Impact Of Respiratory Infections Research Articles

The impact of respiratory infections and probiotic use on the nasal microbiota of frail residents in long-term care homes.

Residents in long-term care homes, who tend to be of advanced age and frail, are at increased risk of respiratory infections. The respiratory microbiota is known to change with age, but whether these changes contribute to the risk of infection is not known. Our goal was to determine how the nasal microbiota of frail older adults changes during symptoms of influenza-like illness (ILI) and how this may be impacted by enrolment in a placebo-controlled trial testing the feasibility of administering a Lactobacillus rhamnosus GG probiotic to prevent respiratory infection (2014-2017). The microbiome of the nasal (mid-turbinate) of 150 residents of long-term care homes was interrogated using 16S rRNA gene sequencing. We identified a diverse and individualised microbiota which could be separated into nine distinct clusters based on Bray-Curtis distances. Samples collected during symptoms of ILI differed statistically from those collected pre- and post-cold and influenza season, and we observed decreased temporal stability (as measured by movement between clusters) in individuals who experienced ILI compared to those who did not. The use of probiotics decreased ILI-induced changes to the microbiota; however, it is not clear whether this decrease is sufficient to prevent respiratory illness.

Summary of the National Advisory Committee on Immunization (NACI) Statement-Recommendations on Fractional Influenza Vaccine Dosing in the Event of a Shortage: Pandemic preparedness.

At the commencement of a pandemic, it is important to consider the impact of respiratory infections on the health system and the possibility of vaccine shortages due to increased demand. In the event of an influenza vaccine shortage, a strategy for administration of fractional influenza vaccine doses might be considered. This article reviews the available evidence for efficacy, effectiveness, immunogenicity and safety of fractional influenza vaccine dosing, and summarizes the National Advisory Committee on Immunization (NACI) recommendations on fractional dosing strategies by public health programs in Canada. Two rapid literature reviews were undertaken to evaluate the efficacy, effectiveness, immunogenicity and safety of fractional influenza vaccine dosing via the intramuscular or intradermal route. The NACI evidence-based process was used to assess the quality of eligible studies, summarize and analyze the findings, and apply an ethics, equity, feasibility and acceptability lens to develop recommendations. There was limited evidence for the effectiveness of fractional influenza vaccine dosing. Fractional dosing studies were primarily conducted in healthy individuals, mainly young children and infants, with no underlying chronic conditions. There was fair evidence for immunogenicity and safety. Feasibility issues were identified with intradermal use in particular. NACI recommended that, in the event of a significant population-level shortage of influenza vaccine, a full-dose influenza vaccine should continue to be used, and existing vaccine supply should be prioritized for those considered to be at high risk or capable of transmitting to those at high risk of influenza-related complications or hospitalizations. NACI recommended against the use of fractional doses of influenza vaccine in any population.

Impact of concomitant respiratory infections in the management and outcomes acute myocardial infarction-cardiogenic shock

ObjectiveTo evaluate the prevalence and impact of respiratory infections in cardiogenic shock complicating acute myocardial infarction (AMI-CS). MethodsUsing the National Inpatient Sample (2000–2017), this study identified adult (≥18 years) admitted with AMI-CS complicated by respiratory infections. Outcomes of interest included in-hospital mortality of AMI-CS admissions with and without respiratory infections, hospitalization costs, hospital length of stay, and discharge disposition. Temporal trends of prevalence, in-hospital mortality and cardiac procedures were evaluated. ResultsAmong 557,974 AMI-CS admissions, concomitant respiratory infections were identified in 84,684 (15.2%). Temporal trends revealed a relatively stable trend in prevalence of respiratory infections over the 18-year period. Admissions with respiratory infections were on average older, less likely to be female, with greater comorbidity, had significantly higher rates of NSTEMI presentation, and acute non-cardiac organ failure compared to those without respiratory infections (all p < 0.001). These admissions received lower rates of coronary angiography (66.8% vs 69.4%, p < 0.001) and percutaneous coronary interventions (44.8% vs 49.5%, p < 0.001), with higher rates of mechanical circulatory support, pulmonary artery catheterization, and invasive mechanical ventilation compared to AMI-CS admissions without respiratory infections (all p < 0.001). The in-hospital mortality was lower among AMI-CS admissions with respiratory infections (31.6% vs 38.4%, adjusted OR 0.58 [95% CI 0.57–0.59], p < 0.001). Admissions with respiratory infections had longer lengths of hospital stay (127–20 vs 63–11 days, p < 0.001), higher hospitalization costs and less frequent discharges to home (27.1% vs 44.7%, p < 0.001). ConclusionsRespiratory infections in AMI-CS admissions were associated with higher resource utilization but lower in-hospital mortality.

1509. Impact of Respiratory Viral Infection on Outcomes of Congenital Heart Repair Surgery

BackgroundRespiratory viral infections are common in the pediatric population and can range from mild to life-threatening. Given the risk factors that accompany these infections, some pediatric cardiothoracic surgeons in the United States avoid performing surgery for patients with congenital heart disease when there is a possibility of concurrent viral respiratory illness. Studies in this patient population have been limited either by small study populations, or a study focus that is too narrow. The impact of respiratory infections on patient outcomes based on previous literature is also unclear.MethodsThis retrospective chart review study aimed to compare outcomes after congenital heart repair surgery in patients with positive respiratory viral testing to those with negative testing over a five-year period, to determine if there are significant differences related to post-operative hospital course or morbidity.Patient Inclusion Flowchart ResultsThis study included 120 patients, of whom 43 tested positive for respiratory viruses and 77 tested negative. Patients were additionally divided based on the presence or absence of symptoms of respiratory infection, with 79 patients demonstrating respiratory symptoms and 41 who did not. Results demonstrate that negative respiratory viral testing is associated with a significant increase in post-operative ICU LOS (p = 0.01), hospital LOS (p < 0.01), and duration of post-operative respiratory support (p < 0.01), compared to positive testing. Additionally, an absence of respiratory symptoms at the time of testing was associated with a significant increase in post-operative ICU LOS (p = 0.01) and hospital LOS (p < 0.01), compared to patients who were symptomatic.Outcomes by Positive vs. Negative FilmArray Outcomes by Symptomatic vs. Asymptomatic ConclusionThese results suggest that negative respiratory viral testing or lack of respiratory infectious symptoms should not be a reassuring factor in patients scheduled for repair of congenital heart disease, and positive testing does not appear to result in worse outcomes after surgery. Based on this data, we would recommend that respiratory viral testing should not be a routine component of preoperative planning for patients scheduled to undergo congenital heart repair surgery, which would reduce the burdens of unnecessary testing and delays in definitive heart repair.Disclosures All Authors: No reported disclosures

Bacterial community structure and effects of picornavirus infection on the anterior nares microbiome in early childhood

BackgroundLittle is known regarding the nasal microbiome in early childhood and the impact of respiratory infection on the infants’ nasal microbial composition. Here we investigated the temporal dynamics and diversity of the bacterial composition in the anterior nares in children attending daycare centers.ResultsFor our investigation, we considered 76 parental-taken nasal swabs of 26 children (aged 13 to 36 months) collected over a study period of 3 months. Overall, there was no significant age-specific effect or seasonal shift in the nasal bacterial community structure. In a sub-sample of 14 healthy children the relative abundance of individual taxa as well as the overall diversity did not reveal relevant changes, indicating a stable community structure over the entire study period. Moreover, the nasal bacterial profiles clustered subject-specific with Bray-Curtis similarities being elevated in intra-subject calculations compared to between-subject calculations. The remaining subset of 12 children provided samples taken during picornavirus infection (PVI) and either before or after a PVI. We detected an association between the relative abundance of members of the genus Streptococcus and PV when comparing both (i) samples taken during PVI with samples out of 14 healthy children and (ii) samples taken during PVI with samples taken after PVI within the same individual. In addition, the diversity was higher during PVI than after infection.ConclusionsOur findings suggest that a personalized structure of the nasal bacterial community is established already in early childhood and could be detected over a timeframe of 3 months. Studies following infants over a longer time with frequent swab sampling would allow investigating whether certain parameter of the bacterial community, such as the temporal variability, could be related to viral infection.

Impact of respiratory infections, outdoor pollen, and socioeconomic status on associations between air pollutants and pediatric asthma hospital admissions.

BackgroundEpidemiology studies have shown that ambient concentrations of ozone and fine particulate matter (PM2.5) are associated with increased emergency department (ED) visits and hospital admissions (HAs) for asthma.ObjectiveEvaluate the impact of outdoor pollen, respiratory infections, and socioeconomic status (SES) on the associations between ambient ozone and PM2.5 and asthma HAs in New York City.MethodsDaily ozone, PM2.5, meteorological factors, pollen, and hospitalization records during 1999 to 2009 were obtained for New York City residents. Daily counts of HAs for asthma and respiratory infections were calculated for all-age and specific age groups, and for high- and low-SES communities. Generalized additive models were used to examine ambient concentrations of ozone and PM2.5 and asthma HAs, potential confounding effects of outdoor pollen and HAs for respiratory infections, and potential effect modification by neighborhood SES.ResultsBoth ozone and PM2.5 were statistically significantly associated with increased asthma HAs in children aged 6–18 years (per 10 ppb increase in ozone: RR = 1.0203, 95% CI: 1.0028–1.0382; per 10 μg/m3 increase in PM2.5: RR = 1.0218, 95% CI: 1.0007–1.0434), but not with total asthma HAs, or asthma HAs in other age groups. These associations were stronger for children living in the high-SES areas. Adjustment for respiratory infection HAs at various lags did not result in changes greater than 10% in the risk estimates for either ozone or PM2.5. In contrast, adjustment for outdoor pollen generally attenuated the estimated RRs for both ozone and PM2.5.ConclusionsAmbient ozone and PM2.5 are associated with asthma HAs in school-age children, and these associations are not modified by SES. HAs for respiratory infections do not appear to be a confounder for observed ozone- and PM2.5-asthma HAs associations, but pollen may be a weak confounder.

Impact of respiratory infections by influenza viruses A and B in pediatrics patients from Federal University of Paraná, Brazil

The objective of the present study was to determine the impact of influenza virus on pediatric hospitalized patients. We retrospectively reviewed records of children with laboratory diagnoses, by cell culture and/or indirect immunofluorescence assay, of influenza virus seen in a period of 6 years. A total of 1,033 samples were analyzed, 45 (4.3%) of them being reactive to influenza virus. Thirty-one samples were positive to influenza A virus and 14 to influenza B. The frequency of hospitalization in intensive care and medical emergency was found to be high. Three (8.6%) patients died, two of them due to respiratory failure. Low frequency of influenza virus infection was observed in the study. The data suggest the need of more efficient epidemiological surveillance measures in order to obtain reliable information to better assess the impact of the virus on our region and determine the need of preventive measures, such as immunization.

Role of newer fluoroquinolones in lower respiratory tract infections.

The impact of respiratory infections on inviduals in society is important and is growing as the population ages. Lower respiratory tract infections in particular are major causes of morbidity and mortality. These infections include acute exacerbation of chronic bronchitis (AECB) and community- acquired pneumonia. Of the two conditions, AECB is more prevalent, occurring in 46% of the population over 65 years old in Germany, with an average of 2.4 acute exacerb- ations per patient each year. In the UK, chronic bronchitis causes 5% of deaths and is responsible for 28 million lost working days per year. Community-acquired respiratory tract infections (RTIs) may be caused by Gram-positive organisms (predominantly Streptococcus pneumoniae), Gram-negative organisms (Haemophilus influenzae and Moraxella catarrhalis )a nd 'atypical' bacteria (e.g. Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae). In community- acquired pneumonia (CAP) pathogens, penicillin resistance has emerged worldwide among pneumococci, while β-lactamase production among H. influenzae, M. catarrhalis and many Gram-negative bacilli has led to alterations in first-line

Relationships Among Respiratory Infections, Triggers of Attacks, and Asthma Severity in Children

The present study of asthmatic children examined relationships among the frequencies of prior respiratory infections (i.e., those prior to the development of asthma) and recent (past year) respiratory infections, asthma severity, and the impacts of 12 common asthma triggers: air pollution, allergy problems, anger, cigarette smoke, excitement, high humidity, high or low environmental temperature, laughter, nighttime hours, physical activity, respiratory infection, and stress or worry. Data on these variables were obtained through a survey in which 325 families completed questionnaires; 121 families had asthmatic children who were 2-20 years of age. Pearson correlational analyses revealed many significant positive correlations: The frequencies of prior and recent infections were correlated. The frequency of prior infections was correlated with the impacts of all asthma triggers except allergy problems, but the frequency of recent infections was correlated only with the impacts of air pollution, cigarette smoke, respiratory infection, and nighttime hours as triggers of asthma attacks. Asthma severity was correlated with the frequencies of prior and recent respiratory infections and with the impact of respiratory infection as an asthma trigger.

Genetic factors in the presence, severity, and triggers of asthma.

The role of heredity in the presence of asthma, severity of the condition, and impact of 12 specific triggers of attacks was investigated. Health surveys containing questions about children's asthma characteristics were completed by 325 families with twin children across the United States. Data for 39 monozygotic twin pairs and 55 same sex dizygotic twin pairs who were between 2 and 20 years of age and had asthma present in at least one member of each pair were received and analysed. Results revealed higher concordance for the presence of asthma among monozygotic (58.97%; n = 23) than dizygotic twins (23.64%; n = 13). Further analyses were restricted to data from the concordant monozygotic and dizygotic twin pairs. Asthma severity (the product of attack frequency and intensity ratings) was significantly correlated for monozygotic pairs but not for dizygotic pairs, and this difference in monozygotic and dizygotic severity correlations was significant. Also, monozygotic twins showed significantly higher correlations than dizygotic twins for the impacts of two asthma triggers: respiratory infection and physical activity. These results indicate a role of heredity in the presence of asthma and suggest that genetic factors may also affect the severity of children's asthma condition and the impact of respiratory infection and physical exertion as asthma triggers.

Social Impact of Respiratory Infections

Social Impact of Respiratory Infections

The Impact of Respiratory Infections on Asthma

It is apparent that the effects of viral respiratory infections on the development of airway hyperresponsiveness are multiple and interrelated and involved the production of viral specific IgE, upregulation of leukocyte inflammatory activity, enhancement of the factors involved in the generation of late phase allergic responses, altered beta-adrenergic and cholinergic nervous system activity, and damage to the airway epithelium. The summation of these effects is the development of airway inflammation rather than a direct effect on bronchial smooth muscle, per se. An understanding of this pathogenesis underscores the relative importance of anti-inflammatory rather than antimicrobial therapy in viral-induced exacerbations in asthma symptoms.