Acute Respiratory Tract Research Articles

Correlation between the Number of Leucocytes and Neutrophil to Lymphocytes Count Ratio in Children with Pneumonia at RSUD Koja Jakarta

Pneumonia is an acute lower respiratory tract infection that affects the lungs. This disease is one of infant and toddlers' biggest causes of death. Immature immunity, poor air quality, poor sanitation and nutrition, and incomplete immunization make children vulnerable to this disease. This study used an analytic observational method with a cross-sectional research design. The research subjects used as many as 30 respondents with pneumonia in children with an age range of 1 year -17 years who were in the pediatric ward at Koja Hospital. The study was conducted at the Koja Hospital laboratory from February to June 2022. The sample in this study was the result of a complete blood count, namely the examination of the leukocyte count and the value of the neutrophil-lymphocyte ratio in pediatric patients with pneumonia. The data was collected by performing a complete blood count using the Sysmex XN 1000 Hematology Analyzer. Data analysis in this study used the Pearson product-moment correlation test with a 95% confidence level. Using the Statistical product and service solution version 23 program. The results showed a significance value (p) of 0.05 > 0.03. This study concludes that there is a correlation between the number of leukocytes and the value of the neutrophil-lymphocyte ratio in pediatric patients with pneumonia at Koja Hospital, Jakarta.

A Pilot Study on Aetiology of Acute Lower Respiratory Tract Infections Among Children Hospitalized of Respiratory Illness at a Rural Hospital in South Coastal Karnataka

Objective: Aetiological diagnosis can significantly impact the clinical management and outcome of acute lower respiratory tract infections (LRTI) in children. There is a paucity of data on etiological agents of acute LRTI among children in Karnataka, especially in Udupi district. Present study provides an insight into the pathogens associated with acute LRTI among children in Udupi district of south coastal Karnataka. Methods: A cross sectional study was performed at a rural hospital in south coastal Karnataka, A total of 50 children clinically diagnosed for acute LRTI and admitted in paediatric ward were enrolled for the study. Nasopharyngeal/throat swab specimens were collected, and nucleic acid was extracted, and Multiplex real-time PCR was performed for detection of bacterial and viral aetiology. Results: S. pneumoniae was detected in 16% (8/50), followed by ‎ Respiratory syncytial virus (RSV) 14% (7/50), H. influenzae 8 % (4/50) and M. pneumoniae 2% (1/50). Mixed infection was detected in 28% (14/50) of children. S. pneumoniae and H. influenzae was the most prevalent co-infection and was detected in 10% (5/50) followed by H. Influenzae and RSV (4%, 2/50) co-infection. Conclusion: S. pneumoniae and RSV were the most predominant bacterial and viral pathogens respectively associated with LRTIs among paediatric population in present study. Further we found very high number of cases with mixed infections which signifies the urgent need of much elaborate studies for elucidating the clinical significance of these infections as well as for better understanding of epidemiology of LRTI among children in this region.

Molecular epidemiological surveillance of viral agents of acute lower respiratory tract infections in children in Accra, Ghana

BackgroundAcute lower respiratory tract infection (ALRTI) in children under 5 years is known to be predominantly caused by respiratory syncytial virus (RSV). In recent times, however, human metapneumovirus (HMPV) has also been implicated. This study sought to investigate and genotype respiratory syncytial virus and human metapneumovirus in children presenting with ALRTIs infection at the Princess Marie Louis Children’s Hospital in Accra, Ghana.MethodsChildren below 5 years who were clinically diagnosed of ALRTI and on admission at the study site were recruited between September 2015 and November 2016 for this study. Demographic data information was obtained by means of a standardized questionnaire; and relevant clinical information was obtained from medical records. Nasopharyngeal swabs were collected from 176 children recruited for the study. Ribonucleic acid was extracted from swabs and cDNA syntheses were performed by RT-PCR. RSV-positive amplicons were sequenced and analyzed for genotype assignment.ResultsRSV and HMPV prevalence among the sampled subjects were 11.4 and 1.7% respectively. Of the RSV positives, 8/20 (40%) were RSV-A and 12/20 (60%) were RSV-B. The highest prevalence was observed in children less than 12 months old. Phylogenetic analysis of the second hypervariable region of the RSV G-gene revealed that all RSV group A viruses belonged to the “novel” ON1 genotype containing the 72-nucleotide duplication; and RSV group B viruses belong to the BA IX genotype.ConclusionRSV is frequently detected in children aged under 5 years admitted with ALRTI in Ghana. Continued surveillance of viral aetiological agents is warranted to elucidate the prevalence and transmission patterns of viral pathogens that cause respiratory tract infections among children. This will help inform appropriate intervention approaches.

Acute lung and lower respiratory tract damage after inhalation exposure to hydrogen fluoride

Relevance. Hydrogen fluoride is a highly active chemical substance widely used in industry for production of inorganic fluorides, organofluorine compounds, in the processing of aluminum, stainless steel and alloys. The chemical properties of hydrogen fluoride determine its ability to have a destructive effect on the tissues of the human body and high toxicity with local and systemic exposure. Hydrogen fluoride poisoning is severe and difficult to treat. Clarification of the clinical picture and the search for new methods of treating lesions with hydrogen fluoride are of great importance for protecting the health of workers in chemical industries and eliminating the consequences of technogenic accidents.Intention. To consider the features of the observed clinical case of severe damage to the lungs and lower respiratory tract after inhalation exposure to hydrogen fluoride and treatment methods that made it possible to achieve favorable clinical results. Methodology. The article discusses clinically important chemical properties of hydrogen fluoride, the mechanisms and manifestations of characteristic lesions developing in the human body with various routes of exposure. Modern approaches to the treatment of patients exposed to hydrogen fluoride are outlined.Results and Discussion. Inhalation of gas mixtures, even with low concentrations of hydrogen fluoride, can lead to severe inflammatory-necrotic lung damage with interstitial pneumonia (chemical pneumonitis), adult respiratory distress syndrome, and severe respiratory failure. Improvement of clinical condition of the affected person in the observed case was achieved via complex treatment with glucocorticosteroids, antimicrobial agents, calcium gluconate inhalations. A key role in the patient’s treatment was played by long-term replacement of the impaired function of the lungs using extracorporeal membrane oxygenation.Conclusion. In severe forms of acute damage to the lungs and lower respiratory tract as a result of inhaled exposure to hydrogen fluoride, clinical recovery and improvement in the quality of life of the injured can be achieved through complex therapy using glucocorticosteroids, antibacterial agents, specific antidotes (calcium gluconate) and prolonged replacement of the respiratory function via artificial ventilation and extracorporeal membrane oxygenation.

Implications of Broad Spectrum Antibiotic Treatment in Children with Acute Upper Respiratory Tract infection. A Clinical Study

Aims and objectives: The aims and objectives of current study were to identify the proper spectrum of different broad spectrum antibiotics in children for acute upper respiratory infections. Methodology: Total 200 children patients with acute upper respiratory tract infections like acute sinusitis, acute bronchitis, pharyngitis, otitis media, laryngitis, and tracheitis were reported. Different antibiotics such as quinolones, amoxicillin, co-amoxiclav, azithromycin and clarithromycin were prescribed. Results: All individual reported their medical conditions and predominate symptoms were fever, cough, sore throat and wheezing. Broad spectrum antibiotics were prescribed to the all children patients regarding to their culture sensitivity test. These agents, Amoxicillin, Clamoxin, third generation Cephalosporin, Ciprofloxacin, Levofloxacin, Cefixime were given to all children according to their sensitivity spectrum. Conclusion: More incidences of acute upper respiratory infections with empyema being caused by bacteria have been documented. Microorganisms S. pneumonia and H. influenza were found in a large number of samples.

Determinants of pneumonia among children attending public health facilities in Worabe town

Childhood pneumonia is common in developing countries, with significant morbidity and mortality. Taking the significance of the problem and variability of risk factors into account, a study was needed to identify the potential determinants of pneumonia in under-five children. A facility-based unmatched case–control study was conducted among 435 children (145 cases and 290 controls) aged 2–59 months at public health facilities in Worabe town from December 28, 2016, to January 30, 2017. Data were collected using interviewer-administered questionnaire and analysed using SPSS version 22. Bivariable and multivariable binary logistic regression were used to determine association between dependant and independent variables. Among the factors assessed, stunting [AOR = 3.6,95% CI: 1.9–6.9], carrying the child on the back during cooking [AOR = 2.0,95% CI: 1.2–3.2], absence of chimney in the cooking room [AOR = 2.2, 95% CI: 1.3–3.7], having a history of asthma [AOR = 5.0,95% CI: 2–12], and a previous acute upper respiratory tract infection [AOR = 3.7,95% CI:2.3–6.1] were significantly associated with pneumonia.

Prevalence of viral pathogens in a sample of hospitalized Egyptian children with acute lower respiratory tract infections: a two-year prospective study

BackgroundViral pneumonias are a major cause of childhood mortality. Proper management needs early and accurate diagnosis. This study objective is to investigate the viral etiologies of pneumonia in children.ResultsThis prospective study enrolled 158 and 101 patients in the first and second year, respectively, and their mean age was 4.72 ± 2.89. Nasopharyngeal swabs were collected and subjected to virus diagnosis by reverse transcription polymerase chain reaction (RT-PCR). Viral etiologies of pneumonia were evidenced in 59.5% of the samples in the first year, all of them were affirmative for influenza A, 2 samples were affirmative for Human coronavirus NL63, and one for Human coronavirus HKU1. In the second year, 87% of patients had a viral illness. The most prevalent agents are human metapneumovirus which was detected in 44 patients (43.6%) followed by human rhinovirus in 35 patients (34.7%) and then parainfluenza–3 viruses in 33 patients (32.7%), while 14 patients had a confirmed diagnosis for both Pan coronavirus and Flu-B virus.ConclusionsViral infection is prevalent in the childhood period; however, the real magnitude of viral pneumonia in children is underestimated. The reverse transcriptase polymerase chain reaction has to be a vital tool for epidemiological research and is able to clear the gaps in-between clinical pictures and final diagnoses.

Quality of life, healthcare use and costs in ‘at-risk’ children after early antibiotic treatment versus placebo for influenza-like illness: within-trial descriptive economic analyses of the ARCHIE randomised controlled trial

ObjectivesTo characterise the quality of life, healthcare use and costs associated with early antibiotic treatment of influenza-like illness (ILI) in ‘at-risk’ children.DesignEconomic analysis of a two-arm double-blind parallel group pragmatic...

Burden of respiratory syncytial virus-associated lower respiratory infections in children in Spain from 2012 to 2018

BackgroundRespiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infection (ALRI) leading to infant hospitalization, morbidity and postnatal mortality in children younger than 5 years of age worldwide. The aim of this study was to collect data on hospitalizations for RSV-related ALRI in children in Spain from 2012 to 2018.MethodsWe used the discharge reports from the Minimum Basic Data Set (MBDS) to retrospectively analyze hospital discharge data in children ≤ 14 years of age with a diagnosis of acute lower respiratory tract infection, based on the ICD-9-CM and ICD-10-CM diagnosis codes, from 2012 to 2018.ResultsA total of 190,474 children, 58.1% boys and 41.9% girls, were admitted for lower respiratory tract infections in Spain, including 118,731 cases of bronchiolitis, 53,972 cases of bronchitis, 3710 cases of RSV-positive pneumonia, and 14,061 cases of RSV infections. Of these, 92,426 children (48.5%) had laboratory-confirmed RSV infection. The mean case fatality rate was almost 6 times higher for pneumonia (0.6%) than for bronchiolitis (0.1%) or bronchitis (0.1%). A significant linear increase in the mean annual hospitalization rate for pneumonia of almost 15% per year was found, with no changes in the trend over the study period.ConclusionsRSV-related respiratory infections remain a leading cause of infant hospitalization in Spain. Effective antiviral treatments and preventive vaccines are urgently needed for the management of RSV infection in children, especially for those aged 6 to 12 months.

The Relationship Between Viruses and Clinical Findings in Hospitalized Children Diagnosed with Acute Lower Respiratory Tract Infection

The Relationship Between Viruses and Clinical Findings in Hospitalized Children Diagnosed with Acute Lower Respiratory Tract Infection

MiR-146a alleviates lung injury caused by RSV infection in young rats by targeting TRAF-6 and regulating JNK/ERKMAPK signaling pathways

Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infection in infants and children. The present study aimed to investigate the effects of miR-146a on RSV replication and the related mechanisms. Material and methods: We pretreated A549 and HEp-2 cells and young rats with miR-146a mimic before infection with RSV. The expressions of miR-146a and RSV-F mRNA in cells and lung tissues were detected by RT-qPCR, and production of IL-1β, IL-6, IL-18, and TNF-α in bronchial alveolar lavage fluid (BALF) were determined by ELISA. The expression level of TRAF-6 and activation of the JNK/ERK/MAPK/NF-κB signaling pathway was detected by Western blotting. Results: RSV infection significantly reduced miR-146a levels in both A549 and HEp-2 cells and rat lung tissues. RSV infection resulted in accelerated growth, increased release of inflammatory cytokines, increased expression of TRAF-6, and activation of the JNK pathway in cells, and the lung inflammatory infiltration and the pathological score increased in rats. Overexpression of miR-146a targeted down-regulation of TRAF-6 expression and JNK/ERK/MAPK/NF-κB pathway induced by RSV infection, reduced the production of inflammatory cytokines IL-1β, IL-6 and TNF-α, and alleviate lung injury in young rats. We got similar results in both A549 and HEp-2 cell experiments. Conclusion: MiR-146a alleviates lung injury caused by RSV infection in young rats by targeting TRAF-6 and regulating JNK/ERK/MAPK signaling pathways.

115. Variable Use of Diagnostic Codes for Acute Respiratory Infections Across Emergency Departments and Urgent Care Clinics in an Integrated Healthcare System: Implications for Accuracy of Antibiotic Stewardship Metrics

BackgroundAntibiotic stewardship initiatives can leverage metrics that make peer-peer comparisons. A commonly used metric measures how frequently a clinician prescribes antibiotics for acute respiratory infections (ARIs), as defined by diagnostic codes. However, it is unclear if clinicians differ in their use of ARI diagnostic codes. In this study, we evaluated differences in how frequently clinicians code for ARIs and factors that are associated with the use of ARI diagnostic codes in Emergency Department (ED) and Urgent Care (UC) visits across an integrated healthcare system.MethodsWe analyzed a retrospective cohort of all ED and UC patient-visits across 129 Veterans Affairs medical centers during 2016-2018. ARI visits were identified using ICD-10 codes for acute bronchitis, influenza, pharyngitis, sinusitis, and upper respiratory tract infections for clinicians with 100 or more visits. A generalized linear mixed model with a link logit function that accounted for clustering at the clinician and facility-level was used to calculate median odds ratios (OR) and to identify factors associated with increased likelihood of entering an ARI code.ResultsThere were 6,016,499 patient-visits, and 519,389 (8.6%) were coded as an ARI (Table 1). The mean rate of ARI diagnoses across all visits was 8.9% (SD 2.5%) at the facility-level and 7.4% (SD 4.5%) at the clinician-level (Table 2). The median OR was 2.19 (95% CI 2.18, 2.22), suggesting there was between-clinician variation in coding for ARI diagnoses. Visits were significantly more likely to be coded as ARIs if seen by an advanced practice provider (OR=2.36, 95% CI 2.19, 2.54), if a fever was recorded (OR=4.20, 95% CI 4.18, 4.29), and if the visit occurred between December-March (OR=1.97, 95% CI 1.96, 1.98). Approximately 2/5th of the variability (41.4%) in assigning an ARI diagnostic code was explained by differences across individual clinicians. ConclusionThere was substantial variability in how frequently ED and UC clinicians coded a visit as an ARI, and a large proportion of the variability was explained by differences across clinicians. Unmeasured factors could include different approaches to using diagnostic codes. ARI metrics based on diagnostic codes may need to account for differences in clinicians’ coding behavior.Disclosures All Authors: No reported disclosures

1441. Significant Decrease in the Incidence Rate of Common Outpatient Upper Respiratory Tract Infection Diagnoses per Clinic Visit in the First Respiratory Season of October 2020 to March 2021 During the Covid-19 Pandemic. A Report From an Outpatient Antimicrobial Stewardship Program at a community hospital in Brooklyn

BackgroundAs part of our outpatient Antimicrobial Stewardship Program, we do surveillance of diagnoses and antibiotic use for common upper respiratory tract infections such as acute upper respiratory tract infection, acute bronchitis, sinusitis, and pharyngitis. We sought to evaluate the impact of the Covid-19 pandemic on the incidence rate of upper respiratory tract infection diagnoses per clinic visit during October 2020 to March 2021 season compared to the three prior respiratory seasons. We also sought to reflect of impact of increase in televisits and overlapping symptoms of COVID 19 and upper respiratory tract infections.MethodsOur cohort study extending from October 2017 to March 2021. We collected number of diagnoses of upper respiratory infections and number of unique clinic visits during four consecutive respiratory seasons at our primary care sites via electronic health records.ResultsDuring the recent October 2020 to March 2021 respiratory season which coincided with the second NYC Covid-19 wave, we had 11569 unique clinic visits and 39 diagnoses of an upper respiratory tract infection - incident rate of 1.29. In the three prior respiratory seasons combined, we had 40939 unique clinic visits and 833 diagnoses of an upper respiratory tract infection – incident rate of 1.49. The incident rates showed a dramatic decline using the test based method and the chi square-statistic p< 0.0001 with an incident rate ratio using a poisson exact method of 6.0359. Statistical comparisons of the current season to each prior individual season yielded similar results. The percentage of Tele-visits during the current season was 19% compared to 0% in the 3 prior seasons.ConclusionDuring the first respiratory season from October 2020 to March 2021 in midst of the Covid-19 pandemic which also coincided with the second Covid-19 wave in New York, we saw a statistically significant decrease in incidence of common upper respiratory tract infection diagnoses per clinic visit compared to the three prior respiratory seasons. Overlapping signs and symptoms of upper respiratory tract infections and Covid-19 with the added percentage in Tele-visits did not cause an increase in incidence rates of upper respiratory tract infection diagnoses. Covid-19 related mitigation efforts may have played a role.Disclosures All Authors: No reported disclosures

Evaluation of parental knowledge, attitudes and practices regarding antibiotic use in acute upper respiratory tract infections in children under 18\u2009years of age: a cross-sectional study in Turkey

BackgroundUpper respiratory tract infections (URTIs) are common in children. Antibiotics still continue to be prescribed although most URTIs are of viral origin. This is inappropriate use and this unnecessary administration contributes or may cause antibiotic resistance. The problem of unnecessary antibiotic use among children is a concern for antibiotic resistance in low- and middle-income developing countries. This study aims to evaluate the knowledge and attitudes of parents of children with upper respiratory tract infections regarding antibiotic use and their antibiotic administration practices in a tertiary care hospital in Turkey.MethodsOur study is a cross-sectional survey study. It was carried out between 14 December 2020 and 1 April 2021 for parents over 18 years of age with a child under 18 years’ old who applied to the general pediatrics outpatient clinics of Gazi University Faculty of Medicine Hospital Department of Pediatrics.ResultsFive hundred fifty-four parents responded to the questionnaire (93.2% rate of response). A total of 15.7% of parents stated to use antibiotics in any child with fever. 37% of parents believed that antibiotics could cure infections caused by viruses. 6.3% of parents declared that they put pressure on pediatricians to prescribe antibiotics. While 28% of the parents who thought that the use of inappropriate antibiotics would not change the effect and resistance of the treatment, 41% thought that new antibiotics could be developed continuously. 85.6% of the parents stated that they never gave their children non-prescription antibiotics when they had a high fever. 80.9% of them declared that they never used past antibiotics in the presence of a new infection.ConclusionAccording to the results of our study of parents’ lack of knowledge about antibiotics in Turkey, though generally it shows proper attitude and practices. It shows that some of the restrictions imposed by the National Action Plan are partially working. However, it is still necessary to continue to inform parents, pediatricians and pharmacists about the use of antibiotics, and to be more sensitive about the prescribing of antibiotics, and if necessary, sanctions should be imposed by the state in order to prevent unnecessary antibiotic prescriptions.

Clinical features and epidemiological analysis of respiratory human adenovirus infection in hospitalized children: a cross-sectional study in Zhejiang

BackgroundHAdV is one of the common pathogens in hospitalized children with acute respiratory infections (ARIs). We aim to describe the clinical and laboratory features, epidemiological characteristics, and HAdV species and/or types of inpatients with HAdV respiratory infections.MethodsRespiratory samples were gathered from inpatients diagnosed ARIs in Children’s Hospital, Zhejiang University School of Medicine, and were detected by using Direct Immunofluorescence Assay from 2018 to 2019. PCR amplification and sequencing of the hypervariable zone of hexon gene were used for genotyping. The clinical and laboratory features, and HAdV genotyping, and epidemiological characteristic analysis were retrospectively performed.ResultsOf 7072 samples collected, 488 were identified as HAdV-positive. The overall detection rate was 6.9%. The peaked detection rate was 14.1% in January 2019. HAdV-positive cases with ARIs mainly appeared in winter. The detection rate was highest among children between 6 months and 2 years (8.7%, 123/1408). Clinical diagnosis included pneumonia (70.3%, 343/488), bronchitis (7.0%, 34/488) and acute upper respiratory tract infection (22.7%, 111/488). The common clinical manifestations were fever (93.4%, 456/488), cough (94.7%, 462/488), wheezing (26.2%, 128/488), and shortness of breath (14.8%, 72/488). 213 (43.6%) cases had co-infection and 138 (28.3%) cases had extrapulmonary symptoms. 96(19.7%) cases had intrapulmonary and intrathoracic complications.78 (16.0%) had an underlying condition, most of which were congenital heart diseases (20.5%, 16/78). The proportions of hyperpyrexia, duration of fever > 10 days, severe pneumonia, and wheezing in the co-infection group were remarkably higher than those in HAdV single-infection group (all p < 0.05). The proportions of duration of hospitalization, duration of fever > 10 days, wheezing, shortness of breath, change in level of consciousness, serosal fluids, extrapulmonary symptoms, co-infections and underlying diseases were significantly higher in severe pneumonia group than those in the mild pneumonia group (all p < 0.05). Four HAdV species were successfully identified in 155 cases and presented by 8 genotypes. HAdV-B3 (56.1%, 87/155) and HAdV -B7 (31.0%, 48/155) were the most predominant detected types and occurred commonly in different severity groups (p = 0.000), while, HAdV-B55 was detected only in the severe group. HAdV-B7’s detection rate in the severe pneumonia group was significantly higher than the non-severe pneumonia group.ConclusionHAdV detection rate is related to age and season. Bronchopneumonia accounts for about 70% HAdV-positive inpatients. The common clinical manifestations include hyperpyrexia, cough, wheezing, and shortness of breath. HAdV-B3 and HAdV-B7 are the most common types in children diagnosed with respiration infections.

Usefulness of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections in children

BackgroundThere is a lack of studies comparing PCT, CRP and WBC levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections. It is necessary to explore the correlation between above markers and different types of ARTI.Methods108 children with confirmed bacterial infection were regarded as group A, 116 children with virus infection were regarded as group B, and 122 children with mycoplasmal infection were regarded as group C. The levels of PCT, CRP and WBC of the three groups were detected and compared.ResultsThe levels of PCT, CRP and WBC in group A were significantly higher than those in groups B and C (p < 0.05). The positive rate of combined detection of PCT, CRP and WBC was significant higher than that of single detection. There was no significant difference in PCT, CRP and WBC levels between the group of G+ bacterial infection and G− bacterial infection (p > 0.05). ROC curve results showed that the AUC of PCT, CRP and WBC for the diagnosis of bacterial respiratory infections were 0.65, 0.55, and 0.58, respectively.ConclusionsPCT, CRP and WBC can be combined as effective indicators for the identification of acute bacterial or no-bacterial infections in children. The levels of PCT and CRP have higher differential diagnostic value than that of WBC in infection, and the combined examination of the three is more valuable in clinic.

Clinical Efficacy Analysis of Zukamu Granule in the Treatment of Acute Upper Respiratory Tract Infection

Clinical Efficacy Analysis of Zukamu Granule in the Treatment of Acute Upper Respiratory Tract Infection

Analysis of Rationality of Antibiotic use in Children with Acute Upper Respiratory Tract Infection

Analysis of Rationality of Antibiotic use in Children with Acute Upper Respiratory Tract Infection

COMPARISON BETWEEN THE EFFECT OF CEFTRIAXONE AND AZITHROMYCIN IN THE MANAGEMENT OF COMMUNITY ACQUIRED PNEUMONIA PATIENTS IN HOSPITAL SETTING

Introduction: pneumonia can be defined as symptoms that incorporate acute lower respiratory tract (LRT) infection, comprising of cough and a minimum of one more LRT symptom, in parallel to any other ‘systemic symptom and new focal signs on chest examination. Annually, there were approximately 151.8 million cases about a decade ago and among them 8.7% (13.1 million) required hospitalization. India ranks in top five countries on basis of CAP load with more than 23% worldwide cases.&#x0D; Materials and Methods: the design of this study is a Retrospective Cohort. A total of 123 patients ranging from 3 years old to 17 years old with a average of 9.90 years old, with bacterial pneumonia were included in the study. The diagnostic criteria of Infectious Disease Society of America and the British Thoracic Society were used in this study to determine the diagnosis and conclusion of the study. Out of 123 patients, 65 patients (Group 1) were given azithromycin at the initial dosage of 10 mg/kg followed by 5 mg/kg for 2 to 5 days while 58 patients (Group 2) were given ceftriaxone at the single intramuscular dose of 50 mg/kg. The clinical criteria and Likelihood criteria was determined before and after the treatment in both the groups to compare the efficiency of the two drugs. The adverse effects of the two drugs were also considered.&#x0D; Result: the clinical criteria and Likelihood Ratio was determined before starting the treatment. On Day 5th,after completion of the treatment in both the groups,all the patients were again re-assessed. Group 1 showed more improvement as compared to group 2 patients as the fever in group 1 patients came down to 2.43% from 52.84% of the total number of patients. A high respiratory rate was found in 2.43% of 123 patients in the case of group 1 as compared to 4.06% of 123 patients in the case of group 2. Group 1 patients showed adverse effects like diarrhea, itching and nausea while group 2 patients showed tarry stool, sore throat and weakness as adverse effects. 12.19% of the total patients showed adverse effects from group 1 while 35.77% of the total patients showed adverse effects from group 2.&#x0D; Conclusion: the study concludes that although both of the drugs used are effective in managing CAP. Azithromycin regimen has a significantly beneficial as compared to a single intramuscular dose of ceftriaxone.&#x0D; Keywords: pneumonia, CAP, azithromycin, ceftriaxone, antibiotic

Novel HLA-B7-restricted human metapneumovirus epitopes enhance viral clearance in mice and are recognized by human CD8+ T cells

Human metapneumovirus (HMPV) is a leading cause of acute lower respiratory tract illness in children and adults. Repeated infections are common and can be severe in young, elderly, and immunocompromised persons due to short-lived protective humoral immunity. In turn, few protective T cell epitopes have been identified in humans. Thus, we infected transgenic mice expressing the common human HLA MHC-I allele B*07:02 (HLA-B7) with HMPV and screened a robust library of overlapping and computationally predicted HLA-B7 binding peptides. Six HLA-B7-restricted CD8+ T cell epitopes were identified using ELISPOT screening in the F, M, and N proteins, with M195–203 (M195) eliciting the strongest responses. MHC-tetramer flow cytometric staining confirmed HLA-B7 epitope-specific CD8+ T cells migrated to lungs and spleen of HMPV-immune mice. Immunization with pooled HLA-B7-restricted peptides reduced viral titer and protected mice from virulent infection. Finally, we confirmed that CD8+ T cells from HLA-B7 positive humans also recognize the identified epitopes. These results enable identification of HMPV-specific CD8+ T cells in humans and help to inform future HMPV vaccine design.