Symptoms Of Lower Respiratory Infection Research Articles

Clinical features and outcomes of influenza and RSV coinfections: a report from Canadian immunization research network serious outcomes surveillance network

BackgroundInfluenza and RSV coinfections are not commonly seen but are concerning as they can lead to serious illness and adverse clinical outcomes among vulnerable populations. Here we describe the clinical features and outcomes of influenza and RSV coinfections in hospitalized adults.MethodsA cohort study was performed with pooled active surveillance in hospitalized adults ≥ 50 years from the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN SOS) during the 2012/13, 2013/14, and 2014/15 influenza seasons. Descriptive statistics summarized the characteristics of influenza/RSV coinfections. Kaplan-Meier estimated the probability of survival over the first 30 days of hospitalization.ResultsOver three influenza seasons, we identified 33 cases of RSV and influenza coinfection, accounting for 2.39 cases per 1,000 hospitalizations of patients with acute respiratory illnesses. Adults aged 50 + years commonly reported cough (81.8%), shortness of breath (66.7%), sputum production (45.5%), weakness (33.3%), fever (27.3%), and nasal congestion (24.2%) as constitutional and lower respiratory tract infection symptoms. The mortality rate was substantial (12.1%), and age, comorbidity burden, and frailty were associated with a higher risk for adverse clinical outcomes.ConclusionsOlder adults are at higher risk for complications from influenza and RSV coinfections, especially those over 65 with a high comorbidity burden and frailty.

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

Better COVID-19 Outcomes in Children with Good Asthma Control

Factors associated with COVID-19 presentation in children with asthma are poorly defined. Our study aimed to assess the clinical course of COVID-19 in children with asthma, with particular attention to possible risk factors for severe disease and long-term sequelae in this group of patients. We assessed the occurrence of SARS-CoV-2 infection in children with asthma six months before their regular outpatient visit to the asthma clinic. Characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI) were compared. We focused on factors previously associated with COVID-19 severity. Twenty-seven percent of patients (57/210) reported exposure to SARS-CoV-2 infection. In the symptomatic group, 36% (15/42) reported symptoms of LRTI and 64% (27/42) of URTI. Poorer asthma control was observed in patients with LRTI compared to URTI (80% vs. 7%, p < 0.001). In addition, children with poorer asthma control had a higher risk of presenting with SARS-CoV-2 LRTI in a multiple logistic regression analysis. COVID-19 disease course was not associated with regular ICS use and asthma severity. However, patients on regular ICS had better asthma control (p = 0.026). We found no PFT deterioration post-COVID-19 in either group of patients. Our results suggest good asthma control and treatment adherence prior to infection are associated with better COVID-19 outcomes in children with asthma.

Tuberculous Pericarditis, Two Case Report

Background: Mycobacterium tuberculosis is among the leading causes of death, usually in underdeveloped countries, being the state of Baja California with most cases and deaths in Mexico. This infection can affect pericardium, although infrequent and it represents 1-4% of the cases of tuberculosis. The relevance of this presentation is the difficulty of diagnosis and high mortality. Objective: Demonstrate the importance of keeping the high suspicion that this type of tuberculosis in endemic entities because of high mortality and the existence of treatment. Description Of The Cases: 39 year old male who practiced sex with men and had multiple comorbidities. Referred to the emergency department to start antituberculous treatment. During his stay he presented deterioration of health. Pericardiocentesis was performed with results suggestive of Mycobacterium tuberculosis. He subsequently presents cardio respiratory arrest without spontaneous return of the circulation. The second case it’s about a 69 year old male who came into the emergency room with lower respiratory tract infection symptoms with two months of evolution and signs of cardiac insufficiency. An echocardiogram was performed meeting pericardial effusion which confirms the etiology of tuberculosis and started an antituberculous treatment with good evolution until discharge. Conclusion: Currently, in endemic zones of Mycobacterium tuberculosis is important to suspect this agent in view of typical presentation of infection and atypical presentation of frequent pathologies.

Antimicrobial Susceptibility Pattern of Bacterial Isolates in Patients with Lower Respiratory Tract Infections

Lower respiratory tract infection (LRI) is one of the global public health problems accounting for millions of deathsannually. The present study aim is to determine bacterial pathogens' bacteriological profile and antibiotic susceptibility patternaffecting the patients with LRI attending a tertiary care hospital. Two hundred and eight sputum samples were collected frompatients with signs and symptoms of LRI. The samples were processed in Microbiology laboratory for bacterial pathogens.Bacterial isolates were identified using standard microbiological techniques and antibiotic susceptibility testing was performedusing the Kirby-Bauer disc diffusion method. Klebsiella pneumoniae (39.6%), followed by Pseudomonas (32%), were the mostpredominant bacteria isolated in the present study. The other bacteria isolated were Escherichia coli (16.9%), Staphylococcusaureus (5.6%), Streptococcus species (1.8%), and Acinetobacter (3.7%). Gram-negative bacteria showed high drug resistance toampicillin and cephalosporins and maximum susceptibility to piperacillin-tazobactam, amikacin, and gentamicin. Most of theisolates showed resistance to the Beta-lactam group of antibiotics. The isolated bacterial pathogens' resistance profile indicatesthe need for the appropriate diagnosis and antibiotic susceptibility testing before managing the cases.

Survey of Multidrug Resistanct Bacteria in Patients with Lower Respiratory Tract Infection Attending Some Hospitals in Kebbi State, Nigeria

The rise in multidrug resistance is a growing public health concern among agents of respiratory tract infection, which is responsible for morbidity, mortality and costs in Africa. This study was designed to survey for multidrug resistant bacterial pathogens in patients with lower respiratory tract infection (LRTI) attending some hospitals in Kebbi State, Nigeria. Three hundred and fifty sputum samples were collected from patients with the symptoms of LRTI attending six different hospitals in Kebbi State. The samples were all screened for bacterial pathogens using standard microbiological techniques. The bacterial isolates were identified using conventional biochemical tests and then confirmed using commercial biochemical test kit (MICROBACT) according to manufacturer’s instruction. Antimicrobial susceptibility tests were determined using disc diffusion method to detect resistant isolates as well as multidrug-resistant (MDR) isolates. The overall incidence of multidrug-resistant isolates in this study was 39.8%. High level of MDR was observed among Staphylococcus aureus (28.0%) and then Klebsiella pneumoniae (21.0%). MDR were also detected amongst Aeromonas hydrophila (11.6%), Pseudomanas aeruginosa (11.6.0%), Klebsiella oxytoca (11.6%), Burkholderia pseudomallei (7.1%) Escherichia coli (4.7%) and Acinetobacter baumannii (4.7%). In conclusion, MDR isolates were predominately isolated among Staphylococcus aureus and Klebsiella pneumoniae. Indiscriminate use of antibiotics remains the risk factor for developing multidrug resistance isolates.

Guidance on C-reactive protein point-of-care testing and complementary strategies to improve antibiotic prescribing for adults with lower respiratory tract infections in primary care.

The world faces the threat of increasing antimicrobial resistance, and there is growing consensus that swift action must be taken to improve the rational use of antibiotics and increase the stewardship of antibiotics to safeguard this key resource in modern healthcare. This paper provides the perspective of an international group of experts on the role of C-reactive protein point-of-care testing (CRP POCT) and other complementary strategies to improve antibiotic stewardship in primary care, with regards to the diagnosis and treatment of adult patients presenting symptoms of lower respiratory tract infections (LRTIs). It provides guidance regarding the clinical assessment of symptoms in combination with C-reactive protein (CRP) results, at the point of care, to support the management decision, and discusses enhanced patient communication and delayed prescribing as complementary strategies to decrease the inappropriate use of antibiotics. Recommendation: CRP POCT should be promoted to improve the identification of adults presenting with symptoms of LRTIs in primary care who might gain additional benefit from antibiotic treatment. Appropriateness of antibiotic use can be maximized when CRP POCT is used together with complementary strategies such as enhanced communication skills training and delayed prescribing in addition to routine safety netting.

Risk Factors for Lower Respiratory Tract Infection Associated With Tracheobronchial Foreign Body Aspiration in Children.

Tracheobronchial foreign body aspiration (TFBA) is a major cause of accidental death in children. Lower respiratory tract infection (LRTI) may be caused by TFBA, but there are few reports about LRTI associated with TFBA. This study collected TFBA cases in our hospital to analyze LRTI and determine its risk factors. A total of 194 children who underwent tracheobronchial foreign body (TFB) extraction in The Children's Hospital of Zhejiang University School of Medicine from June 2019 to April 2020 were enrolled. CT chest is routinely used in the workup of suspected airway FB at our institution to evaluate for patients, a FB was already highly suspected. The retention time was defined as from the time of TFB inhalation or presentation (if there was no history of TFBA) to the time of TFB removal. General characteristics including weight, clinical symptoms, operative records, cervicothoracic CT, retention time, type of TFB and postoperative hospitalization time were collected. Chi-square tests, rank sum tests and multivariate logistic regression analyses were performed. The incidence of LRTI was 46.6%, 68.6%, and 68.6% when the retention time was within 24 hours, between 24 hours and up to 1 week and more than 1 week, respectively. Postoperative hospitalization time of LRTI group was significantly longer than that of non-LRTI group. Findings for cervicothoracic CT as pneumonia, emphysema, atelectasis meant more serious clinical manifestations and the retention time was longer in the LRTI group than in the non-LRTI group. There was a positive correlation between the retention time of a TFB and LRTI in multivariate logistic regression analysis. The incidence of LRTI caused by TFBA is high. LRTI is association with longer postoperative hospitalization time. The TFB retention time is an independent risk factor for LRTI. If a patient presents with significant LRTI symptoms, a course of steroids and antibiotics maybe a safer approach rather than proceeding immediately with bronchoscopic removal.

Antibiogram of Bacteria Isolated from Patients with Lower Respiratory Tract Infection at the general outpatient department of some hospitals in Kebbi State, Nigeria

The rise in antibiotic resistance could be a growing public health concern among agents of respiratory tract infection, which is liable for morbidity, mortality, and costs in Africa. This study was designed to determine the antimicrobial susceptibility pattern of bacteria isolated from patients with lower respiratory tract infection (LRTI) attending some Kebbi State, Nigeria hospitals. Three hundred and fifty sputum samples were collected from consented patients with the symptoms of LRTI attending six different hospitals in Kebbi State. The samples were all screened for significant bacterial growth using standard microbiological techniques. The bacterial isolates were identified using conventional biochemical tests and then confirmed using a commercial biochemical test kit (MICROBACT) according to the manufacturer's instructions. Antimicrobial susceptibility tests were identified using the disc diffusion method. Staphylococcus aureus was the foremost predominant bacteria isolated, followed by Klebsiella pneumoniae, with an estimated percentage occurrence of 31.1% and 22.2%, respectively. Other bacteria isolated include Klebsiella oxytoca (13.9%), Escherichia coli (11.1%), Pseudomonas aeruginosa (5.6%), Aeromonas hydrophila (5.6%), Acinetobacter baumannii (4.6%), B. pseudomallei (2.8%) and Proteus spp (2.8%). Most of the isolates were ssusceptible to piperacilin (51%), trimethoprim-sulfamethoxazole (61%), Azithromycin (70%), Ciprofloxacin (71%) and Gentamycin (74%), so as of ranking. High resistance was recorded in βeta-lactam antibiotics, erythromycin and vancomycin tested. Finally, it was revealed that Staphylococcus aureus is the most predominant bacteria isolated. Most of the isolates were resistant to the β-lactam antibiotic tested. Azithromycin, Ciprofloxacin, Gentamycin, and piperacillin remain helpful antibiotics for treating LRTIs in these centers.

Incorporation of biomarkers into a prediction model for paediatric radiographic pneumonia.

The aim of this study was to evaluate biomarkers to predict radiographic pneumonia among children with suspected lower respiratory tract infections (LRTI). We performed a single-centre prospective cohort study of children 3 months to 18 years evaluated in the emergency department with signs and symptoms of LRTI. We evaluated the incorporation of four biomarkers (white blood cell count, absolute neutrophil count, C-reactive protein (CRP) and procalcitonin), in isolation and in combination, with a previously developed clinical model (which included focal decreased breath sounds, age and fever duration) for an outcome of radiographic pneumonia using multivariable logistic regression. We evaluated the improvement in performance of each model with the concordance (c-) index. Of 580 included children, 213 (36.7%) had radiographic pneumonia. In multivariable analysis, all biomarkers were statistically associated with radiographic pneumonia, with CRP having the greatest adjusted odds ratio of 1.79 (95% CI 1.47-2.18). As an isolated predictor, CRP at a cut-off of 3.72 mg·dL-1 demonstrated a sensitivity of 60% and a specificity of 75%. The model incorporating CRP demonstrated improved sensitivity (70.0% versus 57.7%) and similar specificity (85.3% versus 88.3%) compared to the clinical model when using a statistically derived cutpoint. In addition, the multivariable CRP model demonstrated the greatest improvement in concordance index (0.780 to 0.812) compared with a model including only clinical variables. A model consisting of three clinical variables and CRP demonstrated improved performance for the identification of paediatric radiographic pneumonia compared with a model with clinical variables alone.

Biofilm Producing Pseudomonas Aeruginosa in Patients with Lower Respiratory Tract Infections

Background and Aim: Pseudomonas aeruginosa is a vital pathogen causing major life-threatening infections among respiratory disease patients that leads to higher morbidity and mortality. Lower respiratory tract infections (LRTIs) are amongst these infections commonly found in hospitalized patients. Antibiotic tolerant biofilms formation and bacterium high intrinsic resistance to antibiotics make these infections difficult to treat. The present study aimed to assess the biofilm producing pseudomonas aeruginosa in lower respiratory tract infections patients. Methodology: This cross-sectional study was carried out on 246 Lower respiratory tract infections patients admitted to ICUs of Sharif Medical and Dental College Lahore and Mohi-ud-Din Teaching Hospital, Mirpur Azad Kashmir for the duration from June 2021 to December 2021. The signs and symptoms of LRTIs were investigated in each patient. Prior to study conduction, ethical approval was obtained from the institutes research and ethical committee. Each individual provided written informed consent. Identification of isolated organisms and antimicrobial sensitivity was done. Microtiter method was used for all the isolated, to imperil the isolates of P. aeruginosa for biofilm detection. SPSS version 25 was used for the data analysis. Results: Of the total 246 specimens consisted of sputum 198 (80.5%), pleural fluid 19 (7.7%), suction tube 16 (6.5%), and tracheostomy tip specimens 13 (5.3%). The incidence of positive culture was 78 (31.7%). Out of 78 positive cultures, sputum 56 (71.8%) was the major factor followed by pleural fluid 3 (3.8%), suction tube 12 (15.4%) and tracheostomy tip 7 (9.0%). Of the 78 positive specimens, the prevalence of single bacterium and poly-microbial infection was 58 (74.4%) and 20 (25.6%) respectively. The poly-microbial infection consisted of sputum 10 (50%), pleural fluid 1 (5.0%), suction tube 6 (30.0%), and tracheostomy tube 3 (15%). Out of 78 positive culture specimens, isolated gram-negative bacteria were 102, out of which K. pneumonia and P. aeruginosa were present in 46 (45.1%) and 24 (23.5%) respectively. Regarding the resistance pattern of gram-negative respiratory pathogens, Cefepime (86.9%) and ceftriaxone (91.9%) were given higher resistance by K. pneumoniae. Likewise, higher numbers of Acinetobacter spp provided resistance to cefepime (86.7%) and ceftriaxone (87%). Out of 24 P. aeruginosa isolates, biofilm producers were found in 16 isolates, in which the incidence of strong, moderate, and weak biofilm producers was 3 (18.7%), 5 (31.3%), and 8 (50%) respectively. Sputum in 11 (68.8%) was the prevalent biofilm producer isolates followed by suction tube 4 (25%) and tracheostomy tube 1 (6.3%). The incidence of inpatients and outpatients were 15 (93.8%) and 1 (6.2%) respectively. Conclusion: Our study concluded that gram-negative bacteria was the predominant and had increased resistance to antibiotics in Lower respiratory tract infections (LRTIs) patients. In LRTIs, the most common organism was K. pneumonia. Also, P. aeruginosa isolated in LRTIs patients were susceptible to producing biofilm. Biofilm producers had higher resistance than biofilm non-producers. Keywords: Biofilm producing P. aeruginosa, K. pneumonia, Lower respiratory tract infections

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Phase 2b Study of an Ad26.RSV.preF Vaccine for Prevention of RSV-mediated Respiratory Tract Disease in Older Adults

Respiratory syncytial virus (RSV) may cause serious lower respiratory tract disease (LRTD) in older adults, and there is currently no licensed vaccine. CYPRESS (NCT03982199) is a randomized, double-blind, placebo-controlled Phase 2b proof-of-concept trial of an Ad26.RSV.preF-based vaccine for the prevention of RSV-mediated LRTD in older adults. Adults aged ≥65 years were randomized 1:1 before the RSV season to receive Ad26.RSV.preF-based vaccine or placebo. Acute respiratory infection symptoms were collected through a patient eDiary and/or clinician assessment until the end of the RSV season. The primary endpoint was the first occurrence of RTPCR-confirmed RSV-mediated LRTD according to any of 3 case definitions: (1) ≥3 symptoms of lower respiratory tract infection (LRTI), (2) ≥2 symptoms of LRTI, or (3) ≥2 symptoms of LRTI or ≥1 symptom of LRTI with ≥1 systemic symptom. Immunogenicity was assessed in a subset of approximately 200 participants. A total of 2891 participants in each study arm received study treatment. Vaccine efficacy was 80% (94.2% CI, 52.2-92.9%), 75% (50.1-88.5%), and 69.8% (43.7-84.7%) for case definition 1, 2, and 3, respectively (all P <0.001). In the vaccine arm, geometric mean fold increase in antibody titers 14 days after vaccination was 13.5 for RSV neutralizing antibodies and 8.6 for RSV prefusion F-specific binding antibodies, and median frequency of RSV-F-specific INFγ T-cells increased from 34 to 444 SFC/10^6 PBMC; no relevant changes were observed in the placebo arm. The Ad26.RSV.preF-based vaccine was highly effective against RSV-mediated LRTD through the first RSV season and elicited robust immune responses in older adults.

LB14. Efficacy and Immunogenicity of an Ad26.RSV.preF-based Vaccine in the Prevention of RT-PCR-confirmed RSV-mediated Lower Respiratory Tract Disease in Adults Aged ≥65 Years: A Randomized, Placebo-controlled, Phase 2b Study

BackgroundRespiratory syncytial virus (RSV) can cause serious lower respiratory tract disease (LRTD) in older adults. Despite a high burden of disease, there is currently no licensed vaccine for RSV. Here, we report the primary efficacy and immunogenicity results from a Phase 2b proof-of-concept trial of an Ad26.RSV.preF-based vaccine for the prevention of RSV-mediated LRTD in adults aged ≥65 years.MethodsCYPRESS (NCT03982199) is a randomized, double-blind, placebo-controlled Phase 2b trial. Adults ≥65 years of age were randomized 1:1 prior to the RSV season to receive an Ad26.RSV.preF-based vaccine or placebo. Symptoms of acute respiratory infection (ARI) were collected through an RSV-specific patient-reported Respiratory Infection Intensity and Impact Questionnaire (RiiQ) and/or by a clinician assessment until the end of the RSV season. The primary endpoint was the first occurrence of RT-PCR-confirmed RSV-mediated LRTD according to any of 3 case definitions: (1) ≥3 symptoms of lower respiratory tract infection (LRTI), (2) ≥2 symptoms of LRTI, or (3) ≥2 symptoms of LRTI or ≥1 symptom of LRTI with ≥1 systemic symptom. The secondary endpoint was the first occurrence of any RT-PCR-confirmed RSV-mediated ARI. Immunogenicity assessments were performed in a subset of approximately 200 participants.ResultsA total of 5782 participants (2891 in each study arm) received study treatment (92.5% white, 57.7% female, median age 71 years). Vaccine efficacy was 80% (94.2% CI, 52.2–92.9%), 75% (50.1–88.5%), and 69.8% (43.7–84.7%) for case definition 1, 2, and 3, respectively (all P values < 0.001). Efficacy for any RSV-mediated ARI was 69.8% (95% CI, 42.7–85.1%). In the vaccine arm of the immunogenicity subset, geometric mean fold increase in antibody titers 14 days after vaccination was 13.5 for RSV neutralizing antibodies and 8.6 for RSV prefusion F-specific binding antibodies. Median frequency of RSV-F-specific INFγ T-cells increased from 34 to 444 SFC/106 PBMC 14 days after vaccination in the vaccine arm; no relevant changes were observed in the placebo arm.ConclusionIn CYPRESS, the Ad26.RSV.preF-based vaccine was highly effective against RSV-mediated LRTD through the first RSV season and elicited robust humoral and cellular immune responses in adults aged ≥65 years.Disclosures Ann R. Falsey, MD, AstraZeneca (Individual(s) Involved: Self): Grant/Research Support; BioFire Diagnostics (Individual(s) Involved: Self): Grant/Research Support; Janssen (Individual(s) Involved: Self): Grant/Research Support; Merck, Sharpe and Dohme (Individual(s) Involved: Self): Grant/Research Support; Novavax (Individual(s) Involved: Self): Other Financial or Material Support, Paid DSMB member; Pfizer (Individual(s) Involved: Self): Grant/Research Support Kristi Williams, PhD, Janssen R&D US (Employee) Efi Gymnopoulou, MSc, Janssen Infectious Diseases BV (Employee) Arangassery Rosemary Bastian, PhD, Janssen Vaccines & Prevention BV (Employee) Joris Menten, n/a, Janssen Infectious Diseases BV (Employee) Els De Paepe, MSc, Janssen Infectious Diseases BV (Employee) Hilde de Boer, MSc, Janssen-Cilag (Employee) Sjoukje Vandenberghe, n/a, Janssen Infectious Diseases BV (Employee) Eric Chan, PhD, Janssen Global Services, LLC (Employee) Jerald Sadoff, MD, Johnson & Johnson (Employee, Shareholder) Macaya Douoguih, MD, MPH, Janssen (Employee) Benoit Callendret, PhD, Janssen Vaccines & Prevention BV (Employee) Christy Comeaux, MD, Janssen Vaccines & Prevention BV (Employee) Esther Heijnen, MD, Janssen Vaccines & Prevention BV (Employee)

An outbreak of RSV infections in a neonatology clinic during the RSV-season

BackgroundRespiratory syncytial virus (RSV) is the predominant cause of lower respiratory tract infections (LRTI) in infancy. Preterm infants with bronchopulmonary dysplasia (BPD) are at the highest risk of severe RSV-LRTI. This is a retrospective study that analyses a nosocomial outbreak of RSV infections in the Neonatology clinic of the University Hospital of Obstetrics and Gynecology, Sofia, 2019.MethodsTwo groups of infants without contact between them were diagnosed with RSV-infection: 14 infants were treated in the Department for healthy newborns – Group 1, and 7 preterm infants were treated in the Neonatal Intensive Care Unit (NICU) – Group 2. The detection of RSV was performed using Real-Time PCR in nasal/throat swabs.ResultsRespiratory symptoms occurred 2–5 days after discharge in 14 of 148 healthy term infants born February 5 to 18, 2019; 12 babies were re-hospitalized with LRTI and recovered in a few days. RSV-PCR was positive in 6 infants, while in the others, RSV etiology was suggested, due to similar symptoms and contact between them.The first NICU patient with RSV-LRTI was one of the 26 gestational weeks (GW) twins, who had severe BPD. The other twin was always discharged home without LRTI-symptoms. In the period February 19 to March 15, 2019, 26 premature babies born at 26–34 GW, were tested for RSV (33 nasal/throat swabs). They received a first or subsequent palivizumab injection. We identified 11 positive samples in 7 of the babies. Despite the clinical recovery, the second RSV-PCR remained positive in 4 babies. Six of the 7 NICU patients had symptoms of LRTI, and two of them needed mechanical ventilation. Six babies were discharged home after stabilization, one was transferred to the Pediatric department for further treatment of BPD and later discharged too.ConclusionsThis was the most serious outbreak of RSV infections in neonates since the RSV-PCR diagnostic in Bulgaria was introduced. The course of RSV-LRTI was severe in extremely preterm patients with underlying BPD. So, routine in-hospital RSV-prophylaxis with palivizumab should be considered for infants at the highest risk.

TO STUDY THE CLINICAL, RADIOLOGICAL AND MICROBIAL PROFILE OF PULMONARY INFECTION IN IMMUNOCOMPROMISED PATIENTS

BACKGROUND The lung is one of the most frequently involved organs in complications of immunocompromised host. Among these, pulmonary infection is the most common complication. The chest radiograph is initial diagnostic tool for detection of suspected pulmonary infection in immunocompromised. However, chest radiograph ndings are nonspecic in determining pathogens. The early use of Computed Tomography (CT) is helpful in detecting pulmonary lesions which may not be evident on routine chest radiographs. But there is overlap of CT nding in different infections. This study is therefore, designed to document the clinical, radiological &amp; microbial prole of pulmonary infection in immunocompromised patients. AIM To study the clinical, radiological and microbial prole of pulmonary infection in immunocompromised patients, and to study diagnostic yield of sputum examination, induced Sputum examination &amp; bronchoscopic BAL examination. METHODS The present prospective descriptive observational study was conducted in the Department of Chest Medicine at King Edward Memorial Hospital, Pune. It included immunocompromised patients with lower respiratory tract infection symptoms. A total number of 70 indoor &amp; OPD patient with urban &amp; rural background were included in the study. Among them 45 patients were HIV reactive group and 25 patients were having Non-HIV immunocompromised condition. All of them had pulmonary infection. The study was conducted over a period of 15 months. RESULTS Incidence of pulmonary infection was higher in age 31-40 years (28.58%). There were 51 males and 19 females. Opportunistic infections were more common in males as compared to females. Majority of immunocompromised patients were HIV reactive (64.3%) followed by of Malignancy (15.7%). Focal non homogenous opacity (37.5%) was most common radiological nding followed by consolidation with air brochogram (25%). Pulmonary Tuberculosis (40.5%) was most common opportunistic infection in immunocompromised patients followed by bacterial (30.38 %) and fungal infections (17.72%). Sputum (40.98), induced sputum examination (19.29), and Bronchoscopy with BAL (91.42%) had good diagnostic yield in diagnosis of pulmonary infection in immunocompromised patients. CONCLUSION Induced sputum had less diagnostic yield in immunocompromised patients and also it is time consuming.Early bronchoscopy with BAL remains crucial to establish the diagnosis in immunocompromised patients with pulmonary infection when the cause is infectious in nature.

Common bacteria in sputum or gastric lavage of patients presenting with signs and symptoms of lower respiratory tract infections.

Introductionlower respiratory tract infections (LRTIs) are infections involving the trachea, primary bronchi and lungs. People with LRTIs typically experience coughs as the primary symptoms; however, shortness of breath, weakness, fever and fatigue may be coupled with the cough. It is common among the aged, children under five and the immune-suppressed. Persons with symptoms suggestive of pulmonary tuberculosis (TB) may have tuberculosis, other respiratory tract infection or co-infection of tuberculosis and other respiratory pathogens. This study aimed to identify the presence of pathogens in sputum of suspected tuberculosis cases and their antimicrobial resistance patterns.Methodsthis was a retrospective study conducted from September 2018 to November 2019 at Tamale Public Health Laboratory. Sputum or gastric lavage samples were collected from persons with suspected clinical presentations of TB and/or LRTI. These samples were cultured using standard microbiological protocols and antimicrobial susceptibility test performed on the positive cultures by Kirby-Bauer disc diffusion method. Molecular identification of M. tuberculosis was performed on all the suspected TB cases using GeneXpert mycobacterium tuberculosis/rifampin (MTB/RIF) assay.Resultsduring the study period, there were 264 cases of which 49.2% were males and 50.8% were females. Positive cases for culture were 47.3%. Out of the 264 cases, 186 (70.5%) were suspected TB with 51.6% being positive for culture, 6.5% positive for M. tuberculosis (GeneXpert confirmed) and 3.8% co-infection of TB with other bacteria pathogens. Klebsiella spp. (35/125; 28%) and Pseudomonas spp. (19/125; 15.2%) were the most predominant pathogens isolated. There was no significant difference in detection of bacteria in males and females (p=0.89), however individuals with suspected TB were significantly infected with other bacterial species than the unsuspected individuals (p=0.03). Almost all the isolates showed high susceptibility towards carbapenem (meropenem) and high resistance towards the third generation cephalosporins (cefotaxime and ceftriaxone).Conclusionthis study highlights the need to test individuals with classical symptoms of LRTIs for other bacterial infections other than TB only. Sputum culture is recommended for all suspected tuberculosis cases to provide accurate laboratory diagnosis to LRTIs and mitigate unnecessary use of antimicrobials.

Procalcitonin Correlates With but Is Not Superior to Other Diagnostic Markers of Bacterial Pneumonia.

Despite extensive research on procalcitonin (PCT)-guided therapy in lower respiratory tract infections, the association between PCT and bacterial pneumonia remains unclear. We evaluated retrospectively the performance of PCT in patients presenting with lower respiratory tract infection symptoms and grouped by seven diagnoses. All patients had microbial testing, chest imaging, and CBC counts within 1 day of PCT testing. Median PCT level in patients diagnosed with bacterial pneumonia was significantly higher than in patients diagnosed with other sources of infections or those not diagnosed with infections. Median PCT levels were not different among patients grouped by type or quantity of pathogen detected. They were significantly higher in patients with higher pathogenicity scores for isolated bacteria, those with abnormal WBC count, and those with chest imaging consistent with bacterial pneumonia. A diagnostic workup that included imaging, WBC count, and Gram stain had an area under the receiver operating characteristic curve of 0.748, and the addition of PCT increased it to 0.778. PCT was higher in patients diagnosed with bacterial pneumonia. Less clear is its diagnostic ability to detect bacterial pneumonia over and above imaging and laboratory data routinely available to clinicians.

Hot Off the Press: Accuracy of Signs and Symptoms for the Diagnosis of Community-acquired Pneumonia.

To determine which patients with lower respiratory tract infection symptoms require imaging or antibiotics, we need to know how accurate our clinical assessment is for the diagnosis of pneumonia. We discuss a systematic review and meta-analysis by Ebell et al published in Academic Emergency Medicine, July 2020, looking at the accuracy of signs and symptoms in the diagnosis of community acquired pneumonia. We provide critical analysis of the article, and summarize the social media discussion and a podcast in which the authors discuss their work.

Incidentally discovered COVID-19 in low-suspicion patients-a threat to front line health care workers.

PurposeThe COVID-19 pandemic has been responsible for thousands of deaths worldwide. Testing remains at a premium, and criteria for testing remains reserved for those with lower respiratory infection symptoms and/or a known high-risk exposure. The role of imaging in COVID-19 is rapidly evolving; however, few algorithms include imaging criteria, and it is unclear what should be done in low-suspicion patients with positive imaging findings.MethodsFrom 03/01/2020–03/20/2020, a retrospective review of all patients with suspected COVID-19 on imaging was performed. Imaging was interpreted by a board-certified, fellowship-trained radiologist. Patients were excluded if COVID-19 infection was suspected at the time of presentation, was the reason for imaging, or if any lower respiratory symptoms were present.ResultsEight patients with suspected COVID-19 infection on imaging were encountered. Seven patients received testing due to suspicious imaging findings with subsequent lab-confirmed COVID-19. No patients endorsed prior exposure to COVID-19 or recent international travel. COVID-19 was suggested in six patients incidentally on abdominal CT and two on chest radiography. At the time of presentation, no patients were febrile, and seven endorsed gastrointestinal symptoms. Five COVID-19 patients eventually developed respiratory symptoms and required intubation. Two patients expired during the admission.ConclusionsPatients with imaging findings suspicious for COVID-19 warrant prompt reverse transcription polymerase chain reaction (RT-PCR) testing even in low clinical suspicion cases. The prevalence of disease in the population may be underestimated by the current paradigm of RT-PCR testing with the current clinical criteria of lower respiratory symptoms and exposure risk.