Cases Of Respiratory Infection Research Articles

Antimicrobial Drug Prescription Patterns for Respiratory Tract Infections in Military Hospitals Lagos Nigeria.

Background: Antibiotics are powerful and effective medicines used for treating infections caused by bacteria. Of all the challenges faced due to antibiotics abuse, the greatest is antibiotic resistance. A major cause of antibiotic resistance is the wrong use of antibiotics in the management of diseases not caused by bacteria.Antibiotics are irrationally used in the treatment of viral infections as seen in many cases of respiratory tract infections. This study aims to evaluate the frequency of various RTIs, themanagement and factors that influence antimicrobial prescription patterns for various RTIs in Military Hospital Lagos, Lagos State, Nigeria. Methods: A cross-sectional study was conducted in Military Hospital Lagos where Data was obtained, using two designs of questionnaires, from prescribers and patient records. The target population was all patients treated for RTIs within a period of seven years and all prescribers who had treated patients for RTIs in Military Hospital Lagos. Post-Hoc Power Analysis with  Dichotomous Endpoint was utilized in obtaining the sample size. Reliability tests of the instruments was obtained using Cronbach's Alpha. This involved descriptive statistical analysis, Chi-Square test, Binary Logistic regression analysis. The data used in the study were obtained from 209 patient records and 30 physicians. Results: In this study, it was observed that 196(93.8%) patients admitted at Military Hospital Lagos for RTI presented with Upper Respiratory Tract Infections (URTIs; cough, common cold, pharyngitis, tonsillitis), 11(5.3%) with Lower respiratory tract infections  (LRTIs; pneumonia and bronchitis) and2(0.9) with COVID. Young patients<45years  (125) made up about 60% of the admissions. RTIs were more prevalent in females (111, 53.1%) than in males (98, 46.9%). It was observed that 21 (70%) physicians followed the Standard Treatment Guidelines (STG) in prescribing antibiotics for RTIs, 11(36.7%) physicians modelled their choice of  antimicrobials after the senior consultants, 4(13.3%) on sensitivity results, 1(3.3%) on period preferences and 3(10%) on other factors. Out of 209 patients' records sampled, only 6(3%) patients underwent tests as ordered by their physicians before antibioticswere prescribed even though 21(70%) physicians claimed to follow the STG. Results of the laboratory investigation ordered implicated 6 individual organisms: Gram negative cocci, Enterobacter cloacae, E. coli, SARS CoV-2, Streptomyces pyogenes and Staphylococcus species. Conclusion: The gender of patient, physician educational qualification, observation of RTIs and frequency of RTIs significantly influence the antimicrobial prescription pattern for various RTIs in Military Hospital Lagos. In order to increase prescription quality, improve the rationality of drug use and reduce the prevalence of antibiotic resistance, we recommend the development of targeted intervention programs including but not limited to continuous enlightenment of physicians on strict compliance to the guidelines in the management of RTIs.

Clinical and economic burden of respiratory syncytial virus in Spanish children: the BARI study

Respiratory syncytial virus (RSV) infection is a major cause of morbidity in children. However, its disease burden remains poorly understood, particularly outside of the hospital setting. Our study aimed to estimate the burden of medically attended acute lower respiratory infection (ALRI) cases potentially related to RSV in Spanish children. Longitudinal data from September 2017 to June 2018 of 51,292 children aged < 5 years old from the National Healthcare System (NHS) of two Spanish regions were used. Three case definitions were considered: (a) RSV-specific; (b) RSV-specific and unspecified acute bronchiolitis (RSV-specific and Bronchiolitis), and; (c) RSV-specific and unspecified ALRI (RSV-specific and ALRI). A total of 3460 medically attended ALRI cases potentially due to RSV were identified, of which 257 (7.4%), 164 (4.7%), and 3039 (87.8%) coded with RSV-specific, unspecific bronchiolitis, and unspecific ALRI codes, respectively. Medically attended RSV-specific and ALRI cases per 1000 children was 134.4 in the first year of life, 119.4 in the second, and 35.3 between 2 and 5 years old. Most cases were observed in otherwise healthy children (93.1%). Mean direct healthcare cost per medically attended RSV-specific and ALRI case was €1753 in the first year of life, €896 in the second, and €683 between 2 and 5 years old. Hospitalization was the main driver of these costs, accounting for 55.6%, 38.0% and 33.4%, in each respective age group. In RSV-specific cases, mean direct healthcare cost per medically attended case was higher, mostly due to hospitalization: €3362 in the first year of life (72.9% from hospitalizations), €3252 in the second (72.1%), and €3514 between 2 and 5 years old (74.2%). These findings suggest that hospitalization data alone will underestimate the RSV infections requiring medical care, as will relying only on RSV-specific codes. RSV testing and codification must be improved and preventive solutions adopted, to protect all infants, particularly during the first year of life.

Effect of Nickel Mining on Acute Respiratory Infection Cases in Boenaga Village, Lasolo District, North Konawe Regency

Introduction: Nickel mining industry with air with nickel dust and combu stion gases. The main effects of dust on workers are either acute lung disorders or chronic physiological disorders, eye irritation, sensory irritation, and accumulation of harmful substances in the body. One of the negative impacts of nickel processing activities is environmental degradation which is characterized by air and many diseases related to the respiratory tract. This greatly affects the people who live close to mining areas, based on data from the Lasolo Island Health Center shows that ARI cases in 2020 were 126 cases, Asthma 85 cases, and Toddler Pneumonia 23 cases. The purpose of this study was to determine the effect of mining on cases of ARI in mining areas in the village of Boenaga.&#x0D; Method: The type of research used in this study is an observational study with a cross sectional analytic study.&#x0D; Result: The results showed that there was a relationship between dust exposure and cases of respiratory disease.&#x0D; Conclusion: The condition of indoor and outdoor air quality in exposed areas was higher than in non-exposed areas, but all of these are still below the permissible threshold value. The incidence of ARI in exposed locations increased significantly compared to non-exposed locations in Pomalaa district.

Toddler Acute Respiratory Infection Cases by Gender in the North Buton Regency between 2018-2020

A respiratory condition in toddlers that often occur is called ARI (Acute Respiratory Infections), which are usually accompanied by coughs, flu and colds. ARI is an acute infection that attacks one or more parts of the respiratory tract from the nose to the alveoli, including the adnexa. This study was conducted with the objective of describing the number of cases of ARI under five years old in the North Buton Regency for the 2018-2020 period based on gender. This is a survey research utilizing the health report data of the North Buton District Health Office for the period 2017-2020. It includes on the incidence of ARI by gender. The research sample is ARI patients who are children under five. The type of research data is numerical. The research data is presented in the form of graphs with narration. In 2018, ARI cases among children less than five years old in the North Buton Regency were the highest at the North Wakorumba Health Center, with as many as 216 cases in mostly males, the lowest at the Labaraga Health Center with 47 cases. In 2019, the highest was at the Kioko Health Center with as many as 262 cases mostly women and the lowest at the Kulisusu Health Center with 37 cases. Then in 2020 the highest was at the Waode Buri Health Center with 704 cases mostly women and the lowest was at the Boneguru Health Center with 10 cases.&#x0D; Keywords: Acute Respiratory Infections, Toddler, North Buton Regency

Clinical characteristics of Mycoplasma pneumoniae infection and factors associated with co-infections in children

Objective: To describe the clinical characteristics of Mycoplasma pneumoniae infection and analyze the factors associated with co-infections with other pathogens in children, and provide evidence for improvement of community acquired pneumonia (CAP) prevention and control in children. Methods: Based on the surveillance of hospitalized acute respiratory infections cases conducted in Soochow University Affiliated Children's Hospital (SCH), the CAP cases aged <16 years hospitalized in SCH between 2018 and 2021 were screened. The pathogenic test results of the cases were obtained through the laboratory information system, and their basic information, underlying conditions, and clinical characteristics were collected using a standardized questionnaire. The differences in clinical characteristics between M. pneumoniae infection and bacterial or viral infection and the effect of the co-infection of M. pneumoniae with other pathogens on clinical severity in the cases were analyzed; logistic regression was used to analyze the factors associated with the co-infections with other pathogens. Results: A total of 8 274 hospitalized CAP cases met the inclusion criteria. Among them, 2 184 were positive for M. pneumoniae (26.4%). The M. pneumoniae positivity rate increased with age (P<0.001), and it was higher in girls (P<0.001) and in summer and autumn (P<0.001). There were statistically significant differences in the incidence of wheezing, shortness of breath, wheezing sounds and visible lamellar faint shadow on chest radiographs, as well as fever and hospitalization days among M. pneumoniae, bacterial, and viral infection cases (all P<0.05). In the cases aged <60 months years, co-infection cases had higher rates of wheezing, gurgling with sputum and stridor; and in the cases aged ≥60 months, co-infection cases had a higher rate of shortness of breath (all P<0.05). Multifactorial logistic regression analysis showed that being boys (aOR=1.38,95%CI:1.15-1.67), being aged <6 months (aOR=3.30,95%CI:2.25-4.89), 6-23 months (aOR=3.44,95%CI:2.63-4.51), 24-47 months (aOR=2.50,95%CI:1.90-3.30) and 48-71 months (aOR=1.77,95%CI:1.32-2.37), and history of respiratory infection within 3 months (aOR=1.28,95%CI:1.06-1.55) were factors associated with co-infections of M. pneumoniae with other pathogens. Conclusions: M. pneumoniae was the leading pathogen in children hospitalized due to CAP. M. pneumoniae infections could cause fever for longer days compared with bacterial or viral infections; M. pneumoniae was often co-detected with virus or bacteria. Being boys, being aged <72 months and history of respiratory infection within 3 months were associated factors for co-infections.

Emerging strategies in nanotechnology to treat respiratory tract infections: realizing current trends for future clinical perspectives

A boom in respiratory tract infection cases has inflicted a socio-economic burden on the healthcare system worldwide, especially in developing countries. Limited alternative therapeutic options have posed a major threat to human health. Nanotechnology has brought an immense breakthrough in the pharmaceutical industry in a jiffy. The vast applications of nanotechnology ranging from early diagnosis to treatment strategies are employed for respiratory tract infections. The research avenues explored a multitude of nanosystems for effective drug delivery to the target site and combating the issues laid through multidrug resistance and protective niches of the bacteria. In this review a brief introduction to respiratory diseases and multifaceted barriers imposed by bacterial infections are enlightened. The manuscript reviewed different nanosystems, i.e. liposomes, solid lipid nanoparticles, polymeric nanoparticles, dendrimers, nanogels, and metallic (gold and silver) which enhanced bactericidal effects, prevented biofilm formation, improved mucus penetration, and site-specific delivery. Moreover, most of the nanotechnology-based recent research is in a preclinical and clinical experimental stage and safety assessment is still challenging.

Vitamin D Deficiency and its Association with Respiratory Tract Infections in Pediatrics

Respiratory tract infections (RTI) are a major cause of mortality and morbidity in children. Several studies have aim supplementation as a possible preventive measure against respiratory tract infections in children. Vitamin-D (sunshine vitamin) is a type of prohormone with various functions like extracellular calcium ion maintenance, immunomodulation in the body. The three major sources of Vitamin-D are Sun exposure, Diet and Supplements. The main objective of our study was to correlate the vitamin D deficiency in children with RTI’s. A prospective observational study was conducted for 6 months inpatient of the Pediatric department in tertiary care hospital. Demographic details, cause of admission, past medical and medication history, feeding history, sun exposure was taken by interviewing the guardian. Data of a total of 25 pediatric patients with various respiratory tract infection cases were collected, documented and their vitamin D levels were analyzed in our study. The vitamin D level of samples was analyzed by Electro chemiluminescence immunoassay. Statistical methods were applied and significant differences were observed among the vitamin D sufficient and deficient patients with RTI’s. It was observed that out of 25 cases, 16 cases had recurrent respiratory tract infections and 9 had non-recurrent respiratory tract infections which statistically shows P value &lt; 0.05. This study significantly correlates vitamin D deficiency with respiratory tract infections in children. This study also suggests vitamin D as a supplement therapy as it plays an important role in the innate and the adaptive immunity.

Changes in the pattern and disease burden of acute respiratory viral infections before and during the COVID-19 pandemic.

ObjectivesWe conducted a comparative analysis of the differences in the incidence of 8 acute respiratory viruses and the changes in their patterns before and during the coronavirus disease 2019 (COVID-19) pandemic.MethodsThree sentinel surveillance systems of the Korea Disease Control and Prevention Agency and data from the Health Insurance Review and Assessment Service were analyzed. The average numbers of reported cases and the related hospital admissions and outpatient data were compared between April 2018–2019 and 2020–2021. Changes in the disease burden and medical expenditures between these 2 time periods were evaluated.ResultsDuring the COVID-19 pandemic, the number of reported cases of all acute respiratory viral infections, except for human bocavirus, decreased significantly. Data from the Health Insurance Review and Assessment Service also showed decreases in the actual amount of medical service usage and a marked reduction in medical expenditures.Conclusion Non-pharmacological interventions in response to COVID-19 showed preventive effects on the transmission of other respiratory viruses, as well as COVID-19. Although COVID-19 had a tremendous impact on society as a whole, with high social costs, there were also positive effects, such as a reduction in the incidence of acute respiratory viral infections.

The association of obesity-related traits on COVID-19 severity and hospitalization is affected by socio-economic status: a multivariable Mendelian randomization study.

BackgroundDue to its large impact on human health, socio-economic status (SES) could at least partially influence the established association between obesity and coronavirus disease 2019 (COVID-19) severity. To estimate the independent effect of body size and SES on the clinical manifestations of COVID-19, we conducted a Mendelian randomization (MR) study.MethodsApplying two-sample MR approaches, we evaluated the effects of body mass index (BMI, n = 322 154), waist circumference (WC, n = 234 069), hip circumference (n = 213 019) and waist–hip ratio (n = 210 088) with respect to three COVID-19 outcomes: severe respiratory COVID-19 (cases = 8779, controls = 1 000 875), hospitalized COVID-19 (cases = 17 992, controls = 1 810 493) and COVID-19 infection (cases = 87 870, controls = 2 210 804). Applying a multivariable MR (MVMR) approach, we estimated the effect of these anthropometric traits on COVID-19 outcomes accounting for the effect of SES assessed as household income (n = 286 301).ResultsBMI and WC were associated with severe respiratory COVID-19 [BMI: odds ratio (OR) = 1.51, CI = 1.24–1.84, P = 3.01e-05; WC: OR = 1.48, 95% CI = 1.15–1.91, P = 0.0019] and hospitalized COVID-19 (BMI: OR = 1.50, 95% CI = 1.32–1.72, P = 8.83e-10; WC: OR = 1.41, 95% CI = 1.20–1.67, P = 3.72e-05). Conversely, income was associated with lower odds of severe respiratory (OR = 0.70, 95% CI = 0.53–0.93, P = 0.015) and hospitalized COVID-19 (OR = 0.78, 95% CI = 0.66–0.92, P = 0.003). MVMR analyses showed that the effect of these obesity-related traits on increasing the odds of COVID-19 negative outcomes becomes null when accounting for income. Conversely, the association of income with lower odds of COVID-19 negative outcomes is not affected when including the anthropometric traits in the multivariable model.ConclusionOur findings indicate that SES contributes to the effect of obesity-related traits on COVID-19 severity and hospitalization.

A particulate matter: How environmental irritants and particulate matter increase sensitivity to bacterial respiratory tract infections. Commentary for "Underground railway particulate matter and susceptibility to pneumococcal infection".

Respiratory tract infections (RTIs) are a leading cause of morbidity and mortality and deaths attributed to antibiotic resistant organisms are increasing. In 2019, close to 500 million cases of lower RTIs and approximately 2.5 million deaths occurred, making RTIs the 4th leading cause of morbidity and mortality worldwide.1 Pneumonia caused by Streptococcus pneumoniae (the pneumococcus) is the leading cause of these infections and responsible for almost half of all deaths.

Vydovyi spektr bakteriinykh chynnykiv shpytalnykh infektsii dykhalnykh shliakhiv u likarnianykh ustanovakh m. Lvova ta poshyrenist sered nykh antybiotykorezystentnosty

Introduction. Healthcare-associated infections (HAIs) are a pressing problem in the health care system. Respiratory tract infections (RTI) are the second most common group of HAIs. One of the determining factors in the development of nosocomial pneumonia, which is predominantly bacterial in origin, is the properties and level of virulence of microbial factors. Early nosocomial pneumonia occurs when the upper respiratory tract microbiota infects the respiratory tract. Late nosocomial pneumonia is caused by nosocomial strains of microorganisms, characterized by multidrug resistance to antibiotics and disinfectants high levels of virulence, which include P. aeruginosa, Acinetobacter spp., Enterobacteriaceae family, MRSA. Unfortunately, in Ukraine, the structure and prevalence of HAIs and the antimicrobial resistance of pathogens are extremely poorly studied. The aim of the study. Therefore, the study investigates the species spectrum and antimicrobial resistance of the main causative agents of respiratory tract infections. Materials and methods. A study of microbial factors of nosocomial respiratory tract infections in 4 hospitals in Lviv. 205 patients of intensive care units diagnosed with RTI (36.6 %) were examined. Statistical analysis of the results was performed using the standard package of the program “Microsoft Excel 2010”. Microbiological diagnostics were performed following current regulations in the specialty “Bacteriology and Virology” and “Guidelines for Clinical Microbiology” of the 12th revision of the American Association for Microbiology. Microbiological diagnostics is performed in the research laboratory of the Department of Microbiology of Danylo Halytsky Lviv National Medical University. Results. The species profile of the detected pathogens of RTI indicates that among 14 representatives of different taxa, the gram-positive microbiota predominates, but the quantitative level of seeding per gram-negative microbiota accounts for 70.17 %. Among the isolates – factors of HAIs, multidrug-resistant (MDR) share accounted for 62.8 %. 3 strains are classified as pan drug resistant (PDR): 2 – P. putida and 1 – P. aeruginosa. Of the gram-positive microbiota, Enterococcus spp., represented mainly by E. faecalis and E. faecium, was most often detected in clinical material. E. faecalis was most often detected in the clinical material of the gram-positive microbiota. E. faecalis isolates were characterized by pronounced resistance to penicillins (including oxacillin), cephalosporins, fluoroquinolones, erythromycin and azithromycin, clindamycin with preserved sensitivity to vancomycin and linezolid. Pseudomonas aeruginosa isolates showed absolute sensitivity to colistin. Among other antibiotics, the most effective in terms of the number of sensitive strains were carbapenems – imipenem (57.5 %) and meronem (55.0 %). Only 37.5 % of the cultures were sensitive to tobramycin and tegicillin, an inhibitor of the protected cephalosporin antibiotic, sulfperazone. The genus Staphylococcus was among the causative agents of pneumonia other than Staph. aureus subsp. aureus, will Staph. haemolyticus, Staph. lugdunensis. Moreover, only one strain of methicillin-resistant Staphylococcus was detected. Most cases of RTI (57.4%) of patients in intensive care units occurred within 48 hours after the installation of a tracheostomy or intubation tube. Conclusions. According to the results of microbiological diagnostics, it has been established that the main etiological factors of nosocomial pneumonia associated with medical care are opportunistic microorganisms – Pseudomonas aeruginosa and enterococci. 62.8 % of strains were MDR. Furthermore, the results of monitoring the antibiotic resistance of hospital strains of microorganisms show their differences in different institutions of Lviv and the connection exclusively with the hospital environment. Therefore, optimization of antimicrobial treatment of nosocomial pneumonia is possible only based on the broader use of microbiological research results, constant monitoring of the microbiological status of patients in intensive care units, hospitality (distribution and properties of pathogens in hospitals).

Evaluation of amoxicillin efficacy in the pharmacotherapy of bronchopulmonary diseases in children

In recent years, the rational treatment of bronchopulmonary diseases in children has been developing in all directions and is of great importance in modern pediatrics. Medical statistics in different countries record a steady annual increase in the number of cases of respiratory infections, recurrent bronchitis, and bronchopneumonia. One of the main components of adequate etiopathogenetic treatment of bacterial infections, regardless of the severity and localization of the inflammatory process, is the rational choice of antibacterial agents. The urgent problem has been the safe pharmacotherapy of a growing organism, taking into account the etiology and pathogenesis of diseases, in accordance with the standard of treatment. The aim of this study was to evaluate the effectiveness of the drug Amoxicillin, depending on the severity of the course, complication and comorbidity in children receiving inpatient treatment at the Tashkent Pediatric Medical Institute Clinic.

Nosocomial Infections During Extracorporeal Membrane Oxygenation in Pediatric Patients: A Multicenter Retrospective Study.

ObjectiveExtracorporeal membrane oxygenation (ECMO) is increasingly used in critically ill patients with respiratory and/or cardiac failure. This study aimed to investigate the epidemiology and risk factors of nosocomial infection (NI) in pediatric patients who underwent ECMO for respiratory and/or circulatory failure.MethodsMedical records for patients that were administered underwent ECMO support at Xiangya Second Hospital of Central South University, The Sixth Medical Center of PLA General Hospital, and Children's Hospital Affiliation of Zhengzhou University, from September 2012 to December 2019 were retrospectively reviewed. Clinical data of the patients who developed NI were collected and analyzed. Univariate and multivariate logistic regressions were performed to identify the independent predictive factors of NI during ECMO.ResultsA total of 54 first episodes of NI were identified in the 190 patients on ECMO, including 32 cases of respiratory tract infections, 20 cases of bloodstream infections, and 2 cases of surgical site wound infections. Gram-negative pathogens were the dominant pathogens isolated, accounting for 92.6% of the NI. The incidence of ECMO-related NI was 47.6 cases per 1,000 ECMO days. In the univariate logistic regression, ECMO mode, ECMO duration, ICU duration, and peritoneal dialysis were associated with the development of NI in patients with ECMO support. However, in the multivariate analysis, only ECMO duration (OR = 2.46, 95%CI: 1.10, 5.51; P = 0.029), ICU duration (OR = 1.35, 95%CI: 1.05, 1.59; P = 0.017) and peritoneal dialysis (OR = 2.69, 95%CI: 1.08, 5.73; P = 0.031) were the independent predictive factors for NI during ECMO support.ConclusionThis study identified the significant correlation between ECMO-related NI and ECMO duration, ICU duration, and peritoneal dialysis. Appropriate preventive measures are needed for hospitals to reduce the incidence of ECMO in pediatric patients.

Isolation and identification of Aspergillus fumigatus from feline respiratory infection in Baghdad province

Aspergillus fumigatus considered to be the most important species to cause respiratory infection cases in both humans and animals especially in cats in the last decades. In this study, we focused on the isolation and identification of Aspergillus fumigates by collecting 40 samples in deferent veterinary clinics and stray cats in Baghdad city, during the period (October 2021 to January 2022), all samples were cultured on Sabouraud dextrose agar and malt extract agar. The isolates identified by the laboratory methods, it’s depend on macroscopic and microscopic appearance. The results showed that (40) swaps taken from the pharynx of infected cats, included: Aspergillus fumigatus 16 (40%), Aspergillus spp. 7 (17.5%), Aspergillus niger 8 (20%), Penicillium spp. 5 (12.5%), Cryptococcus spp. 3 (7.5%), Fusarium spp. 1 (2.5%), and the presence of infection in female (62.5%) more than male (37.5%), this study indicated that the virulence and normal habitat of Aspergillus fumigatus make it the most important pathogen to cause respiratory infection and allergen in cats.

The Nicaraguan Pediatric Influenza Cohort Study, 2011-2019: Influenza Incidence, Seasonality, and Transmission.

Children account for a large portion of global influenza burden and transmission, and a better understanding of influenza in children is needed to improve prevention and control strategies. To examine the incidence and transmission of influenza we conducted a prospective community-based study of children aged 0-14 years in Managua, Nicaragua, between 2011 and 2019. Participants were provided with medical care through study physicians and symptomatic influenza was confirmed by reverse-transcription polymerase chain reaction (RT-PCR). Wavelet analyses were used to examine seasonality. Generalized growth models (GGMs) were used to estimate effective reproduction numbers. From 2011 to 2019, 3016 children participated, with an average of ∼1800 participants per year and median follow-up time of 5 years per child, and 48.3% of the cohort in 2019 had been enrolled their entire lives. The overall incidence rates per 100 person-years were 14.5 symptomatic influenza cases (95% confidence interval [CI]: 13.9-15.1) and 1.0 influenza-associated acute lower respiratory infection (ALRI) case (95% CI: .8-1.1). Symptomatic influenza incidence peaked at age 9-11 months. Infants born during peak influenza circulation had lower incidence in the first year of their lives. The mean effective reproduction number was 1.2 (range 1.02-1.49), and we observed significant annual patterns for influenza and influenza A, and a 2.5-year period for influenza B. This study provides important information for understanding influenza epidemiology and informing influenza vaccine policy. These results will aid in informing strategies to reduce the burden of influenza.

Genotyping of respiratory syncytial virus among influenza-like illness and severe acute respiratory infection cases of children in the Philippines from 2006 to 2016.

ObjectiveRespiratory syncytial virus (RSV) is a leading cause of severe lower respiratory infection, and therefore, a major threat to global health. This study determined the epidemiological and molecular characteristics of RSV among cases of influenza‐like illness (ILI) and severe acute respiratory infection (SARI) among children in the Philippines.MethodThe study included archived nasopharyngeal swab and oropharyngeal swab samples collected from patients under the age of five who are presented with ILI or SARI for the period of 2006–2016. Swabs were examined for RSV subgroup by multiplex real‐time qRT‐PCR. Partial genome sequencing and phylogenetic analyses of the second hypervariable region (HVR) of the G gene were used to determine the genotype of RSV isolates.ResultsA total of 1036 representative samples from all sites were selected and tested. Of these samples, 122 were RSV‐positive at 11.8% prevalence rate, and 58.2% (71/122) were classified as RSV‐A. Six genotypes were identified, which include NA1 (27/122, 22.1%), ON1 (5/122, 4.1%), GA2 (1/122, 0.8%), and GA5 (1/122, 0.8%) for RSV‐A; and BA2 (13/122, 10.7%) and BA9 (1/122, 0.8%) for RSV‐B. Most RSV‐related cases were significantly associated with clinical characteristics such as runny nose (88.1% RSV vs. 11.9% non‐RSV: p value = 0.021), pneumonia (80.6% RSV vs. 19.4% non‐RSV; p value = 0.015), and bronchitis (71.7% RSV vs. 28.3% non‐RSV; p value < 0.001). Increased RSV‐related cases were observed among children below 24 months old.ConclusionThe RSV trend and genetic variability in the Philippines resembles a similar pattern of transmission globally.

From COVID-19 to Influenza-Real-Life Clinical Practice in a Pediatric Hospital.

The COVID-19 pandemic, through the restrictions and the non-pharmaceutical interventions implemented, has importantly impacted the circulation and epidemiology of respiratory viruses. Specifically, the 2020/21 season was entirely dominated by SARS-CoV-2, while influenza activity reached an all-time low, despite initial warnings that a double concurrent epidemic could be possible. The current season, 2021/22, started with the shift of circulating SARS-CoV-2 variants from delta to omicron, which then rapidly spread globally, as most countries, including Romania, removed all restrictions and compulsory non-pharmaceutical interventions. In this report we present the clinical reality observed in March 2022 in a tertiary paediatric hospital in Bucharest, Romania, where we observed a sudden surge in influenza cases, after two consecutive years (March 2020 to March 2022) when influenza had stopped circulating in our country. Thus, in March 2022 the positivity rate of rapid influenza antigen tests unexpectedly increased to 33.5%, paralleled by a decrease to 7.5% in the positivity rate of rapid SARS-CoV-2 antigen tests. This significant increase in the influenza attack rate was observed from the first week (14.9% positivity rate), through the fourth week of March (42.1% positivity rate, p < 0.001), while the COVID-19 attack rate displayed a significant decreasing trend (from 11.2% to 4.8%, p < 0.001). These data serve as a warning about relaxing restrictions in a precipitous approach with minimised vigilance. The evolution of these observations needs to be followed very carefully in all countries, particularly in settings where epidemiological interactions and non-pharmaceutical interventions have so far led to the extensive circulation of only one of these viruses, and we should now be prepared to perform a correct differential diagnosis between influenza and COVID-19, in order to ensure the best quality of care and personalized management of each case of respiratory infection. The results of active influenza surveillance studies for the whole 2021/22 season are awaited, in order to quantify the joint influenza—COVID-19 burden among children.

Clinical Characteristics of Congenital Atresia of the Left Main Coronary Artery in 12 Children.

BackgroundLeft main coronary artery atresia (LMCAA) is an extremely rare abnormality and only <100 cases have been reported worldwide. We describe the clinical manifestations, imaging features, prognosis, and treatments of LMCAA who were admitted in our department, which aimed to improve the clinical diagnosis and treatments of LMCAA in children.MethodsA retrospective study identified 12 patients diagnosed with congenital left coronary artery atresia at Pediatric Heart Center of Beijing Anzhen Hospital from June 2010 to June 2019. The clinical characteristics, imaging data, and treatment follow-up were analyzed.ResultsAmong the 12 cases, 8 were boys and 4 were girls; the age of onset was 2 months to 2 years old (median age 7 months); the age of diagnosis was 7 months to 6 years old (median age 2 years and 11 months). At the initial diagnosis, there were 4 cases of respiratory tract infection with cardiac murmur, 3 cases of cardiac shadow enlargement, 1 case of recurrent syncope, 2 cases of feeding difficulty with cardiac enlargement, and 2 cases of simple cardiac murmur. In 12 cases of electrocardiogram examination, 7 cases showed pathological Q waves of lead I, AVL and v4–v6; in 12 cases of chest X-ray examination, 8 cases showed cardiac shadow enlargement; in 12 cases of our hospital's first cardiac ultrasound examination, 4 cases were definitely diagnosed, and 8 cases showed the possibility of left coronary artery abnormality; in 5 cases of cardiac coronary CT angiography examination, 2 cases were confirmed, 2 cases reported suspected left coronary artery abnormality, and 1 case did not report abnormality; All cases were definitely diagnosed in 8 cases of angiography. Follow-up was performed from 1 to 8 years; one case died suddenly, one case of syncope after activity was treated by oral medication, 3 cases received open coronary angioplasty and mitral valvuloplasty, recovered well after operation, the rest of the children were treated by oral medication, and the symptoms are stable at present.ConclusionsLeft main coronary artery atresia is difficult to diagnose and can result in heart failure early in life. Timely diagnosis and reasonable treatment are the keys to improve the prognosis.

Immunogenicity, Safety, and Clinical Effectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Patients With Spondyloarthritis (Preliminary Data)

Background. Immunosuppressive drugs are widely used for the treatment of patients with spondyloarthritis (SpA) to effectively control the activity of the disease. At the same time, the use of these drugs is associated with an increased risk of developing infections of the upper and lower respiratory tract, which can be prevented by vaccination. The aim of the study was to evaluate the immunogenicity, safety, and clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with SpA. Material and methods. The study included 54 patients with SpA: 39 with ankylosing spondylitis, and 15 with psoriatic arthritis. Most patients had a history of two or more cases of lower respiratory tract infections, 2 patients reported a monthly exacerbation of chronic sinusitis, one patient reported the development of otitis every 2–3 months. 72% of patients received immunosuppressive therapy at the time of inclusion in the study. PPV-23 was administered in the amount of 1 dose (0.5 ml) against the background of ongoing antirheumatic therapy. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics s.r.o., Czech Republic) at baseline, after 1, 3, and 12 months after vaccination. The tolerability of PPV-23, the effect of vaccination on SpA activity (according to the dynamics of the BASDAI index), and the incidence of upper and lower respiratory tract infections were assessed. Results. The concentration of antibodies to pneumococcal capsular polysaccharide was significantly higher 1, 3, and 12 months after vaccination compared to baseline. There was no negative effect of vaccination on the activity of SpA and the emergence of «new» autoimmune disorders. The vaccine was well tolerated by 76% of patients., Only one patient developed pneumonia during the observation period. Patients suffering from frequent sinusitis and otitis reported the absence of these infections after vaccination. Conclusions. Preliminary results of the study indicate sufficient immunogenicity, safety, and clinical efficacy of PPV-23 in patients with SpA.

Whole Genome Profiling of Lung Microbiome in Solid Organ Transplant Recipients Reveals Virus Involved Microecology May Worsen Prognosis.

Solid organ transplantation (SOT) is the final therapeutic option for recipients with end-stage organ failure, and its long-term success is limited by infections and chronic allograft dysfunction. Viral infection in SOT recipients is considered an important factor affecting prognosis. In this study, we retrospectively analyzed 43 cases of respiratory infections in SOT recipients using metagenomic next-generation sequencing (mNGS) for bronchoalveolar lavage fluid (BALF). At least one virus was detected in 26 (60.5%) recipients, while 17 (39.5%) were virus-negative. Among virus-positive recipients, cytomegalovirus (CMV) was detected in 14 (32.6%), Torque teno virus (TTV) was detected in 9 (20.9%), and other viruses were detected in 6 (14.0%). Prognostic analysis showed that the mortality of the virus-positive group was higher than that of the virus-negative group regardless whether it is the main cause of infection. Analysis of different types of viruses showed that the mortality of the CMV-positive group was significantly higher than that of the CMV-negative group, but no significant difference was observed in other type of virus groups. The diversity analysis of the lung microbiome showed that there was a significant difference between the virus-positive group and the negative group, in particular, the significant differences in microorganisms such as Pneumocystis jirovecii (PJP) and Moraxella osloensiswere detected. Moreover, in the presence of CMV, Pneumocystis jirovecii, Veillonella parvula, and other species showed dramatic changes in the lung of SOT patients, implying that high degree of co-infection between CMV and Pneumocystis jirovecii may occur. Taken together, our study shows that the presence of virus is associated with worse prognosis and dramatically altered lung microbiota in SOT recipients.