Complication Of Influenza Infection Research Articles

Influenza Immunization in Very-Low-Birth-Weight Infants: Epidemiology and Long-Term Outcomes.

Very-low-birth-weight infants (VLBWIs; birth weight < 1500 g) are at an increased risk of complicated influenza infection, which frequently includes pneumonia, encephalitis or even death. Data on influenza immunization and its outcome in VLBWIs are scarce. This study aimed to provide epidemiological data on influenza immunization for German VLBWIs and hypothesized that immunization would protect VLBWIs from infection-mediated neurodevelopmental impairment and preserves lung function at early school age. In this observational population-based German Neonatal Network (GNN) study, infants born between 2009 and 2015 were invited to partake in a 6-year follow-up investigation including lung function and developmental testing. Uni- and multivariate analyses were performed to evaluate the clinical characteristics and outcomes of influenza-immunized VLBWIs compared to non-immunized VLBWIs. Influenza immunization was performed in 871 out of the 3358 VLBWIs (26%) with six-year follow-up. Immunized infants were characterized by a low gestational age and higher rates of morbidity, particularly bronchopulmonary dysplasia. Although early immunization showed no safety signals and had protective effects on the long-term risk of bronchitis (OR: 0.2; CI: 0.1-0.6; p = 0.002), most VLBWIs (88.0%) were unimmunized in their first influenza season. Influenza immunization was not associated with improved lung function (forced expiratory volume in one second and forced vital capacity) or a better neurocognitive outcome (intelligence quotient and strengths and difficulties questionnaire) at early school age. In Germany, only one quarter of 6-year-old VLBWIs were immunized against influenza, particularly those born <28 gestational weeks and/or BPD. Specific influenza immunization guidelines that define evidence-based recommendations are needed for this vulnerable group.

12375 Rhabdomyolysis As A Cause Of PTH-independent Hypocalcemia In A Child With Acute Influenza Infection

Abstract Disclosure: S. Bhattarai: None. K. Halpin: None. Introduction: Hypocalcemia is characterized by low blood calcium level. Normal range for calcium for ages 12- 19-year is 8.5-10.6 mg/dli . Severe hypocalcemia is considered as serum calcium level of &amp;lt;7 mg/dl. Hypoparathyroidism, pseudohypoparathyroidism and Vitamin D deficiency are some of the most common causes encountered by pediatrician endocrinologists. Rhabdomyolysis with hypocalcemia and elevated PTH is a rare presentation that should be considered, particularly for children presenting with acute viral illness. We present a rare case of rhabdomyolysis associated with hypocalcemia not related to hypoparathyroidism. Case: A 12-year-old female presented to the ED with body ache, poor oral intake and vomiting. She was found to be influenza positive. Labs showed hypocalcemia (4.8 mg/dl). She had an undetectable 25-OH vitamin D level (&amp;lt;5 ng/ml) and elevated iPTH level (609 pg/ml). We discussed the possibility of her etiology of hypocalcemia as Vitamin D deficiency although her presentation was atypical at an older age with negative imaging for rickets, hyperphosphatemia (6.0 mg/dl), and normal ALP (334 unit/L). She did not have any phenotypic features of Albright’s hereditary osteodystrophy with normal renal function. She had elevated CK (4829 U/L) supporting rhabdomyolysis secondary to acute influenza as a cause of her hypocalcemia. Rhabdomyolysis, a known complication of influenza infection, causes cell membrane destruction which impairs the normal function of Na-K-ATPase channel leading to increase in intracellular sodium activating Na/Ca exchanger. This in turn causes influx of calcium intracellularly causing hypocalcemia. Additionally, any injury leads to high phosphorus release from cells due to its lysis. High phosphorus is also caused by reduced oxidative metabolism in muscles impairing phosphate use. This excess of phosphate then combines with calcium and causes calcium-phosphate complex in soft tissues. Hyperphosphatemia additionally inhibits 1 alpha hydroxylase limiting formation of calcitriol leading to hypocalcemia. iiConclusion: Our patient had severe hypocalcemia due to influenza-related rhabdomyolysis. Rhabdomyolysis is an important cause of hypocalcemia in children, especially with acute viral illness. Accordingly, it is also important to obtain serum electrolytes in patients presenting with rhabdomyolysis as hypocalcemia may lead to complications like seizures and cardiac arrhythmia. Endnotes:i Roizen, Jeffrey &amp; Shah, Vipul &amp; Levine, Michael &amp; Carlow, Dean. (2013). Determination of Reference Intervals for Serum Total Calcium in the Vitamin D-Replete Pediatric Population. The Journal of clinical endocrinology and metabolism. 98. 10.1210/jc.2013-3105.ii Ding LN, Wang Y, Tian J, Ye LF, Chen S, Wu SM, Shang WB. Primary hypoparathyroidism accompanied by rhabdomyolysis induced by infection: A case report. World J Clin Cases. 2019 Oct 6;7(19) Presentation: 6/2/2024

Predictors of complicated influenza infection in children presenting in a tertiary hospital in a tropical country: A case-control study

Influenza causes significant healthcare burden globally1 with highest risks in children and the elderly. In children, multiple studies have identified risk factors for severe influenza such as young age (&lt;5 years), presence of comorbidities, abnormal vital signs (e.g. hypoxia, shock) and bacterial coinfections.2-4 We found similar findings in our centre which included children during the influenza A (H1N1) 2009 pandemic with age &lt;2 years and comorbidity as risk factors for complicated influenza.5

Assessment the awareness of the elderly patient's knowledge and attitudes among influenza vaccination in kingdom of Saudi Arabia 2023

Background: Although influenza vaccination is recommended for people aged 50 and above in Saudi Arabia, and the vaccine is provided free of charge, the elderly influenza vaccination rate is still low, also influenza vaccination reduces rates of pneumonia, hospitalization and mortality, influenza vaccination uptake remains low in older patients. Globally, influenza epidemics cause 3–5 million cases of severe illness and result in a quarter million deaths each year. Despite Saudi Arabia tropical climate, influenza and a significant number of hospitalization's. Influenza vaccination has been shown to reduce influenza‑related hospitalizations and deaths. Patients with an influenza infection are at increased risk of severe illness and complications and have a higher mortality and morbidity rate. Despite the significant role of influenza vaccination in preventing and minimizing the serious complications of influenza infection in elderly patient's. Aim of the study: Assessment the awareness of the elderly patient's knowledge and attitudes among influenza vaccination in kingdom of Saudi Arabia 2023. Methods: This cross-sectional study was conducted among 300 participants from health care centers in Makkah Al-Mokarramah city. A validated self-administered questionnaire was used. It includes questions on socio demographic variables, knowledge, attitude, and vaccine response, during the August to September 2023. Results: shows the majority of participant (47.0%) have average of the knowledge towards influenza vaccination followed by (35.0%) of participant high while Range(2-8) and Mean ±SD(7.011±0.512), X2 38.22 P=0.001also the majority of participant (51.0%) have high of the attitudes towards influenza vaccination followed by (37.0%) of participant average while Range(10-18) and Mean ±SD (15.521±1.755), X2 70.26 P=0.001. Conclusion: The proportion of elderly people aged 50 and above who are willing to receive free influenza vaccine is high in Saudi Arabia. But the level of knowledge about influenza, vaccine and trust in society is low. The government should continue to improve the elderly’s awareness and trust in society through medical staff, family members, television and radio media, and guide the elderly to actively vaccinate against influenza. Effective publicity should be carried out through the above channels to guide the elderly to actively vaccinate against influenza, and a significant number of hospitalization's Keywords: Assessment, Knowledge, attitudes, Patients, PHC, seasonal influenza, Immunization, Saudi Arabia.

Association Between Baloxavir Marboxil Prescription for Children with Influenza B Infections and Short-Term Healthcare Consumption in Japan During the 2018-2019 Influenza Season.

Baloxavir marboxil is an anti-influenza medication that was newly introduced into clinical practice in 2018. Baloxavir might be more beneficial than neuraminidase inhibitors (NAIs), as suggested by a subgroup analysis of a clinical trial. Although the association between baloxavir prescription and healthcare use pertains mainly to influenza A, few studies have investigated the association in influenza B. We evaluated the healthcare utilization of children (0-15 years old) treated with either baloxavir or NAIs between December 2018 and May 2019 using claims records in Japan. The primary endpoint was the composite of medical resource utilization, including hospitalization, antibiotic use, laboratory tests, radiological images, and fluid replacement therapy, over 1-9 days after antiviral prescription. Secondary outcomes representing each single outcome in the composite were examined. Subgroup analyses comparing baloxavir with each NAI were also performed. Of 4490 patients with influenza B who received antiviral treatment, 51.6% were male, and the median age was 8 years old. Baloxavir was prescribed for 29.4% of the population, and NAIs were prescribed for 70.6%. In the total cohort, 49.3% of patients had any comorbidity related to complicated influenza infection. Concerning the composite endpoint, baloxavir prescription was not associated with a risk of subsequent medical resource use (adjusted odds ratio 1.11; 95% confidence interval 0.90-1.38; P = 0.34). Secondary outcomes and subgroup analyses showed similar results to the primary outcome. In a single-year comparative study in Japan, baloxavir prescription for influenza B was not associated with less healthcare consumption than NAIs within 9 days of treatment.

A PAEDIATRIC DEATH DUE TO MENINGITIS-AN AUTOPSY DIAGNOSIS OF A RARE COMPLICATION OF INFLUENZA B INFECTION

Influenza virus belongs to a group of single-stranded RNA viruses in the fam- ily Orthomyxoviridae. They are subdivided into four types as A, B, C and D. As Influenza B is considered a milder form of infection not known to be caus- ing pandemics compared to Influenza A, it is equally a less researched topic than Influenza A. However, few studies have shown that the mortality associ- ated with pediatric Influenza B infection is equal to or sometimes even greater than the mortality associated with Influenza A. Complications of Influenza A or B virus infection include pneumonia, myositis, myocarditis and encephali- tis/encephalopathy. Influenza-associated encephalitis/encephalopathy (IAE) is a rare complication of Influenza infection which is commoner following infec- tion with type A. This case elaborates a death of a three-year-old child due to meningoencephalitis following Influenza Type B infection.

1495. Aspergillosis Complicating Severe Influenza in ICU Patients: A Retrospective Cohort Study

BackgroundInvasive pulmonary aspergillosis (IPA) has been recognized as a complication of influenza infection even in immunocompetent patients. We aimed to understand the incidence of IPA among critically ill patients with influenza infection over multiple seasons.MethodsA retrospective cohort study was conducted in a single center in Chicago. Data was collected over 9 seasons (March 2009-March 2018) from all adult patients admitted to the ICU at a large urban tertiary care center with influenza. Patients were included if they had a positive influenza PCR test, were ≥ 18 years, were admitted to the ICU with respiratory distress, and treated for IPA. IPA was defined per both the EORTC/MSG criteria as well as the revised AspICU criteria. Descriptive statistics were calculated. In univariable analysis, we compared categorical variables by Fisher’s exact test and continuous variables by Wilcoxon Rank Sum where appropriate.ResultsA total of 224 patients with influenza were admitted to the ICU over the study period. The overall rate of IPA in the study population was low at 3.1% (7/224). Factors associated with development of IPA in those with severe influenza pneumonia were history of stem cell transplant (p=0.015). There was a numerical trend towards significance in those with history of hematological malignancy (p=0.09), lung disease (p=0.098) and obesity (p=0.051). There was significantly increased length of stay in those with IPA (p=0.046). There were no significant difference in outcomes such as need for mechanical ventilation, renal replacement therapy, or death. Other coinfections were common with incidences of 31.3% (bacterial), 7.6% (viral), and 8.9% (non-aspergillosis fungi).Baseline Characteristics and Mortality/Morbidity Patient Characteristics in Invasive Pulmonary Aspergillosis ConclusionThe incidence of IPA was significantly lower (3.1%) in our study over 9 influenza seasons than has been reported in similar studies. History of stem cell transplant was a risk factor strongly associated with the development of IPA. IPA did not significantly predict morbidity and mortality among critically ill influenza patients.DisclosuresMichael G. Ison, MD MS, AlloVir (Consultant)

Examining effects of NS1 specific antibodies on sublethal influenza infection and secondary bacterial pneumonia in mice

Influenza is a highly contagious respiratory disease widespread throughout the world that causes disease in humans, birds and many mammalian species. Annually, around 20% of the global human gets sick with influenza so that more than 500,000 people die its various complications. Secondary bacterial pneumonia poses the peak threat during influenza infection, being most frequently caused by S. pneumoniae. Multiple studies in humans confirm the negative impact of influenza virus infection on subsequent outcome of bacterial pneumonia and provides insight into increased morbidity and mortality due to complicated influenza infection. In particular, the last 2009 influenza pandemic caused by H1N1 virus revealed that 25-56% cases of severe disease forms were associated with secondary pneumonia, among which 14-46% of them were fatal. Based on the aforementioned, it is of high priority to investigate a role of influenza virus proteins in developing of pathogen synergism in viral-bacterial pneumonia, particularly influenza virus non-structural protein NS1. The study objective was to examine effects of NS1-specific antibodies on course of influenza infection and secondary bacterial pneumonia in mice. For this, we used an experimental model of sublethal influenza infection followed by secondary Streptococcus pneumoniae bacterial pneumonia. Influenza A/Puerto Rico/8/34 (H1N1) virus and S. pneumoniae No. 3405 strain were used to simulate influenza infection. Rabbit serum containing antibodies against recombinant NS1 protein from A/Puerto Rico/8/34 virus and native rabbit serum (contain no specific antibodies) were used for vaccination. The study was carried out with female BALB/c mice, weighing 20-22 g. Protective activity of animal serum was assessed by using the three criteria: infection-related mortality, life expectancy and body weight change. The data obtained showed that passive transfer of antibodies specific to influenza virus NS1 protein did not lowered viral replication in sublethal murine model of influenza infection. Subsequent secondary bacterial pneumonia induced by S. pneumoniae revealed no protective effect of anti-NS1 protein antibodies assessed by measuring survival rate, lung viral and bacterial titers in treated vs. control mice.

ASPERGILLOSIS COMPLICATING SEVERE INFLUENZA AND RSV PNEUMONIA IN ICU PATIENTS: A RETROSPECTIVE COHORT STUDY

Background: Invasive pulmonary aspergillosis (IPA) has been recognized as a complication of influenza infection even in immunocompetent patients. We aimed to understand the incidence of IPA as well as other coinfections over multiple seasons in patients with either severe influenza and RSV pneumonia in the intensive care unit (ICU), with a focus on solid organ transplant (SOT). Materials and Methods: A retrospective cohort study was conducted in a single center in Chicago. Data were collected over six seasons (January 2012 – March 2018) from adult patients admitted to the ICU at a large urban tertiary care center with severe RSV or influenza pneumonia. Patients were included if they had a positive RSV or influenza PCR test, older than 18 years, admitted to the ICU with acute respiratory failure. IPA was defined per both the EORTC/MSG criteria as well as the revised AspICU criteria.[1] Statistics were calculated with Stata 16.0 (StataCorp, TX). Results: Overall the incidence of IPA was low in patients with RSV or influenza (5.5% and 1.7%, respectively). Patients diagnosed with IPA were both predominantly of male sex in both RSV (87.5%, n=7) and influenza (83.3%, n=6) groups. The median overall length of stay was significantly longer in both RSV (23.6 +/- 4.3 d) and influenza (24.6 +/- 3.7 d) groups with IPA. Patients with RSV that developed IPA had significant mortality (62.5%, p=0.01), while patients with influenza did not (33.3%, p=0.11). In patients with SOT, IPA developed in 16.7% (n=1) of SOT patients with influenza, and 12.5% (n=1) with RSV. All SOT patients with IPA had a history of liver transplantation with comorbidities (malignancy, post-op complications) and developed bacterial coinfections. In patients with severe RSV, history of hematological malignancy and neutropenia showed trends towards the development of IPA. In contrast, those with influenza had a history of hematological malignancy (p=0.03), hematopoietic stem cell transplant (p=0.01), non-transplant related immunosuppression (p=0.01), and history of solid organ malignancy (p=0.01) as significant factors associated with IPA. Other coinfections were common with incidences of RSV and influenza groups at bacterial (27.1% v 46.7%), viral (6.9% v 11.7%), and non-aspergillosis fungal (1.3% v 13.3%).Conclusions and Discussion: The incidence of IPA was significantly lower in both RSV and influenza groups in our study (5.5% and 1.7%) than previously reported in similar studies. While RSV-infected patients with IPA had significant mortality, influenza-infected patients did not. SOT itself does not seem to be a significant factor contributing to the development of IPA in the setting of severe viral pneumonia. At the same time, malignancy and profound immunosuppression are factors strongly associated with the development of IPA. Other coinfections with bacterial, viral, and fungal pathogens are common in those with both severe RSV and influenza pneumonia. Reference: 1. Schauwvlieghe A, Rijnders BJA, Philips N, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med 2018;6:782-92.

Cardiological complications in the course of influenza and COVID-19

Cardiac complications associated with the acute or chronic form of influenza and COVID-19 infection occur in &lt; 10% of cases. They may affect pericardium, myocardium or coronary arteries which finally results in heart failure or in case of pericarditis – fluid in the pericardium and tamponade risk. A relationship has been demonstrated between influenza epidemics and an increased incidence of acute coronary syndromes. An important complication of influenza infection may be myocarditis and subsequent heart failure. Arrhythmias, in various forms and with varying degrees of severity, can occur at any stage of the disease. The possibility of sudden deaths in the course of influenza virus infection has been reported. The treatment of a patient with cardiovascular involvement should be multidirectional: causal, symptomatic and prophylactic in the aspect of heart failure prevention. The knowledge about cardiovascular complications in the course of SARS-CoV-2 infection is increasing. Despite the possibility of using antiviral drugs in treatment, prevention by vaccination still remains the most effective therapeutic method.

Post-influenza aspergillus ventriculitis

Abstract Background Invasive aspergillosis is a complication of influenza infection, usually in the form of invasive pulmonary aspergillosis and more often seen in the context of immunosuppression. Post-influenza central nervous system invasion by aspergillus is very rarely described in the literature. Case report We report a 63-year old male, with a background of rheumatoid arthritis managed with methotrexate, who initially presented with a respiratory infection. He was positive for Influenza A H1N1 by a reverse-transcriptase polymerase chain reaction assay from a throat swab. He subsequently developed a progressive neurological impairment, had cranial imaging consistent with ventriculitis and hydrocephalus, and a lymphocytic cerebrospinal was obtained by lumbar puncture. Imaging of his chest revealed cavitatory lung disease and a possible aspergilloma. Results Following an endoscopic third ventriculostomy, cerebrospinal fluid microscopy revealed fungal hyphae and aspergillus DNA was detected by a polymerase chain reaction assay. Despite appropriate anti-fungal treatment the patient died of complications from an aspergillus ventriculitis. Conclusion Clinicians should remain vigilant for post-influenza aspergillosis, even in patients only minimally immunocompromised. Post-influenza aspergillus infection of the central nervous system, presumably by a haematogenous route, is rarely described but does occur as demonstrated by this case.

Influenza myocarditis complicated with atrioventricular block in a pregnant woman

Acute myocarditis is a well-recognized complication of influenza infection. The incidence of myocardial involvement in influenza infection is variable, and the clinical severity can range from asymptomatic to fulminant forms. Influenza infection can rarely be complicated by acute myocarditis leading to high-degree atrioventricular block and cardiogenic shock. We report a previously healthy pregnant woman, who initially presented with symptoms of influenza-like illness, later confirmed as influenza A infection. She developed hypotension shortly after admission that did not respond to fluid bolus and required inotropic support. On day 5, the electrocardiogram showed Mobitz I second-degree heart block, which later progressed to the third-degree heart block. Echocardiogram showed good cardiac contractility and minimal pericardial effusion while cardiac biomarkers were normal. A diagnosis of influenza myocarditis was made. She completed a course of oral oseltamivir and had temporary cardiac pacing performed, and subsequently recovered well.

2256. Baloxavir Marboxil in Combination with Oseltamivir in Two Critically Ill Patients with Influenza A (H1N1; 2009 strain) on Veno-Venous Extra-Corporal Membranous Oxygenation

BackgroundCurrently, there are no clinical data regarding the use of baloxavir marboxil in patients with complicated influenza infection. A study in a mouse model of influenza A infection suggested that there may be a potential benefit of combination therapy with neuraminidase inhibitors. We present the first reported use of baloxavir marboxil in combination with oseltamivir in two critically ill patients requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) support due to severe acute respiratory distress syndrome (ARDS) caused by influenza AH1N1 2009.MethodsCases: (1) 56-year-old man with a history of coronary artery disease who was vaccinated for flu this season, presented with 5 days of cough and dyspnea and required cannulation for VV-ECMO due to severe ARDS. He was placed on continuous renal replacement therapy (CRRT) for renal failure as well as vasopressor and inotropic support. Bronchoalveolar lavage (BAL) polymerase chain reaction (PCR) was positive for Influenza A H1N1 2009 strain. He received a dose of baloxavir 80 mg on Day 1 and a 7-day course of oseltamivir which was started on Day 0. Influenza PCR testing obtained 5 days after receipt of baloxavir was negative. The patient was decannulated on hospital day 7 and extubated at 14 days. (2) 50-year-old man with a history of hypertension and dyslipidemia who was not flu vaccinated, presented with symptoms of cough and dyspnea for 3 days. He was cannulated due to severe ARDS. He required CRRT for renal failure. BAL PCR tested positive for Influenza A H1N1 2009 strain. He was given two 80 mg doses of baloxavir on hospital days 1 and 5 and treated with oseltamivir for 10 days. Despite a negative PCR test for influenza on day 15, the patient remained critically ill on ECMO with multisystem organ failure.Results-ConclusionWe describe the first reported clinical use of baloxavir in combination with oseltamivir for influenza A H1N1 infection in two critically ill patients with respiratory failure requiring VV ECMO. Further pharmacokinetic/pharmacodynamic analysis is needed to determine optimal dosing in critically ill patients, and those requiring CRRT. Baloxavir synergy with the neuraminidase inhibitors may be of benefit in critically ill patients, and additional prospective clinical study is needed.Disclosures All authors: No reported disclosures.

Successful management of refractory respiratory failure caused by avian influenza H7N9 and secondary organizing pneumonia: a case report and literature review

BackgroudOrganizing pneumonia (OP) is a rare complication of influenza infection that has substantial morbidity. We report the first case of OP associated with avian influenza H7N9 infection that had significant improvement with corticosteroid treatment.Case presentationA 35-year-old male admitted to intensive care unit because of respiratory failure. He was diagnosed as severe pneumonia caused by avian influenza H7N9 viral infection. After initial clinical improvement supported by extracorporeal membrane oxygenation (ECMO), the patient’s condition worsened with persistent fever, refractory hypoxemia. Chest x-rays and computed tomographies showed areas of consolidation and ground glass opacification. Although OP was suspected and 1 mg/kg methylprednisolone was used, the patient’s condition didn’t improved considerably. An open lung biopsy was performed, and histopathological examination of the specimen was compatible with OP. The patient was treated with methylprednisolone 1.5 mg/kg for 5 days. ECMO was weaned on day 15, and he was discharged on day 71 with good lung recovery.ConclusionsTo the best of our knowledge, this was the first case of successful management of refractory severe respiratory failure caused by avian influenza H7N9 infection complicated with OP. Refractory hypoxia with clinical manifestation and radiological findings compatible with OP, a differential diagnosis should be considered among patients at the second or third week of influenza H7N9 infection, especially in patients with clinical condition deteriorated after the primary influenza pneumonia was controlled. And a steroid dose of methylprednisolone 1.5 mg/kg may be suggested for treatment of OP associated with avian influenza H7N9 infection.

First tidal volume greater than 8mL/kg is associated with increased mortality in complicated influenza infection with acute respiratory distress syndrome.

Severe influenza infection causes substantial morbidity and mortality worldwide and remains an important threat to global health. This study addressed factors related to treatment outcomes in subjects of complicated influenza infection with acute respiratory distress syndrome (ARDS) during the Taiwan epidemic in the Spring of 2016. This is a retrospective study conducted by Taiwan Severe Influenza Research Consortium (TSIRC), including eight tertiary referral medical centers. Patients with virology-proven influenza infection admitted to intensive care unit (ICU) between January and March 2016 were included for analysis. We identified 263 patients with complicated influenza infection who fulfilled ARDS criteria; the mean age was 59.8±14.6 (years), and 66.1% (166/263) were male. Type A influenza (77.9%, 205/263) virus was the main pathogen during this epidemic. The 30-day mortality rate was 23.2% (61/263). The mean tidal volume (VT) in the first three days after intubation was greater than 8mL/kg of predicted body weight (PBW). Patients whose first measured VT was >8mL/kg PBW had an increased 30-day mortality (p=0.04, log-rank test). In a multivariate Cox proportional hazard regression model, an increase of 1mL/kg PBW of first VT was associated with 26.1% increase in 30-day mortality (adjusted hazard ratio 1.261, 95% confidence interval [CI] 1.072-1.484, p<0.01). First tidal volume, shortly after intubation, greater than 8mL/kg PBW is an independent risk factor for mortality in complicated influenza infection with ARDS. Timely recognition of ARDS with strict adherence to protective ventilation strategy of lowering VT may be important in reducing mortality.

Invasive Pulmonary Aspergillosis and Methicillin-Resistant Staphylococcus aureus Associated With Influenza A Infection

Abstract Bacterial superinfection is a known complication of influenza infection, with Streptococcus pneumoniae and Staphylococcus aureus often being the offending pathogens. In recent decades, there has been an increased prevalence of superinfection with Aspergillus in seemingly immunocompetent hosts. We describe a fatal case of influenza complicated by simultaneous methicillin-resistant S. aureus pneumonia and invasive pulmonary aspergillosis.

Influenza Vaccination in Type 2 Diabetes Patients: Coverage Status and Its Determinants in Southwestern Saudi Arabia.

Despite the significant role of seasonal influenza vaccination in preventing and minimizing the serious complications of influenza infection in type 2 diabetes mellitus (T2DM) patients, unsatisfactory compliance still exists for vaccination. Study objectives were to explore the vaccination status and determinants in T2DM patients in southwestern Saudi Arabia. A cross-sectional study on a representative sample of T2DM patients in Abha city, southwestern Saudi Arabia, was conducted. Data for sociodemographic characteristics, clinical criteria, vaccination status, vaccination motivators and barriers and seasonal influenza knowledge were collected. Out of 353 T2DM patients included in the study, seasonal influenza vaccination coverage was 61% in year 2017. A significant factors associated with non-vaccination were; poor influenza and its vaccine knowledge (OR = 4.31, 95% CI: 2.73–6.80), illiteracy (OR = 1.93, 95% CI: 1.11–3.37), and more than 10 years disease duration (OR = 2.07, 95% CI: 1.11–3.87). Presence of family history of DM and ischemic heart comorbidity minimized the possibility of non-vaccination (OR = 0.54 and 0.28 respectively). Healthcare givers’ advice was the most reported vaccination motivator (84.7%) while; fear of vaccine side effects was the most stated barrier (73%). In conclusion, influenza vaccination rate among T2DM in the present study is less than the recommended level. Continuous primary health care center-based educational programs should be implemented to aware and encourage influenza vaccination among T2DM patients.

Influenza-associated neurological complications during 2014–2017 in Taiwan

IntroductionSeasonal influenza-associated neurological complications had high mortality and morbidity rates in recent studies. We reported influenza-associated encephalitis/encephalopathy in children during 2014–2017 in Taiwan, focusing on neurological presentations, neuroimaging correlations, and critical care managements. Materials/SubjectsDuring January 1st 2014 to June 30th 2017, pediatric patients reported to the Taiwan Centers for Disease Control surveillance system for severe complicated influenza infections in the hospital were retrospectively reviewed. Children with influenza-associated encephalitis/encephalopathy were inspected for clinical presentations, laboratory data, neuroimaging studies, treatment modalities, and neurological outcomes. ResultsTen children with median age 5.9 years were enrolled for analysis. Influenza-associated encephalitis/encephalopathy appeared in the spring and summer, with a delayed peak comparing with the occurrence of pneumonia and septic shock. The neurological symptoms developed rapidly within median 1 day after the first fever episode. All patients had consciousness disturbance. Seven patients (70%) had seizures at initial presentation, and six of them had status epilepticus. Anti-viral treatments were applied in all patients, with median door-to-drug time 0.9 h for oseltamivir and 6.0 h for peramivir. Multi-modality treatments also included steroid pulse therapy, immunoglobulin treatment, and target temperature management, with 85.2% of the major treatments administered within 12 h after admission. Nine of the ten patients recovered without neurological sequelae. Only one patient had epilepsy requiring long-term anticonvulsants and concomitant cognitive decline. ConclusionsIn highly prevalent area, influenza-associated encephalitis/encephalopathy should be considered irrespective of seasons. Our study suggested the effects of timely surveillance and multi-modality treatments in influenza-associated encephalitis/encephalopathy.

The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection.

Severe influenza infection represents a leading cause of global morbidity and mortality. Although influenza is primarily considered a viral infection that results in pathology limited to the respiratory system, clinical reports suggest that influenza infection is frequently associated with a number of clinical syndromes that involve organ systems outside the respiratory tract. A comprehensive MEDLINE literature review of articles pertaining to extra‐pulmonary complications of influenza infection, using organ‐specific search terms, yielded 218 articles including case reports, epidemiologic investigations, and autopsy studies that were reviewed to determine the clinical involvement of other organs. The most frequently described clinical entities were viral myocarditis and viral encephalitis. Recognition of these extra‐pulmonary complications is critical to determining the true burden of influenza infection and initiating organ‐specific supportive care.

Impact of Aging and Cytomegalovirus on Immunological Response to Influenza Vaccination and Infection.

The number of people over the age of 60 is expected to double by 2050 according to the WHO. This emphasizes the need to ensure optimized resilience to health stressors in late life. In older adults, influenza is one of the leading causes of catastrophic disability (defined as the loss of independence in daily living and self-care activities). Influenza vaccination is generally perceived to be less protective in older adults, with some studies suggesting that the humoral immune response to the vaccine is further impaired in cytomegalovirus (CMV)-seropositive older people. CMV is a β-herpes virus infection that is generally asymptomatic in healthy individuals. The majority of older adults possess serum antibodies against the virus indicating latent infection. Age-related changes in T-cell-mediated immunity are augmented by CMV infection and may be associated with more serious complications of influenza infection. This review focuses on the impact of aging and CMV on immune cell function, the response to influenza infection and vaccination, and how the current understanding of aging and CMV can be used to design a more effective influenza vaccine for older adults. It is anticipated that efforts in this field will address the public health need for improved protection against influenza in older adults, particularly with regard to the serious complications leading to loss of independence.