Upper Respiratory Illness Research Articles

Knowledge, Attitudes and Practice of Acute Upper Respiratory Diseases in Rural School Adolescents in Neyyattinkara Taluk, India

Introduction: Public knowledge and practices regarding the common cold is crucial to prevent improper treatment and preserve resources and well - being. Despite global studies on the topic, there's a gap in research focusing on rural school - going late adolescents, like those in Neyyattinkara Taluk. This study aims to assess Knowledge, Attitude and Practices regarding acute upper respiratory illness among late adolescents in NeyyattinkaraTaluk. Methods: An observational cross - sectional study was conducted to assess the knowledge, attitude and practices of late adolescents in rural schools of a part of India from July to September 2019. The study was done among late adolescents (aged 15 - 18) in government higher secondary schools of Neyyattinkara Taluk. A sample size of 197 was taken. Data was collected using a semi - structured questionnaire covering demographics, knowledge, attitudes, and practices regarding upper respiratory illness. Point estimate was done at 95% confidence interval. Results: Most of the adolescents had limited knowledge about upper respiratory illness, with 167 (85%) not considering it a disease. Self - medication 116 (59%) and reliance on home remedies 110 (56%) were common, while only 39 (20%) opted for antibiotics. Conclusions: There was average knowledge level in adolescents but persistent misconceptions, prevalent self - medication practices, and limited understanding of disease transmission regarding upper respiratory infections.

Secondary Multiple Evanescent White Dot Syndrome in a patient with North Carolina Macular Dystrophy.

To describe a novel case of secondary multiple evanescent white dot syndrome in a patient with North Carolina Macular Dystrophy (NCMD). The patient was evaluated with ultra-widefield color and autofluorescence imaging, fluorescein angiography, and spectral-domain optical coherence tomography. A 43-year-old man with longstanding blurred vision in both eyes acutely developed glare in the right eye after an upper respiratory illness. He had chorioretinal atrophy in both eyes consistent with North Carolina Macular Dystrophy, which was later confirmed by genetic testing. He alsyo had white spots in the macula of the right eye consistent with secondary MEWDS. The diagnosis of secondary MEWDS was confirmed with fundus autofluorescence and fluorescein angiography, as well as a negative infectious workup. His symptoms and the retinal lesions had resolved by 11 weeks and after a short course of oral corticosteroids. Prior studies have suggested a link between disruption of the RPE/Bruch's membrane complex and secondary MEWDS. This report describes the first case of secondary MEWDS after NCMD and provides further support for this association.

The Utility of Musculoskeletal Ultrasound in Diagnosing Uncommon Talocrural Synovitis in an Amateur Weightlifting Athlete

The use of musculoskeletal ultrasound to assess sports-related injuries has been increasing worldwide. This case report focuses on an unusual form of synovitis of the talocrural joint in a 33-year-old male amateur weightlifter who presented to our sports medicine clinic with acute non-traumatic left ankle pain lasting for 2 days. He reported a recent change in his squatting technique and had no significant medical history other than a recent viral upper respiratory illness. Weight-bearing ankle X-rays were inconclusive, however, ultrasound evaluation revealed effusion in the talocrural joint upon assessment of the ankle’s anterior joint capsule. Additionally, the ultrasound examination helped rule out other common soft tissue ankle pathologies that can affect athletes. The athlete's symptoms resolved by day 5 with conservative measures, including weight bearing as tolerated, nonsteroidal anti-inflammatory drugs, and lymphatic drainage techniques. This report demonstrates the utility of musculoskeletal ultrasound in diagnosing an uncommon cause of ankle pain in athletes.

Study on Acute Upper Respiratory Illness among Late Adolescents in Rural Schools of Neyyattinkara Taluk, India: Knowledge, Attitude and Practices

Study on Acute Upper Respiratory Illness among Late Adolescents in Rural Schools of Neyyattinkara Taluk, India: Knowledge, Attitude and Practices

Combined Turmeric, Vitamin C, and Vitamin D Ready-to-Drink Supplements Reduce Upper Respiratory Illness Symptoms and Gastrointestinal Discomfort in Elite Male Football Players.

Elite football is associated with the increased risk of illness, although targeted supplementation can reduce illness risk. This study assessed the effects of a supplement containing turmeric root within a black pepper and fat-soluble blend, vitamin C and vitamin D, on upper respiratory symptoms (URS), gastrointestinal symptoms (GIS), muscle soreness, and markers of inflammation and gut permeability in elite male footballers. Twenty-three footballers completed 3 weeks of no intervention (CON), followed by 16 weeks of daily consuming 60 mL of a commercially available supplement containing raw turmeric root (17.5 g, estimated to contain 700 mg of curcumin), vitamin C (1000 mg), and vitamin D3 (3000 IU/75 mcg) (SUP). URS and GIS were measured daily. Immediately (0 h), 40, and 64 h after six competitive matches (two in CON, four in SUP), the subjective soreness and plasma concentrations of creatine kinase [CK], c-reactive protein [CRP], and intestinal fatty-acid binding protein [I-FABP] were assessed. URS incidence (p < 0.001), GIS (p < 0.05), and plasma [I-FABP] at 0 h (p < 0.05) were greater during CON versus SUP. At 40 h, [CRP] was greater than 0 h during CON (p < 0.01) but not SUP (p = 0.204). There were no differences in soreness or [CK]. This study indicates that turmeric root, vitamin C, and vitamin D supplementation over 16 weeks can reduce URS, GIS, and post-match [I-FABP] in elite footballers.

Assessing immune factors in maternal milk and paired infant plasma antibody binding to human rhinoviruses.

Before they can produce their own antibodies, newborns are protected from infections by transplacental transfer of maternal IgG antibodies and after birth through breast milk IgA antibodies. Rhinovirus (RV) infections are extremely common in early childhood, and while RV infections often result in only mild upper respiratory illnesses, they can also cause severe lower respiratory illnesses such as bronchiolitis and pneumonia. We used high-density peptide arrays to profile infant and maternal antibody reactivity to capsid and full proteome sequences of three human RVs - A16, B52, and C11. Numerous plasma IgG and breast milk IgA RV epitopes were identified that localized to regions of the RV capsid surface and interior, and also to several non-structural proteins. While most epitopes were bound by both IgG and IgA, there were several instances where isotype-specific and RV-specific binding were observed. We also profiled 62 unique RV-C protein loop sequences characteristic of this species' capsid VP1 protein. Many of the RV-C loop sequences were highly bound by IgG from one-year-old infants, indicating recent or ongoing active infections, or alternatively, a level of cross-reactivity among homologous RV-C sites.

CLINICAL OUTCOME OF GUILLAIN BARRE SYNDROME IN THE INTENSIVE CARE UNIT OF A PEDIATRIC TERTIARY CARE HOSPITAL

Since poliomyelitis was eradicated, Guillain-Barre syndrome has been the leading cause of acute flaccid paralysis globally. Critical care and mechanical breathing may be necessary in extreme circumstances. Among paediatric patients hospitalized in the intensive care unit of a Karachi tertiary hospital, we aimed to quantify the incidence of Guillain-Barré Syndrome clinical outcomes. Cardiology Intensive Care Unit (NICH) in Karachi, Pakistan. January 9, 2020, to July 10, 2020—six months. Children admitted to the intensive care unit at NICH with GBS, as defined operationally, ranging in age from six months to twelve years, were included in the study. They stimulated the posterior tibial nerve (PTN) and common peroneal nerve (CPN), allowing for studying motor nerve conduction and using the median and ulnar nerves to measure compound muscle action potentials' onset delay, amplitude and conduction velocity (CMAPs). Research on the conduction of sensory nerves was carried out to quantify SNAPs in the sural, median, and ulnar regions. All patients were given intravenous immunoglobulin for five days at a 400 mg/kg/day dosage, as per the protocol. Clinical outcomes were evaluated using the HFG scale at discharge and four weeks. The average patient age was 5.81 ± 3.26 years out of 30. Thirteen men (43.3%) and seventeen females (56.7%) were present. Fifteen patients (53.3%) had a history of upper respiratory illness, while seven (23.3%) had a history of gastrointestinal infection. A mean HFG score of 3.03 ±1.90 was recorded. Outcomes were good for 21 patients (56.7%) and deficient for 9 (43.3%). A tertiary care hospital in Karachi reported that 56.7% of children admitted with Guillain-Barre Syndrome had good clinical results in the intensive care unit.

Pathophysiology Manifestations of SARS-CoV-2: A Comprehensive Review

Coronaviruses (CoVs) are wrapped up positive-sense RNA viruses, classified by Club-like spikes that stretch across the surface and follow exceptionally large RNA genomes and unique amplification mechanisms. The diseases caused by coronaviruses in animals and birds range from potentially fatal respiratory infections in humans to enteritis in pigs, cattle, and poultry with upper respiratory illnesses. Here, we provide a short overview of viruses, including their morphology, categorization, mechanisms of replication, and pathogenicity, particularly in humans, as well as the most recent approaches to COVID-19 prevention and therapy. We have presented the pandemic virus relationships with pathophysiological human conditions like blood group cases and age group mortality, the effect on men's fertility and obstetricians in pregnant women, and also address the outbreaks greatly pathogenic SARS-CoV (“Severe Acute Respiratory Syndrome Coronavirus”) &amp;MERS-CoV (“Middle East Respiratory Syndrome”) recently reported. The novel coronavirus disease (COVID-19) is a pandemic cause for the whole world so its scientific data or information will be beneficial for the research and development in the recent scenario as well as for future perspective.

Cost of acute respiratory illness episode and its determinants among community-dwelling older adults: a four-site cohort study from India

IntroductionAdvocacy for the provision of public health resources, including vaccine for the prevention of acute respiratory illnesses (ARIs) among older adults in India, needs evidence on costs and benefits. Using...

COVID-19.

COVID-19, the illness caused by SARS-CoV-2, became a worldwide pandemic in 2020. Initial clinical manifestations range from asymptomatic infection to mild upper respiratory illness but may progress to pulmonary involvement with hypoxemia and, in some cases, multiorgan involvement, shock, and death. Older adults, pregnant persons, those with common comorbidities, and those with immunosuppression are at greatest risk for progression. Vaccination is effective in preventing symptomatic infection and reducing risk for severe disease, hospitalization, and death. Antiviral treatment and immunomodulators have been shown to benefit certain patients. This article summarizes current recommendations on prevention, diagnosis, management, and treatment of COVID-19.

Antioxidant Capacity of Essential Oils Obtained from Myrtus communis L. and Citrus sinensis (L.) Osbeck Plants Widely Consumed in Adana Region

Vitamin C, an antioxidant, is abundant in oranges (Citrus sinensis (L.) Osbeck), which are consumed worldwide. It has treated constipation, diarrhea, upper respiratory illnesses, obesity, menstruation issues, hypertension, and stress. Traditional medicine worldwide uses myrtle (Myrtus communis L.). Clinical and experimental studies show that the plant has a wide range of pharmacological and therapeutic activities, including antioxidant, anticancer, antidiabetic, antibacterial, antifungal, antiviral, pulmonary and skin diseases, dysentery, vomiting, rheumatism, sinusitis, leucorrhoea, and hair loss control. These plants contain flavonoids, terpenes, steroids, fatty acids, carbohydrates, volatile chemicals, carotenoids, and nutritional components. Plant antioxidants have gained popularity due to their health benefits. Many studies focused on medicinal organic antioxidants. The main goal of this research was to investigate the volatile components and antioxidant capacities of the essential oils of myrtle and orange, both of which are commonly utilized for medicinal purposes in the Adana region. Myrtle and orange extracts demonstrated substantial antioxidant properties when tested with the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, a test based on the scavenging of the DPPH radical. It has been revealed that myrtle essential oil has a higher capacity in terms of antioxidant activity than orange essential oil.

Sweet’s Syndrome: A Rare Case Report

Sweet’s Syndrome, also known as acute febrile neutrophilic dermatosis is a rare disease of unknown etiology, but has been associated with autoimmune processes, malignancies, infections, GI disorders and drug reactions. It is more prevalent in women than men, except in case of malignancy associated origin. Clinical features of this disorder include acute onset of painful plaques on skin, neutrophilic leukocytosis, fever, dermal infiltrations by neutrophils. Usually, sweet’s syndrome is presented in three main clinical settings which includes: the classical (idiopathic), malignancy-associated, and drug induced. Classical Sweet’s Syndrome (CSS) is usually seen in women between the age of 30 to 50 years. It is frequently preceded by an upper respiratory illness and could be linked to pregnancy, inflammatory bowel disease, and both. Recurrence of the dermatosis is usually seen in one third of the patients experiencing classical sweet’s syndrome. Malignancy associated Sweet’s Syndrome (MASS) is usually present in patients with confirmed cancer and manifested as a paraneoplastic syndrome. Also occurs in those whose solid tumor or hematologic dyscrasia associated with sweet’s syndrome was previously undetected. Drug induced Sweet’s Syndrome (DISS) occurs in patients being treated with granulocyte-colony stimulating factor. Various other drugs including antibiotics like Minocycline, Trimethoprim Sulfamethoxazole, nitrofurantoin, antiepileptics like Carbamazepine, Diazepam, NSAIDS, Diuretics and Retinoids can also cause DISS. Diagnosis of sweet syndrome is usually done by two major criteria (histopathology and acute cutaneous lesion), and four minor criteria’s (infection, malignancy, medications, fever, and extra cutaneous manifestations like leukocytosis and corticosteroid response. Systemic corticosteroids are the golden standard of treatment for Sweet’s Syndrome. Systemic corticosteroids (0.5mg to 1mg/kg/day) for 4-6 weeks improves the systemic symptoms and reduce the skin lesions. For treating localized lesions, topical application of high potency corticosteroids or intralesional corticosteroids are effective. Other first line agents including potassium iodide and colchicine are also used. Second line agents include Indomethacin, Cyclosporine, Dapsone and Clofazimine. Keywords: Sweet’s Syndrome, Corticosteroids, Malignancy, Leukocytosis

Communication Strategies to Improve Antibiotic Prescribing in Pediatric Urgent Care Centers.

Urgent care (UC) clinicians frequently prescribe inappropriate antibiotics for upper respiratory illnesses. In a national survey, pediatric UC clinicians reported family expectations as a primary driver for prescribing inappropriate antibiotics. Communication strategies effectively reduce unnecessary antibiotics while increasing family satisfaction. We aimed to reduce inappropriate prescribing practices in otitis media with effusion (OME), acute otitis media (AOM), and pharyngitis in pediatric UC clinics by a relative 20% within 6 months using evidence-based communication strategies. We recruited participants via e-mails, newsletters, and Webinars from pediatric and UC national societies. We defined antibiotic-prescribing appropriateness based on consensus guidelines. Family advisors and UC pediatricians developed script templates based on an evidence-based strategy. Participants submitted data electronically. We reported data using line graphs and shared deidentified data during monthly Webinars. We used χ 2 tests to evaluate change in appropriateness at the beginning and end of the study period. The 104 participants from 14 institutions submitted 1183 encounters for analysis in the intervention cycles. Using a strict definition of inappropriateness, overall inappropriate antibiotic prescriptions for all diagnoses trended downward from 26.4% to 16.6% ( P = 0.13). Inappropriate prescriptions trended upward in OME from 30.8% to 46.7% ( P = 0.34) with clinicians' increased use of "watch and wait" for this diagnosis. Inappropriate prescribing for AOM and pharyngitis improved from 38.6% to 26.5% ( P = 0.03) and 14.5% to 8.8% ( P = 0.44), respectively. Using templates to standardize communication with caregivers, a national collaborative decreased inappropriate antibiotic prescriptions for AOM and had downward trend in inappropriate antibiotic prescriptions for pharyngitis. Clinicians increased the inappropriate use of "watch and wait" antibiotics for OME. Future studies should evaluate barriers to the appropriate use of delayed antibiotic prescriptions.

An in-depth appraisal of clinico-biochemical and radiological findings of COVID-19 patients during the COVID-19 pandemic in a dedicated COVID Care Hospital in Eastern India and its outcome in relation to the COVAXIN vaccination status: A 2-year study.

COVID-19 pandemic hit Odisha province from April 2020 to December 2020, then from April 2021 to August 2021 and from February 2022 to April 2022 as the first, second, and third waves, respectively, with the most severe form witnessed during the second wave. Kalinga Institute of Medical Sciences hospital in Odisha was declared a Dedicated COVID Hospital (DCH) during those three waves and witnessed 9485 cases of admissions among which there were 1214 deaths. COVAXIN vaccination of the vulnerable population was launched in February 2021 onwards. This study has been done to know the clinic-biochemical profiles, radiologic findings of COVID-19 admitted patients, the predictors of mortality in the second wave, and clinical outcomes in the three waves in relation to COVAXIN vaccination status. This was a serial three-round retrospective study from the electronic medical records using multistage random sampling where we collected and critically analyzed the demographic, and all the relevant possible health data of the cases that consist of 514 cases admitted in three waves. The data from death certificates among the 555 cases in the second wave have been analyzed to conclude predictors of mortality. Mortality increased with age, male gender, comorbidities, and raised C-reactive protein level. High NL ratio, extent of pulmonary involvement. There was a wide variation in incidence and spectrum of illness starting from 79% incidence of mild symptomatic in the initial and third wave, but remained in the range of 35-65% in the second wave, respectively, and the most noticeable symptomatic illness was that of the upper respiratory tract. In fulminant cases, the mode of presentations was severe pneumonia and acute respiratory distress syndrome. Males were more sufferers than females. Children had better outcomes compared to adults. COVID-associated coagulopathy had a normal platelet count. Subsequently, in 2021 year onwards vaccination of the vulnerable population was launched in a phased manner that changed the dynamics of the disease outcome by better survival chances despite intercurrent COVID infection by induction of herd immunity. On the contrary, there was a higher prevalence of serious illness among non-vaccinated individuals. While the cases continued during the second wave of the pandemic, long COVID became a clinical entity of symptomatic that persisted or recurred among the COVID illness recovered cases after reverse transcriptase polymerase chain reaction results for COVID-19 became negative. The symptoms consisted of fatigue, cough, dyspnea as pulmonary manifestations and extra-pulmonary involvement of the cardiac, renal, and central nervous systems and the pulmonary imaging features consisted of interstitial pneumonia, consolidation, cavity pattern, and prone to microbial infection. These events lead to morbidity and admission. Coinciding with the vaccination of all population of Odisha province with the first dose of the vaccine by around the period of the first quarter of 2022, there was a new variant named Omicron responsible in the third wave, in which the majority of the admitted cases had.mild upper respiratory illness. This was not as lethal as its predecessors due to its lower propensity to invade the lungs and blood vessels. Immune dysregulation plays a central role in the pathogenesis of the manifestations. Vaccine-induced protection and the induction of herd immunity played a proactive role in the waning of the severity of clinical presentations.

Heterozygous TCF3-Related Disease Presenting as X-linked Agammaglobulinemia Mimicry in a Male Toddler with B-cell Aplasia, Agammaglobulinemia, and Severe Neutropenia

IntroductionDisease associated with TCF3 variants are rare and associated with autosomal dominant inheritance agammaglobulinemia. Patients present with profound reduction in CD19+ cells and a block in B cell development at the common lymphoid precursor to pro–B cell phase of differentiation. Severe neutropenia is frequently described in X-linked agammaglobulinemia (XLA) patients but not yet described as a presenting finding in TCF3-related disease. Case ReportThis case describes a 13-month-old full term male with a history of reactive airway disease and recurrent infections including multiple bouts of acute otitis media, hand -foot-mouth, and viral upper respiratory illnesses who presented with fever and persistent severe neutropenia (absolute neutrophil count <100 cell/uL) necessitating hospital admission. Given his infectious history and severe neutropenia, he underwent evaluation for an underlying inborn error of immunity with the following pertinent findings: undetectable IgG (<16 mg/dL), IgM (<10 mg/dL), IgA (<2 mg/dL) and IgE (<2 kU/L), negative pneumococcal, tetanus and diphtheria vaccine titers despite vaccination, lymphocyte subsets with normal CD3, CD4, CD8, and CD16/56 absolute values but extremely low CD19 level (38 cells/cmm), and negative anti-neutrophil antibodies. Patient Bruton tyrosine kinase (Btk) protein flow cytometry results in monocytes were similar to an experimental control, while B-cell subset analysis was unable to be obtained given low B-cell numbers. Comprehensive genetic testing subsequently identified a heterozygous pathogenic TCF3 variant, c.1663G>A, p. (Glu555Lys). Following initiation of intravenous immunoglobulin (IVIG) replacement, our patient's neutropenia resolved quickly and completely. He continues to receive monthly IVIG with goal IgG troughs >800 mg/dL and resultant significant improvement in infections. ConclusionAs in XLA, our patient's severe neutropenia rapidly resolved with initiation of immunoglobulin replacement. While it has been shown that neutrophil development is somewhat dependent on the Btk protein, further study into the importance of the TCF3 protein and additionally adequate immunoglobulin levels in neutrophil expansion is needed. Finally, germline inborn errors of immunity, including TCF3 variants, should be considered in children with a history of recurrent infections and persistent neutropenia.

Characterizing A Novel Variant in ABCB1 in a Family with Activated PI3K Delta Syndrome-like Presentation

IntroductionActivated PI3K delta syndrome (APDS) is a rare inborn error of immunity (IEI) due to a heterozygous gain-of-function mutation in the PIK3CD or PIK3R1 genes. APDS patients have high variability in clinical manifestations including recurrent sinopulmonary infections, lymphoproliferation, and susceptibility to CMV and/or EBV viremia. APDS is characterized by a block in B-cell development to follicular stage. Therefore, increase in transitional compartment is almost exclusively seen in untreated APDS patients. We describe a family that present with APDS-like clinical and laboratory findings, while harboring a novel variant in ATP binding cassette subfamily B member 1 (ABCB1), which is involved in adenosine salvage and mTORC1 pathways. MethodsRetrospective chart review was performed for clinical and laboratory data. Extensive immune phenotyping was obtained. Genetic evaluation included targeted immune panel and whole exome sequencing. Mitotracker-green detection by flow cytometry was used to determine progression to follicular B cell stage. Case PresentationIndex case is a 14-year-old female with a complex presentation of infectious and non-infectious complications notable for lifelong hypogammaglobulinemia with poor vaccine response, multiple intubations for upper respiratory illnesses, bronchiectasis, and short stature. Patient had 3 other siblings who also had similar presentation with varied severity, including features of short stature, recurrent infections, alopecia universalis and immune dysregulation. Three siblings required immunoglobulin replacement therapy. Extensive immune-phenotyping revealed significant expansion of CD24hiCD38hi transitional and CD19hiCD21lo B-cells, with decrease in follicular and memory B-cell compartment in all. Although clinical and lab findings prompted APDS diagnosis, repeated targeted genetic panel testing did not show variants in PIK3CD or PIK3R1. Consequent whole exome sequencing revealed a candidate variant in ABCB1 p.Ala1187Thr that was shared among all. Interestingly, surface expression of ABCB1 was significantly elevated in patients compared to healthy controls. Initial functional testing showed disruption in mitochondrial efflux, further supporting the block from transitional to follicular stage. Discussion/ConclusionsDetermining diagnostic approaches in APDS-like disorders liked to ABCB1 variant is challenging, especially when pathogenesis is yet to be determined. Although further functional testing of ABCB1 and its potential role in PI3K signaling is needed, ABCB1 gene may play an important role in APDS pathology.

Seronegative Isaac Syndrome Presenting as Focal Limb Stiffness Responsive to Plasma Exchange Therapy (P8-8.015)

<h3>Objective:</h3> N/A <h3>Background:</h3> Isaac syndrome is an autoimmune disorder of peripheral nerve hyperexcitability characterized by neuromyotonia, myokymia, muscles stiffness, pseudomyotonia, and pseudotetany frequently accompanied by dysautonomia and neuropathic pain. Approximately 50% of cases are associated with antibodies against contactin-associated protein-like 2 (CASPR2) or less commonly leucine-rich glioma inactivated protein 1 (LGI1), both components of the voltage-gated potassium channel (VGKC) complex. Paraneoplastic, genetic, and toxic etiologies must be considered. Management includes membrane-stabilizing drugs as well as immunotherapy in more severe cases. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 50-year-old woman presented with one year of left neck, shoulder, and upper extremity pain and stiffness that began one month after an upper respiratory illness. Her exam was notable for anterocollis, left shoulder elevation, impaired left shoulder abduction beyond 35–40 degrees, tonically contracted left biceps, and marked tenderness to palpation of the affected muscles. Symptomatic management with diazepam, lorazepam, baclofen, mexiletine, and trihexyphenidyl was ineffective. EMG demonstrated widespread neuromyotonic discharges throughout the proximal greater than distal left upper extremity, cervical and thoracic paraspinals, and right deltoid. Laboratory studies including CASPR2, LGI1, VGKC, GAD-65, and amphiphysin antibodies were unremarkable. Comprehensive screening for occult malignancy was unrevealing. She received partial benefit from carbamazepine, levetiracetam, cyclobenzaprine, and onabotulinumtoxinA injections, but symptoms remained debilitating. She was treated with IVIg 1g/kg Q2 weeks for three months with symptom progression to the jaw and lower extremities. She was started on plasmapheresis QOD for ten days every four weeks with rapid improvement in symptoms. <h3>Conclusions:</h3> We report a case of seronegative Isaac syndrome initially presenting with focal limb stiffness and dystonic posturing that was exquisitely responsive to plasmapheresis. This case highlights the need to consider peripheral nerve hyperexcitability syndromes in patients presenting with focal limb stiffness or painful dystonia and provides additional support for plasmapheresis as an effective treatment option for patients with debilitating symptoms. <b>Disclosure:</b> Dr. Khalil has received personal compensation in the range of $0-$499 for serving as a Resident and Fellow Council Member with American Association of Neuromuscular &amp; Electrodiagnostic Medicine. Dr. Khalil has received personal compensation in the range of $0-$499 for serving as a MS Mentorship Forum Participant with Foundation of the Consortium of Multiple Sclerosis Centers. Dr. Bradshaw has nothing to disclose.

Protean presentation of COVID-19: An evidence-based study – Lessons learned

Introduction: Variants of the severe acute respiratory syndrome (SARS) coronavirus 2, responsible for SARS, continue to cause devastating impact on public health and the economy. To critically assess the clinical, laboratory, extent of radiological involvement in the lung parenchyma, and their outcomes among admitted cases during the pandemic surge and to determine whether there is a protean presentation of the biological behavior of the COVID-19 virus variants, a study was conducted in the Odisha province of Eastern India. Materials and Methods: A retrospective observational study was conducted by data collected from the electronic medical records relating to detail demographic, clinical, laboratory, imaging, and outcome among the reverse transcriptase–polymerase chain reaction (RT-PCR)-positive admitted cases relating to three cycles of admission from April 2020 to April 2022 consisting of the 272 admitted cases during the period from April 2020 to December 2020 as a first wave and 200 admitted cases during the period from April 2021 to August 2021 as a second wave and pattern of illness from February 2022 to April 2022, as per local health authority information. In the 200 cases, there were 70 COVID-19-vaccinated and 130 nonvaccinated persons. Following COVID-recovered cases, a study was undertaken for the pulmonary imaging evaluation Results: Wide variations in incidence and illness type were seen, with pneumonia accounting for 28% of cases in the second wave and mild upper respiratory illnesses for 79% of cases in the first. Acute respiratory distress syndrome was observed in 72% of cases, and nonvaccinated people had a higher prevalence of severe cases than vaccinated people. Males suffered more than females. Normal platelet count in coagulopathy associated with COVID was witnessed. More extensive lung involvement and associated comorbidities were poor prognostic indicators, but paradoxically, cases recovered despite elevated neutrophil–lymphocyte ratios, C-reactive protein, and D -dimer levels. Conclusion: While the majority of illnesses during the second wave were moderate to severe, mild upper respiratory illnesses were observed during the first wave period. The subsequent COVID illness was a mild upper respiratory infection. This was due to the community-wide rollout of the COVID vaccine, which began in phases and continued in full force. After the RT-PCR for COVID turned out to be negative during the second wave, long COVID started to appear among the recovered cases. It included pulmonary manifestations such as, fatigue, coughing, and dyspnea, and imaging features such as fibrosis, ground-glass opacity, cavities, and extrapulmonary presentations. Vaccination of the population is the only tool to contain this pandemic.

The rapid diagnosis of Mycoplasma pneumonia using in situ hybridization on clinical samples

The microbiological etiology of seasonal upper respiratory illnesses in the United States is dominated by viruses, including influenza A, B, respiratory syncytial virus, and SARS-CoV2. Mycoplasma pneumonia, treatable with antibiotics, can also cause upper respiratory symptoms and is typically associated with about 15 % of cases. There is no clinical or radiologic finding diagnostic of Mycoplasma pneumonia infection and PCR-based testing is not routinely used in the clinical setting. Further, the bacteria grows slowly in culture and the diagnostic IgM response will take days after the onset of infection. Thus, a rapid diagnostic test for Mycobacterium pneumonia infection is needed. This study documented two cases of Mycoplasma pneumonia infection of the upper respiratory system using in situ hybridization in a series of over 20 patients who were being tested for SARS-CoV2 infection. The respiratory secretions were placed on a glass slide, fixed in 10 % buffered formalin, and then tested using a Mycoplasma pneumonia probe. The high bacterial number associated with acute infection allowed for straightforward detection by in situ hybridization in a few hours. Antibiotic therapy led to rapid resolution of the symptoms. This highlights the ability of standard in situ hybridization as a rapid diagnostic test for Mycoplasma pneumonia in the clinical setting.

1383. Necrotizing Fasciitis and Streptococcus pyogenes (GAS) Infection Seasonality and Risk Factors for Infection— a Multicenter Research Network Study

Abstract Background Streptococcus pyogenes causes acute pharyngitis and type II necrotizing fasciitis. Seasonal variations in the incidence of S. pyogenes infections are not robustly characterized. We aim to identify seasonal variations and risk factors of S. pyogenes infections and all causes of necrotizing fasciitis. Methods From 2010 to 2019, we identified all infectious adult cases of S. pyogenes using ICD-10 diagnoses and lab results (PCR and antigen-based assays) and cases of necrotizing fasciitis using ICD-10 diagnoses within a federated research network. We extracted seasonal (quarterly) incidence rates. We used an autoregressive integrated moving average (ARIMA) model to assess the seasonality of the cases (6-month intervals). Demographic characteristics and 3-month outcomes of S. pyogenes pharyngitis were compared to a cohort of patients with acute upper respiratory illnesses excluding S. pyogenes. Results We identified 238,088 cases of S. pyogenes pharyngitis and 26,931 cases of necrotizing fasciitis in adults. S. pyogenes infection average incidence was higher during the winter than the summer: 0.34 vs. 0.20 cases per 1,000 patients. Necrotizing fasciitis diagnoses were highest during the summer months (average 0.026 per 1000 patients). There was a significant ARIMA seasonal variation in the time series analysis for S. pyogenes infections (p=0.006) (figure 1). However, necrotizing fasciitis was not significant (p=0. 0.79) (Figure 2). Compared to adults with acute respiratory infections other than S. pyogenes, adults with S. pyogenes pharyngitis were more likely to be younger (25.8 ± 14.9 vs. 45.4 ± 19.9 years old, p&amp;lt; 0.0001) and of Hispanic or Latino ethnicity (11% vs. 8%, p &amp;lt; 0.0001). For age-matched outcomes, adults with S. pyogenes pharyngitis had lower rates of hospitalization (0.888% vs. 1.714%, p&amp;lt; 0.0001) and mortality (0.114% vs. 0.174%, p&amp;lt; 0.0001) at three months relative to adults with acute respiratory infections other than S. pyogenes. Figure 1.Seasonal variation of adults with established ICD code or testing for Streptococcus pyogenes (GAS) infectionsFigure 2.Seasonal variation of adults with established ICD code for necrotizing fasciitis Conclusion Peaks in S. pyogenes infections are more likely to occur in the winter months, although spring and fall seasons can display variably high rates of S. pyogenes year over year. Necrotizing fasciitis of any microbiological did not show a significant seasonal variation. Disclosures All Authors: No reported disclosures.