Mild Respiratory Infection Research Articles

Pulmonary immune profiling of SIDS: impaired immune maturation and age-related cytokine imbalance

BackgroundFor sudden infant death syndrome (SIDS), an impaired immunocompetence has been discussed for a long time. Cytokines and chemokines are soluble immune mediators (SIM) whose balance is essential for the immune status. We hypothesized that an imbalanced immune response might contribute to the etiology of SIDS.MethodsWe investigated 27 cytokines, chemokines, and growth factors in protein lysates of lungs derived from 29 SIDS cases and 15 control children deceased for other reasons.ResultsExcept for the CCL5, no significant differences were detected in the lungs between SIDS cases with and without mild upper respiratory tract infections. In contrast, IL-1RA, IL-7, IL-13, and G-CSF were decreased in the merged SIDS cases compared to control cases without evidence of infection. Plotting SIM concentrations against infant age resulted in increasing concentrations in control but not in SIDS lungs, indicating a disturbed immune maturation. Moreover, an age-dependent shift towards a Th2-related pattern was observed in SIDS.ConclusionsOur findings suggest that an impaired maturation of the immune system, an insufficient response to respiratory pathogens, and an immune response modulated by Th1/Th2 imbalance might play a possible role in triggering SIDS. These findings might in part be explained by chronic stress.ImpactMaturation of the cytokine and chemokine network may be impaired in SIDS.An imbalance between Th1- and Th2-related cytokines, which may reflect a state of chronic stress causing a more Th2 shift.An impaired immune maturation, an insufficient response to respiratory pathogens, and an immune response modulated by Th1/Th2 imbalance might play a possible role in SIDS.

Human Air-Liquid-Interface Organotypic Airway Cultures Express Significantly More ACE2 Receptor Protein and Are More Susceptible to HCoV-NL63 Infection than Monolayer Cultures of Primary Respiratory Epithelial Cells.

ABSTRACTHuman coronavirus NL63 (HCoV-NL63) is commonly associated with mild respiratory tract infections in infants, being that the respiratory epithelial cells are the main target for infection and initial replication of this virus. Standard immortalized cells are highly permissive to HCoV-NL63, and they are routinely used for isolation and propagation of the virus from clinical specimens. However, these cell lines are not the natural cell target of the virus and lack sufficient complexity to mimic the natural infection process in vivo. This study comparatively evaluated the differences on the susceptibility to HCoV-NL63 infection and virus replication efficiency of submerged monolayer cultures of LLC-MK2 and primary human respiratory epithelial cells (HRECs) and organotypic airway cultures of respiratory cells (ALI-HRECs). Productive viral infection and growth kinetics were assessed by morphologic examination of cytopathic effects, immunofluorescence, reverse transcription quantitative real-time PCR, and flow cytometry. Results from this study showed higher susceptibility to HCoV-NL63 infection and replication in LLC-MK2 cells followed by ALI-HRECs, with very low susceptibility and no significant virus replication in HRECs. This susceptibility was associated with the expression levels of angiontensin-converting enzyme 2 (ACE2) receptor protein in LLC-MK2, ALI-HRECs, and HRECs, respectively. Remarkably, organotypic ALI-HREC cultures expressed significantly more ACE2 receptor protein and were more susceptible to HCoV-NL63 infection than monolayer cultures of HREC. The ACE2 receptor is, therefore, a critical factor for susceptibility to HCoV-NL63 infection and replication, as is the type of culture used during infection studies.IMPORTANCE HCoV-NL63 is widespread globally, accounting for a significant number of respiratory infections in children and adults. HCoV-NL63 gains entrance into respiratory epithelial cells via the ACE2 receptor, the same cell receptor used by severe acute respiratory syndrome coronavirus (SARS-CoV) and SARS-CoV-2. Thus, HCoV-NL63 has been suggested as safe surrogate for studying disease mechanisms and therapeutic interventions against SARS-like CoVs, while working under BSL-2 conditions. The present study not only showed the critical role of ACE2 for effective HCoV-NL63 infection and replication, but also shed light on the need of more refined and complex in vitro organotypic models that recapitulate the proxy of air-liquid respiratory epithelia cell composition, structure, and functionality. These cultures have broaden virological studies toward improving our understanding of how coronaviruses cause disease and transmission not just within humans but also in animal populations.

COVID-19 Outbreak at Sports Club: Conditions of Occurrence and Causes of the Spread of Infection

Relevance. The new coronavirus infection (COVID-19), which appeared in late 2019 in China, has spread to almost all countries of the world in just a few months. The explosive nature of its spread was accompanied by the formation of large epidemic foci in organizations of various profiles, including leisure and sports. Aims. To establish the conditions and causes of the spread of SARS-CoV-2 among the members of one of the sports clubs based on an in-depth epidemiological analysis. Materials and methods. To study the features of the spread of the SARS-CoV-2 virus in a sports organization, the following documents were used previously developed by the authors and successfully tested in practice: «Act of epidemiological investigation of group and outbreak morbidity of new coronavirus infection (COVID-19) at an enterprise/organization/institution» and «Individual card of a patient with a new coronavirus infection (COVID-19) at the enterprise / organization/institution». In the process of epidemiological investigation, in order to detect SARS-CoV-2 RNA in PCR, a laboratory examination of sports club participants (sick and contact) was conducted, followed by genome-wide sequencing of isolated SARS-CoV-2 viruses on the basis of the Laboratory of Molecular Virology of the A. A. Smorodintsev Influenza Research Institute, which performs these types of studies. Results. Within 17 days, 26 cases of COVID- 19 were registered among the sports team members and staff from the support group (coaching staff, medical staff, administrators), which was 74.3% of their actual number. The majority of patients (76.9%) had mild acute respiratory infection, two (7.7%) had no symptoms, and four (15.4%) had interstitial pneumonia. Of the clinical manifestations of the disease, the most frequent were weakness, fever, headache, muscle and joint pain, difficulty in nasal breathing and serous-mucous discharge from the nose, sore throat, cough, shortness of breath, anosmia and dyspeptic manifestations in the form of diarrhea, nausea or vomiting. The occurrence of the outbreak was the result of the introduction of infection from the opposing team at the tournament. The leading factors that contributed to the spread of COVID-19 among sports club members were the admission to games and training of athletes with acute respiratory infections, prolonged close contact between players during training and competitions, violations in the use of personal protective equipment, compliance with hygiene and hand antiseptics, disinfection measures in the premises of sports institutions and defects in the implementation of the regulations for the examination of teams for SARS-CoV-2 during tournaments. Conclusion. Based on the results of the study, data were obtained on the features of the spread of SARS-CoV-2 in sports organizations, which can be used in conducting preventive and anti-epidemic measures in sports and leisure institutions.

COVID-19 in a Child With Transposition of the Great Arteries S/P Fontan Palliation: A Case Report and Literature Review

BackgroundAlthough adult patients with cardiovascular disease are at higher risk of adverse outcomes such as death or severe infection, limited data exist regarding pediatric patients with congenital heart disease. We would like to report our experience with COVID-19 in a pediatric patient with Fontan circulation. Furthermore, we present a review of patients with Fontan palliation and COVID-19 previously reported in the literature to summarize the clinical characteristics of this population.Case PresentationA 9-year-old boy with dextro-transposition of the great arteries, ventricular septal defect, pulmonary stenosis, patent foramen ovale, and borderline left ventricle post bidirectional Glenn shunt and Fontan palliation presented with paroxysmal cough in the context of COVID-19. The coagulation profile was beyond the normal limits, and the patient began to receive anticoagulant aspirin. On the 5th day, the patient presented with fever, sore throat, and fatigue. The oxygen saturations dropped to 93%, and he received nasal catheter oxygen inhalation. On the 7th day, computed tomography of the chest revealed little emerging flaky exudation in the posterior basal segment of the left lower lobe. Nasal cannula was removed on the 12th day, and the coagulation profile returned to normal on the 16th day. After two consecutively negative SARS-CoV-2 viral RNA tests (on the 18th and 19th days, interval ≥ 24 h), he was discharged from the hospital on the 21st day. Literature review indicated that COVID-19 with Fontan palliation seemed to be more common in male adults. Disease presentation varied from mild upper respiratory tract infection to severe pneumonia. Complications were not uncommon in this population. The treatments varied depending on the specific factors. Fortunately, most patients reported a favorable prognosis.ConclusionAlthough patients with COVID-19 and Fontan circulation might have the risk of adverse outcomes due to multiple mechanisms, most patients have a favorable prognosis.

Characteristics of pediatric COVID-19 patients admitted to the emergency department and factors associated with pneumonia.

OBJECTIVES:Coronavirus disease 2019 (COVID-19) that causes a respiratory illness, continues to be a global pandemic. In this study, we purpose to identify the features of children with COVID-19 and the factors affecting disease severity.METHODS:This is a retrospective, observational study was conducted on patients who presented with suspicion of COVID-19 from April 1, 2020, to March 31, 2021, at a tertiary care medical center in Turkey. The characteristics of 640 children who were confirmed to have COVID-19 by real-time reverse transcription-polymerase chain reaction were retrieved from medical records.RESULTS:The mean age of the cases was 10 ± 6 years, and 56% of them were male. Seasonal difference did not affect the number of cases. The majority of the cases (n = 501, 78%) were infected by family members. Fever (67%) and cough (38%) were common complaints. The mean duration of fever was 1.9 ± 1.1 days. One-fourth of the cases were asymptomatic, 462 (72%) had mild upper respiratory tract infections, and 18 (3%) had pneumonia. Patients with pneumonia were more likely to have comorbidities and had a longer fever duration (both P < 0.001). Fever, cough, and respiratory distress were more common in patients with pneumonia (P = 0.010, P = 0.023, and P < 0.001, respectively). The mean C-reactive protein (CRP) value of the patients with pneumonia was significantly higher than that of the others (P < 0.001). A total of 70 (11%) complicated patients were hospitalized, 5 of them requiring intensive care admission. All hospitalized patients were discharged with recovery.CONCLUSIONS:Although pediatric COVID-19 patients tended to have a mild disease, some children with comorbidities can still develop a severe illness. CRP value is a useful indicator in the diagnosis of COVID-19 pneumonia. Furthermore, the prevalence rate of COVID-19 did not decrease with hot seasons.

Demographic and clinical profile of RT-PCR confirmed severe acute respiratory syndrome coronavirus 2 patients of Chhindwara, Madhya Pradesh

Background - Globally, over 2.3 million people were infected with Severe Acute Respiratory Syndrome Coronavirus 2 worldwide leading to a global pandemic with mortality rates ranging from 1.4% and 5%. Clinical manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 include asymptomatic carriers, mild upper respiratory tract infections, severe viral pneumonia, multiple organ failure, acute respiratory distress syndrome and death. The present study conducted to describe the demographic and clinical characteristics in RT-PCR confirmed Severe Acute Respiratory Syndrome Coronavirus 2 cases. Material and Methods - Between October 2020 to December 2020, 264 RTPCR confirmed Severe Acute Respiratory Syndrome Coronavirus 2 patients were analyzed for demographic and clinical characteristics.Throat and nasal swabs were collected for qualitative detection of nucleic acid. Results - Among 264 patients, mean age was 51.9 ± 15.9 standard deviation years, 72.34% were males, 65.53% patients admitted in isolation ward and 34.46% patients in ICU. The values of Q1, Q2, Q3 and Q4 were 56 (21.21%), 99 (37.5%), 86 (32.57%) and 23 (8.71%), respectively.Common symptoms were Cough 87 (33.0%), Breathlessness 69 (26.1%) and Fever 60 (22.7%). The highest fatality rate 16.5% was seen in age group of 61-75 years.Significant difference was found in deaths and age p value (0.001).

Penyuluhan dan Pelatihan Penerapan 5M dalam Beradaptasi Covid-19

Who has declared covid-19 a global health emergency. Diseases due to covid-19 virus infection can cause mild moderate respiratory infections, severe and even to eliminate the life of sufferers. Until now the number of cases in Indonesia confirmed positive until July 23, 2021 is 3,033,339 people with the number of deaths 79,032 people. The application of 5M in everyday life can reduce exposure and increase the rate of covid-19. Various violations of the implementation of health protocols are still common in various areas, although raids are often carried out by officers. This incompatibility is what makes the transmission of the virus more rapidly widespread. The 3M movement is felt less because the number of covid exposure continues to increase. Other efforts can be done by doing Health counseling and 5M Application training. The methods used are lectures, lectures and demonstrations. Activities are carried out for 3 sessions with a duration of 30 minutes for each session. The results achieved, namely the improvement of people's knowledge and skills in the application of 5M in adapting covid-19. It is expected that the implementation of 5M continues to be improved in everydays life.

Development of Digital Pocket Book for Disaster Mitigation Materials Coronavirus Disease 2019 (COVID-19) to Increase Student Resilience to Disasters

Entering the beginning of 2020 there was an extraordinary phenomenon, namely the outbreak of the Coronavirus Disease (COVID-19) which attacked almost all parts of the country in the world. The COVID-19 pandemic disaster causes mild respiratory infections to severe respiratory infections such as pneumonia and the greatest risk can cause death. Other negative impacts include increasing stress and anxiety in individuals. The individual's capacity to deal with and reduce stress and anxiety can arise from having resilience. Resilience is the resilience possessed by individuals, groups, or communities that allow them to face, prevent, minimize and even eliminate the adverse effects of unpleasant conditions, or even change the conditions that include them into a natural thing to overcome, to overcome. Therefore, students need to have resilience abilities. The importance of increasing student resilience in efforts to mitigate the COVID-19 disaster through education is very necessary because schools are an effective means of conveying information. Submission of learning about the dangers of COVID-19 mitigation can be delivered through a learning process with innovative learning media. Based on the results of observations in one high school in Bogor City, it was found that the level of student resilience was still relatively low, namely 56%. The purpose of this study was to determine the effect of digital pocket books on COVID-19 disaster mitigation materials in increasing student resilience to disasters and to determine the effectiveness of digital pocket books on COVID-19 disaster mitigation materials. The research was conducted using themethod Research and Development using the ADDIE model (analyze, design, development, implementation, evaluation). The population in this study were students of class XI MIPA 2 with a sample of 29 students. The results showed that digital pocket books were able to increase students' resilience to disasters to 69% which was included in the medium category. The effectiveness of learning media has a very effective category which is obtained from the average percentage of student responses of 90% and teacher responses of 84%. Keywords: Digital Pocket Book; COVID-19 Disaster Mitigation, Resilience.

COVID-19 infections in infants

The study aimed to analyse the clinical course of COVID-19 in 300 infants, selected from 1283 children diagnosed with COVID-19 between March and December 2020, registered in the SARSTerPED multicenter database. Most of the infants were registered in October and November 2020. 44% of the group were girls, and 56% were boys. At diagnosis, the most common symptoms were fever in 77% of the children, cough in 40%, catarrh in 37%. Pneumonia associated with COVID-19 was diagnosed in 23% of the children, and gastrointestinal symptoms in 31.3%. In 52% of the infants, elevated levels of D-dimers were observed, and in 40%, elevated levels of IL-6 serum concentration were observed. During the second wave of the pandemic, 6 times more infants were hospitalized, and the children were statistically significantly younger compared to the patients during the first wave (3 months vs 8 months, p < 0.0001 respectively). During the second wave, the infants were hospitalized for longer. COVID-19 in infants usually manifests as a mild gastrointestinal or respiratory infection, but pneumonia is also observed with falls in oxygen saturation, requiring oxygen therapy. Gastrointestinal symptoms are common in infants infected with SARS-CoV-2, and infant appetite disorders may lead to hospitalization. The clinical course of the disease differed significantly between the first and second wave of the pandemic. It seems that infants may play a role in the transmission of SARS-COV-2 infections in households, despite mild or asymptomatic courses; eating disorders in infants should be an indication for COVID-19 testing.

Effects of Mycoplasma pneumoniae CARDS Toxin on mitochondrial homeostasis

Abstract Mycoplasma pneumoniae is an atypical bacterial pathogen known to cause mild respiratory infections and pneumonia. M. pneumoniae produces Community-Acquired Respiratory Distress Syndrome toxin (CARDS toxin), a virulence factor that plays a primary role in pathogenesis. CARDS toxin is known to have dramatic vacuolating and inflammatory properties, however these properties have not been fully characterized. Recent evidence from our lab has supported that the toxin localizes on the mitochondria, affecting homeostasis and triggering inflammation. Our current study is focused on characterizing the effects of CARDS toxin on mitochondrial stress and production of mitochondrial reactive oxygen species (ROS). A549 lung epithelial cells and IMR-90 lung fibroblasts were treated with recombinant CARDS toxin exogenously, and mitochondrial ROS was measured. Additionally, we sought to determine whether ADP-ribosylation or vacuolization were required for CARDS toxin-induced mitochondrial stress by expressing CARDS toxin truncations on a mammalian expression plasmid. Endogenously expressed CARDS toxin truncations were fused to either EGFP or mCherry2. CARDS toxin was detected by western blot and IFA was used to track CARDS toxin localization in the cell. Our findings support our hypothesis that CARDS toxin disrupts mitochondrial homeostasis and triggers mitochondrial ROS production. Our results provide valuable insight into the effects of CARDS toxin on mitochondrial function, which will help us better characterize the role of CARDS toxin during M. pneumoniae pathogenesis. Supported by NIH T34GM008073

Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses.

Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance.

Changes in hematological and other laboratory parameters in COVID-19 infection

Severe acute respiratory syndrome-CoV-2 was declared as a pandemic by the World Health Organization in March 2020. The virus belongs to the family Coronaviridae and causes infection of varying severity ranging from mild respiratory tract infection to severe pneumonia or acute respiratory disease syndrome. Several laboratory parameters are deranged in COVID-19 infection. The gold standard of diagnosis of COVID-19 infection is polymerase chain reaction (PCR) from the nasopharyngeal and oropharyngeal swab. However, at remote places, where PCR reports are made available to patients after a time gap laboratory parameters may guide the treating physician regarding diagnosis, disease severity, and prognosis.

Pulmonary embolism in patients with the Coronavirus Disease 2019

Coronaviruses are RNA viruses causing infectious diseases. They had been responsible for 15% cases of a common cold before December 2019. With the new strain of coronavirus SARS CoV2 which causes COVID-19 disease, the ongoing pandemic surprised with the severity of symptoms and its course compared to the previously known mild respiratory tract infections. In the end of December 2021, over 274 million people were diagnosed with COVID-19 disease, and the total mortality amounted to nearly 5.4 million deaths in more than 200 countries. One of the potentially fatal complications of COVID-19 is pulmonary embolism (PE). It appears that PE has been associated with several coagulation abnormalities as well as with frequent significantly elevated concentration of D‑dimer's. A higher D‑dimer concentration in blood serum, in turn, has been associated with an increased risk of premature death. Moreover, inflammation, typical in the course of COVID-19, is considered a prothrombotic condition; higher interleukin 6 (Il-6) and C‑reactive protein concentrations have been found in patients with more severe forms of COVID-19. So far, none specific for COVID-19 studies have been available with regard to the diagnosis and treatment of PE. Therefore, the practical approach is based on the experience of other groups of patients. Prevention of thrombotic events seems reasonable, at least in COVID-19 patients with the risk factors of developing venous thromboembolism. Low‑molecular‑weight heparins are most commonly prescribed (e.g. enoxaparin, dalteparin). Following the confirmed definite PE diagnosis, proper anticoagulation or, if necessary, thrombolytic treatment must be introduced.

Happy Hypoxemia In COVID-19

The new coronavirus disease 2019 (COVID-19) pandemic is becoming a global health crisis that challenges health systems around the world. The clinical spectrum of COVID-19 varies from mild upper respiratory tract infections to severe pneumonia and acute respiratory distress syndrome, but there are also many patients present with an SpO2 &lt; 90% but without symptoms of shortness of breath. This phenomenon is called happy hypoxemia or silent hypoxemia. Shortness of breath or dyspnea is a subjective sensation resulting from inadequate breathing effort and is usually described as constriction in the chest, difficulty breathing air or difficulty breathing. Breathing is controlled centrally by the respiratory center in the medulla oblongata and the pons region which controls the "respiratory drive" and adapts respiration to the body's metabolic needs. The mechanisms that play a role in this phenomenon include the presence of intrapulmonary shunts, loss of pulmonary perfusion regulation, vascular microthrombus and impaired pulmonary diffusion capacity.

Molecular detection and genetic characterization of human metapneumovirus strains circulating in Islamabad, Pakistan

Lower respiratory illness is one of the leading causes of death among children in low- and high-income countries. Human metapneumovirus (hMPV) is a key contributor to respiratory illnesses commonly reported among children and causes serious clinical complications ranging from mild respiratory infections to severe lower respiratory tract anomalies mainly in the form of bronchiolitis and pneumonia. However, due to the lack of a national surveillance system, the clinical significance of hMPV remains obscure in the Pakistani population. This study was conducted to screen throat swabs samples collected from 127 children reported with respiratory symptoms at a tertiary care hospital in Islamabad. Out of 127, 21 (16.5%) samples were positive for hMPV with its genotype distribution as A2a (10%), A2b (20%), B1 (10%), and B2 (60%). Phylogenetic analysis showed that the hMPV viruses were closely related to those reported from neighboring countries including India and China. This work will contribute to a better understanding of this virus, its diagnosis, and the handling of patients in clinical setups. Further studies at a large-scale are warranted for a better understanding of the disease burden and epidemiology of hMPV in Pakistan.

Methicillin-Resistant Staphylococcus aureus Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). MRSA pneumonia is associated with significant morbidity and mortality. Several virulence factors allow S. aureus to become an effective pathogen. The polysaccharide intracellular adhesin allows for the production of biofilms, some strains can produce capsular polysaccharides that protect against phagocytosis, microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) allow for colonization of epithelial surfaces, and S. aureus secretes several exotoxins that aid in tissue destruction. The α-hemolysin exotoxin secreted by S. aureus is one of the most important virulence factors for the bacteria. The diagnosis of MRSA pneumonia can be challenging; the infection may present as a mild respiratory infection or severe respiratory failure and septic shock. Many individuals are colonized with MRSA and thus a positive nasopharyngeal swab does not confirm infection in the lower respiratory tract. The management of MRSA pneumonia has evolved. Historically, vancomycin has been the primary antibiotic used to treat MRSA pneumonia. Over the past decade, prospective studies have shown that linezolid leads to higher rates of clinical cure. Monoclonal antibodies are being studied as potential therapeutic options. MRSA is an important cause of HAP/VAP; novel diagnostics may facilitate rapid diagnosis of this infection and the available literature should be used to make informed decisions on management.

Mycoplasma pneumoniae among Chinese Outpatient Children with Mild Respiratory Tract Infections during the Coronavirus Disease 2019 Pandemic.

ABSTRACTMycoplasma pneumoniae is a common pathogen causing respiratory disease in children. We sought to investigate the epidemiology of M. pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the coronavirus disease 2019 (COVID-19) pandemic. Eligible patients were prospectively enrolled from January 2020 to June 2021. Throat swabs were tested for M. pneumoniae RNA. M. pneumoniae IgM was tested by a colloidal gold assay. Macrolide resistance and the effect of the COVID-19 countermeasures on M. pneumoniae prevalence were assessed. Symptom scores, treatments, and outcomes were evaluated. Eight hundred sixty-two eligible children at 15 centers in China were enrolled. M. pneumoniae was detected in 78 (9.0%) patients. Seasonally, M. pneumoniae peaked in the first spring and dropped dramatically to extremely low levels over time until the next summer. Decreases in COVID-19 prevalence were significantly associated with decreases in M. pneumoniae prevalence (r = 0.76, P = 0.001). The macrolide resistance rate was 7.7%. The overall sensitivity and specificity of the colloidal gold assay used in determining M. pneumoniae infection were 32.1% and 77.9%, respectively. No more benefits for improving the severity of symptoms and outcomes were observed in M. pneumoniae-infected patients treated with a macrolide than in those not treated with a macrolide during follow-up. The prevalences of M. pneumoniae and macrolide resistance in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs.IMPORTANCE This is the first and largest prospective, multicenter, active, population-based surveillance study of the epidemiology of Mycoplasma pneumoniae among outpatient children with mild respiratory tract infections (RTIs) during the COVID-19 pandemic. Nationwide measures like strict face mask wearing and restrictions on population movement implemented to prevent the spread of COVID-19 might also effectively prevent the spread of M. pneumoniae. The prevalence of M. pneumoniae and the proportion of drug-resistant M. pneumoniae isolates in outpatient children with mild RTIs were at low levels in the early stage of the COVID-19 pandemic but may have rebounded recently. The colloidal gold assay for M. pneumoniae IgM may be not appropriate for screening and diagnosis of M. pneumoniae infection. Macrolides should be used with caution among outpatients with mild RTIs.

Pneumonia identification based on lung texture analysis using modified k-nearest neighbour

Covid-19 is a virus that was first discovered in China, which has the impact of mild and severe respiratory infections such as pneumonia. Pneumonia is inflammation and consolidation of lung tissue due to infectious agents. Generally pneumonia has a high mortality rate, as do Covid-19 patients. For now, it is very difficult to distinguish between Pneumonia and Covid-19, due to the high similarity of X-Ray image results. The high similarity has an impact on the difficulty of difference between Pneumonia and Covid-19 patients. This research aims to be able to different Pneumonia and Covid-19 patients based on texture analysis of the Gray Level Co-Occurrence Matrix using Modified k-Nearest Neighbour as a classifier. The calculations used in the Gray Level Co-Occurrence Matrix method are Contrast, Correlation, Energy, and Homogeneity which will be input for the Modified k-Nearest Neighbour classifier. The results showed that the highest accuracy is when the value of K = 3 using Manhattan Distance and 80%:20% data percentage, which is 87.5%. For the values of K = 7 and K = 9 there is no change in accuracy, so it can be concluded that the value of K that affects accuracy only occurs at the values of K = 3 and K = 5. Then, the higher the K value, the lower the resulting accuracy.

Fatal Pneumonia Associated With a Novel Genotype of Human Coronavirus OC43.

Since its first discovery in 1967, human coronavirus OC43 (HCoV-OC43) has been associated with mild self-limiting upper respiratory infections worldwide. Fatal primary pneumonia due to HCoV-OC43 is not frequently described. This study describes a case of fatal primary pneumonia associated with HCoV-OC43 in a 75-year-old patient with good past health. The viral loads of the respiratory tract specimens (bronchoalveolar lavage and endotracheal aspirate) from diagnosis to death were persistently high (3.49 × 106–1.10 × 1010 copies/ml). HCoV-OC43 at a 6.46 × 103 copies/ml level was also detected from his pleural fluid 2 days before his death. Complete genome sequencing and phylogenetic analysis showed that the present HCoV-OC43 forms a distinct cluster with three other HCoV-OC43 from United States, with a bootstrap value of 100% and sharing 99.9% nucleotide identities. Pairwise genetic distance between this cluster and other HCoV-OC43 genotypes ranged from 0.27 ± 0.02% to 1.25 ± 0.01%. In contrast, the lowest pairwise genetic distance between existing HCoV-OC43 genotypes was 0.26 ± 0.02%, suggesting that this cluster constitutes a novel HCoV-OC43 genotype, which we named genotype I. Unlike genotypes D, E, F, G, and H, no recombination event was observed for this novel genotype. Structural modeling revealed that the loop with the S1/S2 cleavage site was four amino acids longer than other HCoV-OC43, making it more exposed and accessible to protease, which may have resulted in its possible hypervirulence.

A Clinical Retrospective Study on the Transmission of COVID-19 From Mothers to Their Newborn and Its Outcome.

IntroductionIndia is the second most populated country in the world. The declaration of the COVID-19 pandemic has caused significant morbidity and mortality in pregnant women and newborns. Due to the decreased lung volume and immunocompromised state, pregnant women are more prone to rapid clinical deterioration. Regarding the transmission of COVID-19 infection to newborns, there is no clear-cut evidence regarding the intrauterine or vertical transmission of COVID-19 from the affected pregnant women to their neonates.AimThis study aimed to assess the outcome of neonates born to mothers with COVID-19 in a tertiary care hospital in Puducherry, India.MethodsThis retrospective case record-based study was conducted among all neonates born to COVID-19-positive mothers at a tertiary care institution in Puducherry from April 2020 to June 2020. All the newborns born to COVID-19-positive mothers during the specified period of time were included in the study.ResultsA total of 98 COVID-positive mothers were included in the study. Of these, 13.27% showed mild upper respiratory infection, and one had a moderate category. The mean gestational age was 38.4+1.12 weeks. About 53.06% of COVID-19-positive mothers had C-sections, 45.92% had a normal vaginal delivery, and only one had an instrumental vaginal delivery. All the mothers gave birth to singleton neonates; of 98 newborns, 51 were female, and 47 were male with the mean birth weight of 3.1 ± 0.4 kg. Among the 98 neonates, only six developed COVID-19 infection. Among the six, four acquired infections during the first to second week of the postnatal period and two acquired infections during the fourth week. Three neonates born by normal vaginal delivery only had a fever; two neonates manifested fever, cough, and increased respiratory rate; and only one neonate developed hypoxia.ConclusionThe study showed that vertical transmission from the mother to the newborn is extremely minimal. In our study, six neonates acquired infection mostly due to the close contact of the newborn with the mother during rooming-in and breastfeeding.