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Mohammad KN, Chan EYY, Lau SYF, Lam HCY, Goggins WB, Chong KC. Relationship between acute kidney injury, seasonal influenza, and environmental factors: A 14-year retrospective analysis. ENVIRONMENT INTERNATIONAL 2021; 153:106521. [PMID: 33819723 DOI: 10.1016/j.envint.2021.106521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Despite high incidence of acute kidney injury (AKI) among patients hospitalised for influenza, no previous work has attempted to analyse and quantify the association between the two. Herein, we made use of Hong Kong's surveillance data to evaluate the time-varying relationship between seasonal influenza and risk of AKI with adjustment for potential environmental covariates. Generalized additive model was used in conjunction with distributed-lag non-linear model to estimate the association of interest with daily AKI admissions as outcome and daily influenza admissions as predictor, while controlling for environmental variables (i.e. temperature, relative humidity, total rainfall, nitrogen dioxide, and ozone). Results suggested a positive association between risk of AKI admission and number of influenza hospitalisation cases, with relative risk reaching 1.12 (95% confidence interval, 1.10-1.15) at the 95th percentile. Using median as reference, an almost U-shaped association between risk of AKI admission and temperature was observed; the risk increased significantly when the temperature was low. While ozone was not shown to be a risk factor for AKI, moderate-to-high levels of nitrogen dioxide (50-95th percentile) were significantly associated with increased risk of AKI admission. This study mentioned the possibility that AKI hospitalisations are subject to environmental influences and offered support for a positive association between seasonal influenza and AKI occurrence in Hong Kong. Authorities are urged to extend the influenza vaccination program to individuals with pre-existing renal conditions to safeguard the health of the vulnerable. Given that adverse health effects are evident at current ambient levels of nitrogen dioxide, the government is recommended to adopt clean-air policies at the earliest opportunity to protect the health of the community.
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Affiliation(s)
- Kirran N Mohammad
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily Ying Yang Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven Yuk-Fai Lau
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Holly Ching Yu Lam
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - William Bernard Goggins
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Chun Chong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health System and Policy Research, The Chinese University of Hong Kong, Hong Kong, China.
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2
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Ciabatti M, Vignini E, Mattesini A, Di Mario C, Valente S. Why can flu be so deadly? An unusual case of cardiogenic shock. Intern Emerg Med 2020; 15:679-684. [PMID: 31104304 DOI: 10.1007/s11739-019-02094-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Michele Ciabatti
- Structural Interventional Cardiology, Cardiologic Intensive Care Unit, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy
| | - Elisa Vignini
- Structural Interventional Cardiology, Cardiologic Intensive Care Unit, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Cardiologic Intensive Care Unit, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy.
| | - Carlo Di Mario
- Structural Interventional Cardiology, Cardiologic Intensive Care Unit, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy
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Assaf-Casals A, Saleh Z, Khafaja S, Fayad D, Ezzeddine H, Saleh M, Chamseddine S, Sayegh R, Sharara SL, Chmaisse A, Kanj SS, Kanafani Z, Hanna-Wakim R, Araj GF, Mahfouz R, Saito R, Suzuki H, Zaraket H, Dbaibo GS. The burden of laboratory-confirmed influenza infection in Lebanon between 2008 and 2016: a single tertiary care center experience. BMC Infect Dis 2020; 20:339. [PMID: 32397965 PMCID: PMC7216128 DOI: 10.1186/s12879-020-05013-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, since data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited, we aimed to contribute to the understanding of influenza burden in Lebanon. METHODS A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30th, 2016 at a tertiary care center in Beirut was performed. All cases confirmed to have influenza based on rapid antigen detection or/and polymerase chain reaction on a respiratory sample were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis. RESULTS A total of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14% (positive tests over total requested). Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (< 2 years and ≥ 65 years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION Patients with laboratory-confirmed influenza at our center had a high rate of hospitalization and mortality. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.
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Affiliation(s)
- Aia Assaf-Casals
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut Medical Center, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Zeina Saleh
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Sarah Khafaja
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut Medical Center, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Danielle Fayad
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Hady Ezzeddine
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Mohammad Saleh
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Sarah Chamseddine
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Rouba Sayegh
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Sima L Sharara
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Ahmad Chmaisse
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Souha S Kanj
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Zeina Kanafani
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Rima Hanna-Wakim
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut Medical Center, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - George F Araj
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Rami Mahfouz
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Reiko Saito
- Department of Public Health at Niigata University, Niigata, Japan
| | - Hiroshi Suzuki
- Department of Public Health at Niigata University, Niigata, Japan
| | - Hassan Zaraket
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
- Department of Experimental Pathology, Immunology & Microbiology, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - Ghassan S Dbaibo
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut Medical Center, PO Box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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4
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Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, Gravenstein S, Hayden FG, Harper SA, Hirshon JM, Ison MG, Johnston BL, Knight SL, McGeer A, Riley LE, Wolfe CR, Alexander PE, Pavia AT. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis 2020; 68:e1-e47. [PMID: 30566567 DOI: 10.1093/cid/ciy866] [Citation(s) in RCA: 332] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022] Open
Abstract
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry H Bernstein
- Division of General Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - John S Bradley
- Division of Infectious Diseases, Rady Children's Hospital.,University of California, San Diego
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital
| | - Thomas M File
- Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan Gravenstein
- Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville
| | - Scott A Harper
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon Mark Hirshon
- Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Lynn Johnston
- Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Allison McGeer
- Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada
| | - Laura E Riley
- Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Paul E Alexander
- McMaster University, Hamilton, Ontario, Canada.,Infectious Diseases Society of America, Arlington, Virginia
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City
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5
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Keilich SR, Bartley JM, Haynes L. Diminished immune responses with aging predispose older adults to common and uncommon influenza complications. Cell Immunol 2019; 345:103992. [PMID: 31627841 PMCID: PMC6939636 DOI: 10.1016/j.cellimm.2019.103992] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023]
Abstract
Influenza (flu) is a serious disease for older adults, with increased severity of infection and greater risk for hospitalization and death. Flu infection is limited to pulmonary epithelial cells, yet there are many systemic symptoms and older adults are more susceptible to flu-related complications. In older adults, flu rarely comes without additional complications and there is a perfect storm for enhanced disease due to multiple factors including existing co-morbidities, plus impaired lung function and dysregulated immune responses that occur with even healthy aging. Commonly, opportunistic secondary bacterial infections prosper in damaged lungs. Intensified systemic inflammation with aging can cause dysfunction in extra-pulmonary organs and tissues such as cardiovascular, musculoskeletal, neuropathologic, hepatic, and renal complications. Often overlooked is the underappreciated connections between many of these conditions, which exacerbate one another when in parallel. This review focuses on flu infection and the numerous complications in older adults associated with diminished immune responses.
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Affiliation(s)
- Spencer R Keilich
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Jenna M Bartley
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; Department of Immunology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
| | - Laura Haynes
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; Department of Immunology, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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6
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Estofolete CF, de Oliveira Mota MT, Bernardes Terzian AC, de Aguiar Milhim BHG, Ribeiro MR, Nunes DV, Mourão MP, Rossi SL, Nogueira ML, Vasilakis N. Unusual clinical manifestations of dengue disease - Real or imagined? Acta Trop 2019; 199:105134. [PMID: 31415737 DOI: 10.1016/j.actatropica.2019.105134] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 01/10/2023]
Abstract
The disease caused by each of the four serotypes of dengue virus (DENV) have plagued humans since last century. Symptoms of dengue virus (DENV) infection range from asymptomatic to dengue fever (DF) to severe dengue disease (SDD). One third of the world's population lives in regions with active urban DENV transmission, and thousands of serologically naïve travelers visit these areas annually, making a significant portion of the human population at risk of being infected. Even though lifelong immunity to the homotypic serotype is achieved after a primary DENV infection. Heterotypic DENV infections may be exacerbated by a pre-existing immune memory to the primary infection and can result in an increased probability of severe disease. Not only, age, comorbidities and presence of antibodies transferred passively from dengue-immune mother to infants are considered risk factors to dengue severe forms. Plasma leakage and multiple organ impairment are well documented in the literature, affecting liver, lung, brain, muscle, and kidney. However, unusual manifestation, severe or not, have been reported and may require medical attention. This review will summarize and discuss the increasing reports of unusual manifestations in the clinical course of dengue infection.
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Affiliation(s)
| | | | | | | | - Milene Rocha Ribeiro
- São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Delzi Vinha Nunes
- São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Maria Paula Mourão
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation (FMT-HVD), Manaus, Amazonas, Brazil
| | - Shannan L Rossi
- University of Texas Medical Branch (UTMB), Galveston, Texas, USA
| | | | - Nikos Vasilakis
- University of Texas Medical Branch (UTMB), Galveston, Texas, USA.
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7
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Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, Gravenstein S, Hayden FG, Harper SA, Hirshon JM, Ison MG, Johnston BL, Knight SL, McGeer A, Riley LE, Wolfe CR, Alexander PE, Pavia AT. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis 2019; 68. [PMID: 30566567 PMCID: PMC6653685 DOI: 10.1093/cid/ciy866 10.1093/cid/ciz044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry H Bernstein
- Division of General Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - John S Bradley
- Division of Infectious Diseases, Rady Children's Hospital
- University of California, San Diego
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital
| | - Thomas M File
- Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan Gravenstein
- Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville
| | - Scott A Harper
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon Mark Hirshon
- Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Lynn Johnston
- Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Allison McGeer
- Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada
| | - Laura E Riley
- Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Paul E Alexander
- McMaster University, Hamilton, Ontario, Canada
- Infectious Diseases Society of America, Arlington, Virginia
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City
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8
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Bessis S, Matt M. La grippe. Med Mal Infect 2019; 49 Suppl 1:S17-S24. [DOI: 10.1016/s0399-077x(19)30803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Syncope and Influenza B: A Case of an Arresting Association. Case Rep Emerg Med 2018; 2018:1853473. [PMID: 30174963 PMCID: PMC6098913 DOI: 10.1155/2018/1853473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
Influenza is a contagious viral illness that usually presents with upper respiratory and pulmonary symptoms. While generally self-limited, pulmonary, renal, metabolic, neurologic, and cardiac complications have all been described in the literature. Here we describe a case of a 46-year-old male with multiple episodes of syncope, found to have severe bradycardia, sinus arrest, and positive influenza B, requiring permanent pacemaker placement. The viruses responsible for the flu can be differentiated into four types: A, B, C, and D. The two primary viruses responsible for the seasonal winter epidemic influenza in the United States are Human Influenza A and B viruses. It has been postulated that the influenza virus may be responsible for activating acute inflammatory cytokines, which then alter electrical conduction properties of endothelial cells. Although there have been cases of sinus arrest in association with influenza, some requiring pacemaker placement, our patient's presentation with multiple episodes of syncope with severe bradycardia and sinus arrest requiring permanent pacemaker placement, in association with influenza B, is very unusual and possibly unique. Since emergency physicians are at the forefront in the diagnosis, treatment, and disposition of these patients, awareness of influenza triggered cardiac events is essential and lifesaving, especially in unvaccinated patients.
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10
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Sellers SA, Hagan RS, Hayden FG, Fischer WA. The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection. Influenza Other Respir Viruses 2018; 11:372-393. [PMID: 28745014 PMCID: PMC5596521 DOI: 10.1111/irv.12470] [Citation(s) in RCA: 255] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 12/13/2022] Open
Abstract
Severe influenza infection represents a leading cause of global morbidity and mortality. Although influenza is primarily considered a viral infection that results in pathology limited to the respiratory system, clinical reports suggest that influenza infection is frequently associated with a number of clinical syndromes that involve organ systems outside the respiratory tract. A comprehensive MEDLINE literature review of articles pertaining to extra‐pulmonary complications of influenza infection, using organ‐specific search terms, yielded 218 articles including case reports, epidemiologic investigations, and autopsy studies that were reviewed to determine the clinical involvement of other organs. The most frequently described clinical entities were viral myocarditis and viral encephalitis. Recognition of these extra‐pulmonary complications is critical to determining the true burden of influenza infection and initiating organ‐specific supportive care.
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Affiliation(s)
- Subhashini A Sellers
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert S Hagan
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Frederick G Hayden
- Division of Infectious Diseases, The University of Virginia, Charlottesville, VA, USA
| | - William A Fischer
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Nulens EF, Bourgeois MJ, Reynders MB. Post-influenza aspergillosis, do not underestimate influenza B. Infect Drug Resist 2017; 10:61-67. [PMID: 28260935 PMCID: PMC5330186 DOI: 10.2147/idr.s122390] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Our objective is to highlight and focus on post-influenza aspergillosis, triggered by influenza B virus. This relatively new clinical entity is often associated with a fulminant course of respiratory decline and high mortality. A 51-year immunocompetent woman, without any medical history or risk factors for developing a complicated influenza infection, was admitted to the intensive care unit. During admission, she presented with an afebrile flu-like syndrome, myocarditis, rhabdomyolysis, multiple organ failure, and evolved to severe respiratory distress. The broncho-alveolar lavage contained influenza B RNA, and the culture revealed Aspergillus fumigatus. Despite maximal organ support, immunoglobulin, antiviral and antifungal therapy, the patient died. This case demonstrates that influenza B virus may be life threatening even to immunocompetent adults and may trigger an invasive Aspergillus superinfection.
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Affiliation(s)
| | - Marc Jc Bourgeois
- Department of Intensive Care, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende AV, Brugge, Belgium
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12
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Nguyen C, Kaku S, Tutera D, Kuschner WG, Barr J. Viral Respiratory Infections of Adults in the Intensive Care Unit. J Intensive Care Med 2015; 31:427-41. [PMID: 25990273 DOI: 10.1177/0885066615585944] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Abstract
Viral lower respiratory tract infections (LRTIs) are an underappreciated cause of critical illness in adults. Recent advances in viral detection techniques over the past decade have demonstrated viral LRTIs are associated with rates of morbidity, mortality, and health care utilization comparable to those of seen with bacterial community acquired and nosocomial pneumonias. In this review, we describe the relationship between viral LRTIs and critical illness, as well as discuss relevant clinical features and management strategies for the more prevalent respiratory viral pathogens.
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Affiliation(s)
- Christopher Nguyen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shawn Kaku
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dominic Tutera
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ware G Kuschner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Pulmonary Section, Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Juliana Barr
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
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13
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Ordoñez JC, Sánchez G, León R, Ramos JM. Rhabdomyolysis and acute renal failure associated with influenza virus type A infection. Rev Clin Esp 2014; 215:295-6. [PMID: 25529845 DOI: 10.1016/j.rce.2014.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Affiliation(s)
- J C Ordoñez
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España; Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
| | - G Sánchez
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España
| | - R León
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España
| | - J M Ramos
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España; Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Elche, Alicante, España
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14
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A case of acute kidney injury and disseminated intravascular coagulation associated with influenza B viral infection. CEN Case Rep 2014; 4:95-100. [PMID: 28509280 DOI: 10.1007/s13730-014-0147-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 09/21/2014] [Indexed: 12/12/2022] Open
Abstract
There are few reports of acute kidney injury (AKI) associated with influenza viral infection. We treated a case of AKI that developed after an influenza B viral infection. A 35-year-old man visited a local physician for a fever and was diagnosed with influenza B. He was prescribed laninamivir, then returned to the physician 5 days later with dyspnea and was referred to Hospital A. Upon admission, respiratory arrest developed, for which he received tracheal intubation and mechanical ventilation. AKI was noted after admission and the patient was transferred to our hospital the next day. AKI and disseminated intravascular coagulation (DIC) were present at the time of transfer, thus a transfusion and continuous hemodiafiltration (CHDF) were performed, and administrations of thrombomodulin alpha and antithrombin III were initiated. Although the patient had DIC, AKI, and disturbance of consciousness, and was in a clinical state resembling influenza-associated encephalopathy, there was no clear abnormality shown in CT scans of the head. Urine output, renal function, and respiratory condition gradually improved, thus CHDF was stopped and extubation performed. The patient had no complications and was discharged on hospital day 22. Some reports have been presented regarding cases of AKI due to rhabdomyolysis associated with influenza viral infection, whereas our patient developed AKI as a complication of an influenza B viral infection without rhabdomyolysis or hemolytic uremic syndrome. Influenza B may cause AKI and DIC, and affected patients can be in a serious condition requiring immediate attention.
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15
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Hung PL, Lin PC, Tseng PL. Influenza-B associated rhabdomyolysis and acute renal failure. Indian Pediatr 2014; 50:595-6. [PMID: 23942401 DOI: 10.1007/s13312-013-0158-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We present a 15 year old boy who developed severe rhabdomyolysis and acute renal failure following influenza B infection. His renal function was restored after appropriate therapy for rhabdomyolysis. Although rapidly progressive pneumonia, respiratory failure, and acute respiratory distress syndrome are the most common severe complications of influenza B infection, clinicians should be aware that influenza B may be complicated with rhabdomyolysis and acute renal failure in children.
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Affiliation(s)
- Pi-Lien Hung
- Department of Pharmacy, Taiwan, Republic of China.
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17
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Abstract
AIM Influenza B-associated rhabdomyolysis (IBAR) is an infrequent and little-known complication of influenza B virus infection in children. Diagnosis is usually made based on clinical history, the presence of influenza in the community and detection of virus in nasopharyngeal specimens. The aim of this study was to describe the clinical and laboratory manifestations, complications and outcomes of IBAR in Taiwanese children. METHODS A retrospective analysis was conducted in patients aged < 17 years who had been diagnosed with IBAR at a university children's hospital in North Taiwan during 2000-2007. All children enrolled in the study had presented with rhabdomyolysis associated with laboratory-confirmed influenza B infections. Demographic data, clinical manifestations, complications and outcomes were included in the analysis. RESULTS Overall, 24 IBAR cases were analysed. IBAR typically occurred in school-aged children with a 7:3 male:female ratio. The mean age was 7.2 ± 1.9 years. Nearly 63% of cases occurred between the ages of 6 and 9 years. The median interval between the onset of influenza and onset of IBAR was 3.4 days (range, 1-14). The calf muscles were involved in all cases. Laboratory tests indicated a mean initial blood creatine kinase of 4212 U/L. The median time to clinical recovery was 5 days (range 1-24). No patient had renal failure. IBAR tends to occur mainly in winter and spring during influenza B outbreaks. IBAR sometimes induces some complications, and early detection and careful medical treatment are necessary. CONCLUSION The results of this study indicate that outcomes of IBAR are good with proper medical care.
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Affiliation(s)
- C-T Wu
- Division of Pediatric Emergency Medicine, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tauyuan, Taiwan.
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18
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Ann SH, An GH, Lee SY, Oak JH, Moon HI, Moon SK, Han NI, Lee YS. [A case of rhabdomyolysis during hospitalization for acute hepatitis A]. THE KOREAN JOURNAL OF HEPATOLOGY 2009; 15:85-9. [PMID: 19346789 DOI: 10.3350/kjhep.2009.15.1.85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 29-year-old man was admitted to hospital with fever, myalgia, and sore throat. Initial laboratory findings were compatible with acute hepatitis; he was positive for the serologic marker for acute hepatitis A. On the 3rd day of admission, in spite of normalization of body temperature and a reduction in serum liver enzyme levels, serum levels of creatinine phosphokinase had increased up to 16,949 U/L. The patient recovered with supportive therapy and was discharged on the 12th day. We report a case of acute hepatitis A complicated by rhabdomyolysis during hospitalization.
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Affiliation(s)
- Soe Hee Ann
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Harper SA, Bradley JS, Englund JA, File TM, Gravenstein S, Hayden FG, McGeer AJ, Neuzil KM, Pavia AT, Tapper ML, Uyeki TM, Zimmerman RK. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1003-32. [PMID: 19281331 PMCID: PMC7107965 DOI: 10.1086/598513] [Citation(s) in RCA: 495] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Guidelines for the treatment of persons with influenza virus infection were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic issues, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal (interpandemic) influenza. They are intended for use by physicians in all medical specialties with direct patient care, because influenza virus infection is common in communities during influenza season and may be encountered by practitioners caring for a wide variety of patients.
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Affiliation(s)
- Scott A Harper
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Acute renal failure due to rhabdomyolysis after proximal humerus fracture associated with axillary artery rupture. Int Urol Nephrol 2008; 40:855-8. [PMID: 18587662 DOI: 10.1007/s11255-008-9341-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 01/13/2008] [Indexed: 12/15/2022]
Abstract
The anatomical proximity of axillary artery to the humeral head makes it quite vulnerable to blunt trauma during shoulder injury. Axillary artery rupture and prolonged ischemia may lead to rhabdomyolysis and acute renal failure. Herein we present a case of a patient who sustained proximal humerus fracture associated with axillary artery rupture and acute renal failure due to rhabdomyolysis.
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