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Badheeb M, Zarich S, Fara FI, Alam MM. Permanent Complete Heart Block: A Rare Complication of Influenza Infection. Cureus 2023; 15:e51166. [PMID: 38283436 PMCID: PMC10813590 DOI: 10.7759/cureus.51166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
The cardiovascular complications of viral illnesses are often underestimated in clinical practice. The influenza virus, one of the most prevalent viral infections, has been associated with a wide spectrum of arrhythmias that are typically transient and self-resolving. We present the case of a 60-year-old female with no prior cardiac comorbidities who developed a complete heart block after an influenza infection. She presented to the clinic with flu-like symptoms and was found to have a complete heart block with a junctional escape rhythm. Polymerase chain reaction testing subsequently confirmed an influenza A infection. She was initially placed on a temporary pacemaker. However, a permanent dual-chamber pacemaker was implanted as bradycardia persisted. Later follow-ups in the cardiology clinic showed that the patient remained dependent on the pacemaker. While there are a few descriptions of influenza-induced transient atrioventricular block, cases of influenza-induced permanent complete heart block are extremely rare, particularly in the absence of severe myocardial inflammation.
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Affiliation(s)
- Mohamed Badheeb
- Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
| | - Stuart Zarich
- Cardiology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
| | - Faria Islam Fara
- Biotechnology Program, Department of Mathematics & Natural Sciences, BRAC University, Dhaka, BGD
| | - Md Mashiul Alam
- Cardiovascular Disease, Mayo Clinic, Rochester, USA
- Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
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2
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Zeng Q, Yang C, Li Y, Geng X, Lv X. Machine-learning-algorithms-based diagnostic model for influenza A in children. Medicine (Baltimore) 2023; 102:e36406. [PMID: 38050228 PMCID: PMC10695522 DOI: 10.1097/md.0000000000036406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND At present, nucleic acid testing is the gold standard for diagnosing influenza A, however, this method is expensive, time-consuming, and unsuitable for promotion and use in grassroots hospitals. This study aimed to establish a diagnostic model that could accurately, quickly, and simply distinguish between influenza A and influenza like diseases. METHODS Patients with influenza-like symptoms were recruited between December 2019 and August 2023 at the Children's Hospital Affiliated to Shandong University and basic information, nasopharyngeal swab and blood routine test data were included. Computer algorithms including random forest, GBDT, XGBoost and logistic regression (LR) were used to create the diagnostic model, and their performance was evaluated using the validation data sets. RESULTS A total of 4188 children with influenza-like symptoms were enrolled, of which 1992 were nucleic acid test positive and 2196 were matched negative. The diagnostic models based on the random forest, GBDT, XGBoost and logistic regression algorithms had AUC values of 0.835,0.872,0.867 and 0.784, respectively. The top 5 important features were lymphocyte (LYM) count, age, serum amyloid A (SAA), white blood cells (WBC) count and platelet-to-lymphocyte ratio (PLR). GBDT model had the best performance, the sensitivity and specificity were 77.23% and 80.29%, respectively. CONCLUSIONS A computer algorithm diagnosis model of influenza A in children based on blood routine test data was established, which could identify children with influenza A more accurately in the early stage, and was easy to popularize.
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Affiliation(s)
- Qian Zeng
- Clinical Laboratory, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Clinical Laboratory, Jinan Children’s Hospital, Jinan, China
| | - Chun Yang
- Clinical Laboratory, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Clinical Laboratory, Jinan Children’s Hospital, Jinan, China
| | - Yurong Li
- Clinical Laboratory, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Clinical Laboratory, Jinan Children’s Hospital, Jinan, China
| | - Xinran Geng
- Maternity & Child Care Center of Dezhou, China
| | - Xin Lv
- Clinical Laboratory, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Clinical Laboratory, Jinan Children’s Hospital, Jinan, China
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3
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Wu Y, Vos GM, Huang C, Chapla D, Kimpel ALM, Moremen KW, de Vries RP, Boons GJ. Exploiting Substrate Specificities of 6- O-Sulfotransferases to Enzymatically Synthesize Keratan Sulfate Oligosaccharides. JACS Au 2023; 3:3155-3164. [PMID: 38034954 PMCID: PMC10685434 DOI: 10.1021/jacsau.3c00488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 12/02/2023]
Abstract
Keratan sulfate (KS) is a glycosaminoglycan that is widely expressed in the extracellular matrix of various tissue types, where it is involved in many biological processes. Herein, we describe a chemo-enzymatic approach to preparing well-defined KS oligosaccharides by exploiting the known and newly discovered substrate specificities of relevant sulfotransferases. The premise of the approach is that recombinant GlcNAc-6-O-sulfotransferases (CHST2) only sulfate terminal GlcNAc moieties to give GlcNAc6S that can be galactosylated by B4GalT4. Furthermore, CHST1 can modify the internal galactosides of a poly-LacNAc chain; however, it was found that a GlcNAc6S residue greatly increases the reactivity of CHST1 of a neighboring and internal galactoside. The presence of a 2,3-linked sialoside further modulates the site of modification by CHST1, and a galactoside flanked by 2,3-Neu5Ac and GlcNAc6S is preferentially sulfated over the other Gal residues. The substrate specificities of CHST1 and 2 were exploited to prepare a panel of KS oligosaccharides, including selectively sulfated N-glycans. The compounds and several other reference derivatives were used to construct a microarray that was probed for binding by several plant lectins, Siglec proteins, and hemagglutinins of influenza viruses. It was found that not only the sulfation pattern but also the presentation of epitopes as part of an O- or N-glycan determines binding properties.
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Affiliation(s)
- Yunfei Wu
- Department
of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical
Sciences, Utrecht University, Universiteitsweg 99, Utrecht 3584 CG, The Netherlands
| | - Gaël M. Vos
- Department
of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical
Sciences, Utrecht University, Universiteitsweg 99, Utrecht 3584 CG, The Netherlands
| | - Chin Huang
- Complex
Carbohydrate Research Center, University
of Georgia, 315 Riverbend Road, Athens, Georgia 30602, United States
- Department
of Biochemistry, University of Georgia, Athens, Georgia 30602, United States
| | - Digantkumar Chapla
- Complex
Carbohydrate Research Center, University
of Georgia, 315 Riverbend Road, Athens, Georgia 30602, United States
| | - Anne L. M. Kimpel
- Department
of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical
Sciences, Utrecht University, Universiteitsweg 99, Utrecht 3584 CG, The Netherlands
| | - Kelley W. Moremen
- Complex
Carbohydrate Research Center, University
of Georgia, 315 Riverbend Road, Athens, Georgia 30602, United States
- Department
of Biochemistry, University of Georgia, Athens, Georgia 30602, United States
| | - Robert P. de Vries
- Department
of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical
Sciences, Utrecht University, Universiteitsweg 99, Utrecht 3584 CG, The Netherlands
| | - Geert-Jan Boons
- Department
of Chemical Biology and Drug Discovery, Utrecht Institute for Pharmaceutical
Sciences, Utrecht University, Universiteitsweg 99, Utrecht 3584 CG, The Netherlands
- Complex
Carbohydrate Research Center, University
of Georgia, 315 Riverbend Road, Athens, Georgia 30602, United States
- Bijvoet
Center for Biomolecular Research, Utrecht
University, Padualaan
8, Utrecht 3584 CH, The Netherlands
- Department
of Chemistry, University of Georgia, Athens, Georgia 30602, United States
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4
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Stachulski AV, Rossignol JF, Pate S, Taujanskas J, Iggo JA, Aerts R, Pascal E, Piacentini S, La Frazia S, Santoro MG, van Vooren L, Sintubin L, Cooper M, Swift K, O’Neill PM. Thiazolide Prodrug Esters and Derived Peptides: Synthesis and Activity. ACS Bio Med Chem Au 2023; 3:327-334. [PMID: 37599793 PMCID: PMC10436260 DOI: 10.1021/acsbiomedchemau.2c00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 08/22/2023]
Abstract
Amino acid ester prodrugs of the thiazolides, introduced to improve the pharmacokinetic parameters of the parent drugs, proved to be stable as their salts but were unstable at pH > 5. Although some of the instability was due to simple hydrolysis, we have found that the main end products of the degradation were peptides formed by rearrangement. These peptides were stable solids: they maintained significant antiviral activity, and in general, they showed improved pharmacokinetics (better solubility and reduced clearance) compared to the parent thiazolides. We describe the preparation and evaluation of these peptides.
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Affiliation(s)
- Andrew V. Stachulski
- Donnan
and Robert Robinson Laboratories, Department of Chemistry, University of Liverpool, Liverpool L69 7ZD, U.K.
| | | | - Sophie Pate
- Donnan
and Robert Robinson Laboratories, Department of Chemistry, University of Liverpool, Liverpool L69 7ZD, U.K.
| | - Joshua Taujanskas
- Donnan
and Robert Robinson Laboratories, Department of Chemistry, University of Liverpool, Liverpool L69 7ZD, U.K.
| | - Jonathan A. Iggo
- Donnan
and Robert Robinson Laboratories, Department of Chemistry, University of Liverpool, Liverpool L69 7ZD, U.K.
| | - Rudi Aerts
- Romark
Belgium BVBA, Roosveld
6, 3400 Landen, Belgium
| | | | - Sara Piacentini
- Department
of Biology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Simone La Frazia
- Department
of Biology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - M. Gabriella Santoro
- Department
of Biology, University of Rome Tor Vergata, 00133 Rome, Italy
- Institute
of Translational Pharmacology, CNR, Area della Ricerca di Roma 2, Via Fosso del Cavaliere, 00133 Roma, Italy
| | | | | | - Mark Cooper
- Bio-Techne, Avonmouth, Bristol BS11 9QD, U.K.
| | - Karl Swift
- Bio-Techne, Avonmouth, Bristol BS11 9QD, U.K.
| | - Paul M. O’Neill
- Donnan
and Robert Robinson Laboratories, Department of Chemistry, University of Liverpool, Liverpool L69 7ZD, U.K.
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5
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Boehm AB, Wolfe MK, White BJ, Hughes B, Duong D, Bidwell A. More than a Tripledemic: Influenza A Virus, Respiratory Syncytial Virus, SARS-CoV-2, and Human Metapneumovirus in Wastewater during Winter 2022-2023. Environ Sci Technol Lett 2023; 10:622-627. [PMID: 37577361 PMCID: PMC10413932 DOI: 10.1021/acs.estlett.3c00385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
Wastewater monitoring can provide insights into respiratory disease occurrence in communities that contribute to the wastewater system. Using daily measurements of RNA of influenza A (IAV), respiratory syncytial virus (RSV), and human metapneumovirus (HMPV), as well as SARS-CoV-2 in wastewater solids from eight publicly owned treatment works in the Greater San Francisco Bay Area of California between July 2022 and early July 2023, we identify a "tripledemic" when concentrations of IAV, RSV, and SARS-CoV-2 peaked at approximately the same time. HMPV was also widely circulating. We designed novel hydrolysis probe RT-PCR assays for different IAV subtype markers to discern that the dominant circulating IAV subtype was H3N2. We show that wastewater data can be used to identify the onset and offset of wastewater disease occurrence events. This information can provide insight into disease epidemiology and timely, localized information to inform hospital staffing and clinical decision making to respond to circulating viruses. Whereas RSV and IAV wastewater events were mostly regionally coherent, HMPV events displayed localized occurrence patterns.
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Affiliation(s)
- Alexandria B. Boehm
- Department
of Civil & Environmental Engineering, School of Engineering and
Doerr School of Sustainability, Stanford
University, Stanford, California 94305, United States
| | - Marlene K. Wolfe
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Bradley J. White
- Verily
Life Sciences, South
San Francisco, California 94080, United States
| | - Bridgette Hughes
- Verily
Life Sciences, South
San Francisco, California 94080, United States
| | - Dorothea Duong
- Verily
Life Sciences, South
San Francisco, California 94080, United States
| | - Amanda Bidwell
- Department
of Civil & Environmental Engineering, School of Engineering and
Doerr School of Sustainability, Stanford
University, Stanford, California 94305, United States
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6
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Cullin A, Voit MK. The Rare Presentation of Spontaneous Pneumothorax in a Pediatric Patient. Cureus 2023; 15:e41359. [PMID: 37546037 PMCID: PMC10399636 DOI: 10.7759/cureus.41359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/08/2023] Open
Abstract
Children presenting to the Emergency Department (ED) with upper respiratory infection (URI) symptoms of unresolved cough are not uncommon. Differentiation of the child's symptoms with thorough history and physical and when appropriate, further evaluation with blood work and imaging is the responsibility of the ED physician. In a clinical environment with increasing ED visits due to nonspecific URIs in children, it is also important not to overutilize an emergent workup with unnecessary testing. Our case involves a patient with atypical symptoms and hopes to highlight the importance of keeping a broad differential for all patients upon initial evaluation. Spontaneous pneumothorax is a potentially life-threatening condition. Our five-year-old patient presented with an unresolved cough being treated by an outpatient physician. He had no prior airway disease diagnosis. Severe cough in the absence of prior airway disease is notably less likely, but not an unseen cause of spontaneous pneumothorax. Our patient, however, developed just that. He was officially diagnosed with a right-sided pneumothorax on chest x-ray, underwent supplemental oxygen therapy, and was ultimately transferred to a pediatric hospital for continuation of care. Once there, our patient gradually improved was diagnosed as an asthmatic, and was started on appropriate maintenance medications. It is important to remain vigilant when examining multiple pediatric patients in a shift and to keep in mind that even otherwise healthy pediatric patients are at risk for spontaneous pneumothorax. Spontaneous pneumothorax is a potentially life-threatening condition. Our five-year-old patient had no prior airway disease diagnosis making spontaneous pneumothorax notably less likely, however, from severe cough our patient developed just that. He was officially diagnosed with right-sided pneumothorax, underwent supplemental oxygen therapy, and was transferred to a pediatric hospital. Once there patient gradually improved, he was diagnosed as an asthmatic and started on appropriate medication to keep his breathing stable. It is essential to keep in mind that even otherwise pediatric patients are at risk for spontaneous pneumothoraxes and we as emergency physicians must keep this in mind during our evaluation.
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Affiliation(s)
- Alison Cullin
- Emergency Medicine, Inspira Medical Center Mullica Hill, Mullica Hill, USA
| | - Mary-Kate Voit
- Emergency Medicine, Inspira Medical Center Mullica Hill, Mullica Hill, USA
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7
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Parums DV. Editorial: Global Surveillance of Highly Pathogenic Avian Influenza Viruses in Poultry, Wild Birds, and Mammals to Prevent a Human Influenza Pandemic. Med Sci Monit 2023; 29:e939968. [PMID: 36855861 PMCID: PMC9987167 DOI: 10.12659/msm.939968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Strains of avian influenza A, believed to have originated in poultry with transmission to wild birds, have been associated with epidemics and four major pandemics in humans in the past century. The 1918 influenza pandemic was caused by an avian strain of the influenza A(H1N1) virus that initially adapted to infect humans and then rapidly spread between humans. Since 2021, highly pathogenic avian influenza (HPAI) virus subtypes have been identified in poultry and wild birds. In October 2022, the HPAI virus variant A(H5N1) was isolated from intensively farmed American mink. The World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Union Reference Laboratory for Avian Influenza (EURL) have stated that the risk of human infection from birds and mammals and human-to-human transmission from known HPAI viruses is currently low. However, they recommend increased infection surveillance and preparedness. This editorial aims to present the status of HPAI virus transmission in poultry, wild birds, and mammals to highlight the importance of international infection surveillance, control, and preparedness to prevent the next human influenza pandemic.
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8
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Farias LABG, da Silva FJC, Maia KM, Cavalcante KF, Damasceno LS. A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A. Rev Inst Med Trop Sao Paulo 2023; 65:e22. [PMID: 36946818 PMCID: PMC10027061 DOI: 10.1590/s1678-9946202365022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/03/2023] [Indexed: 03/22/2023] Open
Abstract
We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.
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Affiliation(s)
- Luís Arthur Brasil Gadelha Farias
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
- Escola de Saúde Pública do Estado do Ceará, Programa de Residência Médica em Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Francisco José Cândido da Silva
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
- Escola de Saúde Pública do Estado do Ceará, Programa de Residência Médica em Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Kelma Maria Maia
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | | | - Lisandra Serra Damasceno
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
- Universidade Federal do Ceará , Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Fortaleza, Ceará, Brazil
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9
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Ng TA, Rashid S, Kwoh CK. Virulence network of interacting domains of influenza a and mouse proteins. Front Bioinform 2023; 3:1123993. [PMID: 36875146 PMCID: PMC9982101 DOI: 10.3389/fbinf.2023.1123993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
There exist several databases that provide virus-host protein interactions. While most provide curated records of interacting virus-host protein pairs, information on the strain-specific virulence factors or protein domains involved, is lacking. Some databases offer incomplete coverage of influenza strains because of the need to sift through vast amounts of literature (including those of major viruses including HIV and Dengue, besides others). None have offered complete, strain specific protein-protein interaction records for the influenza A group of viruses. In this paper, we present a comprehensive network of predicted domain-domain interaction(s) (DDI) between influenza A virus (IAV) and mouse host proteins, that will allow the systematic study of disease factors by taking the virulence information (lethal dose) into account. From a previously published dataset of lethal dose studies of IAV infection in mice, we constructed an interacting domain network of mouse and viral protein domains as nodes with weighted edges. The edges were scored with the Domain Interaction Statistical Potential (DISPOT) to indicate putative DDI. The virulence network can be easily navigated via a web browser, with the associated virulence information (LD50 values) prominently displayed. The network will aid influenza A disease modeling by providing strain-specific virulence levels with interacting protein domains. It can possibly contribute to computational methods for uncovering influenza infection mechanisms mediated through protein domain interactions between viral and host proteins. It is available at https://iav-ppi.onrender.com/home.
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Affiliation(s)
- Teng Ann Ng
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Shamima Rashid
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Chee Keong Kwoh
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
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10
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Gleason J, Zhao Y, Raitman I, Kang L, He S, Hariri R. Human placental hematopoietic stem cell derived natural killer cells (CYNK-001) mediate protection against influenza a viral infection. Hum Vaccin Immunother 2022; 18:2055945. [PMID: 35404743 PMCID: PMC9255201 DOI: 10.1080/21645515.2022.2055945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Influenza A virus (IAV) infections are associated with a high healthcare burden around the world and there is an urgent need to develop more effective therapies. Natural killer (NK) cells have been shown to play a pivotal role in reducing IAV-induced pulmonary infections in preclinical models; however, little is known about the therapeutic potential of adoptively transferred NK cells for IAV infections. Here, we investigated the effects of CYNK-001, human placental hematopoietic stem cell derived NK cells that exhibited strong cytolytic activity against a range of malignant cells and expressed high levels of activating receptors, against IAV infections. In a severe IAV-induced acute lung injury model, mice treated with CYNK-001 showed a milder body weight loss and clinical symptoms, which led to a delayed onset of mortality, thus demonstrating their antiviral protection in vivo. Analysis of bronchoalveolar lavage fluid (BALF) revealed that CYNK-001 reduced proinflammatory cytokines and chemokines highlighting CYNK-001’s anti-inflammatory actions in viral induced-lung injury. Furthermore, CYNK-001-treated mice had altered immune responses to IAV with reduced number of neutrophils in BALF yet increased number of CD8+ T cells in the BALF and lung compared to vehicle-treated mice. Our results demonstrate that CYNK-001 displays protective functions against IAV via its anti-inflammatory and immunomodulating activities, which leads to alleviation of disease burden and progression in a severe IAV-infected mice model. The potential of adoptive NK therapy for IAV infections warrants clinical investigation.
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Affiliation(s)
| | - Yuechao Zhao
- Celularity Inc., Florham Park, New Jersey, NJ, USA
| | | | - Lin Kang
- Celularity Inc., Florham Park, New Jersey, NJ, USA
| | - Shuyang He
- Celularity Inc., Florham Park, New Jersey, NJ, USA
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11
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Harvey RR, Nett RJ, McNamara K, McClung RP, Pieracci EG, Mayer O, Labar KA, Xu K, Facey J, Honein MA. Influenza-Like Illness Among Personnel Responding to U.S. Quarantine of Cruise Ship Passengers Exposed to SARS-CoV-2. J Occup Environ Med 2022; 64:58-63. [PMID: 34310544 PMCID: PMC8715933 DOI: 10.1097/jom.0000000000002335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Before community transmission of COVID-19 was recognized in the United States, cruise ship passengers with high risk for exposure to SARS-CoV-2 were repatriated and quarantined. We describe cases of influenza-like illness (ILI) among responders. METHODS We reviewed situation reports and responder illness reports to characterize ill responders, including illness onset date, symptoms, fever, diagnostic tests, potential breaches in PPE use, and return to work status. RESULTS Among 339 responders, nine (3%) reported ILI. No breaches in PPE were reported. Three responders with ILI were tested for both SARS-CoV-2 infection and influenza A; none tested positive for SARS-CoV-2 infection and two tested positive for influenza A. CONCLUSIONS Despite an outbreak of ILI among responders, none were diagnosed with COVID-19, suggesting preventive measures in place might have been sufficient to prevent responders from SARS-CoV-2 exposure.
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Affiliation(s)
- R Reid Harvey
- National Institute for Occupational Safety and Health, Morgantown, West Virginia (Dr Harvey, Dr Nett); National Institutes of Health, Bethesda, Maryland (LT McNamara); Centers for Disease Control and Prevention, Atlanta, Georgia (Dr McClung, Dr Pieracci, Dr Mayer, LCDR Labar, Dr Xu, Dr Honein); Environmental Protection Agency, Washington, District of Columbia (Dr Facey)
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12
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Bimler L, Ronzulli SL, Song AY, Johnson SK, Jones CA, Kim T, Le DT, Tompkins SM, Paust S. Matrix Protein 2 Extracellular Domain-Specific Monoclonal Antibodies Are an Effective and Potentially Universal Treatment for Influenza A. J Virol 2021; 95:JVI. [PMID: 33268521 DOI: 10.1128/JVI.01027-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Influenza virus infection causes significant morbidity and mortality worldwide. Humans fail to make a universally protective memory immune response to influenza A. Hemagglutinin and Neuraminidase undergo antigenic drift and shift, resulting in new influenza A strains to which humans are naive. Seasonal vaccines are often ineffective and escape mutants have been reported to all treatments for influenza A. In the absence of a universal influenza A vaccine or treatment, influenza A will remain a significant threat to human health. The extracellular domain of the M2-ion channel (M2e) is an ideal antigenic target for a universal therapeutic agent, as it is highly conserved across influenza A serotypes, has a low mutation rate, and is essential for viral entry and replication. Previous M2e-specific monoclonal antibodies (M2e-MAbs) show protective potential against influenza A, however, they are either strain specific or have limited efficacy. We generated seven murine M2e-MAbs and utilized in vitro and in vivo assays to validate the specificity of our novel M2e-MAbs and to explore the universality of their protective potential. Our data shows our M2e-MAbs bind to M2e peptide, HEK cells expressing the M2 channel, as well as, influenza virions and MDCK-ATL cells infected with influenza viruses of multiple serotypes. Our antibodies significantly protect highly influenza A virus susceptible BALB/c mice from lethal challenge with H1N1 A/PR/8/34, pH1N1 A/CA/07/2009, H5N1 A/Vietnam/1203/2004, and H7N9 A/Anhui/1/2013 by improving survival rates and weight loss. Based on these results, at least four of our seven M2e-MAbs show strong potential as universal influenza A treatments.IMPORTANCE Despite a seasonal vaccine and multiple therapeutic treatments, Influenza A remains a significant threat to human health. The biggest obstacle is producing a vaccine or treatment for influenza A is their universality or efficacy against not only seasonal variances in the influenza virus, but also against all human, avian, and swine serotypes and, therefore, potential pandemic strains. M2e has huge potential as a target for a vaccine or treatment against influenza A. It is the most conserved external protein on the virus. Antibodies against M2e have made it to clinical trials, but not succeeded. Here, we describe novel M2e antibodies produced in mice that are not only protective at low doses, but that we extensively test to determine their universality and found to be cross protective against all strains tested. Additionally, our work begins to elucidate the critical role of isotype for an influenza A monoclonal antibody therapeutic.
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13
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Abstract
BACKGROUND A worldwide concern has been raised that novel infectious diseases may outbreak rapidly with a limited response time due to globalization. Severe Acute Respiratory Syndrome, influenza A, Avian Influenza Virus, and Corona Virus Disease 2019 are acute respiratory diseases that have been affected by the movements of people, and globalization accelerates these movements. These infectious diseases not only have an overwhelming health impact but also impact the worldwide economy. METHODS We will conduct a systematic review and meta-analysis in Chinese National Knowledge Infrastructure, WANFANG Database, and the VIP Database for Chinese Technical Periodicals, Web of Science, PubMed, EMBASE, the Cochrane Library, EBSCO host, ProQuest, ProQuest Dissertations & Theses A&I, SAGE Journals, ScienceDirect, JSTOR, and Scopus. We will evaluate the risk of bias of included RCTs according to the criteria and technique proposed in the Cochrane Handbook V.5.1.0 and use ROBINS-I to assess risk of bias in nonrandomized studies. We will use GRADE to evaluate the quality of evidence. RESULTS Results of this review will be submitted to a peer-reviewed journal. CONCLUSION To the best of our knowledge, this study will firstly evaluate both health and economic impact of infectious diseases in china and may provide strategy development ideas for future resistance.
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Affiliation(s)
- Meiyue Li
- School of Economics, Lanzhou University, Lanzhou
| | - Danxue Fan
- Faculty of Economics and Management, Lanzhou Vocational Technical College, Lanzhou, China
| | - Xiaowen Wang
- School of Economics, Lanzhou University, Lanzhou
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14
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Abstract
Opportunistic fungal infections are rare but life-threatening in immunocompromised patients. We discuss a case of an immunocompromised patient with multiple myeloma who presented with shortness of breath, fever, ocular palsy, and hemiplegia. She was found to have influenza A respiratory tract infection complicated by invasive aspergillosis and mucormycosis. Investigation revealed invasive fungal sinusitis and cerebritis. Serum biomarkers, beta-d-glucan, and galactomannan failed to detect fungal disease. We believe that our case is unique as there is limited data available regarding the occurrence of invasive fungal infections after Influenza infections. Furthermore, it highlights the hurdles in the diagnosis of disseminated fungal infection.
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Affiliation(s)
- Anum Aqsa
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Sami Droubi
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Allison Glaser
- Internal Medicine, Northwell Health-Staten Island University Hospital, Staten Island, USA
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15
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Abstract
INTRODUCTION Hemorrhagic shock and encephalopathy syndrome (HSES) is a type of acute encephalopathy mainly seen in infants. It is a syndrome encompassing an onset of high fever, disturbance of consciousness, convulsion, and shock that rapidly progresses to watery diarrhea and liver and renal dysfunctions. It is extremely rare in adults, and the number of reports is limited worldwide. We report the case of an adult patient with HSES, which occurred after influenza A infection. PATIENT CONCERNS A 52-year-old man visited his family doctor 2 days after he noticed fever and was diagnosed with influenza A using an influenza rapid diagnosis kit; he underwent treatment on an outpatient basis. He was immediately hospitalized after developing fever, abdominal pain, malaise, and shock 16 hours after the commencement of the treatment. Abrupt acute brain swelling was noted 24 hours after hospitalization. DIAGNOSES The antibody titer to influenza A (H3N2) was 1:40. Computed tomography obtained 24 hours after treatment initiation confirmed acute cerebral edema and cerebral herniation. Electroencephalogram at that time showed a flat line. INTERVENTIONS For the treatment of influenza A, laninamivir 150 mg was started immediately after the diagnosis by the family doctor, and 600 mg dose was given daily after hospitalization (or since 24 hours after the treatment initiation). For the management of shock, dobutamine 3 μg/kg/min and noradrenaline up to 0.2 μg/kg/min were used together with bolus infusion. OUTCOMES The patient was declared brain dead on his 6th hospital day and he died on his 27th hospital day. CONCLUSION Drastic courses such as that in our case with HSES can follow influenza infections even in adults.
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Affiliation(s)
- Masafumi Fukuda
- Advanced Emergency Medical Service Center, Kurume University Hospital
| | - Tomohiro Yoshida
- Department of Emergency and Acute Intensive Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Mariko Moroki
- Department of Emergency and Acute Intensive Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Nobuhisa Hirayu
- Department of Emergency and Acute Intensive Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Masakazu Nabeta
- Department of Emergency and Acute Intensive Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Atsuo Nakamura
- Department of Emergency and Acute Intensive Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideaki Uzu
- Department of Emergency and Acute Intensive Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Osamu Takasu
- Department of Emergency and Acute Intensive Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
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16
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Howard A, Uyeki TM, Fergie J. Influenza-Associated Acute Necrotizing Encephalopathy in Siblings. J Pediatric Infect Dis Soc 2018; 7:e172-e177. [PMID: 29741717 PMCID: PMC6636323 DOI: 10.1093/jpids/piy033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/20/2018] [Indexed: 11/13/2022]
Abstract
Encephalopathy is an important complication associated with influenza, most frequently observed in young children, with a wide range of severity. The most severe category of influenza-associated encephalopathy (IAE) is acute necrotizing encephalopathy (ANE), characterized by high frequency of neurologic sequelae and fatal outcomes. We report two young siblings who developed fever and seizures with altered mental status. Influenza A(H1N1)pdm09 virus infection was identified in upper respiratory tract specimens from both patients, and neuroimaging revealed bilateral inflammatory lesions, consistent with acute necrotizing encephalopathy. Neither child had received influenza vaccination. Both children progressed to critical illness and required invasive mechanical ventilation. In addition to critical care management, both patients received high-dose corticosteroids, mannitol, anticonvulsants, and antiviral treatment of influenza. The older child recovered fully and was discharged 2 weeks after illness onset, but the younger sibling developed severe brainstem edema and cerebellar tonsillar herniation, and died on illness day 11. Both children tested positive for Ran Binding Protein 2 (RANBP2) gene mutations. RANBP2 is a genetic polymorphism associated with recurrent episodes of necrotizing encephalitis with respiratory viral infections. Annual influenza vaccination is especially important for ANE survivors, with or without RANBP2 mutations, their household contacts, and caregivers. During influenza season, close monitoring of any child with a history of neurological complications associated with respiratory illness is indicated, with prompt initiation of antiviral treatment with onset of acute respiratory illness, and influenza testing performed by molecular assay.
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Affiliation(s)
- Ashley Howard
- Department of Pediatrics, Driscoll Children’s Hospital, Corpus Christi, Texas
| | - Timothy M. Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children’s Hospital, Corpus Christi, Texas;,Department of Pediatrics, Texas A&M University College of Medicine, Bryan
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17
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Borgogna TR, Hisey B, Heitmann E, Obar JJ, Meissner N, Voyich JM. Secondary Bacterial Pneumonia by Staphylococcus aureus Following Influenza A Infection Is SaeR/S Dependent. J Infect Dis 2018; 218:809-813. [PMID: 29668950 PMCID: PMC6057542 DOI: 10.1093/infdis/jiy210] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/11/2018] [Indexed: 12/28/2022] Open
Abstract
Staphylococcus aureus is a predominant cause of fatal pneumonia following influenza A virus (IAV) infection. Herein we investigate the influence of antecedent IAV infection on S. aureus virulence gene expression. Using a murine model, comparing the USA300 and USA300ΔsaeR/S strains, we demonstrate that S. aureus pathogenesis following IAV infection is SaeR/S dependent. Furthermore, we show that IAV modulates the lung environment to rapidly up-regulate S. aureus virulence factors containing the SaeR-binding domain. Data demonstrate that the pathogen response to IAV infection impacts host outcome and provides evidence that the ability of S. aureus to sense and respond to the lung environment determines severity of pneumonia.
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Affiliation(s)
- Timothy R Borgogna
- Department of Microbiology and Immunology, Montana State University, Bozeman
| | - Bennett Hisey
- Department of Microbiology and Immunology, Montana State University, Bozeman
| | - Emily Heitmann
- Department of Microbiology and Immunology, Montana State University, Bozeman
| | - Joshua J Obar
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Nicole Meissner
- Department of Microbiology and Immunology, Montana State University, Bozeman
| | - Jovanka M Voyich
- Department of Microbiology and Immunology, Montana State University, Bozeman
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18
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Abstract
Influenza A associated with rhabdomyolysis has become more commonly recognized in recent years. It requires prompt recognition and treatment in order to prevent heme pigment-induced acute kidney injury. Here we report a 50-year-old female without a significant past medical history who presented with a one-week history of fevers, chills, fatigue, and generalized body aches. She was on no prior medication. Laboratory studies were significant for leukocytosis and elevated creatinine kinase up to a peak of 28,216 IU/L. Rapid influenza antigen testing was positive for influenza A virus. The patient was diagnosed with influenza A-induced rhabdomyolysis. According to our literature review, we are the first to report a case of influenza A-induced rhabdomyolysis in the 2017-2018 flu season. This case highlights the importance of considering rhabdomyolysis as a manifestation of an influenza infection.
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Affiliation(s)
- Abdisamad M Ibrahim
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | | | - Paolo K Soriano
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Vikrampal Bhatti
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
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19
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Abstract
Introduction Pakistan is extremely susceptible to an influenza outbreak, as it shares borders with the most affected countries, namely China and India. The medical and dental students come into direct contact with the affected population and should be aware of the risk factors and signs and symptoms pertaining to swine influenza virus (SIV). Hence, this survey was conducted to assess the knowledge, perceptions and self-care practices of the medical and dental students with regards to this pandemic. Methods A descriptive, cross-sectional study was conducted to evaluate the swine flu-related knowledge, attitudes and practices of the medical and dental students at various institutions in Karachi, Pakistan. We approached 613 students that were available on the dates of this survey, keeping a medical to dental student ratio of 75:25. All students from first to final year comprised of the study population, and no internists or medical personnel were included. The questionnaire was divided into three sections, namely knowledge, attitudes and, practices. All questions were based on a multiple choice format. The data were entered and interpreted using the IBM Statistical Package for the Social Sciences 23.0 (IBM Corp., Armonk, New York). Results The majority of the students were aware that the swine flu is a transmittable disease (n=485, 80.8%). Most students identified the signs and symptoms correctly; however, diarrhea (15.5%) and vomiting (32.2%) were the least correct answers (n=93, n=193 respectively). Most of the preventative measures were reported accurately by the participants. Despite this, only 15.5% students (n=93) reported the use of a facemask when suffering from fever, cough and a runny nose. Conclusion There is a dire need for the routine integration of the awareness and management programs in the medical and dental schools. There exists a gap between the policy and practice, and it is high time we bridge the divide. The students should also be vaccinated annually for influenza A.
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Affiliation(s)
- Fariha Hasan
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Mohammad O Khan
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Mukarram Ali
- Department of Forensic Medicine and Toxicology, Dow University of Health Sciences (DUHS), Karachi, Pakistan
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20
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Guo C, Zhong LL, Yi HL, Chen M. [Clinical value of fluorescence lateral flow immunoassay in diagnosis of influenza A in children]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18:1272-1276. [PMID: 27974121 PMCID: PMC7403077 DOI: 10.7499/j.issn.1008-8830.2016.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the clinical value of a new type of fluorescence lateral flow immunoassay in rapid detection of influenza A virus. METHODS A total of 378 samples of nasopharyngeal secretions were collected from 378 children with influenza-like symptoms to detect the influenza A virus by fluorescence lateral flow immunoassay, colloidal gold immunoassay, and RT-PCR between July 2015 and August 2015. RESULTS Of the 378 samples, 81 (21.4%) were positive for influenza A virus by RT-PCR. Compared with RT-PCR, the sensitivities of fluorescence lateral flow immunoassay and colloidal gold immunoassay were 90.1% (73/81) and 75.3% (61/81), respectively, and the specificities were 99.3% (295/297) and 98.3% (292/297), respectively. The average threshold cycle (Ct) value for the positive samples detected by the fluorescence lateral flow immunoassay (30.6) was higher than that for the positive samples detected by the colloidal gold immunoassay (28.7). CONCLUSIONS Compared with colloidal gold immunoassay, fluorescence lateral flow immunoassay has higher sensitivity, specificity, and concordance rate with RT-PCR, suggesting that it can be used for early screening and diagnosis of influenza A.
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Affiliation(s)
- Chun Guo
- Children's Medical Center of Hunan People's Hospital, Changsha 410005, China.
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21
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Zhou GF, Wang HM, Zhang RM, Deng JK. [Influencing factors for duration of viral nucleic acid shedding in children with influenza A]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18:1269-1271. [PMID: 27974120 PMCID: PMC7403092 DOI: 10.7499/j.issn.1008-8830.2016.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the features and duration of viral nucleic acid shedding in children with influenza A. METHODS The clinical data of 90 children with influenza A with positive influenza A virus nucleic acid in nasopharyngeal swab detected by PCR were collected, and these children were divided into simple influenza A group (n=10), influenza A-pneumonia group (n=61), influenza A-nervous system damage group (n=10), and influenza A-underlying disease group (n=9). A retrospective analysis was performed for clinical features, treatment process, duration of viral nucleic acid shedding, and prognosis. RESULTS The most common symptoms in these children were fever (89/90, 99%), cough (89/90, 99%), running nose (69/90, 77%), shortness of breath (26/90, 29%), and myalgia (23/90, 26%). The mean duration of viral nucleic acid shedding in 90 children was 9.4±2.9 days. The simple influenza A group had a significantly shorter duration of viral nucleic acid shedding than the influenza A-pneumonia, influenza A-nervous system damage, and influenza A-underlying disease groups (p<0.05), while there were no significant differences between the influenza A-pneumonia, influenza A-nervous system damage, and influenza A-underlying disease groups (p>0.05). The children who received antiviral therapy within 48 hours after disease onset had significantly shorter duration of viral nucleic acid shedding and time to body temperature recovery than those who received antiviral therapy more than 48 hours after disease onset (p<0.05). Of all the children with body temperature recovery, 83% still tested positive for viral nucleic acid. CONCLUSIONS Complications, underlying diseases, and timing of antiviral therapy are influencing factors for the duration of influenza A virus nucleic acid shedding, and whether body temperature returns to normal cannot be used to decide whether to continue antiviral therapy.
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Affiliation(s)
- Gao-Feng Zhou
- Department of Infectious Disease, Shenzhen Children's Hospital, Shenzhen, Guangdong 518038, China.
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22
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Kang HM, Lee EK, Song BM, Jeong J, Choi JG, Jeong J, Moon OK, Yoon H, Cho Y, Kang YM, Lee HS, Lee YJ. Novel reassortant influenza A(H5N8) viruses among inoculated domestic and wild ducks, South Korea, 2014. Emerg Infect Dis 2015; 21:298-304. [PMID: 25625281 PMCID: PMC4313655 DOI: 10.3201/eid2102.141268] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An outbreak of highly pathogenic avian influenza, caused by a novel reassortant influenza A (H5N8) virus, occurred among poultry and wild birds in South Korea in 2014. The aim of this study was to evaluate the pathogenesis in and mode of transmission of this virus among domestic and wild ducks. Three of the viruses had similar pathogenicity among infected domestic ducks: the H5N8 viruses were moderately pathogenic (0%-20% mortality rate); in wild mallard ducks, the H5N8 and H5N1 viruses did not cause severe illness or death; viral replication and shedding were greater in H5N8-infected mallards than in H5N1-infected mallards. Identification of H5N8 viruses in birds exposed to infected domestic ducks and mallards indicated that the viruses could spread by contact. We propose active surveillance to support prevention of the spread of this virus among wild birds and poultry, especially domestic ducks.
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Abstract
Pulmonary infections by viruses may result in serious diseases of public health importance. The problems of the infections are exacerbated by rapid transmission of the pathogenic agents, which occur through inhalation and direct contact with contaminated surfaces. Moreover, cross-species transmission resulting from changes to viral genetic makeup poses a risk for emergence of pathogens with new characteristics, which in some cases may be responsible for causing different diseases. With the advent of efficient sequencing and nucleic acid-based virus-disabling technologies, gene therapy is well placed to advance new treatments to counter respiratory infections. Most studies aimed at using nucleic acids to treat respiratory viral infections have used RNA interference (RNAi) to silence viral gene targets. A few studies have used silencing of host factors required by the viruses as a means of inhibiting viral replication and preventing emergence of escape mutants. By administering antivirals to the airways, studies performed in vivo have taken advantage of the anatomy of the respiratory system to deliver therapeutic nucleic acids. Reported data have shown proof of principle of efficacy of gene therapy in models of respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus, influenza virus A, and measles virus, among others. RNAi-based gene therapy has been advanced to clinical trial for treatment of RSV infection. Although the primary endpoint was not met in an intent-to-treat analysis, the investigation has provided useful information for the advancement of gene therapy for current and emergent respiratory infections.
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24
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Jiménez-García R, Hernández-Barrera V, Rodríguez-Rieiro C, Lopez de Andres A, de Miguel-Diez J, Jimenez-Trujillo I, Gil de Miguel A, Carrasco-Garrido P. Hospitalizations from pandemic Influenza [A(H1N1)pdm09] infections among type 1 and 2 diabetes patients in Spain. Influenza Other Respir Viruses 2013; 7:439-47. [PMID: 22883309 PMCID: PMC5779831 DOI: 10.1111/j.1750-2659.2012.00419.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To describe and analyze the clinical characteristics and outcomes for all patients with diabetes who were hospitalized with laboratory-confirmed A(H1N1)pdm09 infections in Spain during 2009. METHODS Observational retrospective study using data collected by the Spanish National Hospital Discharge Database. We selected all admissions with diagnosis ICD-9-CM code 488·1 [A(H1N1)pdm09]. Discharges were grouped as follows: no diabetes, Type1 and Type 2 diabetes. Underlying medical conditions and risk factors included all those that constitute an indication for annual influenza vaccination, pregnancy, and obesity. The outcome variables analyzed were in-hospital case fatality risk, length of hospital stay, and costs. RESULTS The total number of persons hospitalized with A(H1N1)pdm09 was 11,499. Of those, 97 suffered Type 1 and 936 Type 2, giving an overall prevalence of diabetes of 9%. The most common underlying medical condition among Type 2 subjects was obesity (26·8%), and for Type 1 renal disease (10·3%). In-hospital mortality was 2·1% among Type 1 patients, 3·8% among Type 2 patients, and 2·3% among non-diabetics; after multivariate analysis, diabetes was not a factor independently associated with dying during hospitalization for A(H1N1)pdm09. Independent factors increasing the risk of death among diabetic patients included age (OR 1·03; 95% CI1·01-1·05), hematological disorders (OR 3·49; 95% CI, 1·46-8·37), and obesity (OR 1·88; 95% CI1·07-3·92). CONCLUSIONS Among individuals hospitalized in Spain with A(H1N1)pdm09 infections, the age-specific prevalence of diabetes was higher than the general population in most age groups. The results of multivariate analysis suggest that possibly concomitant conditions such as obesity increase the risk of dying from the infection, but not diabetes itself.
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MESH Headings
- Adolescent
- Adult
- Aged
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/mortality
- Diabetes Mellitus, Type 1/virology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/mortality
- Diabetes Mellitus, Type 2/virology
- Female
- Hospitalization/statistics & numerical data
- Humans
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza A Virus, H1N1 Subtype/physiology
- Influenza, Human/complications
- Influenza, Human/epidemiology
- Influenza, Human/mortality
- Influenza, Human/virology
- Length of Stay
- Male
- Middle Aged
- Pandemics
- Retrospective Studies
- Risk Factors
- Spain/epidemiology
- Young Adult
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SAYERS G, IGOE D, CARR M, COSGRAVE M, DUFFY M, CROWLEY B, O'HERLIHY B. High morbidity and mortality associated with an outbreak of influenza A(H3N2) in a psycho-geriatric facility. Epidemiol Infect 2013; 141:357-65. [PMID: 22672856 PMCID: PMC9167657 DOI: 10.1017/s0950268812000659] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 03/13/2012] [Accepted: 03/21/2012] [Indexed: 11/06/2022] Open
Abstract
In spring 2008, an influenza A subtype H3N2 outbreak occurred in a long stay psycho-geriatric ward and two wards in the intellectual disability services (IDS), part of a large psychiatric hospital. The attack rate in the index ward was 90% (18/20) for patients and 35% (7/20) for staff. It was 14% (1/7) and 17% (2/12) in the affected IDS wards for patients and 0% (0/20) and 4% (1/25) for staff. Many of the laboratory-confirmed cases did not have a fever >38 °C, a typical sign of influenza. Control measures included oseltamivir treatment for cases and prophylaxis for contacts, standard and droplet infection control precautions, active surveillance for early detection and isolation of potential cases. As a result, the outbreak did not spread throughout the hospital. Although the staff vaccination rate (10%) prior to the outbreak was low, we observed a much lower vaccine effectiveness rate in the patients (11%) than in the staff (100%) in the index ward. Vaccination of residents and staff of such facilities remains the key influenza prevention strategy.
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Affiliation(s)
- G. SAYERS
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - D. IGOE
- Health Protection Surveillance Centre, Dublin, Ireland
| | - M. CARR
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - M. COSGRAVE
- North Dublin Mental Health Service, Health Service Executive, North Dublin, Ireland
| | - M. DUFFY
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - B. CROWLEY
- St James's Hospital, Dublin 8 and National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - B. O'HERLIHY
- Department of Public Health, Health Service Executive, Dublin, Ireland
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Chichester JA, Jones RM, Green BJ, Stow M, Miao F, Moonsammy G, Streatfield SJ, Yusibov V. Safety and immunogenicity of a plant-produced recombinant hemagglutinin-based influenza vaccine (HAI-05) derived from A/Indonesia/05/2005 (H5N1) influenza virus: a phase 1 randomized, double-blind, placebo-controlled, dose-escalation study in healthy adults. Viruses 2012; 4:3227-44. [PMID: 23202523 PMCID: PMC3509691 DOI: 10.3390/v4113227] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/15/2012] [Accepted: 11/16/2012] [Indexed: 01/23/2023] Open
Abstract
Recently, we have reported [1,2] on a subunit influenza vaccine candidate based on the recombinant hemagglutinin protein from the A/Indonesia/05/2005 (H5N1) strain of influenza virus, produced it using 'launch vector'-based transient expression technology in Nicotiana benthamiana, and demonstrated its immunogenicity in pre-clinical studies. Here, we present the results of a first-in-human, Phase 1 randomized, double-blind, placebo-controlled study designed to investigate safety, reactogenicity and immunogenicity of three escalating dose levels of this vaccine, HAI-05, (15, 45 and 90 µg) adjuvanted with Alhydrogel® (0.75 mg aluminum per dose) and the 90 µg dose level without Alhydrogel®. Vaccine was administered intramuscularly in two injections three weeks apart to healthy adults of 18-49 years of age. At all dose levels the vaccine was generally safe and well tolerated, with no reported serious adverse events or dose-limiting toxicities. Mild local and systemic reactions were observed in all vaccine dose groups and the placebo group and their occurrence was not dose related. The incidence rates were higher in the groups receiving vaccine with Alhydrogel®. The immune response elicited by the HAI-05 vaccine was variable with respect to both hemagglutination-inhibition and virus microneutralization antibody titers, with the highest responses observed in the 90 µg unadjuvanted group.
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Mukherjee TR, Agrawal AS, Chakrabarti S, Chawla-Sarkar M. Full genomic analysis of an influenza A (H1N2) virus identified during 2009 pandemic in Eastern India: evidence of reassortment event between co-circulating A(H1N1)pdm09 and A/Brisbane/10/2007-like H3N2 strains. Virol J 2012; 9:233. [PMID: 23057530 PMCID: PMC3576275 DOI: 10.1186/1743-422x-9-233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 09/27/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND During the pandemic [Influenza A(H1N1)pdm09] period in 2009-2010, an influenza A (Inf-A) virus with H1N2 subtype (designated as A/Eastern India/N-1289/2009) was detected from a 25 years old male from Mizoram (North-eastern India). OBJECTIVE To characterize full genome of the H1N2 influenza virus. METHODS For initial detection of Influenza viruses, amplification of matrix protein (M) gene of Inf-A and B viruses was carried out by real time RT-PCR. Influenza A positive viruses are then further subtyped with HA and NA gene specific primers. Sequencing and the phylogenetic analysis was performed for the H1N2 strain to understand its origin. RESULTS The outcome of this full genome study revealed a unique reassortment event where the N-1289 virus acquired it's HA gene from a 2009 pandemic H1N1 virus with swine origin and the other genes from H3N2-like viruses of human origin. CONCLUSIONS This study provides information on possibility of occurrence of reassortment events during influenza season when infectivity is high and two different subtypes of Inf-A viruses co-circulate in same geographical location.
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Affiliation(s)
| | - Anurodh S Agrawal
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Sekhar Chakrabarti
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
| | - Mamta Chawla-Sarkar
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, India
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Choudhry A, Singh S, Khare S, Rai A, Rawat D, Aggarwal R, Chauhan L. Emergence of pandemic 2009 influenza A H1N1, India. Indian J Med Res 2012; 135:534-7. [PMID: 22664503 PMCID: PMC3385239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND & OBJECTIVES Pandemic H1N1 caused deluge of cases from 74 countries and prompted World Health Organization to raise warning to phase 6. The present study was conducted on throat and nasal swab samples received and tested at National Centre for Disease Control, Delhi, India during 2009-2010 to collect epidemiological and clinical information on positive cases. METHODS Throat and nasopharyngeal swabs from category C influenza A H1N1 patients during May 2009-September 2010 along with their clinico-epidemiological details were collected from identified hospitals from Delhi and other States. Samples were tested by Real time reverse transcriptase PCR using primers and probes developed at CDC, Atlanta for four influenza target genes. RESULTS A total of 33,751 samples, both throat and nasal swab samples from each patient were tested for H1N1 influenza virus, of which, 7943 (23.5%) were positive for pandemic influenza A H1N1 and 3759 (11.1%) were positive for influenza A (seasonal flu). Maximum number of positive cases (N=2792, 35.1%) were from 20-39 yr age group, comprising 1790 (22.5%) males and 1182 (14.8%) females. Only 2620 (33%) positive cases were close contact of influenza A H1N1 positive patient. Majority cases presented (N=2792, 35.1%) with fever 7005 (88.1%), followed by 6133 cases (77.2%) exhibiting fever and cough, 377 (4.7%) complained of fever, cough, nasal catarrh and 362 (4.5%) cases had fever with shortness of breath. INTERPRETATION & CONCLUSIONS The study showed a peak of cases of pandemic influenza A H1N1 in December 2009 and indicated predominance of H1N1 positive cases among 20-39 yr age group and among males compared to females.
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Affiliation(s)
- Archana Choudhry
- Disease Outbreak Monitoring Cell, National Centre for Disease Control (NCDC), Delhi, India,Division of Microbiology, National Centre for Disease Control (NCDC), Delhi, India,Integrated Disease Surveillance Project, National Centre for Disease Control (NCDC), Delhi, India
| | - Supriya Singh
- Division of Microbiology, National Centre for Disease Control (NCDC), Delhi, India,Division of Biochemistry & Biotechnology, National Centre for Disease Control (NCDC), Delhi, India
| | - Shashi Khare
- Disease Outbreak Monitoring Cell, National Centre for Disease Control (NCDC), Delhi, India,Division of Microbiology, National Centre for Disease Control (NCDC), Delhi, India,Integrated Disease Surveillance Project, National Centre for Disease Control (NCDC), Delhi, India,Reprint requests: Dr Shashi Khare, Additional Director & Head, Division of Microbiology, National Centre for Disease Control (NCDC), 22 Sham Nath Marg, Delhi 110 054, India e-mail:
| | - Arvind Rai
- Division of Biochemistry & Biotechnology, National Centre for Disease Control (NCDC), Delhi, India
| | - D.S. Rawat
- Division of Biochemistry & Biotechnology, National Centre for Disease Control (NCDC), Delhi, India
| | - R.K. Aggarwal
- Division of Microbiology, National Centre for Disease Control (NCDC), Delhi, India
| | - L.S. Chauhan
- Disease Outbreak Monitoring Cell, National Centre for Disease Control (NCDC), Delhi, India,Division of Microbiology, National Centre for Disease Control (NCDC), Delhi, India,Division of Biochemistry & Biotechnology, National Centre for Disease Control (NCDC), Delhi, India,Integrated Disease Surveillance Project, National Centre for Disease Control (NCDC), Delhi, India
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Chudasama RK, Patel UV, Verma PB, Agarwal P, Bhalodiya S, Dholakiya D. Clinical and epidemiological characteristics of 2009 pandemic influenza A in hospitalized pediatric patients of the Saurashtra region, India. World J Pediatr 2012; 8:321-7. [PMID: 23151859 PMCID: PMC7102189 DOI: 10.1007/s12519-012-0376-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 09/28/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND The first case of 2009 pandemic influenza A or H1N1 virus infection in India was reported in May 2009 and in the Saurashtra region in August 2009. We describe the two waves clinicoepidemiological characteristics of children who were hospitalized with 2009 influenza A infection in the Saurashtra region. METHODS From September 2009 to February 2011, we treated 117 children infected with 2009 influenza A virus who were admitted in different hospitals in Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test was used to confirm infection, and the clinico-epidemiological features of the disease were closely monitored. RESULTS In the 117 patients, with a median age of 2 years, 59.8% were male. The median time from onset of the disease to influenza A diagnosis was 5 days, and that from onset of the disease to hospitalization was 7 days. The admitted patients took oseltamivir, but only 11.1% of them took it within 2 days after onset of the disease. More than one fourth (29.1%) of the admitted patients died. The most common symptoms of the patients were cough (98.3%), fever (94.0%), sore throat and shortness of breathing. Pneumonia was detected by chest radiography in 80.2% of the patients. CONCLUSIONS In children with infection-related illness, the survival rate was about 71% after oseltamivir treatment. The median time for virus detection with real-time RT-PCR is 5 days. Early diagnosis and treatment may reduce the severity of the disease.
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Affiliation(s)
- Rajesh K Chudasama
- Department of Community Medicine, M P Shah Medical College, Jamnagar, Gujarat, India.
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Surana P, Tang S, McDougall M, Tong CYW, Menson E, Lim M. Neurological complications of pandemic influenza A H1N1 2009 infection: European case series and review. Eur J Pediatr 2011; 170:1007-15. [PMID: 21234600 PMCID: PMC7086688 DOI: 10.1007/s00431-010-1392-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 12/31/2010] [Indexed: 11/14/2022]
Abstract
Neurological manifestations and outcomes of children with the 2009 H1N1 virus infection have been reported in three American series and from smaller cohorts and case reports worldwide. Of the 83 children admitted between April 2009 and March 2010 with H1N1 virus infection to a tertiary children's hospital in a European setting, five children aged between 2 and 10 years had neurological symptoms. Four patients had seizures and encephalopathy at presentation. One patient presented with ataxia; one developed neuropsychiatric manifestations, and two developed movement disorders during the disease course. Early neuroimaging showed evidence of acute necrotising encephalopathy (ANE) in one case and non-specific white matter changes in another. Initial neuroimaging was normal for the other three, but interval MRI showed increased signal in bilateral periventricular distribution in one and significant cerebral volume loss in the other. Clinical outcomes varied: two recovered fully while three had residual seizures and/or significant cognitive deficits. Conclusion An analysis of our patients along with all reported cases reveal that seizures and encephalopathy were common neurological presentations associated with pandemic 2009 H1N1 influenza virus infection in children requiring hospital admission. Neuroimaging suggestive of ANE, basal ganglia involvement and volume loss appears to be associated with worse neurological outcome.
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Affiliation(s)
- Pinki Surana
- grid.425213.3Department of Paediatric Neurology, Evelina Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Shan Tang
- grid.425213.3Department of Paediatric Neurology, Evelina Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | | | - Cheuk Yan William Tong
- grid.451052.70000000405812008Directorate of Infection, Guys and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Esse Menson
- Department of Paediatrics, Evelina Children’s Hospital, London, UK
| | - Ming Lim
- grid.425213.3Department of Paediatric Neurology, Evelina Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
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Hong DK, Tremoulet AH, Burns JC, Lewis DB. Cross-reactive neutralizing antibody against pandemic 2009 H1N1 influenza a virus in intravenous immunoglobulin preparations. Pediatr Infect Dis J 2011; 30:67-9. [PMID: 20724956 DOI: 10.1097/INF.0b013e3181f127be] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prepandemic intravenous immunoglobulin (IVIG) and sera from Kawasaki disease patients treated with this IVIG were analyzed for 2009 H1N1-specific microneutralization and hemagglutination inhibition antibodies. All 6 different IVIG preparations tested had significant levels of cross-reactive-specific antibody at a concentration of 2.0 g/dL of immunoglobulin. Sera from 18 of 19 Kawasaki disease patients had significant increases of cross-reactive-specific antibody after 2.0 g/kg of prepandemic IVIG. These results suggest a role for adjunctive IVIG therapy for severe and/or drug-resistant 2009 H1N1 virus and other highly antigenically drifted influenza strains, particularly in the immunocompromised.
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Hon KL, Cheung KL, Wong W, Ng PC. Neonates investigated for influenza-like illness during the outbreak of pandemic H1N1 2009: trivial infections but major triage implications. Indian J Pediatr 2010; 77:1033-5. [PMID: 20814838 DOI: 10.1007/s12098-010-0152-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 07/09/2010] [Indexed: 11/26/2022]
Abstract
We report eight cases of neonates (from birth to 25 days) admitted to the neonatal service of a teaching hospital with influenza-like illness during the outbreak of pandemic H1N1 2009, and discuss their management and infection control issues. Empirical antibiotics were often promptly initiated and timely stopped when sepsis was ruled out. Also, there was no pandemic H1N1-09 but influenza A (H3N2, n = 1), parainfluenza (type 3, n = 3) and respiratory syncytial virus (n = 1) have been isolated. The infants recovered spontaneously without any antiviral therapy. There was no outbreak of the respiratory infections in the neonatal service during the admissions. Respiratory viral infections can occur in neonates although the clinical course may be milder and nonspecific. Emergency room and frontline staff must be vigilant of the non-specific clinical features of infections with respiratory viruses in the neonates so that prompt triage and isolation can be implemented to avoid outbreaks in the neonatal service.
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Abstract
The characteristics of pandemic influenza 2009 differ from those of seasonal influenza. In Australia-New Zealand the number of admissions to the intensive care unit (ICU) increased by 15-fold in the southern winter. We compared the characteristics of the Spanish series of the first ICU admissions in July with those of series published in Canada and Australia-New Zealand up to October 2009. Unlike the situation in Spain, only half the admissions in Canada and Australia-New Zealand were due to primary viral pneumonia but bacterial pneumonia was much more frequent. In all series, young people, many of whom had no comorbidities, were the most frequently affected population. The most common comorbidities were obesity, chronic pulmonary disease, pregnancy and heart disease. Diagnosis through reverse-transcriptase polymerase chain reaction can have a false-negative rate of 10%. Shock and acute renal insufficiency were more frequent in the Spanish series. A total of 10-30% of patients required ICU admission and 6 of 10 patients required mechanical ventilation with a high frequency of failure of non-invasive ventilation (75%). Mortality was similar among the series (14-25%) but was higher in patients requiring mechanical ventilation (30%). Early oseltamivir administration (< 48h after symptom onset) has been associated with better outcome. Therefore, early administration of this drug in patients with risk factors or those who, although free from risk factors, show clinical progression, could reduce ICU admissions and mortality.
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Affiliation(s)
- Alejandro Rodríguez
- Servicio de Medicina Intensiva, IISPV, CIBER Enfermedades Respiratorias, Hospital Universitario Joan XXIII, Tarragona, España
| | - Thiago Lisboa
- Servicio de Medicina Intensiva, IISPV, CIBER Enfermedades Respiratorias, Hospital Universitario Joan XXIII, Tarragona, España
- Servicio de Medicina Intensiva, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Jordi Rello
- Unidad de Cuidados Intensivos, Hospital Vall d’Hebron, Barcelona, España
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Abstract
Over the past few years, prompted by pandemic preparedness initiatives, the debate over the modes of transmission of influenza has been rekindled and several reviews have appeared. Arguments supporting an important role for aerosol transmission that were reviewed included prolonged survival of the virus in aerosol suspensions, demonstration of the low infectious dose required for aerosol transmission in human volunteers, and clinical and epidemiological observations were disentanglements of large droplets and aerosol transmission was possible. Since these reviews were published, several new studies have been done and generated new data. These include direct demonstration of the presence of influenza viruses in aerosolized droplets from the tidal breathing of infected persons and in the air of an emergency department; the establishment of the guinea pig model for influenza transmission, where it was shown that aerosol transmission is important and probably modulated by temperature and humidity; the demonstration of some genetic determinants of airborne transmission of influenza viruses as assessed using the ferret model; and mathematical modelling studies that strongly support the aerosol route. These recent results and their implication for infection control of influenza are discussed in this review.
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Affiliation(s)
- Raymond Tellier
- Provincial Laboratory for Public Health of Alberta, Calgary, Canada.
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35
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Chen H, Smith GJD, Li KS, Wang J, Fan XH, Rayner JM, Vijaykrishna D, Zhang JX, Zhang LJ, Guo CT, Cheung CL, Xu KM, Duan L, Huang K, Qin K, Leung YHC, Wu WL, Lu HR, Chen Y, Xia NS, Naipospos TSP, Yuen KY, Hassan SS, Bahri S, Nguyen TD, Webster RG, Peiris JSM, Guan Y. Establishment of multiple sublineages of H5N1 influenza virus in Asia: implications for pandemic control. Proc Natl Acad Sci U S A 2006; 103:2845-50. [PMID: 16473931 PMCID: PMC1413830 DOI: 10.1073/pnas.0511120103] [Citation(s) in RCA: 453] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Preparedness for a possible influenza pandemic caused by highly pathogenic avian influenza A subtype H5N1 has become a global priority. The spread of the virus to Europe and continued human infection in Southeast Asia have heightened pandemic concern. It remains unknown from where the pandemic strain may emerge; current attention is directed at Vietnam, Thailand, and, more recently, Indonesia and China. Here, we report that genetically and antigenically distinct sublineages of H5N1 virus have become established in poultry in different geographical regions of Southeast Asia, indicating the long-term endemicity of the virus, and the isolation of H5N1 virus from apparently healthy migratory birds in southern China. Our data show that H5N1 influenza virus, has continued to spread from its established source in southern China to other regions through transport of poultry and bird migration. The identification of regionally distinct sublineages contributes to the understanding of the mechanism for the perpetuation and spread of H5N1, providing information that is directly relevant to control of the source of infection in poultry. It points to the necessity of surveillance that is geographically broader than previously supposed and that includes H5N1 viruses of greater genetic and antigenic diversity.
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Affiliation(s)
- H. Chen
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - G. J. D. Smith
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - K. S. Li
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
| | - J. Wang
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
| | - X. H. Fan
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - J. M. Rayner
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - D. Vijaykrishna
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - J. X. Zhang
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - L. J. Zhang
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - C. T. Guo
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - C. L. Cheung
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - K. M. Xu
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - L. Duan
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - K. Huang
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - K. Qin
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Y. H. C. Leung
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - W. L. Wu
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - H. R. Lu
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Y. Chen
- Research Center for Medical Molecular Virology of Fujian Province, Xiamen University, Xiamen, Fujian 361005, China
| | - N. S. Xia
- Research Center for Medical Molecular Virology of Fujian Province, Xiamen University, Xiamen, Fujian 361005, China
| | - T. S. P. Naipospos
- Ministry of Agriculture and Animal Health, Government of Indonesia, Pasar Minggu, Jakarta Selatan 12550, Indonesia
| | - K. Y. Yuen
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - S. S. Hassan
- Veterinary Research Institute, 31 400 Ipoh, Malaysia
| | - S. Bahri
- Ministry of Agriculture and Animal Health, Government of Indonesia, Pasar Minggu, Jakarta Selatan 12550, Indonesia
| | - T. D. Nguyen
- **National Institute of Veterinary Research, Dong Da, Hanoi, Vietnam; and
| | - R. G. Webster
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- **National Institute of Veterinary Research, Dong Da, Hanoi, Vietnam; and
- To whom correspondence may be addressed. E-mail:
or
| | - J. S. M. Peiris
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Y. Guan
- Joint Influenza Research Centre (Shantou University Medical College and Hong Kong University), Shantou University Medical College, Shantou, Guangdong 515031, China
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- To whom correspondence may be addressed. E-mail:
or
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Reed KD, Meece JK, Henkel JS, Shukla SK. Birds, migration and emerging zoonoses: west nile virus, lyme disease, influenza A and enteropathogens. Clin Med Res 2003; 1:5-12. [PMID: 15931279 PMCID: PMC1069015 DOI: 10.3121/cmr.1.1.5] [Citation(s) in RCA: 296] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2002] [Accepted: 10/07/2002] [Indexed: 11/18/2022]
Abstract
Wild birds are important to public health because they carry emerging zoonotic pathogens, either as a reservoir host or by dispersing infected arthropod vectors. In addition, bird migration provides a mechanism for the establishment of new endemic foci of disease at great distances from where an infection was acquired. Birds are central to the epidemiology of West Nile virus (WNV) because they are the main amplifying host of the virus in nature. The initial spread of WNV in the U.S. along the eastern seaboard coincided with a major bird migration corridor. The subsequent rapid movement of the virus inland could have been facilitated by the elliptical migration routes used by many songbirds. A number of bird species can be infected with Borrelia burgdorferi, the etiologic agent of Lyme disease, but most are not competent to transmit the infection to Ixodes ticks. The major role birds play in the geographic expansion of Lyme disease is as dispersers of B. burgdorferi-infected ticks. Aquatic waterfowl are asymptomatic carriers of essentially all hemagglutinin and neuraminidase combinations of influenza A virus. Avian influenza strains do not usually replicate well in humans, but they can undergo genetic reassortment with human strains that co-infect pigs. This can result in new strains with a marked increase in virulence for humans. Wild birds can acquire enteropathogens, such as Salmonella and Campylobacter spp., by feeding on raw sewage and garbage, and can spread these agents to humans directly or by contaminating commercial poultry operations. Conversely, wild birds can acquire drug-resistant enteropathogens from farms and spread these strains along migration routes. Birds contribute to the global spread of emerging infectious diseases in a manner analogous to humans traveling on aircraft. A better understanding of avian migration patterns and infectious diseases of birds would be useful in helping to predict future outbreaks of infections due to emerging zoonotic pathogens.
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Affiliation(s)
- Kurt D Reed
- Clinical Research Center, Marshfield Medical Research Foundation, Marshfield, Wisconsin 54449, USA.
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Abstract
The transmembrane domain of the M2 protein from influenza A virus forms a nearly uniform and ideal helix in a liquid crystalline bilayer environment. The exposure of the hydrophilic backbone structure is minimized through uniform hydrogen bond geometry imposed by the low dielectric lipid environment. A high-resolution structure of the monomer backbone and a detailed description of its orientation with respect to the bilayer were achieved using orientational restraints from solid-state NMR. With this unique information, the tetrameric structure of this H(+) channel is constrained substantially. Features of numerous published models are discussed in light of the experimental structure of the monomer and derived features of the tetrameric bundle.
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Affiliation(s)
- Junfeng Wang
- Institute of Molecular Biophysics, Florida State University, Tallahassee, Florida 32310, USA
- The National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - Sanguk Kim
- Institute of Molecular Biophysics, Florida State University, Tallahassee, Florida 32310, USA
- The National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - Frank Kovacs
- Institute of Molecular Biophysics, Florida State University, Tallahassee, Florida 32310, USA
- The National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - Timothy A. Cross
- Department of Chemistry, Florida State University, Tallahassee, Florida 32310, USA
- Institute of Molecular Biophysics, Florida State University, Tallahassee, Florida 32310, USA
- The National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
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Lan RS, Stewart GA, Henry PJ. Modulation of airway smooth muscle tone by protease activated receptor-1,-2,-3 and -4 in trachea isolated from influenza A virus-infected mice. Br J Pharmacol 2000; 129:63-70. [PMID: 10694203 PMCID: PMC1621127 DOI: 10.1038/sj.bjp.0703007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Relaxant and contractile effects of the tethered ligand domain sequences of murine PAR-1, PAR-2, PAR-3 and PAR-4, and of the proteases thrombin and trypsin were examined in mouse isolated tracheal preparations. The epithelium- and cyclo-oxygenase-dependence of these effects and the potential modulatory effects of respiratory tract viral infection were also investigated. In carbachol-contracted preparations, trypsin, thrombin, and the tethered ligand domain sequences of murine PAR-1 (SFFLRN-NH(2)), PAR-2 (SLIGRL-NH(2)) and PAR-4 (GYPGKF-NH(2)), but not PAR-3 (SFNGGP-NH(2)), induced transient, relaxant responses that were abolished by the cyclo-oxygenase inhibitor indomethacin. Repeated administration of SFFLRN-NH(2), SLIGRL-NH(2) or GYPGKF-NH(2) (30 microM) was associated with markedly diminished relaxation responses (homologous desensitization), although there was no evidence of cross-desensitization between these peptides. The tethered ligand domain sequences for PAR-1 and PAR-4 induced a rapid, transient contractile response that preceded the relaxant response. Contractions were not inhibited by indomethacin and were not induced by either thrombin or trypsin. Influenza A virus infection did not significantly affect the responses induced by either the proteases or peptides. Furthermore, epithelial disruption caused by mechanical rubbing had no significant effect on responses to these PAR activators in preparations from either virus- or sham-infected mice. In summary, the proteases trypsin and thrombin, and peptide activators of PAR-1, PAR-2 and PAR-4 induced relaxant responses of mouse isolated tracheal smooth muscle preparations, which were mediated by a prostanoid, probably PGE(2). Interestingly, PAR-mediated relaxations were not significantly diminished following acute damage to the epithelium caused by mechanical rubbing and/or the respiratory tract viral pathogen, influenza A. British Journal of Pharmacology (2000) 129, 63 - 70.
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Affiliation(s)
- Rommel S Lan
- Department of Pharmacology, University of Western Australia, Nedlands, Western Australia, 6907 Australia
| | - Geoff A Stewart
- Department of Microbiology, University of Western Australia, Nedlands, Western Australia, 6907 Australia
| | - Peter J Henry
- Department of Pharmacology, University of Western Australia, Nedlands, Western Australia, 6907 Australia
- Author for correspondence:
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Karupiah G, Chen JH, Mahalingam S, Nathan CF, MacMicking JD. Rapid interferon gamma-dependent clearance of influenza A virus and protection from consolidating pneumonitis in nitric oxide synthase 2-deficient mice. J Exp Med 1998; 188:1541-6. [PMID: 9782132 PMCID: PMC2213404 DOI: 10.1084/jem.188.8.1541] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Viral infection often activates the interferon (IFN)-gamma-inducible gene, nitric oxide synthase 2 (NOS2). Expression of NOS2 can limit viral growth but may also suppress the immune system and damage tissue. This study assessed each of these effects in genetically deficient NOS2(-/-) mice after infection with influenza A, a virus against which IFN-gamma has no known activity. At inocula sufficient to cause consolidating pneumonitis and death in wild-type control mice, NOS2(-/-) hosts survived with little histopathologic evidence of pneumonitis. Moreover, they cleared influenza A virus from their lungs by an IFN-gamma-dependent mechanism that was not evident in wild-type mice. Even when the IFN-gamma-mediated antiviral activity was blocked in NOS2(-/-) mice with anti-IFN-gamma mAb, such mice failed to succumb to disease. Further evidence that this protection was independent of viral load was provided by treating NOS2(+/+) mice with the NOS inhibitor, Nomega-methyl-L-arginine (L-NMA). L-NMA prevented mortality without affecting viral growth. Thus, host NOS2 seems to contribute more significantly to the development of influenza pneumonitis in mice than the cytopathic effects of viral replication. Although NOS2 mediates some antiviral effects of IFN-gamma, during influenza infection it can suppress another IFN-gamma-dependent antiviral mechanism. This mechanism was observed only in the complete absence of NOS2 activity and appeared sufficient to control influenza A virus growth in the absence of changes in cytotoxic T lymphocyte activity.
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Affiliation(s)
- G Karupiah
- Host Defense Laboratory, Viral Engineering and Cytokines Group, Division of Immunology and Cell Biology, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT 2601, Australia.
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