Influenza Patients Research Articles

Platelet Abnormalities in Children with Laboratory-Confirmed Influenza

The role of platelets in the immune response against influenza has been raised, and a diagnostic or prognostic value of platelet parameter abnormalities, including platelet count (PLT), or mean platelet volume (MPV), has been suggested. The study aimed to analyze the prognostic value of platelet parameters in children hospitalized due to laboratory-confirmed influenza. We retrospectively verified the platelet parameters (PLT, MPV, MPV/PLT, and PLT/lymphocyte ratio regarding the influenza complications (acute otitis media, pneumonia, and lower respiratory tract infection-LRTI), and the clinical course (antibiotic treatment, tertiary care transfer, and death). An abnormal PLT was observed in 84 out of 489 laboratory-confirmed cases (17.2%, 44 thrombocytopaenia cases, and 40 thrombocytoses). Patients' age correlated negatively with PLT (rho = -0.46) and positively with MPV/PLT (rho = 0.44), while MPV was not age-dependent. The abnormal PLT correlated with increased odds of complications (OR = 1.67), including LRTI (OR = 1.89). Thrombocytosis was related to increased odds of LRTI (OR = 3.64), and radiologically/ultrasound-confirmed pneumonia (OR = 2.15), mostly in children aged under 1 year (OR = 4.22 and OR = 3.79, respectively). Thrombocytopaenia was related to antibiotic use (OR = 2.41) and longer hospital stays (OR = 3.03). A lowered MPV predicted a tertiary care transfer (AUC = 0.77), while MPV/PLT was the most versatile parameter in predicting LRTI (AUC = 0.7 in <1 yo), pneumonia (AUC = 0.68 in <1 yo), and antibiotic treatment (AUC = 0.66 in 1-2 yo and AUC = 0.6 in 2-5 yo). Platelet parameters, including PLT count abnormalities and MPV/PLT ratio, are related to the increased odds of complications and a more severe disease course, and may add important data in assessing pediatric influenza patients, but should be interpreted cautiously due to age-related specificities.

Investigating Epidemiologic and Molecular Links Between Patients With Community- and Hospital-Acquired Influenza A: 2017-2018 and 2019-2020, Michigan.

Hospital-acquired influenza virus infection (HAII) can cause severe morbidity and mortality. Identifying potential transmission routes can inform prevention strategies. We identified all hospitalized patients testing positive for influenza A virus at a large, tertiary care hospital during the 2017-2018 and 2019-2020 influenza seasons. Hospital admission dates, locations of inpatient service, and clinical influenza testing information were retrieved from the electronic medical record. Time-location groups of epidemiologically linked influenza patients were defined and contained ≥1 presumed HAII case (first positive ≥48 hours after admission). Genetic relatedness within time-location groups was assessed by whole genome sequencing. During the 2017-2018 season, 230 patients tested positive for influenza A(H3N2) or unsubtyped influenza A including 26 HAIIs. There were 159 influenza A(H1N1)pdm09 or unsubtyped influenza A-positive patients identified during the 2019-2020 season including 33 HAIIs. Consensus sequences were obtained for 177 (77%) and 57 (36%) of influenza A cases in 2017-2018 and 2019-2020, respectively. Among all influenza A cases, there were 10 time-location groups identified in 2017-2018 and 13 in 2019-2020; 19 of 23 groups included ≤4 patients. In 2017-2018, 6 of 10 groups had ≥2 patients with sequence data, including ≥1 HAII case. Two of 13 groups met this criteria in 2019-2020. Two time-location groups from 2017-2018 each contained 3 genetically linked cases. Our results suggest that HAIIs arise from outbreak transmission from nosocomial sources as well as single infections from unique community introductions.

Prescription factors influencing baloxavir prescription during the 2018/2019 and 2019/2020 seasons: a administrative database study in Japan

BackgroundWe aimed to evaluate the factors associated with baloxavir prescription in Japanese hospitals using a health insurance claim-based database (MDV analyzer), during the 2018/2019 and 2019/2020 influenza seasons. The MDV analyzer contains anonymized claims data from approximately 420 Diagnosis Procedure Combination hospitals, and does not contain data from clinics.MethodsData were collected for influenza patients treated with anti-influenza drugs during the 2018/2019 and 2019/2020 influenza seasons. Multivariate analysis was used to identify factors associated with baloxavir prescription.ResultsDuring the study period, 322,063 influenza patients were included for analyses. In multivariate analysis, children, female sex, inpatient, hospital bed capacity, and private hospitals were negatively associated with baloxavir prescription. Compared to elderly patients, the adjusted odds ratio (OR) for baloxavir prescription was 0.612 (95% confidence interval (CI), 0.587–0.637) in children aged 6–11 years, and 0.119 (95% CI, 0.111–0.128) in children aged 0–5 years. Compared to small hospitals (bed capacity, 20–299), the adjusted OR for baloxavir prescription was 0.559 (95% CI, 0.540–0.578) in large hospitals (bed capacity, ≥ 500).ConclusionChildren, female sex, inpatient, hospital bed capacity, and private hospitals were negatively associated with baloxavir prescription.

Microbiota composition in the lower respiratory tract is associated with severity in patients with acute respiratory distress by influenza

Several factors are associated with the severity of the respiratory disease caused by the influenza virus. Although viral factors are one of the most studied, in recent years the role of the microbiota and co-infections in severe and fatal outcomes has been recognized. However, most of the work has focused on the microbiota of the upper respiratory tract (URT), hindering potential insights from the lower respiratory tract (LRT) that may help to understand the role of the microbiota in Influenza disease. In this work, we characterized the microbiota of the LRT of patients with Influenza A using 16S rRNA sequencing. We tested if patients with different outcomes (deceased/recovered) and use of antibiotics differ in their microbial community composition. We found important differences in the diversity and composition of the microbiota between deceased and recovered patients. In particular, we detected a high abundance of opportunistic pathogens such as Granulicatella, in patients either deceased or with antibiotic treatment. Also, we found antibiotic treatment correlated with lower diversity of microbial communities and with lower probability of survival in Influenza A patients. Altogether, the loss of microbial diversity could generate a disequilibrium in the community, potentially compromising the immune response increasing viral infectivity, promoting the growth of potentially pathogenic bacteria that, together with altered biochemical parameters, can be leading to severe forms of the disease. Overall, the present study gives one of the first characterizations of the diversity and composition of microbial communities in the LRT of Influenza patients and its relationship with clinical variables and disease severity.

Venous thromboembolism in viral diseases: A comprehensive literature review.

Venous thromboembolism (VTE) is known to be a common respiratory and/or cardiovascular complication in hospitalized patients with viral infections. Numerous studies have proven human immunodeficiency virus infection to be a prothrombotic condition. An elevated VTE risk has been observed in critically ill H1N1 influenza patients. VTE risk is remarkably higher in patients infected with the Hepatitis C virus in contrast to uninfected subjects. The elevation of D-dimer levels supported the association between Chikungunya and the Zika virus and the rise of clinical VTE risk. Varicella-zoster virus is a risk factor for both cellulitis and the consequent invasive bacterial disease which may take part in thrombotic initiation. Eventually, hospitalized patients infected with the coronavirus disease of 2019 (COVID-19), the cause of the ongoing worldwide pandemic, could mainly suffer from an anomalous risk of coagulation activation with enhanced venous thrombosis events and poor quality clinical course. Although the risk of VTE in nonhospitalized COVID-19 patients is not known yet, there are a large number of guidelines and studies on thromboprophylaxis administration for COVID-19 cases. This study aims to take a detailed look at the effect of viral diseases on VTE, the epidemiology of VTE in viral diseases, and the diagnosis and treatment of VTE.

Moderate-to-severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality.

This study aimed to compare ventilatory parameters recorded in the first days of acute respiratory distress syndrome (ARDS) and mortality at day 60 between coronavirus disease 2019 (COVID-19) and influenza ARDS patients with arterial oxygen tension (P aO2 )/inspiratory oxygen fraction (F IO2 ) ≤150 mmHg. We compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure, respiratory system compliance (C rs), ventilator ratio, corrected minute ventilation (V'Ecorr) and surrogate of mechanical power (index=(4×driving pressure)+respiratory rate) were calculated from day 1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed. On day 1 of ARDS, COVID-19 patients had significantly higher P aO2 /F IO2 (median (interquartile range) 97 (79-129.2) versus 83 (62.2-114) mmHg; p=0.001), and lower driving pressure (13.0 (11.0-16.0) versus 14.0 (12.0-16.7) cmH2O; p=0.01), ventilatory ratio (2.08 (1.73-2.49 versus 2.52 (1.97-3.03); p<0.001), V'Ecorr (12.7 (10.2-14.9) versus 14.9 (11.6-18.6) L·min-1; p<0.001) and index (80 (70-89) versus 84 (75-94); p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5, repeated values of P aO2 /F IO2 , arterial carbon dioxide tension, ventilatory ratio and V'Ecorr differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29% versus 21.7%; p=0.43). Ventilation was more impaired in influenza than in COVID-19 ARDS patients on the first day of ARDS with an important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.

Effect of neuraminidase inhibitor (oseltamivir) treatment on outcome of hospitalised influenza patients, surveillance data from 11 EU countries, 2010 to 2020.

BackgroundTimely treatment with neuraminidase inhibitors (NAI) can reduce severe outcomes in influenza patients.AimWe assessed the impact of antiviral treatment on in-hospital deaths of laboratory-confirmed influenza patients in 11 European Union countries from 2010/11 to 2019/20.MethodsCase-based surveillance data from hospitalised patients with known age, sex, outcome, ward, vaccination status, timing of antiviral treatment, and hospitalisation were obtained. A mixed effect logistic regression model using country as random intercept was applied to estimate the adjusted odds ratio (aOR) for in-hospital death in patients treated with NAIs vs not treated.ResultsOf 19,937 patients, 31% received NAIs within 48 hours of hospital admission. Older age (60-79 years aOR 3.0, 95% CI: 2.4-3.8; 80 years 8.3 (6.6-10.5)) and intensive care unit admission (3.8, 95% CI: 3.4-4.2) increased risk of dying, while early hospital admission after symptom onset decreased risk (aOR 0.91, 95% CI: 0.90-0.93). NAI treatment initiation within 48 hours and up to 7 days reduced risk of dying (0-48 hours aOR 0.51, 95% CI: 0.45-0.59; 3-4 days 0.59 (0.51-0.67); 5-7 days 0.64 (0.56-0.74)), in particular in patients 40 years and older (e.g. treatment within 48 hours: 40-59 years aOR 0.43, 95% CI: 0.28-0.66; 60-79 years 0.50 (0.39-0.63); ≥80 years 0.51 (0.42-0.63)).ConclusionNAI treatment given within 48 hours and possibly up to 7 days after symptom onset reduced risk of in-hospital death. NAI treatment should be considered in older patients to prevent severe outcomes.

Establishment of a Pseudovirus Platform for Neuraminidase Inhibiting Antibody Analysis.

Neuraminidase (NA)-based immunity to influenza can be useful for protecting against novel antigenic variants. To develop safe and effective tools to assess NA-based immunity, we generated a baculovirus-based pseudotyped virus, N1-Bac, that expresses the full-length NA of the influenza A/California/07/2009 (H1N1)pdm09 strain. We evaluated the level of NA-inhibiting (NI) antibodies in the paired blood sera of influenza patients by means of an enzyme-linked lectin assay (ELLA) using the influenza virus or N1-Bac. Additionally, we evaluated the level of NA antibodies by means of the enzyme-linked immunosorbent assay (ELISA) with an N1-expressing Sf21 culture. We detected a strong correlation between our results from using the influenza virus and NA-Bac pseudoviruses to detect NI antibodies and a medium-strong correlation between NI antibodies and NA antibodies determined by an N1-cell ELISA, indicating that baculovirus-based platforms can be successfully used to evaluate NI or NA antibodies. Furthermore, animal experiments showed that immunization with N1-Bac protected against infection with a drift variant of the A/H1N1pdm09 influenza virus. Our results demonstrate that recombinant baculovirus can be an effective influenza pseudotype to evaluate influenza serologic immunity and protect against influenza virus infection.

Prevention of acquired invasive fungal infection with decontamination regimen in mechanically ventilated ICU patients: a pre/post observational study

Background Invasive fungal infections acquired in the intensive care unit (AFI) are life-threating complications of critical illness. However, there is no consensus on antifungal prophylaxis in this setting. Multiple site decontamination is a well-studied prophylaxis against bacterial and fungal infections. Data on the effect of decontamination regimens on AFI are lacking. We hypothesised that multiple site decontamination could decrease the rate of AFI in mechanically ventilated patients. Methods We conducted a pre/post observational study in 2 ICUs, on adult patients who required mechanical ventilation for >24 h. During the study period, multiple-site decontamination was added to standard of care. It consists of amphotericin B four times daily in the oropharynx and the gastric tube along with topical antibiotics, chlorhexidine body wash and nasal mupirocin. Results In 870 patients, there were 27 AFI in 26 patients. Aspergillosis accounted for 20/143 of ventilator-associated pneumonia and candidemia for 7/75 of ICU-acquired bloodstream infections. There were 3/308 (1%) patients with AFI in the decontamination group and 23/562 (4%) in the standard-care group (p = 0.011). In a propensity-score matched analysis, there were 3/308 (1%) and 16/308 (5%) AFI in the decontamination group and the standard-care group respectively (p = 0.004) (3/308 vs 11/308 ventilator-associated pulmonary aspergillosis, respectively [p = 0.055] and 0/308 vs 6/308 candidemia, respectively [p = 0.037]). Conclusion Acquired fungal infection is a rare event, but accounts for a large proportion of ICU-acquired infections. Our study showed a preventive effect of decontamination against acquired fungal infection, especially candidemia. Take home message Acquired fungal infection (AFI) incidence is close to 4% in mechanically ventilated patients without antifungal prophylaxis (3% for pulmonary aspergillosis and 1% for candidemia). Aspergillosis accounts for 14% of ventilator-associated pneumonia and candidemia for 9% of acquired bloodstream infections. Immunocompromised patients, those infected with SARS-COV 2 or influenza virus, males and patients admitted during the fall season are at higher risk of AFI. Mechanically ventilated patients receiving multiple site decontamination (MSD) have a lower risk of AFI.

Understanding metabolic alterations after SARS-CoV-2 infection: insights from the patients’ oral microenvironmental metabolites

BackgroundCoronavirus disease 2019 is a type of acute infectious pneumonia and frequently confused with influenza since the initial symptoms. When the virus colonized the patient's mouth, it will cause changes of the oral microenvironment. However, few studies on the alterations of metabolism of the oral microenvironment affected by SARS-CoV-2 infection have been reported. In this study, we explored metabolic alterations of oral microenvironment after SARS-CoV-2 infection.MethodsUntargeted metabolomics (UPLC-MS) was used to investigate the metabolic changes between oral secretion samples of 25 COVID-19 and 30 control participants. To obtain the specific metabolic changes of COVID-19, we selected 25 influenza patients to exclude the metabolic changes caused by the stress response of the immune system to the virus. Multivariate analysis (PCA and PLS-DA plots) and univariate analysis (students’ t-test) were used to compare the differences between COVID-19 patients and the controls. Online hiplot tool was used to perform heatmap analysis. Metabolic pathway analysis was conducted by using the MetaboAnalyst 5.0 web application.ResultsPLS-DA plots showed significant separation of COVID-19 patients and the controls. A total of 45 differential metabolites between COVID-19 and control group were identified. Among them, 35 metabolites were defined as SARS-CoV-2 specific differential metabolites. Especially, the levels of cis-5,8,11,14,17-eicosapentaenoic acid and hexanoic acid changed dramatically based on the FC values. Pathway enrichment found the most significant pathways were tyrosine-related metabolism. Further, we found 10 differential metabolites caused by the virus indicating the body’s metabolism changes after viral stimulation. Moreover, adenine and adenosine were defined as influenza virus-specific differential metabolites.ConclusionsThis study revealed that 35 metabolites and tyrosine-related metabolism pathways were significantly changed after SARS-CoV-2 infection. The metabolic alterations of oral microenvironment in COVID-19 provided new insights into its molecular mechanisms for research and prognostic treatment.

Prevalence and patient risk factors for pneumothorax in COVID-19 and in influenza pneumonia: a nationwide comparative analysis.

Pneumothorax is a rare but deadly complication in patients who require mechanical ventilation. As with any condition associated with acute respiratory distress syndrome (ARDS), coronavirus disease 2019 (COVID-19) is known to be associated with pneumothorax. However, in the literature, comparative data on the risk factors for pneumothorax in COVID-19 and other diseases like influenza are limited. The aim of this study is to determine the prevalence and risk factors for pneumothorax in hospitalized COVID-19 patients and compare them with influenza pneumonia patients. This study is a retrospective analysis of the National Inpatient Sample (NIS) 2020 database cohort. Univariate and multivariate logistic regression were used to identify the prevalence and risk factors for pneumothorax in COVID-19 patients and compared with the risk of pneumothorax in influenza patients. The NIS 2020 database includes 1,608,980 hospitalizations of COVID-19 patients, of which 22,545 [95% confidence interval (CI): 21,491-23,598] (1.4%) developed pneumothorax. On multivariate analysis, factors associated with pneumothorax in COVID-19 included patient age of 41-64 years; male sex; Hispanics, Native Americans, and other races; hospitals with large-bed size; privately owned hospitals; urban teaching hospitals; hospitals in the southern United States (US); stroke; malnutrition; chronic obstructive pulmonary disease (COPD); bronchiectasis; pulmonary fibrosis; liver disease; non-invasive and invasive ventilation; and extracorporeal membrane oxygenation (ECMO). Of 184,980 influenza patients, 1,630 (95% CI: 1,448-1,811) (0.88%) developed pneumothorax. The prevalence of pneumothorax was higher (1.4%) in COVID-19 patients compared to patients with influenza pneumonia (0.88%). COVID-19 patients who develop pneumothorax have a poor prognosis. Several risk factors for the development of pneumothorax were identified. Patients with these risk factors should be prioritized in applying evidence-based guidelines to prevent pneumothorax.

Detection of bacterial co-infection in patients with severe influenza

Viral infections engender bacterial colonization in the host by causing alteration in the innate immune response to common bacterial pathogens. These alterations may lead to severe bacterial pneumonia during influenza. Bacterial co-infection is common in influenza pneumonia and increases morbidity and mortality. With the onset of the COVID-19 pandemic worldwide, research in viral diseases has intensified. With this study, it can be thought that bacterial colonization may also support viral activity in the human body. This study sought to investigate bacterial co-infection in respiratory specimens using samples from the Australian influenza epidemic of 2009 as a model for analysis. Furthermore, it was thought that this study could shed light on bacterial co-infection studies in patients with COVID-19, which caused the current pandemic. 200 clinical specimens were extracted for isolation of genomic DNA and directly tested in a multiplexed quantitative PCR. Multiplex-tandem PCR (MT-PCR) assay based on 16S rRNA consensus sequence of a family (Enterobacteriaceae species) and four genera (Staphylococcus spp., Streptococcus spp., Enterococcus spp., and Pseudomonas spp.) was performed. According to MT-PCR results, respiratory tract samples showed a very high rate of bacterial identification (163/200-81.5%), and Enterococci were commonly found as the dominant genus identified in influenza patients. In a total of 200 putative co-infection samples, Enterococcus spp. was apparently present in 139 samples (69.5%), being the dominant signal (any other signal was ≤10%) from 106 samples. Streptococcus spp. was next most commonly indicated with 137 positive results (68.5%), but was the dominant signal in 19 of 137. It was determined that bacterial co-infection was high in the samples taken from patients with severe influenza, and Enterococcus was the dominant bacteria in the upper respiratory tract of patients treated for severe pneumonia, while Streptococcus was more dominant in the lower respiratory tracts than the other species.

Distribution characteristics of traditional Chinese medicine syndromes in 4 367 adult influenza patients: a Meta-analysis

To systematically evaluate the distribution characteristics of traditional Chinese medicine (TCM) syndromes in adult influenza patients and to provide a basis for the TCM syndrome differentiation of influenza. The CNKI, CBM, Wanfang, VIP, PubMed, Embase, Cochrane Library databases were searched to collect cross-sectional studies on the distribution pattern of TCM syndromes in adult patients with influenza. The risk of bias assessment tool for cross-sectional studies developed by the Joanna Briggs Institute (JBI) evidence-based health care center was used to evaluate the literature quality, and the Stata 15.1 software was used to conduct a Meta-analysis of the pooled effect sizes of the included studies. A total of 11 studies with 4 367 influenza patients were included. Quality assessment results of JBI showed that the risk bias was higher in the sample size calculation, and the description of sampling modalities and response rate was unclear. There were 17 influenza syndromes after specification, and a single group rate Meta-analysis was performed of the syndromes with ≥ 50 incident cases showed that there were 9 syndromes with an incidence ≥ 10% and statistical significance, the top 5 syndromes were syndrome of wind and heat invading the defense [n = 1 583, RATE = 34.3%, 95% confidence interval (95%CI) was 22.2%-46.3%], syndrome of exterior cold and interior heat (n = 1 122, RATE = 36.1%, 95%CI was 21.2%-51.1%), syndrome of wind-cold fettering the exterior (n = 860, RATE = 19.4%, 95%CI was 10.7%-28.0%), syndrome of heat and toxin in the lung (n = 217, RATE = 17.1%, 95%CI was 9.1%-25.0%), and syndrome of disease involving both defense phase and qi phase (n = 184, RATE = 38.8%, 95%CI was 14.2%-63.5%). The results of the subgroup analysis in different geographical regions showed that the frequency of distribution of syndrome of wind and heat invading the defense and heat and toxin in the lung was higher in the South (RATE: 36.5%, 18.6%) than in the North (RATE: 30.9%, 15.4%), and the frequency of distribution of syndrome of wind-cold fettering the exterior and exterior cold and interior heat in the North (RATE: 23.8%, 40.1%) was higher than that in the South (RATE: 15.7%, 32.3%). There are 9 common TCM syndromes of influenza, including wind and heat invading the defense syndrome, exterior cold and interior heat syndrome, wind-cold fettering the exterior syndrome, heat and toxin in the lung syndrome, disease involving both defense phase and qi phase syndrome, wind and heat complicated by dampnessinvading the surface syndrome, wind and cold complicated by dampnessinvading the surface syndrome, defense phase syndrome and dampness and heatinvading the surface syndrome, which can provide a reference for the TCM syndrome differentiation and treatment of influenza.

Active immunization with Pseudomonas aeruginosa vaccine protects mice from secondary Pseudomonas aeruginosa challenge post-influenza virus infection.

Influenza virus infection complicated by secondary bacterial pneumonia contributes significantly to death during seasonal or pandemic influenza. Secondary infection of Pseudomonas aeruginosa (P. aeruginosa) in influenza virus-infected patients contributes to morbidity and mortality. Mice were first infected with PR8 influenza virus, followed by a secondary infection of P. aeruginosa. Body weights and survival rate of mice was monitored daily over 20 days. Bronchoalveolar lavage fluids (BALFs) and lung homogenates were harvested for measuring bacterial titers. Lung tissue section slides were stained with hematoxylin and eosin for microscopic observation. After vaccination with inactivated P. aeruginosa cells or recombinant PcrV protein, the mice were subjected to PR8 influenza virus infection followed by a secondary infection of a P. aeruginosa. The inhibition against P. aeruginosa of serum was evaluated by detecting the growth of P. aeruginosa in broth containing diluted sera. The prior influenza infection greatly enhanced the susceptibility to secondary infection of P. aeruginosa and increased morbidity and mortality in mice. Active immunization with inactivated P. aeruginosa cells could protect mice from secondary P. aeruginosa challenge in influenza virus infected mice. To develop an effective P. aeruginosa vaccine might be a promising strategy to decrease the threat of secondary P. aeruginosa infection in influenza patients.

Molecular Detection of H1N1 and Impact of Cytokines among Infected Patients with Respiratory Distress: A Cross-sectional Study

Introduction: Viruses are spread from one individual to another. In respect to the mode of transmission, the majority of them enter the human body by the inward breath of infective respiratory beads. Upper Respiratory Tract Infections (URTI) are infections of the body’s respiratory tract, which include the sinuses, nose, throat, airways, and lungs. The influenza virus has four key structural antigens: the internal Ribonucleoprotein (RNP), the viral envelope Matrix (M), and two surface Glycoproteins (GP), Neuraminidase (NA) and Haemagglutinin (HA). A respiratory virus called swine flu/H1N1 evolved and spread widely around the world. H1N1 outbreaks with various virus strains were noted before the most recent severe pandemic, which occurred in 2009. Seasonal outbreaks that are extremely infrequent since the 2009 pandemic the influenza strain have occurred. Aim: To assess the prevalence and level of cytokines in H1N1- infected patients with signs and symptoms of respiratory distress. Materials and Methods: This is a cross-sectional study of viral molecular, immunological and epidemiological parameters. The study was done at the Indian Council of Medical Research (ICMR) at the Department of Health Research (DHR), Virus Research and Diagnostic Laboratory (VRDL), Department of Microbiology, Burdwan Medical College and Hospital (BMCH), Burdwan, India. The duration of the study was seven months, from January 2022- July 2022. Samples in Viral Transport Medium (VTM) were collected from suspected influenza patients with mild or severe Acute Respiratory Distress Symptoms (ARDS) and Influenza Like Symptom (ILS). The RNA samples were isolated and the nucleic acid purified from samples was screened by Real-time Polymerase Chain Reaction (RT-PCR). The extracted clinical Ribonucleic Acid (RNA) samples are then converted into Complementary Deoxyribonucleic acid (cDNA). The HA gene sequences of endemic swine influenza A virus (H1N1) and sequences from a panel of human and avian type A influenza virus strains, including the type A human seasonal strains, were retrieved from the GenBank database in the National Centre for Biotechnology Information (NCBI) portal. The Enzymelinked Immunoassay (ELISA) method was used to measure the proinflammatory cytokines Interleukin (IL)-8, IL2 and antiinflammatory cytokine IL10, as well as the IL3 concentration level in severe Acute Respiratory Distress Syndrome (ARDS) +Immediate Life Support (ILS) positive H1N1 infected patients. Analysis of all the data was performed by Statistical Package for Social Sciences (SPSS) software version 22. Results: In this study, all samples (n=120) were examined using RT-PCR, which revealed that 53 samples were infected with the Influenza A Virus (IAV). Among the total positive 24 were males and 29 were females. the average concentration of IL3 was 1749.49 pg/mL. The increase in IL8 was not as big as the increase in IL2 and IL3. IL8 was identified as a significant proinflammatory factor during angiogenesis, or uncontrolled cell growth. Conclusion: The prevalence of H1N1 infection was found to be high in children under the age of ten. The concentration of IL-3 in H1N1-infected patients’ samples was higher than the concentrations of the other three cytokines.

Possible high fever in influenza outpatients with migraine – A retrospective cohort study

Background. There is limited information on neurologic complications associated with influenza in adults. Objectives. To identify headache features and high fever in influenza outpatients with migraine in the Department of Internal Medicine by a neurologist. Methods. In 2022, a retrospective cohort study was performed to review the medical records during 2016 to 2019. A total of 64 (44 women; 53 unvaccinated; 47 type A) influenza patients were included. All patients were physically examined, and axillary temperatures were measured at around 9 am. The mean body temperature in 34 patients without headache was compared to that in 22 with headache and 8 with headache and an underlying migraine. Results. Among the 27 unvaccinated influenza type A patients (18 women) under 50 years old, the mean body temperatures were 37.79, 38.10, and 38.86 degrees C for the 12 (6 women) without headache, 10 (8 women) with headache, and 5 (4 women) with headache and a history of migraine, respectively. The mean [SD] ages were 33.58 [7.27], 37.30 [9.58], and 32.40 [7.50] years, respectively. Levene`s Test showed no equal variances between the body temperatures of the 12 without headache and those of 5 with headache and a history of migraine (P=0.007). Welch`s Test showed significant differences in their mean body temperatures (P=0.012). Conclusion. There is a possibility of high fever in unvaccinated influenza type A outpatients under 50 years old with migraine.

2199. Herpesviridae lung reactivation and infection in patients with severe Covid-19 or influenza virus pneumonia: a comparative study

Abstract Background Lung reactivations of Herpesviridae, herpes simplex virus (HSV) and cytomegalovirus (CMV) have been reported in Covid-19 patients. Whether or not those viral reactivations are more frequent than in other patients is not known. Methods Retrospective monocentric cohort study of 145 patients with severe Covid-19 pneumonia requiring invasive mechanical ventilation and who were tested for HSV and CMV in bronchoalveolar lavage performed during fiberoptic bronchoscopy for ventilator-associated pneumonia suspicion. Rates of HSV and CMV lung reactivations, and HSV bronchopneumonitis were assessed and compared with an historical cohort of 89 patients with severe influenza pneumonia requiring invasive mechanical ventilation. Results Among the 145 Covid-19 patients included, 50% and 42 % had HSV and CMV lung reactivations, respectively; whereas among the 89 influenza patients, 63% and 28% had CMV lung reactivations, respectively. Cumulative incidence of HSV lung reactivation (taking into account extubation and death as competing events) was higher in influenza than in Covid-19 patients (p = 0.03, see figure 1), whereas the rate of HSV bronchopneumonitis was similar in both groups (31% and 25%, respectively). Cumulative incidence of CMV lung reactivation (taking into account extubation and death as competing events) was similar in Covid-19 and influenza patients (p=0.07). Outcomes of patients with HSV or CMV lung reactivations were similar to that of patients without, whatever the underlying conditions, i.e., in Covid-19 patients, in influenza patients, or when all patients were grouped. Estimated cumulative incidence of herpes simplex virus (HSV) lung reactivation, extubation or death in Covid-19 and influenza patients, taking into account only the first event that occurred. p values for differences between Covid-19 and influenza patients were 0.03 for HSV reactivation, 0.53 for death and 0.87 for extubation. Conclusion HSV and CMV lung reactivations are frequent in Covid-19 patients, but not more frequent than in patients with influenza-associated severe pneumonia, despite a higher severity of illness at intensive care unit (ICU) admission of the latter and a longer duration of mechanical ventilation of the former. Although no impact on outcome of HSV and CMV lung reactivations was detected, the effect of antiviral treatment against these Herpesviridae remains to be determined in these patients. Disclosures CHARLES-EDOUARD LUYT, MD PhD, AdvanzPharma: Honoraria|Aerogen: Honoraria|Merck: Honoraria.

593: PRE-COVID, COVID, AND POST-COVID TRENDS OF RSV AND INFLUENZA ACROSS GEOGRAPHIC REGIONS IN THE USA

Introduction: Admissions to Pediatric Intensive Care Units (PICUs) for respiratory illnesses, particularly RSV and Influenza (INF), have decreased during the COVID-19 pandemic. The differences in trends for RSV and INF admissions to PICUs across different regions in the U.S. are unknown. Changes in these trends before (2014-19), during (2019-20), and towards the end of the pandemic (2021-22), and utilization patterns across regions have not been evaluated. This analysis aimed at addressing these questions. Methods: 874,066 USA PICU cases from the Virtual Pediatric Systems database (myvps.org), from Q1-2014 to Q2-2022, were used to study RSV and INF in patients < 18 years. The geographic regions according to U.S. Census definition included Mid-West (MW), Northeast (NE), South (S), and West (W). RSV and INF were defined by ICD-9 and ICD-10 codes. After removing low-risk patients (PRISM III POD < 0.004) the cohort size was 492,642. Segmented regression analysis (Muggeo 2016) was used to fit the trends in yearly rates for RSV and INF. Least-squares linear fits were applied to data segments before and after breakpoints (change in slope) to determine the correlation coefficients of each segment. Fisher’s Z-transform was used to investigate significant differences between segments before and after their respective breakpoints. Utilization amongst regions was done by ANCOVA analysis, and Bonferroni corrected p-values for the most prevalent procedures in the cohorts. Results: All regions showed an increase in RSV and INF between 2014-19, but decreasing during 2020-21. In 2021-22 all regions showed an increase trend in INF, but RSV increased only in MW and S compared to NE and W. Further analysis using RSV segmented regression revealed: MW, NE, and W breakpoints (positive to negative) in: 2018, 2019, and 2019, respectively. For INF, breakpoints for MW, NE, S, and W were detected in: 2019, 2020, 2019, and 2019, respectively. CPAP use in W was greater than S (p< 0.02). All other procedure comparisons had p-values>0.05. Conclusions: RSV and INF increased in all regions during pre-COVID. RSV and INF decreased in all regions during COVID. INF increased in all the regions towards the end of pandemic. RSV increased in MW and S near the end of the pandemic. Differences in use of CPAP for RSV were found between W and S.

260. Corticosteroid treatment in influenza virus and SARS-CoV-2 co-infected patients

Abstract Background Co-infections with SARS-CoV-2 and influenza virus may become more prevalent now that many countries are easing restrictions to reduce the spread of SARS-CoV-2. Co-infected patients are more likely to receive invasive mechanical ventilation (IMV) and have higher odds of in-hospital mortality. In the RECOVERY trial, dexamethasone was found to reduce the risk of 28-day mortality in hospitalised COVID-19 patients. On June 16, 2020, corticosteroids were included in clinical guidelines for the treatment of COVID-19 patients requiring supplemental oxygen. However, corticosteroid treatment in severe influenza virus infection may increase mortality. The effect of steroids in influenza and COVID-19 co-infected patients is unknown. Methods Adult patients with RT-PCR confirmed SARS-CoV-2 and influenza virus co-infection were evaluated. Patients without supplemental oxygen during admission were excluded. Patients who were hospitalised prior to June 16, 2020 were included in the ‘early’ group and patients who were hospitalised on or after June 16, 2020 were included in the ‘late’ group. Results 171 co-infected patients were included, 123 patients in the early group (table 1) and 48 in the late group (table 2). In the early group, 25 patients received steroids. In the late group, 40 patients received steroids. In the early group, the proportion of patients who were admitted to critical care was slightly lower in the group that received steroids. IMV was similar in both groups. In-hospital mortality was slightly higher in the group treated with steroids. In the late group, critical care admission and receipt of IMV were higher in the group not treated with corticosteroids than the group with corticosteroid treatment. In-hospital mortality was slightly lower in the group not treated with steroids. Conclusion There are differences between co-infected patients who were treated and not treated with corticosteroids and differences between the early and late groups. A limitation is that no dates were collected for the start of steroid treatment, making it impossible to draw conclusions on the causality of the need for IMV and treatment with steroids in this analysis. Future research should focus on the effect of steroids in COVID-19 and influenza co-infected patients. Disclosures Peter Openshaw, PhD, Bavarian Nordic: Advisor/Consultant|Cepheid: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|Janssen: Advisor/Consultant|Pfizer: Advisor/Consultant Calum Semple, PhD, Integrum Scientific: Scientific Advisory Board|Integrum Scientific: Stocks/Bonds.

Outcomes and risk factors with COVID-19 or influenza in hospitalized asthma patients

BackgroundAt the time of the SARS-CoV-2 emergence, asthma patients were initially considered vulnerable because respiratory viruses, especially influenza, are associated with asthma exacerbations, increased risk of hospitalization and more severe disease course. We aimed to compare the asthma prevalence in patients hospitalized for COVID-19 or influenza and risk factors associated with poor prognosis with the diseases.MethodsThis retrospective cohort study used the Paris university hospitals clinical data warehouse to identify adults hospitalized for COVID-19 (January to June 2020) or influenza (November 2017 to March 2018 for the 2017–2018 influenza period and November 2018 to March 2019 for the 2018–2019 period). Asthma patients were identified with J45 and J46 ICD-10 codes. Poor outcomes were defined as admission in intensive care or death.ResultsAsthma prevalence was significantly higher among influenza than COVID-19 patients (n = 283/3 119, 9.1%, 95% CI [8.1–10.1] in 2017–2018 and n = 309/3 266, 9.5%, 95% CI [8.5–10.5] in 2018–2019 versus n = 402/9 009, 4.5%, 95% CI [4.0–4.9]). For asthma patients, 31% with COVID-19 were admitted to an intensive care unit versus 23% and 21% with influenza. Obesity was a risk factor for the 2017–2018 influenza period, smoking and heart failure for the 2018–2019 period. Among COVID-19 patients with asthma, smoking and obesity were risk factors for the severe form.ConclusionsIn this study, patients with an asthma ICD-10 code were less represented among COVID-19 patients than among influenza-infected ones. However, outcomes were poorer for COVID-19 than influenza patients, both with asthma. These data highlight the importance of protective shields and vaccination against influenza and COVID-19 in this population.