Respiratory Viral Infections In Patients Research Articles

Rationale and protocol for a prospective cohort study of respiratory viral infections in patients admitted from emergency departments of community hospitals: Effect of respiratory Virus infection on EmeRgencY admission (EVERY) study

IntroductionRespiratory syncytial virus (RSV) is a causative virus for the common cold worldwide and can result in hospitalisations and even death in patients with high-risk conditions and older adults. However,...

2721. Respiratory Virus Infections Following CAR T-cell Therapy: Risk Factors and Outcomes

Abstract Background Chimeric antigen receptor (CAR) T-cell therapy is a novel cancer therapy which functions by engineering patients’ own cells to target a malignancy. The preparative lymphodepleting chemotherapy and cell versus tumor effect create a novel, dynamic state of immunocompromise. Respiratory viruses have been found to be the predominant late infectious complication, but little is known about specific risk factors and outcomes of these infections. Methods We retrospectively identified adult patients who received CD19-directed CAR T-cell therapy at our center and followed them up to two years post-infusion (or until disease progression, death, or February 2022 — whichever came first). We undertook structured chart review using REDCap. Descriptive statistics were used where indicated. An adapted ordinal scale was used to assess the severity of respiratory virus infections (RVIs) (PMCID: PMC9278199). Results We found 73 patients who met search criteria. Of those, 23 patients (32%) developed an RVI, and their baseline characteristics are listed in Table 1. There were 38 episodes of RVI with an average of 1.65 episodes per affected patient. The median time from infusion to RVI was 180 days. The etiologic agent for the majority of RVIs was either unknown or rhino/enterovirus (Figure 1). The median ordinal score for RVI severity was 1, corresponding to ambulatory management for most (Figure 2). However, 24% of patients required a higher level of care. In patients where serial NAATs were performed, the duration of viral shedding was a median of 33 days (IQR 32 – 39). Immediately prior to infection the median IgG was 370 mg/dl (IQR 292 – 566), ANC was 1690 cells/μL (IQR 873 – 3165), and ALC was 480 cells/μL (IQR 285 – 703). 10 (43%) patients were treated with IVIG and 4 (17%) patients received antivirals. Many patients did not seek care for their RVIs or sought care outside of the Hematology/Oncology clinic. The RVI diagnosis relied on the impression of the treating physician at the time the patient presented with symptoms, or when the patient described past symptoms for which they did not present to the Hematology/Oncology clinic for care. Additionally, sometimes a full panel of respiratory viral nucleic acid amplification testing was done and negative (possibly false negative due to a collection issue or non-tested virus). Other times only COVID/FLU/RSV testing was done. Other times no respiratory virus panel was done. “Unknown” is a clinical syndrome of respiratory viral infection encompassing patients either without nucleic acid amplification testing being performed or with negative testing. The Ordinal Scale for EHR Use* was used to rank the severity of each instance of RVI. Possible rankings included 1, 3, 5, 7, 9, or 11. None of the RVIs met the criteria for 9 (organ support) or 11 (death). *Khodaverdi M, Price BS, Porterfield JZ, Bunnell HT, Vest MT, Anzalone AJ, Harper J, Kimble WD, Moradi H, Hendricks B, Santangelo SL, Hodder SL; N3C Consortium Collaborators. An ordinal severity scale for COVID-19 retrospective studies using Electronic Health Record data. JAMIA Open. 2022 Jul 9;5(3):ooac066. doi: 10.1093/jamiaopen/ooac066. PMID: 35911666; PMCID: PMC9278199. Conclusion There is a high burden of delayed RVI in patients who receive CAR T-cell therapy, and these infections can lead to severe illness requiring hospitalization. Clearance of virus was delayed, with duration of shedding lasting at least one month for most. Many CAR T-cell therapy patients had lower immunoglobulin G and lymphocyte counts prior to RVI. Further research is needed to understand the best treatment and prevention strategies for RVIs in this population. Disclosures All Authors: No reported disclosures

2120. Respiratory Viral Infections in Patients with Hematologic Malignancies

Abstract Background Respiratory virus infections (RVI) are an important cause of pneumonia with increased risk of morbidity and mortality in patients with hematologic malignancies (HM) especially after stem cell transplantation. However, data on RVI in this population without stem cell transplant is still lacking. Here we aim to look at trends of RVI in HM population. Methods We conducted a retrospective cohort study of adult patients with HM diagnosed with RVI at our institution. We analyzed data from multiplex qualitative PCR-based respiratory viral panel (RVP) samples taken from January 2016 to June 2020. Lower respiratory tract infection (LRTI) was defined as abnormal chest radiography with positive RVP. Results Fifty-seven unique episodes were analyzed out of 54 patients. Thirty (52.6%) were females and the most common underlying malignancy was Non-Hodgkin’s Lymphoma (21, 36.8%). Median age was 61 (range 23-92) years old and 44/57 (77.1%) patients received chemotherapy within 30 days prior to RVI. Patient characteristics are summarized in Table 1. Most common viruses included Rhinovirus/Enterovirus (25, 43.8%), Influenza A/B (14, 24.5%) and RSV A/B (7,12.2%), respectively. Out of 39 patients who underwent chest imaging, 13/39 (33.3%) had evidence of LRTI. Out of 45 cases diagnosed as outpatients, 11/45 (24.4%) required hospital admission. ICU admission and mechanical ventilation were required in 5/57 (8.7%) and 2/57 (3.5%), respectively. Bacterial and fungal co-infection were seen in 1 (Pseudomonas spp) and 3 (Aspergillus spp.), respectively. Of note, only 1/57(1.8%) died at 30 days after RVI diagnosis. Conclusion Only one third developed LRTI after RVI in HM patients with very low 30-day mortality. However, we still found several bacterial and fungal co-infections. Thus, adequate diagnosis for RVI and co-infections with proper treatment should be required. Further studies with larger sample size are still needed. Disclosures All Authors: No reported disclosures.

Human rhinoviruses prevailed among children in the setting of wearing face masks in Shanghai, 2020

BackgroundHuman rhinovirus (HRV) is the predominant etiological agent of the common cold in children and adults. A recent study showed that the inhibitory effect of face masks on viral shedding of HRV was less prominent than that on other respiratory viruses. Considering that most Chinese people have worn face masks in public area since the outbreak of coronavirus disease 2019, we aimed to find out whether HRV prevailed among children in 2020 and demonstrate the details of the epidemiological features of HRV under such a special circumstance.MethodsWe summarized the incidences of various respiratory virus infections in patients who visited the Children’s Hospital of Fudan University during 2018–2020, and genotyped HRV positive nasopharyngeal specimens collected from 316 inpatients and 72 outpatients that visited the hospital in 2020.ResultsThere was a major prevalence of HRV among children in the latter half of 2020, with a clear seasonality that HRV-As prevailed in summer while HRV-Cs in autumn. HRV-As were more prone to cause severe lower respiratory tract infections (LRTI), while HRV-Cs were closely associated with childhood wheezing. The predominant genotypes were A11, A28, A47, A82, A101, C40 and C43. Notably, A21, A82 and A101 took up larger proportions in severe cases than in non-severe cases.ConclusionsOur findings described a major prevalence of HRVs among children in 2020, which highlight the unique transmitting pattern of HRV and help to narrow the targets for antiviral strategies.

A Lower Level of Post-Vaccinal Antibody Titer against Influenza Virus A H1N1 May Protect Patients with Autoimmune Rheumatic Diseases from Respiratory Viral Infections.

Background and Objectives: The concentration of antibodies against virus influenza A H1N1 in the titer (≥1:32) positively correlates with resistance to flu in healthy persons. In elderly and immune-compromised patients, an influenza vaccine may be less immunogenic. Hypothesis: A lower post-vaccinal antibody titer (≥1:16) may be sero-protective against respiratory viral infections in patients with autoimmune rheumatic diseases. Materials and Methods: Fifty patients with autoimmune rheumatic diseases (Systemic Lupus Erythematosus—24; Rheumatoid Arthritis—15; and Sjögren’s Syndrome—11), who were at least 65 years old or whose relative disease duration (disease duration/age) was greater than 1/8, were examined. Thirty-four of them were vaccinated with a trivalent inactivated non-adjuvant influenza vaccine. The antibody concentration against influenza virus A H1N1 was measured using the standardized hemagglutination inhibition test and patients who got any respiratory viral infection were registered. To test the hypothesis, a correlative analysis was applied, followed by a binary logistic regression that included potential confounding variables, such as age, disease duration and therapy (personal/health-related conditions). Results: Vaccinated patients were significantly less affected by respiratory viral infections (21% vs. 75%). The lower titer considered (≥1:16) was significantly present more often among vaccinated patients (68% vs. 6%). The correlation between its presence/absence and that of respiratory viral infections was –0.34 (p < 0.05). The binary logistic regression evidenced the relevance of this correlation, confirming the hypothesis. Vaccination was associated with the 87.3% reduction in the likelihood of getting respiratory viral infections, whereas the lower antibody titer (≥1:16) was associated with the 77.6% reduction in the likelihood of getting respiratory viral infections. The vaccine was well tolerated by all patients and after vaccination no exacerbation of the underlying disease was observed. Conclusions: A lower antibody titer (≥1:16) against influenza virus A H1N1 could be protective against respiratory viral infections for certain autoimmune rheumatic diseases patients, which confirms the clinical effectiveness of influenza vaccination.

The Role of Respiratory Viruses in Children with Ataxia-Telangiectasia.

Background: The impact of respiratory virus infection in patients diagnosed with ataxia-telangiectasia (A-T) has not been well studied. Methods: A prospective case control study was performed at a National Reference Unit for Primary Immunodeficiency in Spain (from November 2018 to July 2019), including patients younger than 20 years. Symptom questionnaires and nasopharyngeal swabs from multiple respiratory viruses’ polymerase chain reaction were collected monthly, and between visits in case of symptoms. Results: Twenty-two individuals were included (11 patients; 11 controls); 164 samples were obtained (81 patients; 84 controls). Patients presented respiratory symptoms more frequently compared with controls (26.5% vs. 3.5%; p < 0.01). Viral detection was observed in 23 (27.3%) episodes in patients and in 15 (17.8%) episodes in controls (p = 0.1). Rhinovirus was the most frequent virus in patients and controls (60% and 53.3%, respectively). Episodes with positive viral detection had associated symptoms in 54% of patients and 18% of controls (p = 0.07). However, patients with A-T presented a similar rate of symptoms during episodes with positive and negative viral detection (26% vs. 27%). The median points given for each questionnaire during symptomatic episodes with negative viral detection were 13/23 points, and during symptomatic positive detection, 7.5/23 points (p = 0.1). In the control group, all but two were asymptomatic during positive viral episodes (score: 2/23 and 3/23 points). Symptomatic episodes, with either positive or negative viral detection, were associated with lower IgA and higher IgM titers and higher CD8+ counts (p < 0.05), particularly when these episodes were moderate/severe. Conclusions: Patients with A-T more frequently present symptomatic viral infections than controls, especially those with lower IgA and higher IgM titers and higher CD8+ counts.

Several Common Respiratory Viral Pathogens in Hematopoietic Stem Cell Transplantion Patients with Primary Immunodeficiency Disease

To investigate the prevalence of respiratory viral infections in patients with primary immunodeficiency disease (PID) during hematopoietic stem cell transplantation. 108 specimens of nasopharyngeal aspirate were collected from 22 PID patients before and after hematopoietic stem cell transplantation from July 2016 to July 2018 in the Department of Hematology. The TR-PCR was used to detect for respiratory viruses including respiratory syncytial virus(RSV)，human metapneumoviros(hMPV)，coronavirus(CoV) and parainfluenza 1-3 (PIV1-3). And the clinical characteristics and co-infection were analyzed. Among the total 108 specimens, viral pathogens were identified in 41 (37.96%) specimens. Among which the pathogens of highest detection rate was RSV (25.9%). Different types of PID showed different virus infection rates, among which the highest infection rate was severe combined immunodeficiency disease (SCID) patients, with the virus detection rate was 57.9%. The incidence of co-infection with two or more than two viruses was 19.5%. Patients with PID who undergo hematopoietic stem cell transplantation are more susceptible to respiratory viruses. RSV is an important respiratory tract virus pathogen after hematopoietic stem cell transplantation.

2798. Respiratory Viral Infections in Patients with Lymphoma and Multiple Myeloma: Risk Factors Associated with Progression to Lower Respiratory Tract Infection and Mortality

BackgroundRespiratory viral infections (RVIs) commonly infect immunocompromised patients, and may cause increased morbidity and mortality. However, data on lymphoma and multiple myeloma (MM) patients with RVIs is scarce. The objectives of our study were to identify risk factors for progression to lower respiratory tract infection (LRTI) and fatal outcome in this patient population with RVIs.MethodsAll lymphoma or MM patients at our center who were diagnosed with either influenza, respiratory syncytial virus (RSV), parainfluenza virus (PIV) or human metapneumovirus (hMPV) from January 2016 and July 2018 were included in our study. All demographics and clinical data were collected from electronic medical records retrospectively. Patients were classified as having an upper respiratory tract infection (URTI) if nasal wash was positive for the respiratory virus with no radiological evidence of lower respiratory tract involvement. Patients were deemed with lower respiratory tract infection (LRTI) if nasal wash was positive for the respiratory virus and with new or progressive infiltrates on chest imaging with (proven LRTI) or without (probable LRTI) microbiological evidence of the respiratory virus in the lower airways.ResultsA total of 353 patients were included in our study; of those 207 (59%) were MM patients. Most patients were on active chemotherapy (317, 90%) and steroids (242, 69%) at the time of diagnosis. Majority of the patients were infected with PIV and influenza (figure). A total of 150 (43%) patients had an LRTI, of those 36 (24%) were proven. Mortality was 12% (n = 18) within 30 days of onset of infection. Diagnosis of MM, active disease, the use of steroids (regardless of dose), prior stem cell transplantation, nosocomial infection and lymphopenia ≤ 200 cells/mL were significantly associated with LRTI (table).ConclusionAlthough mortality from these different viruses was uncommon, the proportion of patient with LRTI was high. Several risk factors for LRTI were identified. These findings may help us identify patients at high-risk for worse outcomes and who may benefit from antiviral therapies. DisclosuresRoy F. Chemaly, MD, MPH, FACP, FIDSA, Chimerix: Advisory Board, Research Grant; Clinigen: Advisory Board; Merck: Advisory Board, Consultant, Grant/Research Support, Research Grant, Speaker’s Bureau; Oxford immunotec: Consultant, Grant/Research Support; Shire: Research Grant, Speaker’s Bureau; Viracor: Grant/Research Support.

Treatment of influenza and other acute respiratory viral infections in patients with diabetes mellitus

The study of the influenza and ARVI clinical performance, the development of patients with diabetes mellitus, evaluation of the effectiveness and safety application of antiviral therapy, carried out in the framework of routine clinical practice. 126 patients aged from 22 to 83 years (27.8% of men) with ARVI or influenza that occurred with medical care during the first 5 days of the disease (60.3% in the first 48 hours) are included. All patients suffer from diabetes, for the treatment of which oral hypoglycemic agents or insulins were constantly taken. The patients were divided into two groups: the first group received standard symptomatic treatment of ARVI; antiviral drug Kagocel. Diabetes and other acute respiratory viral infections. There is an increase in the incidence of bacterial complications - 2.2 times, an increase in the frequency of systemic antibiotics - 2.3 times. The purpose of the drug prescription led to a more rapid regression of all the symptoms of influenza and ARVI, but the most striking positive dynamics was observed in the symptoms of general weakness and headache. The prescription of Kagocel was accompanied by a 58% reduction in the number of bacterial complications and a 53% reduction in the use of antibiotics, which led to a reduction in the number of cases of the disease and an improvement in initial diseases, with an frequency increase in 1.8 times. The most significant effect achieved with early treatment and early initiation of antiviral therapy (in the first 48 hours of the disease).

Nozin in Preventing Respiratory Viral Infections in Patients Undergoing Stem Cell Transplant, PREV-NOSE STUDY

Nozin in Preventing Respiratory Viral Infections in Patients Undergoing Stem Cell Transplant, PREV-NOSE STUDY

Outcomes in Invasive Pulmonary Aspergillosis Infections Complicated by Respiratory Viral Infections in Patients With Hematologic Malignancies: A Case-Control Study.

BackgroundData regarding invasive pulmonary aspergillosis (IPA) following respiratory viral infections (RVIs) in patients with leukemia and/or hematopoietic stem cell transplantation (LHSCT) are limited.MethodsWe conducted a retrospective case-control study of post-RVI IPA (2006–2016). Cases were patients who underwent LHSCT and had RVI due to respiratory syncytial virus (RSV), influenza virus (INF), or parainfluenza virus (PIV) followed by culture-documented IPA within 6 weeks. Controls had IPA only.ResultsWe identified 54 cases and 142 controls. Among cases, 29 (54%) had PIV infection, 14 (26%) had INF infection, and 11 (20%) had RSV infection. The median time to IPA after RVI was 7 days. A greater percentage of cases (37 [69%]) than controls (52 [37%]) underwent allogeneic HSCT (P < .0001). Cases were more likely to be nonneutropenic (33 [61%] vs 56 [39%]; P = .009) and in hematologic remission (27 [50%] vs 39 [27%]; P = .003) before IPA. Cases were more likely to have monocytopenia (45 [83%] vs 99 [70%]; P = .05) and less likely to have severe neutropenia (21 [39%] vs 86 [61%]; P = .007) at IPA diagnosis. Prior use of an Aspergillus-active triazole was more common in cases (27 of 28 [96%] vs 50 of 74 [68%]; P = .0017). Median time to empirical antifungal therapy initiation was 2 days in both groups. Crude 42-day mortality rates did not differ between cases (22%) and controls (27%), but the 42-day mortality rate was higher among cases with IPA after RSV infection (45%) than among those with IPA following INF or PIV infection (13%; P = .05).ConclusionsIPA had comparable outcomes when it followed RVI in patients who underwent LHSCT, and post-RVI IPA occurred more frequently in patients with prior allogeneic HSCT and was associated with leukemia relapse and neutropenia.

Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant.

Survival rates for pediatric cancer have steadily improved over time but it remains a significant cause of morbidity and mortality among children. Infections are a major complication of cancer and its treatment. Community acquired respiratory viral infections (CRV) in these patients increase morbidity, mortality and can lead to delay in chemotherapy. These are the result of infections with a heterogeneous group of viruses including RNA viruses, such as respiratory syncytial virus (RSV), influenza virus (IV), parainfluenza virus (PIV), metapneumovirus (HMPV), rhinovirus (RhV), and coronavirus (CoV). These infections maintain a similar seasonal pattern to those of immunocompetent patients. Clinical manifestations vary significantly depending on the type of virus and the type and degree of immunosuppression, ranging from asymptomatic or mild disease to rapidly progressive fatal pneumonia Infections in this population are characterized by a high rate of progression from upper to lower respiratory tract infection and prolonged viral shedding. Use of corticosteroids and immunosuppressive therapy are risk factors for severe disease. The clinical course is often difficult to predict, and clinical signs are unreliable. Accurate prognostic viral and immune markers, which have become part of the standard of care for systemic viral infections, are currently lacking; and management of CRV infections remains controversial. Defining effective prophylactic and therapeutic strategies is challenging, especially considering, the spectrum of immunocompromised patients, the variety of respiratory viruses, and the presence of other opportunistic infections and medical problems. Prevention remains one of the most important strategies against these viruses. Early diagnosis, supportive care and antivirals at an early stage, when available and indicated, have proven beneficial. However, with the exception of neuraminidase inhibitors for influenza infection, there are no accepted treatments. In high-risk patients, pre-emptive treatment with antivirals for upper respiratory tract infection (URTI) to decrease progression to LRTI is a common strategy. In the future, viral load and immune markers may prove beneficial in predicting severe disease, supporting decision making and monitor treatment in this population.

Respiratory virus infections and inflammatory cytokines in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease

Objective: To investigate the characteristics of respiratory viral infections, and correlation between inflammatory cytokines and respiratory virus infections in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Methods: A prospective cohort of patients with acute exacerbations of COPD was enrolled. The sputum of all patients were collected, and 15 respiratory viruses were detected using multi-channel real-time fluorescence quantitative PCR. The clinical characteristics associated with viral infections were analyzed. The peripheral blood of the patients was collected and cytokines including IL-6, IL-8, RANTES, IP-10, sIL-2R, IFN-γ, TNF-α in the serum were detected by ELISA. Association of these cytokines with respiratory viral infections was evaluated and a discriminant model was established. Results: A total of 99 patients with acute exacerbations of COPD were enrolled in this study. Thirty-four cases (34.3%, 34/99) were positive for viral detection. Among them, the positive rate of influenza A virus was the highest (38.2%, 13/34), followed by rhinovirus (35.3%, 12/34). Multifactor logistic regression analysis showed that, fever, COPD assessment test (CAT) score in stable stage, serum IP-10 and TNF-α levels were correlated with respiratory viral infections in patients with acute exacerbations of COPD. The levels of serum IP-10 and sIL-2R increased significantly in patients with influenza A virus. Conclusions: Respiratory viral infections were common in acute exacerbations of COPD. Influenza A virus and rhinovirus were the two most common viruses. Fever was a common symptom. Patients with severe respiratory symptoms at stable stage were susceptible to viral infection. Viral infection was associated with an increase in systemic inflammatory levels, most significantly in influenza virus infection. A discriminant model composed of fever, CAT score in stable stage, serum IP-10 and TNF-α levels can be used to predict respiratory viral infections in acute exacerbations of COPD.

355. Invasive Pulmonary Aspergillosis (IPA) Complicating Respiratory Viral Infections in Patients With Hematological Malignancies

BackgroundData regarding respiratory viral infections (RVIs) in patients with leukemia and/or stem cell transplantation (LSCT) and their predisposition to invasive pulmonary aspergillosis (IPA) are limited. To that end, we conducted a case–control study of post-RVI-IPA in LSCT patients.MethodsWe analyzed all consecutive adult patients (2006–2016) with culture-documented IPA (EORTC/MSG criteria). Cases were patients with confirmed (either by nasal wash and/or BAL PCR and/or respiratory viral culture) RVIs [respiratory syncytial virus (RSV), Influenza A/B (INFA/B), or parainfluenza virus (PIV)] followed by IPA up to 5 weeks after. Controls were patients with IPA without evidence of RVIs.ResultsWe identified 54 cases (proven 1, probable 53), and 142 patients with IPA (proven 12, probable 130) as controls. The distribution of viruses were 34 PIV (52%), 18 INFA/B (27%), and 14 RSV (21%). The median days of post-RVIs-IPA infection was 8(−6–57) days. Among cases, the most common hematological malignancies were AML (34%) and CLL (26%). Most cases had prior allogeneic SCT (57%). Non-fumigatus Aspergillus species were the cause of IPA in 58% of cases. In univariate analysis, patients with post-RVs-IPA infection were more likely to be in complete or partial remission (43.9% vs. 22.3% P = 0.007), to have prior allogeneic SCT (57% vs. 31%, P = 0.0009) and an absolute lymphocyte count between 500 and 1,000/mm3 at RVI diagnosis (41% vs. 27%, P = 0.04). In addition, coinfections within 2 weeks after viral infection (58% vs. 18%, P = 0.0001), especially of the lower respiratory tract (37% vs. 18%, P = 0.004) were more common in patients with post-RVIs-IPA. RVIs-IPA patients were less likely to have an absolute neutrophil count <100 mm3 at IPA diagnosis (17% vs. 37%, P = 0.005). Need for ICU post-RVIs-IPA disease (31% vs. 26% P = 0.5) and 42 days crude mortality (22% vs. 27%, P = 0.45) were no different between cases and controls.ConclusionPost-RVIs-IPA occurs more frequently in patients with prior transplantation and is less associated with leukemia relapse and neutropenia. Although co-infections are common, this entity does not appear to be associated with worse outcome compared with IPA without preceding RVI.Disclosures D. P. Kontoyiannis, Merck: Consultant, Research support and Speaker honorarium. Pfizer: Consultant, Research support. Astellas: Consultant, Research support and Speaker honorarium. Gilead: Speaker’s Bureau, Speaker honorarium. F2G Inc.: Speaker’s Bureau, Speaker honorarium. Cidara Inc.: Speaker’s Bureau, Speaker honorarium. Jazz Pharmaceuticals: Speaker’s Bureau, Speaker honorarium.

Survey of Respiratory Virus in Patients Hospitalised for Acute Exacerbations of Heart Failure – A Prospective Observational Study

Respiratory virus (RV) infections have been implicated in acute exacerbation cardiopulmunary conditions. This study aimed to determine the prevalence of RV infections in patients admitted to the cardiology unit with acute decompensated heart failure (ADHF) in a tertiary hospitals in Singapore. This was a single-centre, prospective observational study. A total of 194 adults (aged >21) admitted to the Singapore General Hospital with ADHF were recruited. A nasopharyngeal swab was taken for multiplex polymerase chain reaction (PCR) detection of influenza virus, rhinovirus, parainfluenza virus (HPIV), human coronavirus (HcoV), adenoviurs, human bocavirus (HboV), human metapneumovirus (hMPV), and respiratory syncytial virus (RSV). Twenty-five (13%) had RVs detected by RV multiplex PCR. There comprised 9 rhinoviruses (36%), 4 influenza A viruses (16%), 3 HPIV (12%), 3 HCoV (12%), 2 adenoviruses (8%), 1 human HBoV (4%), 1 hMPV (4%), and 1 RSV (4%). Symptoms-wise, cough was significantly more common in the PCR-positive group (48% vs 24%, P = 0.02). There were no statistically significant differences in laboratory investigations (haemoglobin, leukocytes, platelets, creatine kinase, creatine kinase-muscle/brain, troponin T), and radiology findings between RV PCR-positive and -negative groups. The PCR-positive group did not have increased mortality or length of hospital stay. This study identified a considerable burden of RVs in our ADHF cohort, and highlights the need for prevention of RVs in this group of patients. We also recognised the difficulty with clinical diagnosis of RVs in ADHF patients.

The importance of gastrointestinal presentation for understanding respiratory virus infection in patients with acute respiratory illness: a cross-sectional study in Guangzhou

Background: Respiratory virus infections often cause a wide spectrum of symptoms including gastrointestinal presentations (GP). The epidemiology of respiratory viruses in patients with GP needs to be better described.Methods: Throat swabs were collected and tested for 15 respiratory viruses from pediatric patients (≤14 years old) with acute respiratory illness in Guangzhou over a 3-year period. The features of respiratory virus infections were analyzed among those with GP.Results: Of 4,242 patients enrolled, 1,223 (28.8%) had GP. Among those, 647 (52.9%) were positive with one or more of the 15 tested respiratory viruses. The most frequently detected viruses were respiratory syncytial virus (RSV) (21.1%, 258), enterovirus (EV) (10.1%, 124), influenza A virus (infA) (7.8%, 95), adenovirus (ADV) (5%, 61), human metapneumovirus (HMPV) (4.1%, 50), and human bocavirus (HBoV) (3.5%, 43). More RSV (p = .001) and EV (P&lt;0.001) infections were found in patients with GP than in patients without GP. 734 (60.0%) patients with GP presented with “Poor appetite”, 480 (39.2%) with “Vomiting”, 301 (24.6%) with “Diarrhea” and 73 (6.0%) with “Stomachache”. Significant differences in the virus positivity rate were found for RSV (p &lt; .001), EV (p = .002) and PIV3 (p = .037). 90.6% (1,108/1,223) of patients with GP were under 5 years old. Among different age groups, significant differences in the virus positivity rate were found for infA (p = .005), influenza B virus (infB) (p = .006), RSV (p &lt; .001), parainfluenza virus type 3 (PIV3) (p = .019), ADV (P&lt;0.001), and HBoV (p = .009). RSV was mostly detected in patients under 2 years old (90.3%, 233/258) with frequency declining with age, while frequency of infA and infB increased with age. ADV, HBoV, and PIV3 reached their highest peaks in the age groups of 6-10 years old (11%), 7-12 months (8%) and 4–6 months (5.8%), respectively. In general, sample positivity rates in patients with GP increased when seasons changed. RSV, EV, infA, ADV, HMPV, and HBoV formed the bulk of the positive samples.Conclusions: In this study, the epidemiology of respiratory virus infections in patients with GP was analyzed. This information increases our understanding of respiratory virus infections and may help in clinical diagnosis of these viruses.

Upper respiratory viral infections in patients with haematological malignancies after allogeneic haematopoietic stem cell transplantation: a retrospective study.

Community respiratory viruses (CRVs) are associated with upper respiratory viral infections (URI), pneumonia or life-threatening respiratory disease in patients with allogeneic haematopoietic stem cell transplantation (allo-HSCT). Our aim is to demonstrate our URI experience related to CRVs after allo-HSCT. From January 2013 to November 2015, 39 post allo-HSCT patients with acute URI symptoms were included in the study. We evaluated CRVs by multiplex PCR from nasopharyngeal wash and throat swabs. The median age of the patients was 39 (range 20-67 years). A total of 25 patients (64%) had viral panel positivity at a median 140 days post-transplant (range 3-617 days). The most common agents detected were respiratory syncytial virus (32%) and parainfluenza (32%). The patients with viral panel positivity had significantly lower lymphocyte count (1.05×109/l versus 3.09×109/l; P=0.013). During follow-up, 20 patients (80%) were diagnosed with pneumonia. Patients with concurrent bacterial or fungal infections were more likely to have pneumonia (100% versus 68%; P=0.023). 10 patients (40%) died due to pneumonia and related complications. Lower lymphocyte counts and higher C-reactive protein levels at the time of viral panel positivity were risk factors for mortality (1.5×109/l versus 0.39×109/l, P=0.007; 74.2 versus 199.7, P=0.006). The viral panel was positive in 64% of patients with acute URI symptoms. Lower lymphocyte count was detected in CRV-positive patients. The onset of concomitant bacterial or fungal infections increased the risk of lower respiratory infection disease. Indeed, prospective studies should be designed for risks and outcomes of CRVs in allo-HSCT recipients.

Respiratory viral infections are underdiagnosed in patients with suspected sepsis

The study aim was to investigate the prevalence and clinical relevance of viral findings by multiplex PCR from the nasopharynx of clinically septic patients during a winter season. During 11 weeks of the influenza epidemic period in January–March 2012, consecutive adult patients suspected to be septic (n = 432) were analyzed with cultures from blood and nasopharynx plus multiplex PCR for respiratory viruses on the nasopharyngeal specimen. The results were compared with those from microbiology analyses ordered as part of standard care. During the winter season, viral respiratory pathogens, mainly influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus were clinically underdiagnosed in 70% of patients positive by the multiplex PCR assay. During the first four weeks of the influenza epidemic, few tests for influenza were ordered by clinicians, indicating low awareness that the epidemic had started. Nasopharyngeal findings of Streptococcus pneumoniae and Haemophilus influenzae by culture correlated to pneumonia diagnosis, and in those patients laboratory signs of viral co-infections were common but rarely suspected by clinicians. The role of respiratory viral infections in patients presenting with a clinical picture of sepsis is underestimated. Specific antiviral treatment might be beneficial in some cases and may reduce spread in a hospital setting. Diagnosing viral infections may promote reduction of unnecessary antibiotic use. It can also be a tool for decisions concerning patient logistics, in order to minimize exposure of susceptible patients and personnel.

Clinical practice of respiratory virus diagnostics in critically ill patients with a suspected pneumonia: A prospective observational study

BackgroundClinical guidelines suggest testing for respiratory viruses during the influenza season, but are unclear which categories of patients on the intensive care unit (ICU) should be tested. ObjectiveWe described the clinical practice of diagnostic testing for respiratory virus infections in patients presenting to ICU with suspected community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). Study designProspective observational study in consecutive CAP and HAP patients with an ICU stay of more than 24h in two tertiary care hospitals in The Netherlands, from 2011 to December 2013. The proportion of patients receiving diagnostic testing with PCR for the presence of respiratory viruses in respiratory tract specimens was determined. ResultsIn total, 1452 patients were included, of which 712 patients presented with CAP and 740 with HAP. In CAP, 282 of 712 (40%) were tested for respiratory viruses (190 of 417 (46%) during the influenza season). In HAP, 95 of 740 (13%) were tested (50 of 372 (13%) during the influenza season). Regardless of the season, virus diagnostic tests were ordered significantly more often in patients with comorbidities, and in those presenting with elevated CRP and leucopenia. In patients who were tested during the influenza season, the prevalence of influenza was 14% in patients with CAP and 10% in those with HAP. Influenza was absent during the summer in both groups. ConclusionsLess than half of patients admitted to the ICU with suspected pneumonia were tested for the presence of viral pathogens, either in or outside the influenza season.

Digging through the Obstruction: Insight into the Epithelial Cell Response to Respiratory Virus Infection in Patients with Cystic Fibrosis.

Respiratory virus infections are common but generally self-limiting infections in healthy individuals. Although early clinical studies reported low detection rates, the development of molecular diagnostic techniques by PCR has led to an increased recognition that respiratory virus infections are associated with morbidity and acute exacerbations of chronic lung diseases, such as cystic fibrosis (CF). The airway epithelium is the first barrier encountered by respiratory viruses following inhalation and the primary site of respiratory viral replication. Here, we describe how the airway epithelial response to respiratory viral infections contributes to disease progression in patients with CF and other chronic lung diseases, including the role respiratory viral infections play in bacterial acquisition in the CF patient lung.