Influenza Pneumonia Research Articles

Comparison of the Clinical Characteristics and Severity of Influenza and Non-influenza Respiratory Virus-Related Pneumonia in China: A Multicenter, Real-World Study.

PurposeRespiratory viruses are important etiologies of community-acquired pneumonia (CAP). However, the impact of different RVs on the outcomes of CAP is not well elucidated. This study aims to compare the clinical features and severity of influenza (Flu-p) and non-influenza respiratory viruses-related pneumonia (NIRVs-p) onset in the community among immunocompetent adults.MethodsThe data of the patients hospitalized with laboratory-confirmed RVs-p were retrospectively reviewed from five teaching hospitals in China from January 2013 to May 2019. Univariate and multivariate logistic regressions were performed to compare the clinical characteristics and outcomes between Flu-p and NIRVs-p.ResultsA total of 1079 patients with Flu-p and 341 patients with NIRVs-p were included in this study. A multivariate logistic regression model revealed chronic pulmonary disease [odd ratio (OR) 0.341, 95% confidence interval (CI) 0.225–0.515, p < 0.001], solid malignant tumor (OR 0.330, 95% CI 0.163–0.668, p = 0.002), myalgia (OR 1.697, 95% CI 1.236–2.330, p < 0.001), lymphocytes <0.8×109/L (OR 10.811, 95% CI 6.949–16.818, p < 0.001) and blood albumin <35 g/L (OR 0.327, 95% CI 0.242–0.442, p < 0.001) were predictors for Flu-p. After adjusting for confounders, the multivariate logistic regression analysis confirmed that influenza B-related pneumonia (FluB-p) (OR 0.419, 95% CI 0.272–0.646, p < 0.001) and NIRVs-p (OR 0.260, 95% CI 0.158–0.467, p < 0.001) were associated with a decreased risk of 30-day mortality compared with the influenza A-related pneumonia (FluA-p).ConclusionOur results showed that patients with FluA-p experience a more severe disease than those with FluB-p and NIRVs-p. Some clinical features are helpful to distinguish between NIRVs-p and Flu-p.

Reduning plus ribavirin display synergistic activity against severe pneumonia induced by H1N1 influenza A virus in mice.

To investigate synergistic effect of Reduning (RDN) injection plus ribavirin against severe pneumonia induced by H1N1 influenza A virus in mice. We established a mouse model of severe pneumonia induced by influenza A virus by infecting Balb/c mice with CA07 virus. We randomly assigned the infected mice into four groups, and treated them with normal saline (NS group), RDN (injection, 86.6 mg/kg), ribavirin (injection, 66.6 mg/kg) or double Ribavirin plus RDN group, the same dosage as used in the single treatments) for 5 d. Lung index and lung pathology were recorded or calculated in terms of the curative effective. Cytokines, NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome related protein including caspase-associated recruitment domain (CARD) domain Apoptosis-associated speck-like protein containing a caspase recruitment domain(ASC), caspase-1 and NOD-like receptor family, pyrin domain containing 3 (NLRP3), and reactive oxygen species were simultaneously investigated. RDN plus ribavirin treatment, not RDN or ribavirin alone, provided a significant survival benefit to the influenza A virus-infected mice. The combination treatment protected the mice against severe influenza infection by attenuating the severe lung injury. The combined treatment also reduced the viral titers in mouse lungs and lung index, downregulated their immunocytokine levels, including IL-1β and IL-18, and down regulated the NLRP3, especially the transcription and translation of caspase-1. Meanwhile NS group had significantly higher reactive oxygen species (ROS) expression which could was dramatically reduced by the treatment of RDN plus ribavirin. Our study showed that RDN combined with ribavirin could protect the mice, and reduce the lung immunopathologic damage caused by severe influenza pneumonia. The mechanism could be that it reduced ROS produce and inhibited NLRP3 inflammasome activation so that mainly lower the downstream inflammatory cytokines IL-1β and IL-18.

Considering Interim Interventions to Control COVID-19 Associated Morbidity and Mortality-Perspectives.

Aims and objectives: The pandemic of COVID-19 is evolving worldwide, and it is associated with high mortality and morbidity. There is a growing need to discuss the elements of a coordinated strategy to control the spread and mitigate the severity of COVID-19. H1N1 and Streptococcus pneumonia vaccines are available. The current analysis was performed to analyze the severity of COVID-19 and influenza (H1N1) vaccination in adults ≥ 65. Also, to correlate the lower respiratory tract infections (LRIs), and influenza attributable to the lower respiratory tract infections' incidence with Covid-19 mortality. Evolutionarily influenza is close in resemblance to SARS-CoV-2 viruses and shares some common epitopes and mechanisms.Methods: Recent influenza vaccination data of 34 countries from OECD and other publications were correlated with COVID-19 mortality from worldometer data. LRIs attributable to influenza and streptococcus pneumonia were correlated with COVID-19 mortality. Specifically, influenza-attributable LRI incidence data of various countries (n = 182) was correlated with COVID-19 death by linear regression and receiver operating characteristic (ROC) curve analyzes. In a logistic regression model, population density and influenza LRI incidence were correlated with COVID-19 mortality.Results: There is a correlation between COVID-19-related mortality, morbidity, and case incidence and the status of influenza vaccination, which appears protective. The tendency of correlation is increasingly highlighted as the pandemic is evolving. In countries where influenza immunization is less common, there is a correlation between LRIs and influenza attributable to LRI incidence and COVID-19 severity, which is beneficial. ROC curve showed an area under the curve of 0.86 (CI 0.78 to 0.944, P < 0.0001) to predict COVID-19 mortality >150/million and a decreasing trend of influenza LRI episodes. To predict COVID-19 mortality of >200/million population, the odds ratio for influenza incidence/100,000 was −1.86 (CI −2.75 to −0.96, P < 0.0001). To predict the parameter Covid-19 mortality/influenza LRI episodes*1000>1000, the influenza parameter had an odd's ratio of −3.83 (CI −5.98 to −1.67), and an AUC of 0.94.Conclusion: Influenza (H1N1) vaccination can be used as an interim measure to mitigate the severity of COVID-19 in the general population. In appropriate high-risk circumstances, Streptococcus pneumonia vaccination would also be an adjunct strategy, especially in countries with a lower incidence of LRIs.

Value Of High-Resolution Computed Tomography in the Differential Diagnosis of Imported COVID-19 and Seasonal Influenza Pneumonia: Differential Diagnosis of COVID-19 and Influenza Pneumonia using HRCT

Background: Nowadays, the world is facing COVID-19 pandemic, and seasonal influenza is also sweeping the world. Therefore, it is essential to make an early differential diagnosis between imported COVID-19 and seasonal influenza pneumonia. Objectives: The present study aimed to determine the diagnostic value of high-resolution computed tomography (HRCT) imaging characteristics for imported coronavirus disease 2019 (COVID-19) and seasonal influenza pneumonia. Methods: The HRCT imaging features with 22 cases of imported COVID-19 and 39 cases of seasonal influenza pneumonia were retrospectively analyzed in the current study. The patients with COVID-19 or influenza were diagnosed according to the World Health Organization guidelines and were confirmed following positive reverse transcription-polymerase chain reaction(RT-PCR) analysis of respiratory secretion samples. Results: Both imported COVID-19 and influenza demonstrated multiple lesions. In the former, the lesions were mostly distributed in the subpleural of peripheral lung (90.9%), and some of them showed an anti-butterfly wing sign (18.2%; P&lt;0.05). In the latter, the lesions were distributed around the bronchial vascular tree with subpleural lesions in peripheral lung (33.3%); nonetheless, they were fewer than those observed in the former (P&lt;0.05). There were some differences in ground-glass opacity (GGO) (95.5% vs. 66.7%, respectively, P&lt;0.05), consolidation (68.2% vs. 12.8%, respectively, P&lt;0.05), and crazy paving sign (86.4% vs. 10.3%, respectively, P&lt;0.05). The air bronchogram sign in the former appeared earlier than those in the latter. When both GGO lesions were mixed, the latter had more solid areas and higher density. Conclusions: The different chest HRCT features of COVID-19 and seasonal influenza pneumonia can provide considerable evidence for the early diagnosis of imported COVID-19 and seasonal influenza pneumonia and can be of great help for the prevention and control of COVID-19.

Recruitment Strategy for Potential COVID-19 Convalescent Plasma Donors

Recruitment Strategy for Potential COVID-19 Convalescent Plasma Donors

A Retrospective Study on Amoxicillin Susceptibility in Severe Haemophilus influenzae Pneumonia.

Introduction Treatment of Haemophilus influenzae (Hi) pneumonia is on concern because resistance to amoxicillin is largely diffused. This study describes the evolution of resistance to amoxicillin and amoxicillin/clavulanic acid (AMC) in Hi isolates and characteristics of patients with Hi severe pneumonia. Methods A monocentric retrospective observational study including patients from 2008 to 2017 with severe pneumonia hospitalized in ICU. Evolution of amoxicillin and AMC susceptibility was showed. Characteristics of patients with Hi pneumonia were compared to characteristics of patients with Streptococcus pneumoniae (Sp) pneumonia, as reference. Risk factors for amoxicillin resistance in Hi were investigated. Results Overall, 113 patients with Hi and 132 with Sp pneumonia were included. The percentages of AMC resistance among Hi strains decreased over the years (from 10% in 2008-2009 to 0% in 2016-2017) while resistance to amoxicillin remained stable at 20%. Also, percentages of Sp resistant strains for amoxicillin decreased over years (from 25% to 3%). Patients with Hi pneumonia experienced higher prevalence of bronchitis (18% vs. 8%, p=0.02, chronic obstructive pulmonary disease (43% vs. 30% p=0.03), HAP (18% vs. 7%, p=0.01, ventilator-associated pneumonia (27% vs. 17%, p=0.04, and longer duration of mechanical ventilation (8 days vs. 6 days, p=0.04) than patients with Sp pneumonia. Patients with Sp pneumonia had more frequently local complications than patients with Hi pneumonia (17% vs. 7%, p=0.03). De-escalation of antibiotics was more frequent in patients with Sp than in patients with Hi (67% vs. 53%, p=0.03). No risk factors were associated with amoxicillin resistance among patients with Hi pneumonia. Conclusions Amoxicillin resistance was stable over time, but no risk factors were detected. AMC resistance was extremely low, suggesting that AMC could be used for empiric treatment of Hi pneumonia, as well as other molecules, namely, cephalosporins. Patients with Hi pneumonia had more pulmonary comorbidities and severe diseases than patients with Sp pneumonia.

MicroRNA-4485 ameliorates severe influenza pneumonia via inhibition of the STAT3/PI3K/AKT signaling pathway.

The present study aimed to explore the potential roles and mechanism of microRNA-4485 (miR-4485) in severe influenza pneumonia. miR-4485 expression was detected in patients with severe H1N1 pneumonia using quantitative PCR. Furthermore, the effects of aberrantly expressed miR-4485 on H1N1-infected A549 cells were investigated using Cell Counting Kit-8, terminal deoxynucleotidyl transferase dUTP nick end labeling, western blotting and (ELISA) assays. Furthermore, the regulatory relationships between miR-4485 and the STAT3-mediated PI3K/AKT/mTOR signaling pathway were explored using a luciferase reporter and rescue assay. MiR-4485 expression was downregulated following H1N1 infection and in patients with H1N1 pneumonia. In addition, miR-4485 alleviated H1N1-induced A549 cell injury by promoting cell viability and the production of cytokines, as well as reducing apoptosis in A549 cells. Furthermore, STAT3 was revealed to be a target gene of miR-4485. Additionally, STAT3 silencing reversed the protective effects of miR-4485 knockdown on H1N1-induced cell injury via inhibition of the PI3K/AKT/mTOR signaling pathway. In conclusion, miR-4485 inhibited H1N1-induced severe pneumonia in A549 cells by targeting STAT3 via the PI3K/AKT/mTOR signaling pathway.

Risk factors for non-invasive ventilation failure in influenza infection with acute respiratory failure in emergency department.

Non-invasive ventilation (NIV) has been widely used in hypoxemic acute respiratory failure (ARF) due to influenza pneumonia in the emergency department (ED). However, NIV used in influenza-associated acute respiratory failure had a variable rate of failure. Previous studies have reported that prolonged use of NIV was associated with increased mortality. Our study aimed to identify risk factors for NIV failure in influenza infection with acute respiratory failure in ED. We performed a retrospective cohort observational study. Enrolled patients were older than 18years who used NIV due to influenza infection with ARF between 1 January 2017 to 31 December 2018 in Ramathibodi Emergency Department. Patients characteristics, comorbidity, clinical, laboratory outcome, chest imaging, initial NIV setting, and parameters were collected in ED setting. Sequential organ failure assessment (SOFA) score and PaO2/FiO2 (PF) ratio were calculated from the first arterial blood gas in ED. We followed the outcome success or failure of the NIV used. A total of 162 patients were enrolled and 72 (44%) suffered NIV failure in influenza infection with ARF. We used univariate and multivariate logistic analyses to assess risk factors for NIV failure. The ability of risk factor to predict NIV failure was analyzed using the area under the receiver operating characteristic (AUROC). Risk factors of NIV failure included SOFA score (P=0.001), PF ratio (P=0.001) and quadrant infiltrations in chest x-rays (CXR) (P=0.001). SOFA score, PF ratio, and number quadrant infiltrations in chest radiography have good ability to predict NIV failure, AUROC 0.894 (95%CI 0.839-0.948), 0.828 (95%CI 0.764-0.892), and 0.792 (95%CI 0.721-0.863), respectively and no significant difference in the ability to predict NIV failure among three parameters. The use of PF ratio plus number quadrant infiltrations in chest radiography demonstrated a higher predictive ability for NIV failure in influenza infection with ARF. SOFA score, PF ratio, and quadrant infiltrations in chest radiography were good predictors of NIV failure in influenza infection with ARF.

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

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

Impact of Wearing Masks, Hand Hygiene, and Social Distancing on Influenza, Enterovirus, and All-Cause Pneumonia During the Coronavirus Pandemic: Retrospective National Epidemiological Surveillance Study.

BackgroundThe coronavirus disease (COVID-19) pandemic is an important health crisis worldwide. Several strategies were implemented to combat COVID-19, including wearing masks, hand hygiene, and social distancing. The impact of these strategies on COVID-19 and other viral infections remains largely unclear.ObjectiveWe aim to investigate the impact of implemented infectious control strategies on the incidences of influenza, enterovirus infection, and all-cause pneumonia during the COVID-19 pandemic.MethodsWe utilized the electronic database of the Taiwan National Infectious Disease Statistics System and extracted incidences of COVID-19, influenza virus, enterovirus, and all-cause pneumonia. We compared the incidences of these diseases from week 45 of 2016 to week 21 of 2020 and performed linear regression analyses.ResultsThe first case of COVID-19 in Taiwan was reported in late January 2020 (week 4). Infectious control strategies have been promoted since late January. The influenza virus usually peaks in winter and decreases around week 14. However, a significant decrease in influenza was observed after week 6 of 2020. Regression analyses produced the following results: 2017, R2=0.037; 2018, R2=0.021; 2019, R2=0.046; and 2020, R2=0.599. A dramatic decrease in all-cause pneumonia was also reported (R2 values for 2017-2020 were 0.435, 0.098, 0.352, and 0.82, respectively). Enterovirus had increased by week 18 in 2017-2019, but this was not observed in 2020.ConclusionsUsing this national epidemiological database, we found a significant decrease in cases of influenza, enterovirus, and all-cause pneumonia during the COVID-19 pandemic. Wearing masks, hand hygiene, and social distancing may contribute not only to the prevention of COVID-19 but also to the decline of other respiratory infectious diseases. Further studies are warranted to elucidate the causal relationship.

Clinical characteristics of COVID-19 and its comparison with influenza pneumonia

ABSTRACT Objectives To recognise clinical features of COVID-19 pneumonia and its differences from influenza pneumonia. Methods 246 patients were enrolled into COVID-19 cohort and 120 patients into influenza cohort. All data were collected and analysed retrospectively. The variables under focus included demographic, epidemiological, clinical, laboratory and imaging characteristics of COVID-19 pneumonia and comparison were made with influenza pneumonia. Results The COVID-19 cohort included 53.25% female and 46.75% male. Their main symptom was fever; while 28.05% of patients had only initially fever; 21.54% of them remained feverless. After excluding prior kidney diseases, some patients showed abnormal urinalysis (32.11%), elevated blood creatinine (15.04%) and blood urea nitrogen (19.11%). Typical CT features included ground glass opacity, consolidation and band opacity, which could present as characteristic ‘bat wing sign’. Our data showed that male, aged 65 or above, smoking, with comorbidities including diabetes, cardiovascular and kidney diseases, would experience more severe COVID-19 pneumonia. In comparison, COVID-19 cohort showed significantly higher incidence of clustering; the influenza cohort showed higher rate of fever. Both cohorts showed reduced lymphocyte numbers; however, 6 influenza patients showed lymphocytes increased, which was statistical significant compared with COVID-19 cohort. Also, influenza cohort displayed higher white blood cell counts and PCT values. Conclusion There is no significant gender difference in the incidence of COVID-19 pneumonia. It predominantly affects the lung as well as the kidney. Age, smoking and comorbidities could contribute to disease severity. Although COVID-19 is more infectious, the rate of secondary bacterial infection is lower than influenza.

Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study

ObjectivesTo prospectively investigate in patients with severe COVID-19-associated cytokine storm syndrome (CSS) whether an intensive course of glucocorticoids with or without tocilizumab accelerates clinical improvement, reduces mortality and prevents invasive...

COVID‐19‐associated pulmonary aspergillosis (CAPA) in patients admitted with severe COVID‐19 pneumonia: An observational study from Pakistan

SummaryBackgroundInvasive aspergillosis is a well‐known complication of severe influenza pneumonia with acute respiratory distress syndrome (ARDS). However, recent studies are reporting emergence of aspergillosis in severe COVID‐19 pneumonia, named as COVID‐19‐associated pulmonary aspergillosis (CAPA).MethodsA retrospective observational study was conducted in patients with severe COVID‐19 pneumonia from February 2020 to April 2020. Patients ≥18 years of age with clinical features and abnormal chest imaging with confirmed COVID‐19 by RT‐PCR for SARS‐CoV‐2 were included. CAPA was diagnosed based on clinical parameters, radiological findings and mycological data. Data were recorded on a structured proforma, and descriptive analysis was performed using Stata ver 12.1.ResultsA total of 147 patients with confirmed COVID‐19 and 23 (15.6%) patients requiring ICU admission were identified. Aspergillus species were isolated from tracheal aspirates of nine (39.1%) patients, and of these, five patients (21.7%) were diagnosed with CAPA and four (17.4%) had Aspergillus colonisation. The mean age of patients with CAPA was 69 years (Median age: 71, IQR: 24, Range: 51‐85), and 3/5 patients were male. The most frequent co‐morbid was diabetes mellitus (4/5). The overall fatality rate of COVID‐19 patients with aspergillosis was 44% (4/9). The cause of death was ARDS in all three patients with CAPA, and the median length of stay was 16 days (IQR: 10; Range 6‐35 days).ConclusionThis study highlights the need for comparative studies to establish whether there is an association of aspergillosis and COVID‐19 and the need for screening for fungal infections in severe COVID‐19 patients with certain risk factors.

Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, cross-sectional study.

BackgroundTo determine the diagnostic value of hematologic markers for coronavirus disease 2019 (COVID‐19) and explore their relationship with disease severity.MethodsSubjects included 190 COVID‐19 patients, 190 healthy subjects, and 105 influenza pneumonia (IP) patients. COVID‐19 patients were divided into the ARDS and non‐ARDS groups. Routine blood examination, biochemistry indicator, days in hospital, body temperature, pneumonia severity index (PSI), CURB‐65, and MuLBSTA were recorded. Correlations between variables were assessed using Spearman's correlation analysis. Receiver operating characteristic (ROC) curves were used to study the accuracy of the various diagnostic tests.ResultsCompared with healthy subjects, COVID‐19 patients had lower white blood cell (WBC), lymphocyte, platelet, and hemoglobin levels; higher percentages of neutrophils and monocytes; lower percentages of lymphocytes and higher neutrophil‐to‐lymphocyte ratio (NLR), monocyte‐to‐lymphocyte ratio (MLR), and platelet‐to‐lymphocyte ratio (PLR) values (P < .05). COVID‐19 patients had higher WBC and neutrophil levels and lower percentages of lymphocytes compared to IP (P < .05). ROC curve analysis revealed that MLR had a high diagnostic value in differentiating COVID‐19 patients from healthy subjects, but not from IP patients. NLR showed significant positive correlations with PSI, CURB‐65, and MuLBSTA. Lymphocyte count was lower in the ARDS group and yielded a higher diagnostic value than the other variables.ConclusionsMonocyte‐to‐lymphocyte ratio showed an acceptable efficiency to separate COVID‐19 patients from healthy subjects, but failed to rule out IP patients. NLR may be a reliable marker to evaluate the disease severity of COVID‐19. Lymphocyte count may be useful to establish the early diagnosis of ARDS in the COVID‐19 patients.

In Response.

In Response.

Clinical characteristics and outcomes of patients with H1N1 influenza pneumonia admitted at a tertiary care hospital in Karachi, Pakistan

IntroductionInfluenza viruses specifically, A and B mainly contribute to seasonal outbreaks that occur globally. However, due to limited diagnostics for influenza there is little data regarding clinical outcomes of patients with H1N1 pneumonia in our region. Our objective was to determine the clinical characteristics and outcomes of patients hospitalized with H1N1 pneumonia at a tertiary care facility in Karachi, Pakistan.MethodsA retrospective study of adult patients admitted with influenza pneumonia from November 2017 to February 2018 at a tertiary care hospital in Karachi, Pakistan. Patient characteristics were compared between influenza A H1N1 and other types of influenza using multivariable logistic regression analysis and subgroup analysis for factors associated with mortality in H1N1 Pneumonia was performed.ResultsOut of 497 adult patients with community acquired pneumonia (CAP), 172 fulfilled the criteria for Influenza like illness (ILI). 88 patients had PCR confirmed Influenza pneumonia of whom n = 57 (65%) had Influenza A H1N1. The mean age of patients 53.5 years (SD: 17.3) and 60% were male. The overall mortality from Influenza in this study was 15.9% (n = 14); out of these 11 (78.5%) had Influenza A H1N1. Multivariable analysis showed that the increase in length of hospital admission was significantly associated with H1N1 Influenza A infection (OR: 1.47 CI: 1.2–1.8). Factors associated with mortality showed that presence of ARDS, Septic shock and multi-organ failure was highly significantly associated with death (p-value < 0.001) along with deranged liver function tests (p-value 0.01) and presence of nosocomial infection (p-value 0.027).ConclusionInfluenza A H1N1 is associated with greater length of stay compared with infection due to other types of Influenza and mortality in H1N1 Pneumonia was found to be associated with presence of nosocomial infection among several other factors which may have implications given higher rates in a low-middle income country.

Association of Nonsteroidal Anti-inflammatory Drug Use and Adverse Outcomes Among Patients Hospitalized With Influenza

During the ongoing coronavirus disease 2019 pandemic, case reports have suggested that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may lead to adverse outcomes. To study the association of NSAID use with adverse outcomes in patients hospitalized with influenza or influenza pneumonia. This cohort study used propensity score matching among 7747 individuals aged 40 years or older who were hospitalized with influenza, confirmed by polymerase chain reaction or antigen testing, between 2010 and 2018. Data were collected using Danish nationwide registers. All analyses reported were performed on May 29, 2020. Prescription fill of an NSAID within 60 days before admission. Risk ratio (RR) and risk difference (RD) with 95% CIs for intensive care unit admission and death within 30 days of admission. A total of 7747 patients (median [interquartile range] age, 71 [59-80] years, 3980 [51.4%] men) with confirmed influenza were identified. Of these, 520 (6.7%) were exposed to NSAIDs. In the unmatched cohorts, 104 of 520 patients (20.0%) who used NSAIDs and 958 of 7227 patients (13.3%) who did not use NSAIDs were admitted to the intensive care unit. For death within 30 days of admission, we observed 37 events (7.1%) among those who used NSAIDs compared with 563 events (7.8%) among those who did not. Current NSAID use was associated with intensive care unit admission (RR, 1.51; 95% CI, 1.26 to 1.81; RD, 6.7%; 95% CI, 3.2% to 10.3%), while NSAID use was not associated with death (RR, 0.91; 95% CI, 0.66 to 1.26; RD, -0.7%; 95% CI, -3.0% to 1.6%). In the matched cohorts, risks were unchanged for patients who used NSAIDs, while 83 ICU admissions (16.0%) and 36 deaths (6.9%) were observed among matched individuals who did not use NSAIDs. Matched (ie, adjusted) analyses yielded attenuated risk estimates for intensive care unit admission (RR, 1.25; 95% CI, 0.95 to 1.63; RD, 4.0%; 95% CI, -0.6% to 8.7%) and death (RR, 1.03; 95% CI, 0.66 to 1.60; RD, 0.2%; 95% CI, -2.9% to 3.3%). Associations were more pronounced among patients who used NSAIDs for a longer period (eg, for intensive care unit admission: RR, 1.90; 95% CI, 1.19 to 3.06; RD, 13.4%; 95% CI, 4.0% to 22.8%). In this cohort study of adult patients hospitalized with influenza, the use of NSAIDs was not associated with 30-day intensive care unit admission or death in adjusted analyses. There was an association between long-term use of NSAIDs and intensive care unit admission.

Therapeutic Potential of B-1a Cells in COVID-19.

Coronavirus disease 2019 (COVID-19) is a life-threatening respiratory illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Its clinical presentation can vary from the asymptomatic state to acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. Due to our insufficient understanding of its pathophysiology and lack of effective treatment, the morbidity and mortality of severe COVID-19 patients are high. Patients with COVID-19 develop ARDS fueled by exaggerated neutrophil influx into the lungs and cytokine storm. B-1a cells represent a unique subpopulation of B lymphocytes critical for circulating natural antibodies, innate immunity, and immunoregulation. These cells spontaneously produce natural IgM, interleukin (IL)-10, and granulocyte-monocyte colony stimulating factor (GM-CSF). Natural IgM neutralizes viruses and opsonizes bacteria, IL-10 attenuates the cytokine storm, and GM-CSF induces IgM production by B-1a cells in an autocrine manner. Indeed, B-1a cells have been shown to ameliorate influenza virus infection, sepsis, and pneumonia, all of which are similar to COVID-19. The recent discovery of B-1a cells in humans further reinforces their potentially critical role in the immune response against SARS-CoV-2 and their anticipated translational applications against viral and microbial infections. Given that B-1a cells protect against ARDS via immunoglobulin production and the anti-COVID-19 effects of convalescent plasma treatment, we recommend that studies be conducted to further examine the role of B-1a cells in the pathogenesis of COVID-19 and explore their therapeutic potential to treat COVID-19 patients.

Neighborhood Disorder, Social Ties, and Preventive Healthcare Utilization among Urban-Dwelling Older Adults.

Objectives: This research examines whether perceived neighborhood disorder influences the use of preventive healthcare services (i.e. influenza vaccine, pneumonia vaccine, cholesterol screening, colonoscopy, and dental care) by older adults and whether social ties buffer the potential adverse effects of perceived neighborhood disorder. Methods: Using data from the 2012 wave of the Health and Retirement Study, binary logistic regression was used to generate odds ratio estimates of preventive healthcare use in the past 2years. Results: We find that greater levels of neighborhood disorder were associated with fewer dental care visits net of social and health factors. Regular participation in four or more social activities was associated with decreased odds of restricted use and increased odds of receiving a pneumonia vaccine and colonoscopy. Discussion: This research provides evidence that perceived neighborhood disorder may act as a barrier for specific preventive healthcare services and highlights the need for targeted intervention.

Antiviral Activity of Kagocel® on the Model of Experimental Lethal Influenza Infection

Despite the obvious advances in vaccination and therapy, influenza remains a poorly controlled infection with high morbidity and mortality. This study examined the antiviral activity of interferon inducer Kagocel on a mouse model of lethal influenza pneumonia. It has been shown that the therapeutic and prophylactic use of Kagocel leads to a dose-dependent decrease in specific mortality and suppression of virus reproduction in lung tissue. The effect of Kagocel was statistically identical to the effect of the reference drug — Arbidol (umifenovir).