Influenza Patients Research Articles

The frequency and outcome of Influenza in children admitted to Tabriz children's training and treatment center in Northwest Iran During 2014-2019

Background. Influenza causes various seasonal respiratory diseases, resulting in significant morbidity and mortality in children. Influenza is a highly contagious disease causing global pandemics. This study aimed to investigate the frequency and outcome of influenza in children admitted to the Tabriz Children's Hospital. Methods. This cross-sectional study included suspected influenza patients admitted to the Tabriz Children's Medical Center between 2014 and 2019 diagnosed with positive influenza through RT-PCR of pharyngeal secretions samples. Results. We evaluated 114 cases of influenza with a median age of 48 months (range: 2-156 months) and 53.5% were boys. A total of 87 cases (77%) were infected with subtype A/H3N2, which was the most frequent, followed by 2 cases (1.8%) of subtype A/H1N1, 23 cases (20.4%) of subtype B 23, and one case (0.8%) of uncategorized A subtype. The disease was common in winter with 63 cases (56.3%). Conclusion. The frequency of influenza in children during five years was 8.95%, which is higher in males. Also, the highest frequency of influenza in the present study was observed in the age group of 1 to 5 years. The mortality rate of influenza in children during the last five years was equal to 7.9%. Practical Implications. Children under 5 years of age are more susceptible to influenza (especially type A subtype H3N2) and higher hospitalization rate and mortality, which can be prevented with a vaccine.

The prevalence of influenza bacterial co-infection and its role in disease severity: A systematic review and meta-analysis.

Evidence suggests that influenza bacterial co-infection is associated with severe diseases, but this association has not been systematically assessed. We aimed to assess the prevalence of influenza bacterial co-infection and its role in disease severity. We searched PubMed and Web of Science for studies published between 1 January 2010 and 31 December 2021. We performed a generalised linear mixed effects model to estimate the prevalence of bacterial co-infection in influenza patients, and the odds ratios (OR) of death, intensive care unit (ICU) admission, and requirement of mechanical ventilation (MV) for influenza bacterial co-infection compared to influenza single-infection. Using the estimates of OR and prevalence, we estimated the proportion of influenza deaths attributable to bacterial co-infection. We included 63 articles. The pooled prevalence of influenza bacterial co-infection was 20.3% (95% confidence interval (CI) = 16.0-25.4). Compared with influenza single-infection, bacterial co-infection increased the risk of death (OR = 2.55; 95% CI = 1.88-3.44), ICU admission (OR = 1.87; 95% CI = 1.04-3.38), and requirement for MV (OR = 1.78; 95% CI = 1.26-2.51). In the sensitivity analyses, we found broadly similar estimates between age groups, time periods, and health care settings. Likewise, while including studies with a low risk in confounding adjustment, the OR of death was 2.08 (95% CI = 1.44-3.00) for influenza bacterial co-infection. Based on these estimates, we found that approximately 23.8% (95% uncertainty range = 14.5-35.2) of influenza deaths were attributable to bacterial co-infection. We found that bacterial co-infection is associated with a higher risk of severe illnesses compared to influenza single-infection. Approximately one in four influenza deaths could be attributable to bacterial co-infection. These results should inform prevention, identification, and treatment for suspected bacterial co-infection in influenza patients. PROSPERO CRD42022314436.

Community-acquired and hospital-acquired bacterial co-infections in patients hospitalized with Covid-19 or influenza: a retrospective cohort study

BackgroundBacterial co-infections are believed to be less frequent in patients with Covid-19 than influenza, but frequencies varied between studies.MethodsThis single-center retrospective, propensity score-matched analysis included adult patients with Covid-19 or influenza admitted to normal-care wards between 02/2014 and 12/2021. Covid-19 cases were propensity score matched to influenza cases at a 2:1 ratio. Community-acquired and hospital-acquired bacterial co-infections were defined as positive blood or respiratory cultures ≤ 48 h or > 48 h after hospital admission, respectively. The primary outcome was comparison of community-acquired and hospital-acquired bacterial infections between patients with Covid-19 and influenza in the propensity score-matched cohort. Secondary outcomes included frequency of early and late microbiological testing.ResultsA total of 1337 patients were included in the overall analysis, of which 360 patients with Covid-19 were matched to 180 patients with influenza. Early (≤ 48 h) microbiological sampling was performed in 138 (38.3%) patients with Covid-19 and 75 (41.7%) patients with influenza. Community-acquired bacterial co-infections were found in 14 (3.9%) of 360 patients with Covid-19 and 7 (3.9%) of 180 patients with influenza (OR 1.0, 95% CI 0.3–2.7). Late (> 48 h) microbiological sampling was performed in 129 (35.8%) patients with Covid-19 and 74 (41.1%) patients with influenza. Hospital-acquired bacterial co-infections were found in 40 (11.1%) of 360 patients with Covid-19 and 20 (11.1%) of 180 patients with influenza (OR 1.0, 95% CI 0.5–1.8).ConclusionThe rate of community-acquired and hospital-acquired bacterial co-infections was similar in hospitalized Covid-19 and influenza patients. These findings contrast previous literature reporting that bacterial co-infections are less common in Covid-19 than influenza.

EE127 Healthcare Resource Utilization Among Influenza Patients Treated with Baloxavir Marboxil Compared with Oseltamivir with Medicaid Insurance Coverage

To compare all-cause and respiratory-related healthcare resource utilization (HRU) among influenza patients treated with antiviral agents baloxavir marboxil (BALOX) or oseltamivir (OSELT).

Genetic analysis of cuproptosis subtypes and immunological features in severe influenza

The mechanisms regulating cuproptosis in severe influenza are still unknown. We aimed to identify the molecular subtypes of cuproptosis and immunological characteristics associated with severe influenza in patients requiring invasive mechanical ventilation (IMV). The expression of cuproptosis modulatory factors and immunological characteristics of these patients were analyzed using the public datasets (GSE101702, GSE21802, and GSE111368) from the Gene Expression Omnibus (GEO). Seven cuproptotic-associated genes (ATP7B, ATP7A, FDX1, LIAS, DLD, MTF1, DBT) related to active immune responses were identified in patients suffering from severe and non-severe influenza and two cuproptosis-associated molecular subtypes were discovered in severe influenza patients. Singe-set gene set expression analysis (SsGSEA) indicated that compared with subtype 2, subtype 1 was characterized by reduced adaptive cellular immune responses and increased neutrophil activation. Gene set variation assessment revealed that cluster-specific differentially expressed genes (DEGs) in subtype 1 were involved in autophagy, apoptosis, oxidative phosphorylation, and T cell, immune, and inflammatory responses, amongst others. The random forest (RF) model revealed the most differentiating efficiency with relatively small residual and root mean square error and an increased area under the curve value (AUC = 0.857). Lastly, a five-gene-based RF model (CD247, GADD45A, KIF1B, LIN7A, HLA_DPA1) was established, which showed satisfactory efficiency in the test datasets GSE111368 (AUC = 0.819). Nomogram calibration and decision curve analysis demonstrated its accuracy for the prediction of severe influenza. This study suggests that cuproptosis might be associated with the immunopathology of severe influenza. Additionally, an efficient model for the prediction of cuproptosis subtypes was developed which will contribute to the prevention and treatment of severe influenza patients needing IMV.

Differences in clinical characteristics and outcomes between COVID-19 and influenza in critically ill adult patients: A national database study

Prior to the coronavirus disease 2019 (COVID-19) pandemic, influenza was the most frequent cause of viral respiratory pneumonia requiring intensive care unit (ICU) admission. Few studies have compared the characteristics and outcomes of critically ill patients with COVID-19 and influenza. This was a French nationwide study comparing COVID-19 (March 1, 2020-June 30, 2021) and influenza patients (January 1, 2014-December 31, 2019) admitted to an ICU during pre-vaccination era. Primary outcome was in-hospital death. Secondary outcome was need for mechanical ventilation. 105,979 COVID-19 patients were compared to 18,763 influenza patients. Critically ill patients with COVID-19 were more likely to be men with more comorbidities. Patients with influenza required more invasive mechanical ventilation (47 vs. 34%, p<0·001), vasopressors (40% vs. 27, p<0·001) and renal-replacement therapy (22 vs. 7%, p<0·001). Hospital mortality was 25 and 21% (p<0·001) in patients with COVID-19 and influenza, respectively. In the subgroup of patients receiving invasive mechanical ventilation, ICU length of stay was significantly longer in patients with COVID-19 (18 [10-32] vs. 15 [8-26] days, p<0·001). Adjusting for age, gender, comorbidities, and modified SAPS II score, in-hospital death was higher in COVID-19 patients (adjusted sub-distribution hazard ratio [aSHR]=1.69; 95%CI=1.63-1.75) compared with influenza patients. COVID-19 was also associated with less invasive mechanical ventilation (aSHR=0.87; 95%CI=0.85-0.89) and a higher likelihood of death without invasive mechanical ventilation (aSHR=2.40; 95%CI=2.24-2.57). Despite younger age and lower SAPS II score, critically ill COVID-19 patients had a longer hospital stay and higher mortality than patients with influenza.

Peripheral Neuropathy in Long-COVID Patients: Demographic Distribution and Risk Factors (P6-10.001)

<h3>Objective:</h3> To examine the demographic distribution and risk factors in long-COVID patients developing new-onset or progressing peripheral neuropathy (PN). <h3>Background:</h3> Neurologic symptoms following acute-phase COVID are common. Incidence of PN has been shown to be higher in long-COVID patients compared to influenza patients and the general population for reasons not well understood. This is a novel study on the risk factors of both new-onset and progressing long-COVID PN and may guide future studies on etiology and clinical management. <h3>Design/Methods:</h3> Electronic health records of patients who visited a multi-disciplinary post-COVID clinic (PCC) between March 2021 and September 2022 were reviewed. Patients were categorized into four groups: new-onset PN group had new PCC or EMG PN diagnosis following COVID infection; progressing PN group had both new and pre-existing diagnoses relative to infection; non-progressing PN group had pre-existing but no new diagnosis; non-PN group had never received a diagnosis. Demographics, BMI, prior COVID vaccination, chronic comorbidities, and medications were studied. <h3>Results:</h3> Of 639 patients, 21(3.29%) had new-onset PN, 20(3.13%) had progressing PN, and 31(4.85%) had non-progressing PN. Patients with new-onset PN were older (55.5±13.2 vs. 50.3±14.0, p=0.047), more male (47.6% vs 26.1%, p=0.029), and more likely been hospitalized for COVID (47.6% vs 22.4%, p=0.007) compared with non-PN patients. Patients with progressing PN were older (65.5±9.2 vs 50.3±14.0, p&lt;0.001), more likely to have diabetes (35.0% vs 15.0%, p=0.016) and hypertension (70.0% vs 34.3%, p&lt;0.001) and take some form of diabetes medication (30.0% vs 14.1%, p=0.048) and hypertension medication (65.0% vs 39.0%, p=0.019) compared to patients with no PN. Patients with progressing PN were older (65.5±9.14 vs 57.0±11.85, p=0.050) than non-progressing PN patients. <h3>Conclusions:</h3> Older age was associated with new-onset and progressing PN in long-COVID patients. This and other associated findings provide further opportunities to study possible contribution of immunological, metabolic, and degenerative factors to long-COVID neurologic symptoms. <b>Disclosure:</b> Mr. Li has nothing to disclose. Mr. Bohn has nothing to disclose. Mr. Todd has nothing to disclose. Ms. A Pater has nothing to disclose. Ms. Carroll has nothing to disclose. Dr. Henriksen has nothing to disclose. Dr. Chang has nothing to disclose.

Comparison of Chest CT Findings between COVID-19 Pneumonia and Influenza Pneumonia

Introduction: With increasing global concerns about the prevalence of COVID-19, chest imaging findings are essential for effective diseases diagnosis and treatment. There is a need to distinguish between imaging features of COVID-19 pmeumonia and other viral pneumonia like Influenza.For this purpose, a study was performed on a comparison of chest CT findings between COVID-19 pneumonia and Influenza pneumonia. Methods: Fifty patients with respiratory symptoms and positive real-time PCR (RT-PCR) of nasopharyngeal swab for Influenza and fifty patients with respiratory symptoms and positive real-time PCR (RT-PCR) of nasopharyngeal swabfor COVID-19 from March to May 2020 were enrolled in the study. In the patient’s checklist, information such as demographic characteristics (age, sex), laboratory findings including (CRP, ESR, WBC), and clinical signs (fever, cough, fatigue, dyspnea) were also recorded. Results: Gastrointestinal symptoms, anorexia, high CRP, ground-glass opacityare more common in patients with COVID-19 pneumonia than in patients with influenza pneumonia and this difference was statistically significant (P &lt;0.05). But, fever is more common in influenza patients than in Covid-19 patients and this difference is statistically significant (P=0.029). The location of CT scan findings in COVID-19 patients was dominant in peripheral (54 %), while the location of CT scan findings in patients with Influenza was dominant in central (32 %), which is statistically significant (P &lt;0.05). Conclusion: According to the results of the study, lung CTscan findings along with some clinical and laboratory findings can help differentiate COVID-19 pneumonia from influenza pneumonia, which is very important in faster diagnosis and timely treatment of both diseases.

History of heart failure and chronic kidney disease and risk of all-cause death after COVID-19 during the first three waves of the pandemic in comparison with influenza outbreaks in Sweden: a registry-based, retrospective, case–control study

ObjectivesTo explore how cardiorenal disease (CRD; heart failure and/or chronic kidney disease) impacted mortality in men and women hospitalised for COVID-19 during the first three waves of the pandemic in...

Incidence of new-onset in-hospital and persistent diabetes in COVID-19 patients: comparison with influenza.

This study investigated the incidences and risk factors associated with new-onset persistent type-2 diabetes during COVID-19 hospitalization and at 3-months follow-up compared to influenza. This retrospective study consisted of 8216 hospitalized, 2998 non-hospitalized COVID-19 patients, and 2988 hospitalized influenza patients without history of pre-diabetes or diabetes in the Montefiore Health System in Bronx, New York. The primary outcomes were incidences of new-onset in-hospital type-2 diabetes mellitus (I-DM) and persistent diabetes mellitus (P-DM) at 3 months (average) follow-up. Predictive models used 80%/20% of data for training/testing with five-fold cross-validation. I-DM was diagnosed in 22.6% of patients with COVID-19 compared to only 3.3% of patients with influenza (95% CI of difference [0.18, 0.20]). COVID-19 patients with I-DM compared to those without I-DM were older, more likely male, more likely to be treated with steroids and had more comorbidities. P-DM was diagnosed in 16.7% of hospitalized COVID-19 patients versus 12% of hospitalized influenza patients (95% CI of difference [0.03,0.065]) but only 7.3% of non-hospitalized COVID-19 patients (95% CI of difference [0.078,0.11]). The rates of P-DM significantly decreased from 23.9% to 4.0% over the studied period. Logistic regression identified similar risk factors predictive of P-DM for COVID-19 and influenza. The adjusted odds ratio (0.90 [95% CI 0.64,1.28]) for developing P-DM was not significantly different between the two viruses. The incidence of new-onset type-2 diabetes was higher in patients with COVID-19 than influenza. Increased risk of diabetes associated with COVID-19 is mediated through disease severity, which plays a dominant role in the development of this post-acute infection sequela. None.

Single cell RNA-seq resolution revealed CCR1+/SELL+/XAF+ CD14 monocytes mediated vascular endothelial cell injuries in Kawasaki disease and COVID-19

IntroductionThe COVID-19 pandemic provide the opportunities to explore the numerous similarities in clinical symptoms with Kawasaki disease (KD), including severe vasculitis. Despite this, the underlying mechanisms of vascular injury in both KD and COVID-19 remain elusive. To identify these mechanisms, this study employs single-cell RNA sequencing to explore the molecular mechanisms of immune responses in vasculitis, and validate the results through in vitro experiments. MethodThe single-cell RNA sequencing (scRNA-seq) analysis of peripheral blood mononuclear cells (PBMCs) was carried out to investigate the molecular mechanisms of immune responses in vasculitis in KD and COVID-19. The analysis was performed on PBMCs from six children diagnosed with complete KD, three age-matched KD healthy controls (KHC), six COVID-19 patients (COV), three influenza patients (FLU), and four healthy controls (CHC). The results from the scRNA-seq analysis were validated through flow cytometry and immunofluorescence experiments on additional human samples. Subsequently, monocyte adhesion assays, immunofluorescence, and quantitative polymerase chain reaction (qPCR) were used to analyze the damages to endothelial cells post-interaction with monocytes in HUVEC and THP1 cultures. ResultsThe scRNA-seq analysis revealed the potential cellular types involved and the alterations in genetic transcriptions in the inflammatory responses. The findings indicated that while the immune cell compositions had been altered in KD and COV patients, and the ratio of CD14+ monocytes were both elevated in KD and COV. While the CD14+ monocytes share a large scale of same differentiated expressed geens between KD and COV. The differential activation of CD14 and CD16 monocytes was found to respond to both endothelial and epithelial dysfunctions. Furthermore, SELL+/CCR1+/XAF1+ CD14 monocytes were seen to enhance the adhesion and damage to endothelial cells. The results also showed that different types of B cells were involved in both KD and COV, while only the activation of T cells was recorded in KD. ConclusionIn conclusion, our study demonstrated the role of the innate immune response in the regulation of endothelial dysfunction in both KD and COVID-19. Additionally, our findings indicate that the adaptive immunity activation differs between KD and COVID-19. Our results demonstrate that monocytes in COVID-19 exhibit adhesion to both endothelial cells and alveolar epithelial cells, thus providing insight into the mechanisms and shared phenotypes between KD and COVID-19.

Risk factors, clinical characteristics and prognostic value of acute kidney injury in COVID-19 compared with influenza virus and respiratory syncytial virus.

Acute Kidney Injury (AKI) complicates a substantial part of patients withCOVID-19. Direct viral penetration of renal cells through the Angiotensin Converting Enzyme 2 receptor, and indirect damage by the aberrant inflammatory response characteristic of COVID-19 are likely mechanisms. Nevertheless, other common respiratory viruses such as Influenza and Respiratory Syncytial Virus (RSV) are also associated with AKI. We retrospectively compared the incidence, risk factors and outcomes of AKI among patients who were admitted to a tertiary hospital because of infection withCOVID-19, influenza (A + B) or RSV. We collected data of 2593 patients hospitalized withCOVID-19, 2041patients with influenza and 429 withRSV. Patients affected byRSV were older, had more comorbidities and presented with higher rates of AKI at admission and within 7 days (11.7% vs. 13.3% vs. 18% for COVID-19, influenza and RSV, respectively p = 0.001). Nevertheless, patients hospitalized withCOVID-19 had higher mortality (18% with COVID-19vs. 8.6% and 13.5% forinfluenza and RSV, respectively P < 0.001) and higher need ofmechanical ventilation (12.4% vs. 6.5% vs.8.2% for COVID-19, influenza and RSV, respectively, P = 0.002). High ferritin levels and low oxygen saturation were independent risk factors for severe AKI only in the COVID-19 group. AKI in the first 48h of admission and in the first 7 days of hospitalization were strong independent risk factors for adverse outcome in all groups. Despite many reports of direct kidney injury by SARS-COV-2, AKI was less in patients with COVID-19 compared to influenza and RSV patients. AKI was a prognostic marker for adverse outcome across all viruses.

COVID-19 and H1N1 Influenza: Are They 2 Sides of the Same Coin?

Swine flu (H1N1) and Coronavirus diseases (COVID-19) have been compared in the past few months. Both pandemics sparked a worldwide major panic. Although both have some common symptoms and diagnoses, they are quite different in many aspects. The current study aimed to investigate the differences in clinical and viral behaviors between H1N1 Influenza and COVID-19 pneumonia. This was a retrospective study of adult patients hospitalized with H1N1 influenza pneumonia between January 2019 and February 2020, and patients hospitalized with COVID-19 during the outbreak. A demographic and clinical characteristic of H1N1 influenza and COVID-19 patients were recorded. Both groups were compared-using an independent samples student t test for continuous variables and a chi-square test for categorical data-to identify significantly different parameters between the 2 diseases. A total of 78 patients were included and divided into 2 groups: 33 patients (42.3%) with H1N1 and 45 patients (57.7%) with COVID-19. The mean age of the patients was 43.3 ± 10.6 years. Bronchial asthma was significantly higher among patients with H1N1, while diabetes mellitus was significantly higher among patients with COVID-19. Right lower lobe affection was significantly present among those with H1N1 than those with COVID (100% vs 0%). The monocytic count was significantly higher among those with H1N1 than COVID-19 (11.63 ± 1.50 vs 7.76 ± 1.68; P < 0.001). Respiratory rates of more than 22 c/min significantly increased in patients with HINI than in those with COVID-19 (18.2% vs 4.4%; P = 0.05). Mortality increased in patients with HINI than in those with COVID-19 (18.2% vs 6.7%). However, the difference did not reach statistical significance (P = 0.15). Clinically, it is difficult to distinguish between H1N1 and COVID-19. Thus, a polymerase chain reaction is recommended for all patients suffering from influenza-like symptoms to rule out influenza A subtype H1N1 and/or SARS-CoV2.

The Role of Procalcitonin as an Antimicrobial Stewardship Tool in Patients Hospitalized with Seasonal Influenza

Up to 60% of the antibiotics prescribed to patients hospitalized with seasonal influenza are unnecessary. Procalcitonin (PCT) has the potential as an antimicrobial stewardship program (ASP) tool because it can differentiate between viral and bacterial etiology. We aimed to explore the role of PCT as an ASP tool in hospitalized seasonal influenza patients. We prospectively included 116 adults with seasonal influenza from two influenza seasons, 2018-2020. All data was obtained from a single clinical setting and analyzed by descriptive statistics and regression models. In regression analyses, we found a positive association of PCT with 30 days mortality and the amount of antibiotics used. Influenza diagnosis was associated with less antibiotic use if the PCT value was low. Patients with a low initial PCT (<0.25 µg/L) had fewer hospital and intensive care unit (ICU) days and fewer positive chest X-rays. PCT had a negative predictive value of 94% for ICU care stay, 98% for 30 days mortality, and 88% for bacterial coinfection. PCT can be a safe rule-out test for bacterial coinfection. Routine PCT use in seasonal influenza patients with an uncertain clinical picture, and rapid influenza PCR testing, may be efficient as ASP tools.

K-medoids clustering of hospital admission characteristics to classify severity of influenza virus infection.

Patients are admitted to the hospital for respiratory illness at different stages of their disease course. It is important to appropriately analyse this heterogeneity in surveillance data to accurately measure disease severity among those hospitalized. The purpose of this study was to determine if unique baseline clusters of influenza patients exist and to examine the association between cluster membership and in-hospital outcomes. Patients hospitalized with influenza at two hospitals in Southeast Michigan during the 2017/2018 (n = 242) and 2018/2019 (n = 115) influenza seasons were included. Physiologic and laboratory variables were collected for the first 24 h of the hospital stay. K-medoids clustering was used to determine groups of individuals based on these values. Multivariable linear regression or Firth's logistic regression were used to examine the association between cluster membership and clinical outcomes. Three clusters were selected for 2017/2018, mainly differentiated by blood glucose level. After adjustment, those in C171 had 5.6 times the odds of mechanical ventilator use than those in C172 (95% CI: 1.49, 21.1) and a significantly longer mean hospital length of stay than those in both C172 (mean 1.5days longer, 95% CI: 0.2, 2.7) and C173 (mean 1.4days longer, 95% CI: 0.3, 2.5). Similar results were seen between the two clusters selected for 2018/2019. In this study of hospitalized influenza patients, we show that distinct clusters with higher disease acuity can be identified and could be targeted for evaluations of vaccine and influenza antiviral effectiveness against disease attenuation. The association of higher disease acuity with glucose level merits evaluation.

Secondary infections in critically ill patients with viral pneumonia due to COVID-19 and influenza: a historical cohort study

PurposeTo compare the incidence and nature of secondary infections (SI) between critically ill patients with viral pneumonia due to COVID-19 and seasonal influenza and explore the association between SI and clinical outcomes.MethodsWe conducted a historical cohort study of patients admitted to the intensive care unit (ICU) at two tertiary care centers during the first wave of the COVID-19 pandemic and patients admitted with influenza during the 2018–2019 season. The primary outcome was the rate of SI. Secondary outcomes included rates of ICU and in-hospital mortality, organ-support-dependent disease, and length of ICU and hospital stay.ResultsSecondary infections developed in 55% of 95 COVID-19 patients and 51% of 47 influenza patients (unadjusted odds ratio [OR], 1.16; 95% confidence interval [CI], 0.57 to 2.33). After adjusting for baseline differences between cohorts, there were no significant differences between the COVID-19 cohort and the influenza cohort (adjusted OR, 1.00; 95% CI, 0.41 to 2.44). COVID-19 patients with SI had longer ICU and hospital stays and duration of mechanical ventilation. The SI incidence was higher in COVID-19 patients treated with steroids than in those not treated with steroids (15/20, 75% vs 37/75, 49%).ConclusionSecondary infections were common among critically ill patients with viral pneumonia including COVID-19. We found no difference in the incidence of SI between COVID-19 and influenza in our cohort study, but SI in patients with COVID-19 were associated with worse clinical outcomes and increased healthcare resource use. The small cohort size precludes any causal inferences but may provide a basis for future research.

The use of bioinformatics methods to identify the effects of SARS-CoV-2 and influenza viruses on the regulation of gene expression in patients.

SARS-CoV-2 infection is a respiratory infectious disease similar to influenza virus infection. Numerous studies have reported similarities and differences in the clinical manifestations, laboratory tests, and mortality between these two infections. However, the genetic effects of coronavirus and influenza viruses on the host that lead to these characteristics have rarely been reported. COVID-19 (GSE157103) and influenza (GSE111368, GSE101702) datasets were downloaded from the Gene Expression Ominbus (GEO) database. Differential gene, gene set enrichment, protein-protein interaction (PPI) network, gene regulatory network, and immune cell infiltration analyses were performed to identify the critical impact of COVID-19 and influenza viruses on the regulation of host gene expression. The number of differentially expressed genes in the COVID-19 patients was significantly higher than in the influenza patients. 22 common differentially expressed genes (DEGs) were identified between the COVID-19 and influenza datasets. The effects of the viruses on the regulation of host gene expression were determined using gene set enrichment and PPI network analyses. Five HUB genes were finally identified: IFI27, OASL, RSAD2, IFI6, and IFI44L. We identified five HUB genes between COVID-19 and influenza virus infection, which might be helpful in the diagnosis and treatment of COVID-19 and influenza. This knowledge may also guide future mechanistic studies that aim to identify pathogen-specific interventions.

Blood Inflammatory Biomarkers Differentiate Inpatient and Outpatient Coronavirus Disease 2019 From Influenza.

The ongoing circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a diagnostic challenge because symptoms of coronavirus disease 2019 (COVID-19) are difficult to distinguish from other respiratory diseases. Our goal was to use statistical analyses and machine learning to identify biomarkers that distinguish patients with COVID-19 from patients with influenza. Cytokine levels were analyzed in plasma and serum samples from patients with influenza and COVID-19, which were collected as part of the Centers for Disease Control and Prevention's Hospitalized Adult Influenza Vaccine Effectiveness Network (inpatient network) and the US Flu Vaccine Effectiveness (outpatient network). We determined that interleukin (IL)-10 family cytokines are significantly different between COVID-19 and influenza patients. The results suggest that the IL-10 family cytokines are a potential diagnostic biomarker to distinguish COVID-19 and influenza infection, especially for inpatients. We also demonstrate that cytokine combinations, consisting of up to 3 cytokines, can distinguish SARS-CoV-2 and influenza infection with high accuracy in both inpatient (area under the receiver operating characteristics curve [AUC] = 0.84) and outpatient (AUC = 0.81) groups, revealing another potential screening tool for SARS-CoV-2 infection. This study not only reveals prospective screening tools for COVID-19 infections that are independent of polymerase chain reaction testing or clinical condition, but it also emphasizes potential pathways involved in disease pathogenesis that act as potential targets for future mechanistic studies.

Risk Factors for Influenza-Induced Exacerbations and Mortality in Non-Cystic Fibrosis Bronchiectasis.

Influenza infection is a cause of exacerbations in patients with chronic pulmonary diseases. The aim of this study was to investigate the clinical outcomes and identify risk factors associated with hospitalization and mortality following influenza infection in adult patients with bronchiectasis. Using the Chang Gung Research Database, we identified patients with bronchiectasis and influenza-related infection (ICD-9-CM 487 and anti-viral medicine) between 2008 and 2017. The main outcomes were influenza-related hospitalization and in-hospital mortality rate. Eight hundred sixty-five patients with bronchiectasis and influenza infection were identified. Five hundred thirty-six (62%) patients with bronchiectasis were hospitalized for influenza-related infection and 118 (22%) patients had respiratory failure. Compared to the group only seen in clinic, the hospitalization group was older, with more male patients, a lower FEV1, higher bronchiectasis aetiology comorbidity index (BACI), and more acute exacerbations in the previous year. Co-infections were evident in 55.6% of hospitalized patients, mainly caused by Pseudomonas aeruginosa (15%), fungus (7%), and Klebsiella pneumoniae (6%). The respiratory failure group developed acute kidney injury (36% vs. 16%; p < 0.001), and shock (47% vs. 6%; p < 0.001) more often than influenza patients without respiratory failure. The overall mortality rate was 10.8% and the respiratory failure group exhibited significantly higher in-hospital mortality rates (27.1% vs. 6.2%; p < 0.001). Age, BACI, and previous exacerbations were independently associated with influenza-related hospitalization. Age, presence of shock, and low platelet counts were associated with increased hospital mortality. Influenza virus caused severe exacerbation in bronchiectasis, especially in those who were older and who had high BACI scores and previous exacerbations. A high risk of respiratory failure and mortality were observed in influenza-related hospitalization in bronchiectasis. We highlight the importance of preventing or treating influenza infection in bronchiectasis.

Evaluation of clinical and para-clinical parameters related to disease severity and mortality in patients with influenza in Isfahan, Iran; a cross sectional study

Introduction: Managing influenza (flu) due to its rapid transmission is a considerable challenge for the health system. Considering the variety of clinical symptoms in influenza and recognizing its symptoms in different conditions of patients can be effective in its management. Objectives: In the present cross-sectional study, we evaluate the relationship between clinical and para-clinical findings and the treatment measures observed at the time of hospitalization of influenza patients and their conditions at the time of discharge from the hospital. Patients and Methods: Our investigation was conducted from March 2019 to March 2021 in Alzahra hospital of Isfahan, Iran. The research population included influenza patients admitted to the infectious ward. Results: A total of 122 hospitalized influenza patients (n=122) were included in this research. The number of patients with influenza A and B was 44 and 78, respectively. There was a significant relationship between the type of influenza and the patient’s condition upon discharge (P=0.001). Influenza vaccination (P&lt;0.001), diabetes (P=0.038), and cardiovascular disease (P=0.004) were significantly associated with the patient’s condition at discharge. According to our investigation, among the drugs used, oseltamivir significantly reduced mortality in patients receiving it (P&lt;&lt;0.001). There was a statistically significant difference between the variables of all chest radiology and the patient’s condition at the time of discharge (P&lt;0.001). Furthermore, there was a statistically significant difference between the length of hospital stay (P=0.001), the number of white blood cells (P=0.001), the number of platelets (P=0.006), and the amount of C-reactive protein (CRP) (P&lt;0.001) with the patient’s condition upon discharge. Conclusion: Among the comorbidities studied, diabetes and cardiovascular disease were significantly associated with mortality in patients with influenza. Vaccination significantly reduces mortality from influenza in high-risk patients. The antiviral drug oseltamivir is recommended as a useful drug for patients with the influenza. However, a multi-center study with larger sample size is necessary for a more conclusive result.