- Internal Medicine Services, National Institutes of Health Clinical Center, Bethesda, MD
| | - Earnest Alexander
- Clinical Pharmacy Services, Department of Pharmacy, Tampa General Hospital, Tampa, FL
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, Bethesda, MD
| | - Brian K Jefferson
- Division of Hepatobiliary and Pancreatic Surgery, Department of Internal Medicine-Critical Care Services, Atrium Health Cabarrus, Concord, NC
| | - Andre C Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, MN
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - Stanley Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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7
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Galar A, Juárez M, Sousa-Casasnovas I, Catalán P, Valerio M, Antunez-Muiños P, Barbeito-Castiñeiras G, Blanco-Alonso S, Folgueira MD, García-Acuña JM, Lalueza A, Lázaro-Perona F, López de Sá E, Martín L, Muñez E, Portero F, Ramos-Martínez A, Romero-Gómez MP, Rosillo S, Fernández-Avilés F, Martínez-Sellés M, Bouza E, Muñoz P. Systematic influenza screening in cardiac intensive care units during the influenza season: A prospective study in Spain. Int J Infect Dis 2023; 136:37-42. [PMID: 37669725 DOI: 10.1016/j.ijid.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Little is known about the incidence of influenza among admissions to the cardiac intensive care unit (C-ICU), accuracy of clinical suspicion, and influenza vaccination uptake. We evaluated the incidence of influenza at C-ICU admission during the influenza season, potential underdiagnosis, and vaccination uptake. METHODS Prospective study at five C-ICUs during the 2017-2020 influenza seasons. A nasopharyngeal swab was collected at admission from patients who consented (n = 788). Testing was with Xpert®XpressFlu/RSV. RESULTS Influenza was detected in 43 patients (5.5%) (40 FluA; 3 FluB) and clinically suspected in 27 (62.8%). Compared to patients without influenza, patients with influenza more frequently had heart failure (37.2% vs 22.8%, P = 0.031), previous contact with relatives with influenza-like illnesses (23.3% vs 12.5%, P = 0.042), antimicrobial use (67.4% vs 23.2%, P <0.01), and need for mechanical ventilation (25.6% vs 14.5%, P = 0.048). Patients received oseltamivir promptly. We found no differences in mortality (11.6% vs 5.2%, P = 0.076). Patients with influenza more frequently had myocarditis (9.3% vs 0.9%, P <0.01) and pericarditis (7.0% vs 0.8%, P = 0.01). Overall, 43.0% of patients (339/788) were vaccinated (51.9% of those with a clear indication [303/584]). CONCLUSION Influenza seems to be a frequently underdiagnosed underlying condition in admissions to the C-ICU. Influenza should be screened for at C-ICU admission during influenza epidemics.
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Affiliation(s)
- Alicia Galar
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain.
| | - Miriam Juárez
- Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV - Madrid, Spain
| | - Iago Sousa-Casasnovas
- Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV - Madrid, Spain
| | - Pilar Catalán
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain
| | - Pablo Antunez-Muiños
- Cardiology Department, Complejo Hospitalario Universitario de Santiago - Santiago de Compostela, Spain
| | - Gema Barbeito-Castiñeiras
- Clinical Microbiology Department, Complejo Hospitalario Universitario de Santiago - Santiago de Compostela, Spain
| | - Silvia Blanco-Alonso
- Internal Medicine Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain
| | - María Dolores Folgueira
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario Doce de Octubre - Madrid, Spain
| | - José María García-Acuña
- Cardiology Department, Complejo Hospitalario Universitario de Santiago - Santiago de Compostela, Spain
| | - Antonio Lalueza
- Internal Medicine Department, Hospital Universitario Doce de Octubre - Madrid, Spain; Research Institute of Hospital 12 de Octubre (i+12) - Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid - Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III - Madrid, Spain
| | - Fernando Lázaro-Perona
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario La Paz - Madrid, Spain
| | | | - Lorena Martín
- Cardiology Department, Hospital Universitario La Paz - Madrid, Spain
| | - Elena Muñez
- Internal Medicine Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain
| | - Francisca Portero
- Clinical Microbiology Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain
| | - Antonio Ramos-Martínez
- Internal Medicine Department, Hospital Universitario Puerta de Hierro - Majadahonda, Spain; Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA) - Majadahonda, Spain
| | - María Pilar Romero-Gómez
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario La Paz - Madrid, Spain
| | - Sandra Rosillo
- Clinical Microbiology and Infectious Diseases Department, Hospital Universitario La Paz - Madrid, Spain
| | - Francisco Fernández-Avilés
- Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense - Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense - Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid - Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058) - Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón - Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón - Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid - Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058) - Madrid, Spain
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8
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Pierangeli A, Piralla A, Uceda Renteria S, Giacomel G, Lunghi G, Pagani E, Giacobazzi E, Vian E, Biscaro V, Piccirilli G, Lazzarotto T, Menzo S, Ferreri ML, Novazzi F, Petrarca L, Licari A, Ferrari G, Oliveto G, Antonelli G, Binda S, Galli C, Pellegrinelli L, Pariani E, Baldanti F. Multicenter epidemiological investigation and genetic characterization of respiratory syncytial virus and metapneumovirus infections in the pre-pandemic 2018-2019 season in northern and central Italy. Clin Exp Med 2023; 23:2725-2737. [PMID: 36522554 PMCID: PMC9754777 DOI: 10.1007/s10238-022-00973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) cause a high burden of disease, particularly in children and the elderly. With the aim to add knowledge on RSV and HMPV infections in Italy, a prospective, multicenter study was conducted by eight centers of the Working Group on Respiratory Virus Infections (GLIViRe), from December 2018-April 2019. Weekly distribution and patients' demographic and clinical data were compared in 1300 RSV and 222 HMPV-positive cases. Phylogenetic analysis of the G-glycoprotein coding region was performed to characterize circulating strains. RSV positivity ranged from 6.4% in outpatients of all ages to 31.7% in hospitalized children; HMPV positivity was 4-1.2% with no age-association. RSV season peaked in February and ended in mid-April: HMPV circulation was higher when RSV decreased in early spring. RSV was more frequent in infants, whereas HMPV infected comparatively more elderly adults; despite, their clinical course was similar. RSV-B cases were two-thirds of the total and had similar clinical severity compared to RSV-A. Phylogenetic analysis showed the circulation of RSV-A ON1 variants and the predominance of RSV-B genotype BA10. HMPV genotype A2c was the prevalent one and presented insertions of different lengths in G. This first multicenter Italian report on seasonality, age-specific distribution, and clinical presentation of RSV and HMPV demonstrated their substantial disease burden in young patients but also in the elderly. These data may provide the basis for a national respiratory virus surveillance network.
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Affiliation(s)
- Alessandra Pierangeli
- Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, V.Le Porta Tiburtina, 28; 00185, Rome, Italy
| | - Antonio Piralla
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Uceda Renteria
- Virology Unit, Clinical Laboratory, Foundation IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy
| | - Giovanni Giacomel
- Virology Unit, Clinical Laboratory, Foundation IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy
| | - Giovanna Lunghi
- Virology Unit, Clinical Laboratory, Foundation IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy
| | - Elisabetta Pagani
- Laboratorio Aziendale Di Microbiologia E Virologia, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Elisabetta Giacobazzi
- Laboratorio Aziendale Di Microbiologia E Virologia, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Elisa Vian
- Microbiology Unit, Hospital of Treviso (AULSS2), Treviso, Italy
| | - Valeria Biscaro
- Microbiology Unit, Hospital of Treviso (AULSS2), Treviso, Italy
| | - Giulia Piccirilli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Tiziana Lazzarotto
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Menzo
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
| | - Monica Lucia Ferreri
- Virology Laboratory, Azienda Ospedaliera Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Federica Novazzi
- Ospedale Di Circolo E Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Amelia Licari
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Guglielmo Ferrari
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Oliveto
- Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, V.Le Porta Tiburtina, 28; 00185, Rome, Italy
| | - Guido Antonelli
- Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, V.Le Porta Tiburtina, 28; 00185, Rome, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fausto Baldanti
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Cilloniz C, Luna CM, Hurtado JC, Marcos MÁ, Torres A. Respiratory viruses: their importance and lessons learned from COVID-19. Eur Respir Rev 2022; 31:220051. [PMID: 36261158 PMCID: PMC9724808 DOI: 10.1183/16000617.0051-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Carlos M Luna
- Pneumology Division, Hospital of Clínicas, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Carlos Hurtado
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - María Ángeles Marcos
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Antoni Torres
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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10
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Hsu CH, Chen HP, Chen PL, Chan YJ. Detection of influenza and non-influenza respiratory viruses in lower respiratory tract specimens among hospitalized adult patients and analysis of the clinical outcome. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:820-828. [PMID: 34974992 DOI: 10.1016/j.jmii.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) is one of the most fatal diseases for adults. Influenza is a well-recognized cause of severe pneumonia; however, the outcomes of LRTI caused by non-influenza respiratory viruses (NIRVs) have not been sufficiently investigated. This study aimed to describe the characteristics and outcomes of LRTI associated with respiratory viruses (RVs) in adults. MATERIALS/METHODS A retrospective review was performed using medical records of adult patients whose lower respiratory tract (LRT) specimens (endotracheal aspirate and bronchoalveolar lavage fluid) tested positive for RVs using multiplex PCR. Underlying comorbidities, laboratory data, and clinical outcomes were analyzed. RESULTS Among the 808 LRT specimens collected from 666 adult patients, RV was identified in 115 specimens (14%) from 106 patients (16%). The underlying comorbidities and laboratory data did not differ between patients with influenza- and NIRV-related LRTI. The 14-day and 30-day mortality rates were higher in the influenza group than in the NIRV group (24% versus 7%, p = 0.03 and 33% versus 13%, p = 0.02, respectively), whereas the 90-day mortality rate did not. In a multivariate Cox model to predict 90-day mortality, shock and acute kidney injury independently predicted a higher mortality rate (hazard ratio (HR): 4.28, 95% CI: 1.46-12.58, p = 0.01 and HR: 2.80, 95% CI: 1.28-6.15, p = 0.01, respectively), whereas the detection of influenza did not. CONCLUSIONS Influenza and NIRVs were associated with increased mortality due to LRTI in adults. Therefore, NIRVs are among key pathogens causing LRTI and should not be neglected by clinicians.
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Affiliation(s)
- Ching-Hao Hsu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Pai Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Po-Liang Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Jiun Chan
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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11
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Giardina FAM, Piralla A, Ferrari G, Zavaglio F, Cassaniti I, Baldanti F. Molecular Epidemiology of Rhinovirus/Enterovirus and Their Role on Cause Severe and Prolonged Infection in Hospitalized Patients. Microorganisms 2022; 10:microorganisms10040755. [PMID: 35456806 PMCID: PMC9030097 DOI: 10.3390/microorganisms10040755] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
Rhinovirus is one of the most common respiratory viruses, causing both upper and lower respiratory tract infections. It affects mainly children and could cause prolonged infections, especially in immunocompromised patients. Here we report our data on a 15-month surveillance of Rhinovirus seasonality and circulation in Lombardy Region, Italy. All rhinovirus/enterovirus-positive samples were amplified with RT-PCR for the VP4-VP2 region to assign the correct genotype. The median age of RV/EV-positive patients is 9 years, with a range of 0–96. RV-A and RV-C were detected in the majority of cases, while RV-B accounted for less than 10% of cases. An enterovirus species was detected in 6.45% of the cases. A total of 7% of the patients included in this study had a prolonged infection with a median duration of 62 days. All these patients were immunocompromised and most of them were pediatric with an RV-A infection. Two outbreaks were identified, mainly in the neonatal intensive care unit (NICU) and Oncohematology Department, caused by RV A89 and C43, respectively. Nearly 4.5% of the patients were admitted to the ICU requiring mechanical ventilation; all of which had preexisting comorbidities.
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Affiliation(s)
- Federica A. M. Giardina
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (F.A.M.G.); (G.F.); (F.Z.); (I.C.); (F.B.)
| | - Antonio Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (F.A.M.G.); (G.F.); (F.Z.); (I.C.); (F.B.)
- Correspondence: ; Tel.: +39-038-250-2420
| | - Guglielmo Ferrari
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (F.A.M.G.); (G.F.); (F.Z.); (I.C.); (F.B.)
| | - Federica Zavaglio
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (F.A.M.G.); (G.F.); (F.Z.); (I.C.); (F.B.)
| | - Irene Cassaniti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (F.A.M.G.); (G.F.); (F.Z.); (I.C.); (F.B.)
| | - Fausto Baldanti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (F.A.M.G.); (G.F.); (F.Z.); (I.C.); (F.B.)
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, 27100 Pavia, Italy
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12
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Cillóniz C, Pericàs JM, Rojas JR, Torres A. Severe Infections Due to Respiratory Viruses. Semin Respir Crit Care Med 2022; 43:60-74. [PMID: 35172359 DOI: 10.1055/s-0041-1740982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe viral infections may result in severe illnesses capable of causing acute respiratory failure that could progress rapidly to acute respiratory distress syndrome (ARDS), related to worse outcomes, especially in individuals with a higher risk of infection, including the elderly and those with comorbidities such as asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. In addition, in cases of severe viral pneumonia, co-infection with bacteria such as Streptococcus pneumoniae and Staphylococcus aureus is related to worse outcomes. Respiratory viruses like influenza, rhinovirus, parainfluenza, adenovirus, metapneumovirus, respiratory syncytial virus, and coronavirus have increasingly been detected. This trend has become more prevalent, especially in critically ill patients, due to the availability and implementation of molecular assays in clinical practice. Respiratory viruses have been diagnosed as a frequent cause of severe pneumonia, including cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. In this review, we will discuss the epidemiology, diagnosis, clinical characteristics, management, and prognosis of patients with severe infections due to respiratory viruses, with a focus on influenza viruses, non-influenza viruses, and coronaviruses.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,Internal Medicine Department, Vall d'Hebron Institute for Research, Barcelona, Spain
| | - Jorge R Rojas
- Department of Pneumology, Hospital Regional Docente Clínico Quirúrgico Daniel Alcides Carrión, Huancayo, Perú
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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13
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Fromentin M, Ricard JD, Roux D. Lung Microbiome in Critically Ill Patients. Life (Basel) 2021; 12:life12010007. [PMID: 35054400 PMCID: PMC8778861 DOI: 10.3390/life12010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022] Open
Abstract
The historical hypothesis of sterility of the lungs was invalidated over a decade ago when studies demonstrated the existence of sparse but very diverse bacterial populations in the normal lung and the association between pulmonary dysbiosis and chronic respiratory diseases. Under mechanical ventilation, dysbiosis occurs rapidly with a gradual decline in diversity over time and the progressive predominance of a bacterial pathogen (mainly Proteobacteria) when lung infection occurs. During acute respiratory distress syndrome, an enrichment in bacteria of intestinal origin, mainly Enterobacteriaceae, is observed. However, the role of this dysbiosis in the pathogenesis of ventilator-associated pneumonia and acute respiratory distress syndrome is not yet fully understood. The lack of exploration of other microbial populations, viruses (eukaryotes and prokaryotes) and fungi is a key issue. Further analysis of the interaction between these microbial kingdoms and a better understanding of the host−microbiome interaction are necessary to fully elucidate the role of the microbiome in the pathogenicity of acute diseases. The validation of a consensual and robust methodology in order to make the comparison of the different studies relevant is also required. Filling these different gaps should help develop preventive and therapeutic strategies for both acute respiratory distress syndrome and ventilator-associated pneumonia.
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Affiliation(s)
- Mélanie Fromentin
- Anesthesiology and Intensive Care Department, AP-HP, Hôpital Cochin, 75014 Paris, France;
- UMR1137 IAME, Université de Paris, INSERM, 75018 Paris, France;
| | - Jean-Damien Ricard
- UMR1137 IAME, Université de Paris, INSERM, 75018 Paris, France;
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, 92700 Colombes, France
| | - Damien Roux
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, 92700 Colombes, France
- Institut Necker-Enfants Malades, Université de Paris, INSERM U1151, CNRS UMR 8253, 75015 Paris, France
- Correspondence: ; Tel.: +33-1-47-60-63-29
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14
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Abstract
Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location's epidemiology; for patients admitted to the intensive care unit, specific recommendations on disease management are available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.
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Affiliation(s)
- Catia Cillóniz
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Michael S Niederman
- Weill Cornell Medical College, Department of Pulmonary Critical Care Medicine, New York, NY, USA
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Li D, Wolk DM, Cantor MN. Comparing Clinical Characteristics of Influenza and Common Coronavirus Infections Using Electronic Health Records. J Infect Dis 2021; 223:1879-1886. [PMID: 33011809 PMCID: PMC7797744 DOI: 10.1093/infdis/jiaa626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We compared outcomes in inpatients and outpatients, pre-COVID-19, who were infected with either coronavirus or influenza. METHODS Using deidentified electronic health records data from the Geisinger-Regeneron partnership, we compared patients with RT-PCR-positive tests for the 4 common coronaviruses (229E, HKU1, NL63, OC43) or influenza (A and B) from June 2016 to February 2019. RESULTS Overall, 52 833 patients were tested for coronaviruses and influenza. For patients ≥21 years old, 1555 and 3991 patient encounters had confirmed positive coronavirus and influenza tests, respectively. Both groups had similar intensive care unit (ICU) admission rates (7.2% vs 6.1%, P = .12), although patients with coronavirus had significantly more pneumonia (15% vs 7.4%, P < .001) and higher death rate within 30 days (4.9% vs 3.0%, P < .001). After controlling for other covariates, coronavirus infection still had a higher risk of death and pneumonia than influenza (odds ratio, 1.64 and 2.05, P < .001), with no significant difference in ICU admission rates. CONCLUSIONS Common coronaviruses cause significant morbidity, with potentially worse outcomes than influenza. Identifying a subset of patients who are more susceptible to poor outcomes from common coronavirus infections may help plan clinical interventions in patients with suspected infections.
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Affiliation(s)
- Dadong Li
- Regeneron Genetics Center, Tarrytown, New York, USA
| | - Donna M Wolk
- Geisinger Health System, Danville, Pennsylvania, USA
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16
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Rachina S, Zakharenkov I, Dekhnich N, Kozlov R, Sinopalnikov A, Ivanchik N, Sukhorukova M, Yatsyshina S, Arkhipenko M, Gordeeva S, Lebedeva M, Portnyagina U. Aetiology of severe community-acquired pneumonia and antimicrobial susceptibility of Streptococcus pneumoniae in adults in Russia. J Antimicrob Chemother 2021; 76:1368-1370. [PMID: 33604613 DOI: 10.1093/jac/dkab014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Svetlana Rachina
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Ivan Zakharenkov
- Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Smolensk, Russian Federation
| | | | - Roman Kozlov
- Smolensk State Medical University, Smolensk, Russian Federation
| | - Alexander Sinopalnikov
- Russian Medical Academy of Continuing Professional Education, Moscow, Russian Federation
| | - Nataly Ivanchik
- Smolensk State Medical University, Smolensk, Russian Federation
| | | | | | - Marina Arkhipenko
- Regional Clinical Hospital No. 1 n.a. Prof. S.V. Ochapovsky, Krasnodar, Russian Federation
| | - Svetlana Gordeeva
- Regional Clinical Hospital n.a. P.A. Bayandin, Murmansk, Russian Federation
| | | | - Ulyana Portnyagina
- North-Eastern Federal University n.a. M.K. Ammosov, Yakutsk, Russian Federation
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17
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Sangla F, Legouis D, Marti PE, Sgardello SD, Brebion A, Saint-Sardos P, Adda M, Lautrette A, Pereira B, Souweine B. One year after ICU admission for severe community-acquired pneumonia of bacterial, viral or unidentified etiology. What are the outcomes? PLoS One 2020; 15:e0243762. [PMID: 33315946 PMCID: PMC7735561 DOI: 10.1371/journal.pone.0243762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Multiplex polymerase chain reaction (mPCR) for respiratory virus testing is increasingly used in community-acquired pneumonia (CAP), however data on one-year outcome in intensive care unit (ICU) patients with reference to the causative pathogen are scarce. MATERIALS AND METHODS We performed a single-center retrospective study in 123 ICU patients who had undergone respiratory virus testing for CAP by mPCR and with known one-year survival status. Functional status including dyspnea (mMRC score), autonomy (ADL Katz score) and need for new home-care ventilatory support was assessed at a one-year post-ICU follow-up. Mortality rates and functional status were compared in patients with CAP of a bacterial, viral or unidentified etiology one year after ICU admission. RESULTS The bacterial, viral and unidentified groups included 19 (15.4%), 37 (30.1%), and 67 (54.5%) patients, respectively. In multivariate analysis, one-year mortality in the bacterial group was higher compared to the viral group (HR 2.92, 95% CI 1.71-7.28, p = 0.02) and tended to be higher compared to the unidentified etiology group (p = 0.06); but no difference was found between the viral and the unidentified etiology group (p = 0.43). In 64/83 one-year survivors with a post-ICU follow-up consultation, there were no differences in mMRC score, ADL Katz score and new home-care ventilatory support between the groups (p = 0.52, p = 0.37, p = 0.24, respectively). Severe dyspnea (mMRC score = 4 or death), severe autonomy deficiencies (ADL Katz score ≤ 2 or death), and major adverse respiratory events (new home-care ventilatory support or death) were observed in 52/104 (50.0%), 47/104 (45.2%), and 65/104 (62.5%) patients, respectively; with no difference between the bacterial, viral and unidentified group: p = 0.58, p = 0.06, p = 0.61, respectively. CONCLUSIONS CAP of bacterial origin had a poorer outcome than CAP of viral or unidentified origin. At one-year, impairment of functional status was frequently observed, with no difference according to the etiology.
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Affiliation(s)
- Frédéric Sangla
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
- * E-mail:
| | - David Legouis
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pierre-Emmanuel Marti
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sebastian D. Sgardello
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Amélie Brebion
- Laboratoire de Virologie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Pierre Saint-Sardos
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Mireille Adda
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Bruno Pereira
- Département de Biostatistique, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Bertrand Souweine
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
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Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia. Infect Control Hosp Epidemiol 2020; 42:817-825. [PMID: 33256870 DOI: 10.1017/ice.2020.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Viruses are more common than bacteria in patients hospitalized with community-acquired pneumonia. Little is known, however, about the frequency of respiratory viral testing and its associations with antimicrobial utilization. DESIGN Retrospective cohort study. SETTING The study included 179 US hospitals. PATIENTS Adults admitted with pneumonia between July 2010 and June 2015. METHODS We assessed the frequency of respiratory virus testing and compared antimicrobial utilization, mortality, length of stay, and costs between tested versus untested patients, and between virus-positive versus virus-negative patients. RESULTS Among 166,273 patients with pneumonia on admission, 40,787 patients (24.5%) were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. Viral assays were positive in 5,133 of 40,787 tested patients (12.6%), typically for influenza and rhinovirus. Tested patients were younger and had fewer comorbidities than untested patients, but patients with positive viral assays were older and had more comorbidities than those with negative assays. Blood cultures were positive for bacterial pathogens in 2.7% of patients with positive viral assays versus 5.3% of patients with negative viral tests (P < .001). Antibacterial courses were shorter for virus-positive versus -negative patients overall (mean 5.5 vs 6.4 days; P < .001) but varied by bacterial testing: 8.1 versus 8.0 days (P = .60) if bacterial tests were positive; 5.3 versus 6.1 days (P < .001) if bacterial tests were negative; and 3.3 versus 5.2 days (P < .001) if bacterial tests were not obtained (interaction P < .001). CONCLUSIONS A minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.
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Pellegrinelli L, Galli C, Bubba L, Cereda D, Anselmi G, Binda S, Gramegna M, Pariani E. Respiratory syncytial virus in influenza-like illness cases: Epidemiology and molecular analyses of four consecutive winter seasons (2014-2015/2017-2018) in Lombardy (Northern Italy). J Med Virol 2020; 92:2999-3006. [PMID: 32314816 DOI: 10.1002/jmv.25917] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Besides seasonal influenza viruses (IV), several other pathogens-including respiratory syncytial virus (RSV)-are involved in clinically undistinguished influenza-like illnesses (ILIs). This study aimed at investigating the contribution of RSV in ILI cases in Lombardy (Northern Italy) during four consecutive winter seasons. MATERIALS AND METHODS In the framework of influenza surveillance, respiratory samples from ILI outpatients were collected from 2014-2015 to 2017-2018 season. IV-negative swabs were included in the study and analyzed to detect and molecularly characterize RSV-A and RSV-B. RESULTS A total of 12.9% (135/1047) of samples were positive to RSV that was mostly detected among children ≤5 years (51/183, 27.8%) and those aged 6 to 15 years (30/158, 18.9%), whereas elderly >65 years accounted for 12% of RSV cases (15/125). The median start of RSV epidemic was in the end of November, with a peak in mid-February and a width of nearly 4 months, almost overlapping seasonal influenza epidemic. RSV-A and RSV-B co-circulated in all considered seasons, with RSV-B predominating on RSV-A (63.6% vs 36.4%; P < .001). Most (85.2%) RSV-A belonged to genotype ON1 and the remaining to NA1. All RSV-B clustered within the BA genotype. CONCLUSIONS In this study, RSV significantly contributed to ILI cases, especially among pediatric population (<15 years), although it was detected in all age groups. RSV-B predominated on RSV-A, and the most recent evolved genotypes (BA and ON1, respectively) circulated. Investigating the epidemiological and molecular characteristics of RSV in ILI cases can increase baseline epidemiological information before the introduction of RSV vaccination.
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Affiliation(s)
- Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Bubba
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Giovanni Anselmi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Interuniversity Research Center on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
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20
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Chen L, Han XD, Li YL, Zhang CX, Xing XQ. Comparison of the Clinical Characteristics and Severity of Influenza and Non-influenza Respiratory Virus-Related Pneumonia in China: A Multicenter, Real-World Study. Infect Drug Resist 2020; 13:3513-3523. [PMID: 33116670 PMCID: PMC7555280 DOI: 10.2147/idr.s267102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose Respiratory viruses are important etiologies of community-acquired pneumonia (CAP). However, the impact of different RVs on the outcomes of CAP is not well elucidated. This study aims to compare the clinical features and severity of influenza (Flu-p) and non-influenza respiratory viruses-related pneumonia (NIRVs-p) onset in the community among immunocompetent adults. Methods The data of the patients hospitalized with laboratory-confirmed RVs-p were retrospectively reviewed from five teaching hospitals in China from January 2013 to May 2019. Univariate and multivariate logistic regressions were performed to compare the clinical characteristics and outcomes between Flu-p and NIRVs-p. Results A total of 1079 patients with Flu-p and 341 patients with NIRVs-p were included in this study. A multivariate logistic regression model revealed chronic pulmonary disease [odd ratio (OR) 0.341, 95% confidence interval (CI) 0.225–0.515, p < 0.001], solid malignant tumor (OR 0.330, 95% CI 0.163–0.668, p = 0.002), myalgia (OR 1.697, 95% CI 1.236–2.330, p < 0.001), lymphocytes <0.8×109/L (OR 10.811, 95% CI 6.949–16.818, p < 0.001) and blood albumin <35 g/L (OR 0.327, 95% CI 0.242–0.442, p < 0.001) were predictors for Flu-p. After adjusting for confounders, the multivariate logistic regression analysis confirmed that influenza B-related pneumonia (FluB-p) (OR 0.419, 95% CI 0.272–0.646, p < 0.001) and NIRVs-p (OR 0.260, 95% CI 0.158–0.467, p < 0.001) were associated with a decreased risk of 30-day mortality compared with the influenza A-related pneumonia (FluA-p). Conclusion Our results showed that patients with FluA-p experience a more severe disease than those with FluB-p and NIRVs-p. Some clinical features are helpful to distinguish between NIRVs-p and Flu-p.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, People's Republic of China
| | - Xiu-Di Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, Shandong Province, People's Republic of China
| | - Yan-Li Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chun-Xiao Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, People's Republic of China
| | - Xi-Qian Xing
- Department of Pulmonary and Critical Care Medicine, The 2nd People's Hospital of Yunnan Province, Kunming City, Yunnan Province, People's Republic of China
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21
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Rachow T, Lamik T, Kalkreuth J, Kurze S, Wagner K, Stier P, Hammersen FJ, Rüthrich MM, Winkelmann N, Klink A, Hilgendorf I, Hermann B, Lang S, Hochhaus A, von Lilienfeld-Toal M. Detection of community-acquired respiratory viruses in allogeneic stem-cell transplant recipients and controls-A prospective cohort study. Transpl Infect Dis 2020; 22:e13415. [PMID: 32779843 PMCID: PMC7404629 DOI: 10.1111/tid.13415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
Background Community‐acquired respiratory viruses (CARV) cause upper and lower respiratory tract infections (URTI/LRTI) and may be life‐threatening for recipients of an allogeneic stem cell transplantation (allo‐SCT). Methods In a prospective study encompassing 4 winter‐seasons, we collected throat gargles (TG) at random time points from allo‐SCT recipients (patients) and controls and followed them up for at least 3 weeks including repetitive sampling and documentation of symptoms. A Multiplex‐PCR system to identify 20 CARV and Mycoplasma pneumoniae was used to detect CARV. Results One hundred ninety‐four patients with 426 TG and 273 controls with 549 TG were included. There were more patients with a positive test result (25% vs 11% in the controls), and the patients had a higher number of positive TG (70 = 16%) compared to controls (32 = 6%) (P < .001). Altogether, 115 viruses were detected. Multiple viruses in one TG (11/48, 34%) and prolonged shedding were only observed in patients (13/48, 27%). Patients had more RSV (18/83, 26%) and adenovirus (15/83, 21%) than controls (both viruses 2/32, 6%). Independent risk factors for the detection of CARV included age >40 years (OR 3.38, 95% CI 1.8‐6.4, P < .001) and presence of URTI‐symptoms (OR 3.22, 95% CI 1.9‐5.5, P < .001). No controls developed a LRTI or died whereas 4/48 (8%) patients developed a LRTI (coronavirus in 2, RSV in 1 and influenza A H1N1 in 1 patient). One patient died of CARV (influenza A H1N1). Conclusion Allo‐SCT‐recipients have more CARV‐infections, exhibit a different epidemiology, have more cases of co‐infection or prolonged shedding and have a higher rate of LRTI and mortality.
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Affiliation(s)
- Tobias Rachow
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Toni Lamik
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Jana Kalkreuth
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Stephanie Kurze
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Kathleen Wagner
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.,Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, Jena, Germany
| | - Pia Stier
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.,Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, Jena, Germany
| | - Friedrich J Hammersen
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Maria Madeleine Rüthrich
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Nils Winkelmann
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Anne Klink
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Beate Hermann
- Dianovis GmbH, Greiz, Germany.,Institut für Medizinische Mikrobiologie, Universitätsklinikum Jena, Jena, Germany
| | - Susanne Lang
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Marie von Lilienfeld-Toal
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.,Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, Jena, Germany
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22
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Monge S, Duijster J, Kommer GJ, van de Kassteele J, Krafft T, Engelen P, Valk JP, de Waard J, de Nooij J, Riezebos-Brilman A, van der Hoek W, van Asten L. Ambulance dispatch calls attributable to influenza A and other common respiratory viruses in the Netherlands (2014-2016). Influenza Other Respir Viruses 2020; 14:420-428. [PMID: 32410358 PMCID: PMC7298355 DOI: 10.1111/irv.12731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ambulance dispatches could be useful for syndromic surveillance of severe respiratory infections. We evaluated whether ambulance dispatch calls of highest urgency reflect the circulation of influenza A virus, influenza B virus, respiratory syncytial virus (RSV), rhinovirus, adenovirus, coronavirus, parainfluenzavirus and human metapneumovirus (hMPV). METHODS We analysed calls from four ambulance call centres serving 25% of the population in the Netherlands (2014-2016). The chief symptom and urgency level is recorded during triage; we restricted our analysis to calls with the highest urgency and identified those compatible with a respiratory syndrome. We modelled the relation between respiratory syndrome calls (RSC) and respiratory virus trends using binomial regression with identity link function. RESULTS We included 211 739 calls, of which 15 385 (7.3%) were RSC. Proportion of RSC showed periodicity with winter peaks and smaller interseasonal increases. Overall, 15% of RSC were attributable to respiratory viruses (20% in out-of-office hour calls). There was large variation by age group: in <15 years, only RSV was associated and explained 11% of RSC; in 15-64 years, only influenza A (explained 3% of RSC); and in ≥65 years adenovirus explained 9% of RSC, distributed throughout the year, and hMPV (4%) and influenza A (1%) mainly during the winter peaks. Additionally, rhinovirus was associated with total RSC. CONCLUSION High urgency ambulance dispatches reflect the burden of different respiratory viruses and might be useful to monitor the respiratory season overall. Influenza plays a smaller role than other viruses: RSV is important in children while adenovirus and hMPV are the biggest contributors to emergency calls in the elderly.
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Affiliation(s)
- Susana Monge
- Centre for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Janneke Duijster
- Centre for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Geert Jan Kommer
- Centre for Nutrition, Prevention and Health Services (VPZ), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jan van de Kassteele
- Centre for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht Centre for Global Health, Maastricht, The Netherlands
| | | | - Jens P Valk
- Dispatch Center Regional Ambulance Services Noord Nederland, Leiden, The Netherlands.,Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan de Waard
- Regional Ambulance Service Hollands Midden, Leiden, The Netherlands
| | - Jan de Nooij
- Regional Ambulance Service Hollands Midden, Leiden, The Netherlands
| | - Annelies Riezebos-Brilman
- Department of Microbiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Liselotte van Asten
- Centre for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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23
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Zakharenkov IA, Rachina SA, Dekhnich NN, Kozlov RS, Sinopalnikov AI, Ivanchik NV, Yatsyshina SB, Elkina MA, Archipenko MV, Gordeeva SA, Lebedeva MS, Portnyagina US. [Etiology of severe community - acquired pneumonia in adults: results of the first Russian multicenter study]. TERAPEVT ARKH 2020; 92:36-42. [PMID: 32598661 DOI: 10.26442/00403660.2020.01.000491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM to study the etiology of severe community - acquired pneumonia (SCAP) in adults in Russian Federation. SCAP is distinguished by high mortality and socio - economic burden. Both etiology and antimicrobial resistance are essential for appropriate antibiotic choice. MATERIALS AND METHODS A prospective cohort study recruited adults with confirmed diagnosis of SCAP admitted to multi - word hospitals of six Russian cities in 2014-2018. Etiology was confirmed by routine culture of blood, respiratory (sputum, endotracheal aspirate or bronchoalveolar lavage) and when appropriate, autopsy samples, urinary antigen tests (L. pneumophila serogroup 1, S. pneumoniae); real - time PCR for identification of "atypical" bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) and respiratory viruses (influenza viruses A and B, parainfluenza, human metapneumovirus, etc.) was applied. RESULTS Altogether 109 patients (60.6% male; mean age 50.8±18.0 years old) with SCAP were enrolled. Etiological agent was identified in 65.1% of patients, S. pneumoniae, rhinovirus, S. aureus and K. pneumoniae were the most commonly isolated pathogens (found in 43.7, 15.5, 14.1 and 11.3% of patients with positive results of microbiological investigations, respectively). Bacteriemia was seen in 14.6% of patients and most commonly associated with S. pneumoniae. Co - infection with 2 or more causative agents was revealed in 36.6% of cases. Combination of bacterial pathogens (mainly S. pneumoniae with S. aureus or/and Enterobacterales) prevailed - 57.7% of cases; associations of bacteria and viruses were identified in 38.5% of patients, different viruses - in one case. CONCLUSION S. pneumoniae was the most common pathogen in adults with SCAP. A high rate of respiratory viruses (mainly rhinovirus and influenza viruses) identification both as mixt infection with bacteria and mono - infection should be taken into account.
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Affiliation(s)
- I A Zakharenkov
- Bryansk city hospital №1.,The Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy
| | | | | | - R S Kozlov
- The Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy.,Smolensk State Medical University
| | | | | | | | - M A Elkina
- Central Research Institute of Epidemiology
| | | | - S A Gordeeva
- P.A. Bayandin Murmansk State Regional Clinical Hospital
| | - M S Lebedeva
- State Budgetary Healthcare Institution «Saint-Petersburg clinical scientific and practical center for specialised types of medical care (oncological)»
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24
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Zhu R, Guo C, Zhao L, Deng J, Wang F, Sun Y, Qian Y. Epidemiological and genetic characteristics of human metapneumovirus in pediatric patients across six consecutive seasons in Beijing, China. Int J Infect Dis 2019; 91:137-142. [PMID: 31821893 DOI: 10.1016/j.ijid.2019.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To investigate the genetic characteristics of human metapneumovirus (hMPV) circulating among children with acute respiratory tract infections (ARTIs) in Beijing, China. METHODS Clinical samples were obtained from outpatients and hospitalized children with ARTIs between August 2010 and July 2016. Reverse transcription polymerase chain reaction assays were used to screen and identify hMPV, while partial glycoprotein gene sequences were used for phylogenetic analysis. RESULTS Among the 10 918 samples, 292 (2.7%) were positive for hMPV. Overall, the virus was more prevalent among inpatients (4.3%) than outpatients (1.2%). A biennial alternating pattern of hMPV infection was observed, with infection rates fluctuating between 1.6% and 4.0%. Most cases were detected between December and April, showing clear-cut seasonality. Sub-genotypes A2b, B1, and B2 co-circulated in winter and spring in an alternating pattern, while only one A1-positive case was observed in 2012. The seasonal peak of hMPV was slightly delayed or overlapped with that of respiratory syncytial virus and influenza virus. hMPV activity increased in the 2010-2011 and 2014-2015 seasons, when influenza activity was apparently decreased compared with other epidemic seasons. CONCLUSIONS This study provides information on the epidemiological and genetic characteristics of hMPV in children in Beijing, and reinforces the significance of hMPV in children with ARTIs, especially lower respiratory tract infections.
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Affiliation(s)
- Runan Zhu
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing 100020, China
| | - Chunying Guo
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing 100020, China
| | - Linqing Zhao
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing 100020, China
| | - Jie Deng
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing 100020, China
| | - Fang Wang
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing 100020, China
| | - Yu Sun
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing 100020, China
| | - Yuan Qian
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing 100020, China.
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25
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Ison MG, Hirsch HH. Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs. Clin Microbiol Rev 2019; 32:e00042-19. [PMID: 31511250 PMCID: PMC7399564 DOI: 10.1128/cmr.00042-19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients undergoing solid-organ transplantation (SOT) or allogeneic hematopoietic cell transplantation (HCT) are at increased risk for infectious complications. Community-acquired respiratory viruses (CARVs) pose a particular challenge due to the frequent exposure pre-, peri-, and posttransplantation. Although influenza A and B viruses have a top priority regarding prevention and treatment, recent molecular diagnostic tests detecting an array of other CARVs in real time have dramatically expanded our knowledge about the epidemiology, diversity, and impact of CARV infections in the general population and in allogeneic HCT and SOT patients. These data have demonstrated that non-influenza CARVs independently contribute to morbidity and mortality of transplant patients. However, effective vaccination and antiviral treatment is only emerging for non-influenza CARVs, placing emphasis on infection control and supportive measures. Here, we review the current knowledge about CARVs in SOT and allogeneic HCT patients to better define the magnitude of this unmet clinical need and to discuss some of the lessons learned from human influenza virus, respiratory syncytial virus, parainfluenzavirus, rhinovirus, coronavirus, adenovirus, and bocavirus regarding diagnosis, prevention, and treatment.
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Affiliation(s)
- Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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26
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Muñoz P, Vicent L, Bouza E, Sousa-Casasnovas I, López-Roa P, Juárez M, Eworo A, Devesa C, Bruña V, Catalán P, Fernández-Avilés F, Martínez-Sellés M. Prognostic Implications of Influenza Virus Infection in a Cardiac Intensive Care Unit: Potential Impact of a Screening Program. Cardiology 2019; 143:85-91. [DOI: 10.1159/000501230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/27/2019] [Indexed: 11/19/2022]
Abstract
Objectives: Our goal was to determine the presentation and prognosis of influenza in an intensive cardiac care unit and to analyze the impact of an active surveillance program in the diagnosis. Methods: We performed a prospective registry during the flu season in a coronary unit. In the first phase, no systematic screening was performed. Systematic influenza A and B detection was performed in a second phase for all patients admitted. Results: From 227 patients, we identified 17 (7.5%) with influenza. Influenza patients were more likely to have a non-ischemic cause of admission (14 patients [82.4%] vs. 48 patients [40.3%], p = 0.002), fever (8 patients [47.1%] vs. 3 patients [2.6%], p < 0.001), and respiratory failure (7 patients [41.2%] vs. 8 patients [7%], p = 0.001). Influenza infection was an independent predictor of mortality (odds ratio 12.0, 95% confidence interval 1.9–13.6, p < 0.001). The incidence of influenza was 6.6% (6 patients) when no active screening was performed and 7.9% (11 patients) when systematic detection was performed (p = 0.005). The time to diagnosis was shorter in the systematic screening phase (0.92 ± 1.6 vs. 5.2 ± 3.8 days, p = 0.01). Conclusions: Influenza affects approximately 8% of patients admitted to an intensive cardiac care unit during the flu season, with a high mortality rate. An active surveillance program improves early detection.
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27
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Li YT, Liang Y, Ling YS, Duan MQ, Pan L, Chen ZG. The spectrum of viral pathogens in children with severe acute lower respiratory tract infection: A 3-year prospective study in the pediatric intensive care unit. J Med Virol 2019; 91:1633-1642. [PMID: 31081548 PMCID: PMC7167151 DOI: 10.1002/jmv.25502] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 12/17/2022]
Abstract
Background No comprehensive analysis is available on the viral etiology and clinical characterization among children with severe acute lower respiratory tract infection (SALRTI) in Southern China. Methods Cohort of 659 hospitalized children (2 months to 14 years) with SALRTI admitted to the Pediatric Intensive Care Unit (PICU) in the Guangzhou from May 2015 to April 2018 was enrolled in this study. Nasopharyngeal aspirate specimens or induced sputum were tested for eight categories respiratory viral targets. The viral distribution and its clinical characters were statistically analyzed. Results Viral pathogen was detected in 326 (49.5%) of children with SALRTI and there were 36 (5.5%) viral coinfections. Overall, the groups of viruses identified were, in descending order of prevalence: Influenza virus (IFV) (n = 94, 14.3%), respiratory syncytial virus (RSV) (n = 75, 11.4%), human rhinovirus (HRV) (n = 56, 8.5%), adenovirus (ADV) (n = 55, 8.3%), parainfluenza (PIV) (n = 47, 7.1%), human coronavirus (HCoV) (n = 15, 2.3%), human metapneumovirus (HMPV) (n = 14, 2.1%) and human bocavirus (HBoV) (n = 11, 1.7%). The positive rate in younger children (< 5 years) was significantly higher than the positive rate detected in elder children (> 5 years) (52.5% vs 35.1%, P = 0.001). There were clear seasonal peaks for IFV, RSV, HRV, ADV, PIV, and HMPV. And the individuals with different viral infection varied significantly in terms of clinical profiles. Conclusions Viral infections are present in a consistent proportion of patients admitted to the PICU. IFV, RSV, HRV, and ADV accounted for more than two‐thirds of all viral SALRTI. Our findings could help the prediction, prevention and potential therapeutic approaches of SALRTI in children. Viral infections are present in a consistent proportion of patients admitted to the Pediatric Intensive Care Unit. Influenza virus, respiratory syncytial virus, human rhinovirus and adenovirus accounted for more than two‐thirds of all viral SALRTI.
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Affiliation(s)
- Ya-Ting Li
- Department of Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ying Liang
- Department of Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ye-Sheng Ling
- Department of Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Meng-Qi Duan
- Department of Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Li Pan
- Department of Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhuang-Gui Chen
- Department of Pediatric Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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The Prevalence of Respiratory Viruses Among Patients with Influenza-Like Illness in Zahedan, Southeastern Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.77089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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29
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Kuypers J. Impact of Rapid Molecular Detection of Respiratory Viruses on Clinical Outcomes and Patient Management. J Clin Microbiol 2019; 57:e01890-18. [PMID: 30651392 PMCID: PMC6440761 DOI: 10.1128/jcm.01890-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To determine if rapid molecular testing for respiratory viruses in patients with respiratory illnesses can provide advantages to patients and hospitals, rigorous investigations on the impacts of using these assays are required. Well-conducted studies are needed to inform decisions about implementation of new rapid assays to replace standard molecular testing or to initiate testing in laboratories that are currently not doing molecular tests for respiratory viruses due to the complex nature of standard panels. In this issue of the Journal of Clinical Microbiology, N. Wabe et al. (J Clin Microbiol 57:e01727-18, 2019, https://doi.org/10.1128/JCM.01727-18) report the results of their evaluation of the impact of using a rapid molecular test for influenza A/influenza B and RSV on outcomes for adults hospitalized with respiratory illness. The median time from admission to test result of the rapid test was 7.5 h compared to 40.3 h for the standard PCR assay. Compared to the use of the standard molecular assay, use of a rapid test significantly shortened time in the hospital and reduced the number of other microbiology tests performed. The authors concluded that rapid PCR testing of adults hospitalized with respiratory illnesses could provide benefits to both the patients and the hospital. Patients were able to leave the hospital earlier and a greater proportion of them had received their test results before discharge, which would allow appropriate treatment to be provided more quickly.
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Affiliation(s)
- Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
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30
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Quah J, Jiang B, Tan PC, Siau C, Tan TY. Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis 2018; 18:451. [PMID: 30180811 PMCID: PMC6122562 DOI: 10.1186/s12879-018-3366-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 08/29/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The impact of different classes of microbial pathogens on mortality in severe community-acquired pneumonia is not well elucidated. Previous studies have shown significant variation in the incidence of viral, bacterial and mixed infections, with conflicting risk associations for mortality. We aimed to determine the risk association of microbial aetiologies with hospital mortality in severe CAP, utilising a diagnostic strategy incorporating molecular testing. Our primary hypothesis was that respiratory viruses were important causative pathogens in severe CAP and was associated with increased mortality when present with bacterial pathogens in mixed viral-bacterial co-infections. METHODS A retrospective cohort study from January 2014 to July 2015 was conducted in a tertiary hospital medical intensive care unit in eastern Singapore, which has a tropical climate. All patients diagnosed with severe community-acquired pneumonia were included. RESULTS A total of 117 patients were in the study. Microbial pathogens were identified in 84 (71.8%) patients. Mixed viral-bacterial co-infections occurred in 18 (15.4%) of patients. Isolated viral infections were present in 32 patients (27.4%); isolated bacterial infections were detected in 34 patients (29.1%). Hospital mortality occurred in 16 (13.7%) patients. The most common bacteria isolated was Streptococcus pneumoniae and the most common virus isolated was Influenza A. Univariate and multivariate logistic regression showed that serum procalcitonin, APACHE II severity score and mixed viral-bacterial infection were associated with increased risk of hospital mortality. Mixed viral-bacterial co-infections were associated with an adjusted odds ratio of 13.99 (95% CI 1.30-151.05, p = 0.03) for hospital mortality. CONCLUSIONS Respiratory viruses are common organisms isolated in severe community-acquired pneumonia. Mixed viral-bacterial infections may be associated with an increased risk of mortality.
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Affiliation(s)
- Jessica Quah
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, SingHealth, 2 Simei Street 3, Postal Code, Singapore, 529889, Singapore.
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, SingHealth, Singapore, Singapore
| | - Poh Choo Tan
- Department of Advanced Nursing Practice, Changi General Hospital, SingHealth, Singapore, Singapore
| | - Chuin Siau
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, SingHealth, 2 Simei Street 3, Postal Code, Singapore, 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, SingHealth, Singapore, Singapore
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Pellegrinelli L, Bubba L, Galli C, Anselmi G, Primache V, Binda S, Pariani E. Epidemiology and molecular characterization of influenza viruses, human parechoviruses and enteroviruses in children up to 5 years with influenza-like illness in Northern Italy during seven consecutive winter seasons (2010–2017). J Gen Virol 2017; 98:2699-2711. [DOI: 10.1099/jgv.0.000937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Laura Bubba
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Giovanni Anselmi
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Valeria Primache
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36 - 20133 Milan, Italy
- Department of Health Sciences, CIRI-IT, University of Genoa, Via Antonio Pastore, 1 - 16132 Genoa, Italy
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