Cases Of Respiratory Infection Research Articles

Post-COVID-19 Pandemic Rebound of Macrolide-Resistant Mycoplasma pneumoniae Infection: A Descriptive Study.

The rebound characteristics of respiratory infections after lifting pandemic control measures were uncertain. From January to November 2023, patients presenting at a teaching hospital were tested for common respiratory viruses and Mycoplasma pneumoniae using a combination of antigen, nucleic acid amplification, and targeted next-generation sequencing (tNGS) tests. The number and rate of positive tests per month, clinical and microbiological characteristics were analyzed. A rapid rebound of SARS-CoV-2 was followed by a slower rebound of M. pneumoniae, with an interval of 5 months between their peaks. The hospitalization rate was higher, with infections caused by respiratory viruses compared to M. pneumoniae. Though the pediatric hospitalization rate of respiratory viruses (66.1%) was higher than that of M. pneumoniae (34.0%), the 4094 cases of M. pneumoniae within 6 months posed a huge burden on healthcare services. Multivariate analysis revealed that M. pneumoniae-infected adults had more fatigue, comorbidities, and higher serum C-reactive protein, whereas children had a higher incidence of other respiratory pathogens detected by tNGS or pathogen-specific PCR, fever, and were more likely to be female. A total of 85% of M. pneumoniae-positive specimens had mutations detected at the 23rRNA gene, with 99.7% showing A2063G mutation. Days to defervescence were longer in those not treated by effective antibiotics and those requiring a change in antibiotic treatment. A delayed but significant rebound of M. pneumoniae was observed after the complete relaxation of pandemic control measures. No unusual, unexplained, or unresponsive cases of respiratory infections which warrant further investigation were identified.

Patterns of Non-influenza Respiratory Viruses Among Severe Acute Respiratory Infection Cases in Burkina Faso: A Surveillance Study.

Although influenza viruses cause only one-fifth of severe acute respiratory infections (SARI) in Burkina Faso, the other viral causes of SARI remain poorly investigated to inform clinical and preventive decision making. Between 2016 and 2019, we prospectively enrolled inpatients meeting the World Health Organization (WHO) case definition of SARI in Burkina Faso. Results of viral etiologies among inpatients tested negative for influenza using the Fast Track Diagnostics Respiratory Kits (FTD-33) were reported. Of 1541 specimens tested, at least one respiratory virus was detected in 76.1% of the 1231 specimens negative for influenza virus. Human rhinoviruses (hRVs) were the most detected pathogens (476; 38.7%), followed by human adenoviruses (hAdV) (17.1%, 210/1231), human respiratory syncytial virus (hRSV) (15.4%, 189/1231), enterovirus (EnV) (11.2%, 138/1231), human bocavirus (hBoV) (7.9%, 97/1231), parainfluenza 3 (hPIV3) (6.1%, 75/1231), human metapneumovirus (hMPV) (6.0%,74/1321), parainfluenza 4 (hPIV4) (4.1%, 51/1231), human coronavirus OC43 (hCoV-OC43) (3.4%, 42/1231), human coronavirus HKU1(hCoV-HKU1) (2.7%, 33/1231), human coronavirus NL63 (hCoV-NL63) (2.5%, 31/1231), parainfluenza 1 (hPIV1) (2.0%, 25/1231), parainfluenza 2 (hPIV2) (1.8%, 22/1231), human parechovirus (PeV) (1.1%, 14/1231), and human coronavirus 229E (hCoV-229E) (0.9%, 11/1231). Among SARI cases, infants aged 1-4 years were mostly affected (50.7%; 622/1231), followed by those <1 year of age (35.7%; 438/1231). Most detected pathogens had year-long circulation patterns, with seasonal peaks mainly observed during the cold and dry seasons. Several non-influenza viruses are cause of SARI in Burkina Faso. The integration of the most common pathogens into the routine influenza surveillance system might be beneficial.

Evaluation of Risk Factors for Children with Severe Adenovirus Respiratory Infection: Retrospective Study

Background: Human adenovirus (HAdV) commonly affects children hospitalized with any form of respiratory infection (RI). Severe HAdV infection leads to one of the most serious types of infantile RI, with rapidly progressive illness and a poor prognosis. Objectives: This study investigated the relationship between aspartate aminotransferase (AST) levels and the severity of HAdV RI in children. Methods: We collected clinical data from 665 cases of HAdV RI in children hospitalized at the pediatric ward of Changde First People's Hospital between January and December 2019. We analyzed the relationship between AST levels and disease severity. Results: Of the 665 HAdV-positive cases, 89.8% were &lt; 6 years of age. Among them, upper RI was diagnosed in 18.8% of cases, bronchiolitis in 4.8%, and mild pneumonia in 48.1%. Severe pneumonia was observed in 28.2% of cases. The 665 patients in the cohort were divided into a mild group (n = 477 cases, 71.73%) and a severe group (n = 188 cases, 28.27%). Univariate analysis showed that children with severe HAdV RI had a lower age of onset and lower hemoglobin and serum albumin levels while having higher platelet counts, lactic acid dehydrogenase, creatine kinase, creatine kinase isoenzyme, alanine aminotransferase, and AST levels compared to those with mild infections (P &lt; 0.05). Multivariate analysis revealed that these factors were related to disease severity (P &lt; 0.05). The ROC curve analysis indicated that the area under the AST curve was 0.782. When the intercept value was 52.5 U/L, the sensitivity was 60.6%, and the specificity was 83.4%. Conclusions: Serum AST levels can serve as a predictor of adenoviral RI severity in children.

N-of-1 Trials of Antimicrobial Stewardship Interventions to Optimize Antibiotic Prescribing for Upper Respiratory Tract Infection in Emergency Departments: Protocol for a Quasi-Experimental Study.

Antimicrobial stewardship programs attempting to optimize antibiotic therapy and clinical outcomes mainly focus on inpatient and outpatient settings. The lack of antimicrobial stewardship program studies in the emergency department (ED) represents a gap in tackling the problem of antimicrobial resistance as EDs treat a substantial number of upper respiratory tract infection cases throughout the year. We intend to implement two evidence-based interventions: (1) patient education and (2) providing physician feedback on their prescribing rates. We will incorporate evidence from a literature review and contextualizing the interventions based on findings from a local qualitative study. Our study uses a quasi-experimental design to evaluate the effects of interventions over time in the EDs of 4 public hospitals in Singapore. We will include an initial control period of 18 months. In the next 6 months, we will randomize 2 EDs to receive 1 intervention (ie, patient education) and the other 2 EDs to receive the alternative intervention (ie, physician feedback). All EDs will receive the second intervention in the subsequent 6 months on top of the ongoing intervention. Data will be collected for another 6 months to assess the persistence of the intervention effects. The information leaflets will be handed to patients at the EDs before they consult with the physician, while feedback to individual physicians by senior doctors is in the form of electronic text messages. The feedback will contain the physicians' antibiotic prescribing rate compared with the departments' overall antibiotic prescribing rate and a bite-size message on good antibiotic prescribing practices. We will analyze the data using segmented regression with difference-in-difference estimation to account for concurrent cluster comparisons. Our proposed study assesses the effectiveness of evidence-based, context-specific interventions to optimize antibiotic prescribing in EDs. These interventions are aligned with Singapore's national effort to tackle antimicrobial resistance and can be scaled up if successful. ClinicalTrials.gov NCT05451863; https://clinicaltrials.gov/study/NCT05451836. DERR1-10.2196/50417.

Spatiotemporal dynamics and epidemiological impact of SARS-CoV-2 XBB lineage dissemination in Brazil in 2023.

Brazil was one the most affected countries by the SARS-CoV-2 pandemic, with more than 700,000 deaths by mid-2023. This study reconstructs the dissemination of the virus in the country in the first half of 2023, a period characterized by the dissemination of descendants of XBB.1, a recombinant of Omicron BA.2 lineages evolved in late 2022. The analysis supports that XBB dissemination was marked by the continuous emergence of indigenous lineages bearing similar mutations in key sites of their Spike protein, a process followed by continuous increments in transmissibility, and without repercussions in the incidence of severe cases. Thus, the results suggest that the epidemiological impact of the spread of a SARS-CoV-2 variant is influenced by an intricate interplay of factors that extend beyond the virus's transmissibility alone. The study also underlines the need for SARS-CoV-2 genomic surveillance that allows the monitoring of its ever-shifting composition.

Effects of public health interventions and zero COVID policy on paediatric diseases: A Southern China study.

With the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in schools and communities, clinical evidence is needed to determine the impact of the pandemic and public health interventions under the zero coronavirus disease policy on the occurrence of common infectious diseases and non-infectious diseases among children. The current study was designed to analyse the occurrence of common infectious diseases before and after the pandemic outbreak in southern China. Data was obtained for 1 801 728 patients admitted into children's hospitals in Guangzhou between January 2017 and July 2022. Regression analysis was performed for data analysis. The annual occurrence of common paediatric infectious diseases remarkably decreased after the pandemic compared to the baseline before the pandemic and the monthly occurrence. Cases per month of common paediatric infectious diseases were significantly lower in five periods during the local outbreak when enhanced public health measures were in place. Cases of acute non-infectious diseases such as bone fractures were not reduced. Non-pharmaceutical interventions decreased annual and monthly cases of paediatric respiratory and intestinal infections during the coronavirus disease 2019 (COVID-19) pandemic, especially when enhanced public health interventions were in place. Our findings provide clinical evidence that public health interventions under the dynamic zero COVID policy in the past three years had significant impacts on the occurrence of common respiratory and intestinal infectious diseases among children and adolescents but little impact on reducing non-infectious diseases such as leukaemia and bone fracture.

Basic therapeutic approaches to the management of hematology/oncology patients with new coronavirus infection (COVID-19)

In December 2019, cases of severe respiratory infection were reported in Wuhan, China. The disease was caused by a new, previously undescribed coronavirus, structurally similar to the then known SARS-CoV virus. The World Health Organization has named the new virus SARS-CoV-2 and the disease it causes COVID-19. The problem of COVID-19 is exacerbated by the rapid spread of the SARS-CoV-2 virus and the development of life-threatening complications, the main of which is pneumonia. Due to the severity of the condition, from 5 to 10 % of patients are treated in intensive care units.SARS-CoV-2 initially attacks the respiratory system and causes symptoms such as fever, vomiting, headache, dizziness, general weakness, and diarrhea. Then these symptoms intensify in different directions, and the disease can often lead to death.Initially, only a few methods of symptomatic treatment were available and clinical trials of drugs that had previously shown their effectiveness against infection with the MERS-CoV and SARS-CoV viruses began. Temporary recommendations have appeared suggesting the use of some drugs both in monotherapy and in combination.In patients with hematologic malignancies, the immune response to the SARS-CoV-2 coronavirus is significantly reduced, which explains the high mortality rate (up to 38 %) of these patients hospitalized for SARS-CoV-2 infection. Recently, antiviral drugs and monoclonal antibodies have become available for pre- or post-exposure prophylaxis, as well as for early treatment of COVID-19. These treatments should be offered to patients at high risk of severe COVID-19 and to those who have not responded to vaccination. However, as changes in the genetic structure of the virus accumulate, some treatments may lose their clinical effectiveness against new variants.The combination of hematological malignancies and new coronavirus infection causes a more severe course of COVID-19 compared to the population and high mortality. Factors for an unfavorable prognosis for new coronavirus infection in patients with hematological malignancies include age over 60 years, a high comorbidity index, diagnoses such as acute leukemia, especially acute myeloid leukemia and myelodysplastic syndrome, disease status (relapse, progression, as well as newly diagnosed acute leukemia), severe COVID-19, agranulocytosis (myelotoxic or tumor).

Implementation of Health Protocol on Nursing Students in The Dormitory During Pandemic

Global prevalence data released by WHO (2021) shows a decrease in positive cases of COVID-19 in Indonesia by 18%. One of the government's policy efforts to prevent the spread of the COVID-19 virus is establishing health protocols, including physical distancing, wearing masks, and hand washing. There is an increase in the number of dormitory residents at one of the western Indonesian universities, which causes a decrease in the effectiveness of implementing health protocols. The study aims to identify the application of health protocols, including physical distancing, wearing masks, and hand washing among nursing students. This study uses descriptive quantitative research methods. The instrument used is an online questionnaire, a random sampling technique with univariate data. The results showed that the 2019 and 2020 nursing students, 232 respondents (99.1%) and two respondents (0.9%) did not apply health protocols properly. In conclusion, most nursing students in Western Indonesian universities applied health protocols. Suggestions for students are expected to be able to maintain and improve the implementation of health protocols in dormitories to prevent the increase in the spread of COVID-19 or other infections. For further research, we are expected to use bivariate analysis to suppress the increase in respiratory infection cases.

Molecular identification of bacterial pathogen in suspected cases of respiratory tract infection from chicken

Molecular identification of bacterial pathogen in suspected cases of respiratory tract infection from chicken

Иммуномодулирующие эффекты пробиотиков: возможности профилактики острых респираторных инфекций у детей

Acute respiratory infections (ARIs) currently represent a major health concern in pediatric populations, accounting for up to 90% of all acute respiratory tract infection cases. While the efficacy of probiotics in treating various diseases is well-established, their potential role as a preventive measure to enhance the body's resistance against ARIs is garnering increased attention. Numerous clinical studies involving children have demonstrated that probiotics can reduce the incidence of ARIs, decrease the average duration of ARI episodes, lower the frequency of antibiotic usage, and decrease the number of school or preschool days missed due to illness. The careful selection of probiotic strains — considering their safety, tolerability, and varied physiological effects — has led to the development of several clinically effective probiotics in the market. This article reviews key data supporting the efficacy of Lactobacillus plantarum 7315/7316 in clinical practice. KEYWORDS: probiotic, prevention, Lactobacillus plantarum, children, microbiota, immunity. FOR CITATION: Nikolaeva S.V., Pogorelova O.O., Shushakova E.K., Gorelov A.V. Immunomodulatory effects of probiotics: possibilities of acute respiratory infections prevention in children. Russian Journal of Woman and Child Health. 2024;7(3):276–280 (in Russ.). DOI: 10.32364/2618- 8430-2024-7-3-12.

Five Years' Experience with Respiratory Syncytial Virus Among Hospitalized Patients: A Retrospective Study from Jazan, Saudi Arabia.

RSV is a common seasonal cause of respiratory infections in children and potentially adults and is considered a major cause of mortality and morbidity. While several studies on RSV have been conducted in Saudi Arabia, none have specifically focused on the southwestern region, where distinct climatic and demographic factors may influence RSV pattern. The current study aims to describe five years of experience with RSV cases among hospitalized patients and factors associated with intensive care admission from a tertiary hospital. The study adopts a retrospective observational design, focusing on suspected respiratory infection cases confirmed by rapid RSV antigen tests from 2015 to 2020. Data including age, sex, comorbidities, and outcomes were collected from a tertiary hospital's medical records and microbiology laboratory files. Data were analyzed using a t-test and chi-square test. Among 195 participants, primarily pediatric, monthly, and yearly admissions varied. Monthly variations revealed a U-shaped pattern with most cases reported during January, with a decline in 2020. Oxygen support was required for 40% of cases, and comorbidities were observed in 49.23%. Associations between ICU admission and factors like age, gestational age, ventilation, comorbidities, and length of stay were significant. RSV infection is one of the important causes of morbidity and intensive care admission among infants and young children in Saudi Arabia. As reported by others, the seasonality of RSV is evident. Despite higher prevalence in a younger population, physicians should consider RSV in adults and older patients. Further national studies are required for a better estimation of the RSV burden on the country.

Anesthesia management experience for pediatric day-case PDA ligation under thoracoscopy assisted by a robot: a retrospective study

BackgroundTo summarize the anesthesia management experience for pediatric day-case patent ductus arteriosus (PDA) ligation under robot-assisted thoracoscopy and explore the key points of anesthesia management for this procedure.MethodsThe clinical data of 72 pediatric patients who underwent robot-assisted thoracoscopic day-case PDA ligation at the Children’s Hospital, Zhejiang University School of Medicine from April 2021 to February 2023 were retrospectively analyzed. 0.3% ropivacaine local infiltration combined with S-ketamine 0.2 mg/kg intravenous injection was used for postoperative analgesia The patient’s basic information and intraoperative conditions were analyzed, which included gender, age, weight, surgery time, anesthesia time, extubation time, intraoperative blood loss, MAP before pneumothorax, PaCO2 before pneumothorax, etc. Postoperative conditions were also monitored, such as PACU stay time, agitation during the recovery period, pain, and the incidence of nausea and vomiting. After discharge, the recovery status was assessed.ResultsA total of 70 pediatric patients who met the criteria for day-case PDA ligation were included in this study. Before the occurrence of pneumothorax, the mean arterial pressure (MAP) of these 70 patients was 69.58 ± 12.52 mmHg, and during controlled hypotension, the MAP was 54.96 ± 11.23 mmHg. Before the occurrence of pneumothorax, the partial pressure of carbon dioxide (PaCO2) was 38.69 ± 3.38 mmHg, and during controlled hypotension, the PaCO2 was 51.42 ± 4.05 mmHg. Three cases experienced agitation during the recovery period, and four cases had mild pain, but there was no moderate or severe pain, nausea, or vomiting. Only 1 case of postoperative respiratory tract infection and 1 case of postoperative pneumothorax occurred. Within 30 days after discharge, the unplanned revisit rate, unplanned readmission rate, and surgical wound infection rate were all 0. The residual shunt rate detected by echocardiography was 0 after 1 month.ConclusionsThe children under the robot-assisted thoracoscopic day case PDA surgeries in this study have limited trauma, little bleeding, and little postoperative pain, though still at a risk of respiratory infection and pneumothorax.

Evaluation of Rationality of Drug Use Based on National Rational Drug Use Indicators at Paal Lima Public Health Center Period January – March 2023

Background: World Health Organization (WHO) estimates that more than half of all drugs in the world are prescribed, dispensed and sold in an inappropriate manner and half of patients use drugs inappropriately, thus enabling irrational drug use. If the drug is used irrationally, it can have a negative impact. The purpose of this study was to evaluate the rationality of drug use at the Paal Lima Public Health Center for the period January - March 2023 based on the National Rational Drug Use (POR) indicator.&#x0D; Method: This study used an observational method with retrospective data collection, namely prescription data for non-pneumonic acute respiratory infections (ARI), non-specific diarrhea, and myalgia during the period January - March 2023. The data were analyzed descriptively by calculating the use of antibiotics, injections, and the average drug items which were then displayed in percentage form. There were 509 prescriptions for non-pneumonic acute respiratory infections (ARI) cases, 74 prescriptions for non-specific diarrhea cases, and 120 prescriptions for myalgia cases.&#x0D; Result: The results of the study showed that for the period January - March 2023 it was found that the use of antibiotics in cases of non-pneumonic acute respiratory infections (ARI) was 19.65%, the use of antibiotics in cases of non-specific diarrhea was 35.14%, the use of injections in cases of myalgia was 0%, and the average number of drug items per prescriptions of 3.68 items.&#x0D; Conclusion: Overall, the rationality of drug use at the Paal Lima Public Health Center has not met the requirements, so it needs to be improved.

Mitoxantrone Hydrochloride Liposome Injection Combined with Carmustine, Etoposide, and Cytarabine As Conditioning of Autologous Hematopoietic Stem Cell Transplantation in NHL Patients：a Prospective Single-Arm Clinical Trial

Background：High-dose chemotherapy and autologous stem-cell transplantation (ASCT) is standard consolidation therapy for aggressive lymphoma.Choosing the most effective conditioning regimen prior to ASCT can lead to longer survival in these patients.Mitoxantrone liposome is an anthraquinone antibiotic anti-tumor drug. Previous studies have shown that mitoxantrone liposome monotherapy or combined with other drugs has achieved good efficacy for T-cell lymphoma, but there are no reports of its application in conditioning. Objective:This is a prospective single-arm clinical study to evaluate the efficacy and safety of mitoxantrone hydrochloride liposome injection combined with carmustine, etoposide, cytarabine (modified BEAM protocol) as conditioning of autologous hematopoietic stem cell transplantation for NHL patients (NCT05681403). Methods: Patients with non-Hodgkin lymphoma who planned to undergo ASCT were eligible to participate in the trial if they were 18 to 60 years of age.The patients received mitoxantrone hydrochloride liposome injection 24 mg/m 2,ivgtt,d-7, carmustine 300 mg/m 2,ivgtt,d-6, etoposide200 mg/m 2,ivgtt,d-5~ -2,cytarabine 200 mg/m 2 q12h,ivgtt,d-5~ -2 as conditioning regimen.The primary end point was the relapse rate within three years and the secondary end point was adverse events of modified BEAM protocol. Results：Twenty-five NHL patients (median age 39 years old,17 males and 8 females) were enrolled,including 40% DLBCL, 12% MCL, 4% primary mediastinal B-cell lymphoma,4%B lymphoblastic lymphoma,4%Marginal zone B-cell lymphoma,12% PTCL-NOS, 8% ALK +ALCL,8% NK/T lymphoma, 8% AITL,4% ALK -ALCL and 4% Sézary syndrome. 18 cases achieved complete remission before ASCT, while 7 cases received partial remission before ASCT. The median of neutrophil recovery time was 11 days(7-15) and the median of platelet recovery was 12days (7-60).Nausea,vomit,constipation,blue skin and cough were the most frequently reported conditioning related AEs (88%,16%,12%,12% and 8% of patients,respectively), and other AE included 1 case of hypoxemia, 1 case of hypotension, 1 case of palpitation, 1 case of rash. Except one patient experienced a grade 3 vomit ,the others were grade 1-2 and improved after symptomatic treatment. Nine patients experienced febrile neutropenia and 2 cases of sepsis, 4 cases of respiratory infection, and 3 cases of oral mucositis. All partial remission patients achieved complete remission post-HSCT and one of them relapsed 7 months after ASCT.The others were all in complete remission during follow-up. Conclusion:Mitoxantrone hydrochloride liposome injection combined with carmustine, etoposide, cytarabine (modified BEAM protocol) was a well-tolerated and effective conditioning regimen for NHL and the study is ongoing and updated results will be presented in the future.

2637. Activity of Respiratory Viruses in Georgia 2020-2022

Abstract Background The emergence of SARS-CoV-2 in early 2020 with subsequent implementation of public health and social measures influenced the epidemiology of respiratory viruses worldwide. This study describes circulation of respiratory viruses during two winter seasons and inter-seasonal periods in Georgia. Methods We aggregated data obtained from Influenza like illness (ILI) and Severe Acute Respiratory Infection (SARI) cases during 2020/21 and 2021/22 (weeks 40-20) and inter-seasonal (weeks 21-39) periods in Georgia. All specimens from patients were screened on 22 respiratory viruses by real time RT-PCR. Results During 2020/21 season 50% (868/1729) specimens tested positive on at least one virus. No influenza virus and few RSV detections were observed in Georgia. Mostly identified virus was Rhino (44.8%) circulating almost all season; followed by Coronavirus OC43 (23.7%), primarily seen in weeks 12-18 and SARS-Cov-2 (15%) with highest detection rates during weeks 48-52. In 2021 inter-season 54% (825/1513) of specimens were positive. A gradual increase in RSV detections was observed in summer. Most seen viruses were Rhino (30%), HMPV (22%) and Parainfluenza virus 3 (21%) circulating mainly in June and July. During 2021/22 season 44% (2012/4545) of specimens screened positive, out of which RSV (25.7%) with earlier circulation in weeks 40-2 and Rhino (25.7%) with most detections in the beginning and at the end of the season. Unusually influenza A/H3 (17%) peaked in late spring (weeks 12-18). SARS-Cov-2, Parainfluenza viruses 3 and 4, Adenoviruses, Human bocavirus, enteroviruses were actively co-circulating too. In 2022 inter-season 54% (1320/2456) of samples tested positive. Influenza A/H3 circulation continued until July. SARS-Cov-2 (27.7%), Rhino (22%), HMPV (14.5%), Parainfluenza virus 3 (12.7%), RSV (10.8%) were mostly seen viruses predominantly in June. Conclusion Wider range respiratory viruses with higher positivity rates were detected among ILI and SARI cases in 2021/22 season compared to 2020/21 presumably due to mitigation of public health and social measures. Low detection rates of SARS-CoV-2 at sentinel sites could be explained by referral of COVID-19 patients to dedicated clinics. RSV and Influenza circulations were unusual in summer months in Georgia. Disclosures All Authors: No reported disclosures

Genome-wide association study of susceptibility to hospitalised respiratory infections.

Background: Globally, respiratory infections contribute to significant morbidity and mortality. However, genetic determinants of respiratory infections are understudied and remain poorly understood. Methods: We conducted a genome-wide association study in 19,459 hospitalised respiratory infection cases and 101,438 controls from UK Biobank (Stage 1). We followed-up well-imputed top signals from our Stage 1 analysis in 50,912 respiratory infection cases and 150,442 controls from 11 cohorts (Stage 2). We aggregated effect estimates across studies using inverse variance-weighted meta-analyses. Additionally, we investigated the function of the top signals in order to gain understanding of the underlying biological mechanisms. Results: From our Stage 1 analysis, we report 56 signals at P<5×10 -6, one of which was genome-wide significant ( P<5×10 -8). The genome-wide significant signal was in an intron of PBX3, a gene that encodes pre-B-cell leukaemia transcription factor 3, a homeodomain-containing transcription factor. Further, the genome-wide significant signal was found to colocalise with gene-specific expression quantitative trait loci (eQTLs) affecting expression of PBX3 in lung tissue, where the respiratory infection risk alleles were associated with decreased PBX3 expression in lung tissue, highlighting a possible biological mechanism. Of the 56 signals, 40 were well-imputed in UK Biobank and were investigated in Stage 2. None of the 40 signals replicated, with effect estimates attenuated. Conclusions: Our Stage 1 analysis implicated PBX3 as a candidate causal gene and suggests a possible role of transcription factor binding activity in respiratory infection susceptibility. However, the PBX3 signal, and the other well-imputed signals, did not replicate in the meta-analysis of Stages 1 and 2. Significant phenotypic heterogeneity and differences in study ascertainment may have contributed to this lack of statistical replication. Overall, our study highlighted putative associations and possible biological mechanisms that may provide insight into respiratory infection susceptibility.

Exposure to air pollution and risk of respiratory tract infections in the adult Danish population—a nationwide study

ObjectivesThe association between air pollution and risk of respiratory tract infection (RTI) in adults needs to be clarified in settings with low to moderate levels of air pollution. We investigated this in the Danish population between 2004 and 2016. MethodsWe included 3 653 490 persons aged 18–64 years in a nested case-control study. Exposure was defined as the average daily concentration at the individual's residential address of CO, NOX, NO2, O3, SO2, NH3, PPM2.5, black carbon, organic carbon, mineral dust, sea salt, secondary inorganic aerosols, SO42-, NO3-, NH4+, secondary organic aerosols, PM2.5, and PM10 during a 3-month exposure window. RTIs were defined by hospitalization for RTIs. Incidence rate ratios (IRRs) and 95% CIs were estimated comparing highest with lowest decile of exposure using conditional logistic regression models. ResultsIn total, 188 439 incident cases of RTI were identified. Exposure to most air pollutants was positively associated with risk of RTI. For example, NO2 showed an IRR of 1.52 (CI: 1.48–1.55), and PM2.5 showed an IRR of 1.45 (CI: 1.40–1.50). In contrast, exposure to sea salt, PM10, NH3, and O3 was negatively associated with a risk of RTIs. DiscussionIn this nationwide study comprising adults, exposure to air pollution was associated with risk of RTIs and subgroups hereof. Sea salt, PM10, NH3, and O3 may be proxies for rural areas, as the levels of these species in Denmark are higher near the western coastlines and/or in rural areas with fewer combustion sources.

Risk prediction for liver injury in Epstein-Barr virus infection in pediatric respiratory tract infections

BackgroundEpstein-Barr virus (EBV) infection is likely to co-occur in pediatric respiratory tract infections (RTIs). Liver injury is the common complication of EBV infection. The detailed risk factors for liver injury in EBV infection remain elusive. We aimed to investigate the incidence, characteristics and potential risk factors for liver injury in EBV infection for early risk prediction.MethodsWe retrospectively recruited the pediatric RTIs cases with EBV infection according to a predefined criteria from our hospital between January 2015 and December 2017. We extracted the clinical and laboratory data from the electronical medical records. The impact of age, gender, and various parameters on the liver injury risk was investigated. Univariate logistic regression analysis was performed to analyse the association between clinical/laboratory parameters and liver injury. The related indexes were enrolled in the multivariate logistic regression analysis. Decision curve analysis was used to yield the value of related parameters in predicting liver injury. Receiver operating curve (ROC) analysis was applied to produce the C-index of white blood cell (WBC) count for liver injury. We also tested the non-linear association between WBC count and alanine aminotransferase (ALT).ResultsA total of 216 pediatric RTIs with EBV infection were enrolled. EBV infection is more likely to occur during the winter season. Cytomegalovirus infection was independently associated with liver injury in EBV infection (OR = 6.972, 95% CI = 1.648–29.490, p = 0.008). WBC count was independently associated with liver injury in EBV infection (OR = 1.169, 95% CI = 1.051–1.301, p = 0.004). The P interaction value between WBC count and cytomegalovirus was 0.149. The decision curve analysis showed that WBC count had larger area under curve compared with platelet (PLT) and birthweight (BW). ROC analysis yielded the c-index of WBC count: 0.75 and cut-point of 8.3. The turning point of WBC count in its association with ALT was 16.8. The p value before and after the turning point was < 0.001 and 0.123, respectively.ConclusionsCytomegalovirus co-infection demonstrated 5.972 more times of liver injury risk in EBV infection. WBC count was an independent biomarker for liver injury before the turning point of 16.8 in EBV infection. More attention should be paid to the risk of EBV infection in the winter. Cytomegalovirus infection and WBC count merit attention in the monitoring of possible liver injury in EBV infection among pediatric RTIs.

Analysis of parainfluenza virus infection in acute respiratory tract infection adult cases in Shanghai, 2015-2021

Objective: To study the infection status and epidemiological characteristics of parainfluenza virus (PIV) in acute respiratory tract infection adult cases in Shanghai from 2015 to 2021, and to provide a scientific basis for preventing and controlling PIV. Methods: Acute respiratory tract infections were collected from 13 hospitals in Shanghai from 2015 to 2021. Relevant information was registered, and respiratory specimens were sampled to detect respiratory pathogens by multiplex PCR. Results: A total of 5 104 adult acute respiratory tract infection cases were included; the overall positive rate of the respiratory pathogens was 29.37% (1 499/5 104). The positive rate of PIV was 2.61% (133/5 104), compared with 2.32% (55/2 369) and 2.85% (78/2 735) in influenza-like cases (ILI) and severe acute respiratory infection (SARI) cases, respectively. Among them, PIV3 accounted for the highest proportion (62.41%, 83/133), followed by PIV1 (18.80%, 25/133), PIV2 (9.77%, 13/133), and PIV4 (9.02%, 12/133). The incidence of PIV-positive cases was mainly distributed in the first and second quarters, accounting for 62.41% (83/133). The difference in the incidence in each quarter was significant (χ2=24.78, P<0.001). Mixed infection accounted for 18.80% (25/133) of 133 PIV-positive cases, the mixed infection rates of ILI and SARI were 18.18% (10/55) and 19.23% (15/78), respectively, and the main mixed pathogen of PIV was coronavirus 229E. Conclusions: There are a certain proportion of PIV-positive acute respiratory tract infection cases in Shanghai. It is necessary to strengthen the etiological surveillance in acute respiratory tract infection cases, especially the mixed infection of PIV and other pathogens.

Report of a case of bochdalek hernia in an adult presenting as chronic cough: review of literature and discussion

Adult symptomatic bochdalek hernias (BH) are rare and account for 0.16%-6% of all diaphragmatic hernias. Chronic abdominal pain is commonest type of presentation. We have a patient of BH presented with chronic cough and breathlessness on exertion. Aim was to study clinical course and outcome of patient presented to our institute. We also would like to review relevant literature available online and compare it with our findings. 30-year-male from peripheral area had recurrent episodes of cough and breathlessness on exertion since 7 years. He was treated as a case of lower respiratory tract infection. We did chest radiogram which revealed presence of haziness in left lower zone with obliteration left costophrenic angle. His computerized tomography scan revealed defect of approximate size 43×45 mm in posterolateral aspect of left hemidiaphragm with omental herniation. Patient was operated by lap converted to open primary bochdalek hernia repair. His postoperative course was uneventful. Review of literature done revealed cough as a rare type of presentation. Laparoscopy is becoming emerging modality of treatment to do surgical correction. Adult onset diaphragmatic hernias have variable clinical manifestations. High index of clinical suspicion with imaging studies like contrast enhanced computed tomography (intravenous plus oral contrast) of chest and abdomen are required for timely diagnosis and treatment.