scholarly journals Respiratory Viral Pathogens Among U.S. Military Personnel at a Medical Treatment Facility in Hawaii From 2014 to 2019

2021 ◽  
Author(s):  
Agnes S Montgomery ◽  
Michael B Lustik ◽  
Susan A Reichert-Scrivner ◽  
Ronald L Woodbury ◽  
Milissa U Jones ◽  
...  
Keyword(s):  
Military Personnel ◽  
Influenza A ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Signs And Symptoms ◽  
Military Operations ◽  
Military Population ◽  
Viral Pathogens ◽  
Viral Pathogen ◽  
Medical Treatment Facility

ABSTRACT Introduction Acute respiratory diseases account for a substantial number of outpatient visits and hospitalizations among U.S. military personnel, significantly affecting mission readiness and military operations. We conducted a retrospective analysis of respiratory viral pathogen (RVP) samples collected from U.S. military personnel stationed in Hawaii and tested at Tripler Army Medical Center from January 2014 to May 2019 in order to describe the etiology, distribution, and seasonality of RVP exposure in a military population. Materials and Methods Samples were analyzed by viral culture or multiplex PCR. Distribution of respiratory viruses over time was analyzed as well as subject demographic and encounter data. Presenting signs and symptoms were evaluated with each RVP. Results A total of 2,576 military personnel were tested, of which 726 (28.2%) were positive for one or more RVP. Among positive tests, the three most common viral pathogens detected were influenza A (43.0%), rhinovirus (24.5%), and parainfluenza (7.6%). Symptoms were generally mild and most frequently included cough, fever, and body aches. Conclusion Our study evaluated respiratory virus prevalence, seasonality, and association with clinical symptoms for military personnel in an urban tropical setting in Oahu, HI, over a 5-year period. We show that viral prevalence and seasonality in Hawaii are distinct from those of the CONUS. Results contribute to the broader understanding of seasonality, clinical manifestation, and demographics of RVP among active duty military personnel stationed in Hawaii.

scholarly journals Respiratory Viral Pathogens in Children Evaluated at Military Treatment Facilities in Oahu, Hawaii From 2014 to 2018: Seasonality and Climatic Factors

2020 ◽  
Author(s):  
Agnes S Montgomery ◽  
Michael B Lustik ◽  
Milissa U Jones ◽  
Timothy S Horseman
Keyword(s):  
Respiratory Syncytial Virus ◽  
Influenza A ◽  
Climatic Factors ◽  
Medical Center ◽  
Respiratory Viruses ◽  
Preventive Strategies ◽  
Viral Pathogens ◽  
Treatment Facilities ◽  
Syncytial Virus ◽  
Military Treatment Facilities

Abstract Five-year retrospective analysis of respiratory viruses in children less than 18 years old at Tripler Army Medical Center and outlying clinics in Oahu. Respiratory syncytial virus and influenza A showed pronounced seasonality with peaks from September to December and December to March, respectively. Results provide a better understanding of the timing of viral preventive strategies in Oahu.

scholarly journals Chemokines as Potential Biomarkers for PTSD in Military Population

2021 ◽  
Author(s):  
Lei Zhang ◽  
Xianzhang Hu ◽  
Xiaoxia Li ◽  
Robert J. Ursano
Keyword(s):  
Military Personnel ◽  
Stress Responses ◽  
Therapeutic Interventions ◽  
Health Concern ◽  
Military Operations ◽  
Post Traumatic Stress ◽  
Military Population ◽  
Mental Health Concern ◽  
As Stress ◽  
Education And Development

Post-traumatic stress disorder (PTSD) is a serious mental health concern worldwide among civilians and military personnel. Gaps in our understanding of its biological basis create significant obstacles for accurate diagnosis and assessment of therapeutic interventions. In light of this, investigation of biological factors associated with possible molecular cues of inflammation or neuroimmune disorders, could provide new surrogate markers for PTSD or PTSD treatment response. Analyses to date in deployed military personnel have suggested that sets of chemokines may be useful as biomarkers for PTSD acquired in military operations. Specifically, studies to date suggest that CCL2, CCL15, CCL22, CCL25, CXCL2, and CXCL12 are associated with PTSD onset, while CCL13, CCL20, and CXCL6 are correlated to PTSD risk; CX3CL1 are associated with resilience; CCL3; CXCL11, and CXCL16 are associated with stress response. CCL11, CCL13, CCL20, and CCL25 are correlated with the severity of PTSD symptoms. This chapter reviews the current understanding of potential chemokine markers for PTSD, and the potential chemokines associated with PTSD onset, risk, resilience, as well as stress responses in service members. Although the proposed biomarkers require further validation, these findings may lead to additional knowledge for the education and development of diagnostic and therapeutic approaches for PTSD, not only benefiting military personnel, but civilians as well.

scholarly journals 1776. Step-Wise Algorithm for the Detection of Respiratory Viruses: Integrating a Rapid Influenza A/B and RSV PCR with a Multiplex Respiratory Virus Panel to Target High-Risk Patient Populations

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S654-S654 ◽  
Author(s):  
Nancy Matic ◽  
Tanya Lawson ◽  
Loretta Karakas ◽  
Willson Jang ◽  
Gordon Ritchie ◽  
...  
Keyword(s):  
Influenza A ◽  
Respiratory Virus ◽  
High Risk Patient ◽  
Multiplex Assay ◽  
Influenza B ◽  
Medical Team ◽  
Viral Pathogens ◽  
Viral Pathogen ◽  
Additional Testing ◽  
Virus Testing

Abstract Background In clinical settings, multiplex molecular panels are becoming increasingly common for the detection of respiratory pathogens. Little evidence is available to guide appropriate use of respiratory multiplex panels, particularly with respect to the patient populations most likely to benefit from such testing. Methods During the 2018–2019 influenza season, all patients with a nasopharyngeal swab submitted for respiratory virus detection were initially tested on a commercial rapid PCR platform for influenza A/B and respiratory syncytial virus (RSV) (Cepheid GeneXpert, Sunnyvale, CA). Patients with negative swabs were reviewed by a laboratory physician based on pre-defined criteria (Table 1) for additional testing by a laboratory-developed multiplex assay for parainfluenza 1/2/3, adenovirus, and human metapneumovirus (hMPV). Results In total, 1144 nasopharyngeal swabs were tested. 287 (25.1%) were positive on the GeneXpert: influenza A (234, 81.5%), influenza B (13, 4.5%), and RSV (40, 13.9%). Of the patients who tested negative, 234 (27.3%) met criteria for further respiratory virus testing. The most commonly detected viral pathogens on the multiplex assay were hMPV (20/30, 66.7%), parainfluenza 3 (7/30, 23.3%) and adenovirus (3/30, 10%). The yield of the multiplex assay was highest for patients selected for antimicrobial stewardship (AS) criteria (13/56, 23.2%), followed by transplant (2/16, 12.5%), HIV (7/64, 10.9%), cystic fibrosis (2/19, 10.5%), critical care (6/68, 8.8%), and other/upon physician request (0/11, 0%). Of the patients who received multiplex testing for AS criteria and tested positive for a viral pathogen, only 3/13 (23.1%) had antibiotics discontinued by the medical team within 48 hours of the report. Conclusion Additional testing for respiratory viral pathogens had low overall diagnostic yield, and further refinement of the algorithm is needed to better target utilization of respiratory virus testing. The patient population with the highest yield (those who met AS criteria) failed to demonstrate consistent timely discontinuation of unnecessary antibiotics by the medical team. Implementation of respiratory multiplex panels would be strengthened by collaboration with AS teams. Disclosures All authors: No reported disclosures.

scholarly journals Co-circulation of Influenza A and B During the 2016–2017 Influenza Season at Rush University Medical Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S314-S315 ◽  
Author(s):  
Andrew Simms ◽  
Hemil Gonzalez ◽  
Nicholas M Moore ◽  
Leslie A Chapman ◽  
Karen Lolans ◽  
...  
Keyword(s):  
Influenza A ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Quadrivalent Vaccine ◽  
Influenza B Virus ◽  
Influenza B ◽  
Icu Admission ◽  
B Virus ◽  
Pregnancy Status ◽  
Trivalent Vaccine

Abstract Background Two strains of influenza B virus, B/Yamagata and B/Victoria, co-circulate in the USA, typically appearing in late March. This year, influenza B virus (FluB) co-circulated consistently with influenza A virus (FluA). We hypothesized that this could be explained by an increased use of influenza trivalent vaccine, which lacks the B/Yamagata strain, over the quadrivalent vaccine. Methods We performed a retrospective, observational cohort study of patients with laboratory-diagnosed influenza from October 2016 through April 2017. Age, comorbidity categories, pregnancy status, symptoms, The presence of opacity on chest film, ICU admission, death, and receipt of oseltamivir were reviewed for 256 patients. A subset of FluB specimens were subtyped for lineage using RT–PCR. Results Influenza was detected in 495 (10.4%) of 4,754 samples collected, including 305 FluA and 190 FluB. The H3 strain represented 97% of FluA cases. FluB subtypes were: 70, B/Victoria; 21, B/Yamagata; and 41, not subtyped. Chart review was conducted for 124 randomly selected FluA and 132 sequential FluB patients. Median age of patients with FluA was 44 compared with 27 with FluB (P < 0.001). Forty-three (34.7%) FluA patients had heart disease compared with 21 (15.9%) FluB patients (P < 0.001). Otherwise, there were no differences in comorbidities, pregnancy status, clinical symptoms, or infectious complications between FluA vs. FluB patients. Ninety-three (75%) FluA patients and 78 (59.1%) FluB patients received oseltamivir. ICU admission occurred in 15 (12.1%) FluA and 9 (6.8%) FluB patients (OR 1.414; 95% CI 0.83-2.4). Seventy-seven (30%) patients received flu vaccine, 39 with FluA, and 38 with FluB; 97 (37.9%) were not vaccinated and 82 (32%) were missing data. Of those vaccinated, 6 patients received trivalent vaccine, and 71 received quadrivalent. Only 24 patients with B/Victoria and 7 patients with B/Yamagata were vaccinated. Conclusion The proportion of infected patients who had received vaccination was low, limiting our ability to detect the effect of the trivalent vaccine on the incidence of infection with B/Yamagata. In contrast to conventional thought, when compared with influenza B, influenza A (predominantly H3N2) did not appear to disproportionally affect those with most medical comorbidities, and was not disproportionately associated with our identified clinical complications. Disclosures All authors: No reported disclosures.

scholarly journals Performance of a Rapid Diagnostic Test for Influenza in a Tertiary Military Hospital, Philippines

2021 ◽  
Author(s):  
John Mark Velasco ◽  
Maria Theresa Valderama ◽  
Paula Corazon Diones ◽  
Fatima Claire Navarro ◽  
Maribel Develos ◽  
...  
Keyword(s):  
Predictive Value ◽  
Influenza A ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Age Groups ◽  
Armed Forces ◽  
The Philippines ◽  
Military Hospital ◽  
Ct Value ◽  
Significant Difference

ABSTRACT Introduction It is important to evaluate the performance of existing rapid influenza diagnostic tests (RIDTs) and the factors that can affect performance especially when the circulation dynamics of influenza strains change such as the displacement and replacement of the circulating seasonal influenza strains. Materials and Methods Nasal swabs were collected from patients presenting at V Luna Medical Center, Armed Forces of the Philippines Health Service Command, with influenza-like illness (ILI) with one swab tested using Quickvue (QV) influenza A+B RIDT (Quidel) and the other swab tested using the ABI 7500 (Applied Biosystems) real-time reverse transcriptase-polymerase chain reaction. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated. We identified clinical symptoms predictive of influenza subtype and evaluated the independence of QV sensitivity on (1) Cycle threshold (Ct) value, controlling for timing of collection; (2) timing of collection, controlling for Ct value; and (3) Ct value and timing of collection taken together. Results Between August 2011 and October 2016, patients presenting with ILI (n = 2333) underwent testing. Quickvue sensitivity across all subtypes was significantly correlated with lower Ct values (higher virus titers) (P <.001) and, except for flu A/H3 (P = .974), was also significantly associated with timing of specimen collection (P <.05). No statistically significant difference was noted in QV sensitivity for Flu A/H3 (P = .130), pandemic H1/N1 (P = .207), Flu A/H3 + pandemic H1/N1 (P = .341), and Flu B (P = .103) across different age groups but sensitivity of QV significantly differed (P <.001) across the different influenza subtypes. Conclusion Overall specificity of QV was high across all flu subtypes, but overall sensitivity was low (Flu A/pdm H1) to moderate (Flu A/H3 and Flu B). The findings highlight the need to develop more sensitive influenza RDTs to detect circulating influenza strains and the use of the quadrivalent flu vaccine during the annual influenza vaccination.

The value of signs and symptoms in differentiating between bacterial, viral and mixed aetiology in patients with community-acquired pneumonia

2014 ◽  
Vol 63 (3) ◽  
pp. 441-452 ◽  
Author(s):  
Elisabeth G. W. Huijskens ◽  
Marion Koopmans ◽  
Fernand M. H. Palmen ◽  
Adriana J. M. van Erkel ◽  
Paul G. H. Mulder ◽  
...  
Keyword(s):  
Influenza A ◽  
Pneumonia Severity Index ◽  
Signs And Symptoms ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Respiratory Pathogens ◽  
Clinical Predictors ◽  
Viral Pathogen ◽  
Wide Range ◽  
Pneumonia Severity Index Score

Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted diagnostics and directed treatment. In a prospective study, conducted between April 2008 and April 2009, adult patients with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, PCR, urinary antigen testing and serology. Of 408 patients with CAP, pathogens were detected in 263 patients (64.5 %). Streptococcus pneumoniae and influenza A virus were the most frequently identified bacterial and viral pathogens, respectively. Age had a significant effect on the prediction of aetiology (P = 0.054), with an increase in the relative contribution of viruses with advancing age. Multivariate analyses further showed that the presence of cough increased the likelihood of detecting a viral pathogen [odds ratio (OR) 5.536, 95 % confidence interval (CI) 2.130–14.390], the presence of immunodeficiency decreased the likelihood of detecting a bacterial pathogen (OR 0.595, 95 % CI 0.246–1.437) and an increase in pneumonia severity index score increased the likelihood of detecting a pathogen in general. Although several variables were independently associated with the detection of a pathogen group, substantial overlap meant there were no reliable clinical predictors to distinguish aetiologies. Therefore, testing for common respiratory pathogens is still necessary to optimize treatment.

scholarly journals Viral metagenomic sequencing in a cohort of international travellers returning with febrile illness

2021 ◽  
Author(s):  
Alhena Reyes ◽  
Ellen C. Carbo ◽  
Joost van Harinxma thoe Slooten ◽  
Margriet E.M. Kraakman ◽  
Igor A. Sidorov ◽  
...  
Keyword(s):  
Dengue Virus ◽  
Pathogen Detection ◽  
Medical Center ◽  
Febrile Illness ◽  
Viral Metagenomics ◽  
Metagenomic Sequencing ◽  
Serum Samples ◽  
Viral Pathogens ◽  
Viral Pathogen ◽  
Genome Coverage

Background Diagnosis of infections in returning international travellers can be challenging because of the broad spectrum of potential infectious aetiologies potentially involved. Viral metagenomic next-generation sequencing (mNGS) has the potential to detect any virus present in a patient sample and is increasingly being used for difficult to diagnose cases. The aim of this study was to analyse the performance of mNGS for viral pathogen detection in the clinical setting of international travellers returning with febrile illness. Methods Thirty-eight serum samples from international travellers returning with febrile illness and presenting at the outpatient clinic of the Leiden University Medical Center in the Netherlands in the time period 2015-2016 were selected retrospectively. Samples were processed for viral metagenomic sequencing using a probe panel capturing all known vertebrate viruses. Bioinformatic analysis was performed using Genome Detective software for metagenomic virus detection. Metagenomic virus findings were compared with viral pathogen detection using conventional methods. Results In 8 out of the 38 patients (21%), a pathogenic virus was detected by mNGS. All viral pathogens detected by conventional assays were also detected by mNGS: dengue virus (n=4 patients), Epstein-Barr virus (n=2), hepatitis B virus (n=1). In addition, mNGS resulted in additional pathogenic findings in 2 patients (5%): dengue virus (n=1), and hepatitis C virus (n=1). Non-pathogenic viruses detected were: GB virus C (n=1) and torque teno viruses (n=3). High genome coverage and depth using capture probes enabled typing of the dengue viruses detected. Conclusions Viral metagenomics has the potential to assist the detection of viral pathogens and co-infections in one step in international travellers with a febrile syndrome. Furthermore, viral enrichment by probes resulted in high genome coverage and depth which enabled dengue virus typing.

scholarly journals Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yucan Zheng ◽  
Zhihua Zhang ◽  
Kunlong Yan ◽  
Hongmei Guo ◽  
Mei Li ◽  
...  
Keyword(s):  
Rare Earth ◽  
Digestive Tract ◽  
Foreign Bodies ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Rare Earth Magnet ◽  
Gastrointestinal Obstruction ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Surgical Group

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including 5(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%)cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer([80(5–336) vs 26(2–216)]hours, p < 0.001) while there was no significant difference in the mean age or the number of magnets swallowed. Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 h, even in asymptomatic patients.

Meningiomas Of the Internal Auditory Canal

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 119-128 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Sharham Mirzai ◽  
Cordula Matthies ◽  
Peter Vorkapic ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Clinical Symptoms ◽  
Management Strategies ◽  
Internal Auditory Canal ◽  
Signs And Symptoms ◽  
Vestibular Schwannomas ◽  
Additional Patient ◽  
Surgical Removal ◽  
Neurosurgical Department ◽  
Vestibulocochlear Nerve

Abstract OBJECTIVE: Meningiomas arising primarily within the internal auditory canal (IAC) are notably rare. By far the most common tumors that are encountered in this region are neuromas. We report a series of eight patients with meningiomas of the IAC, analyzing the clinical presentations, surgical management strategies, and clinical outcomes. METHODS: The charts of the patients, including histories and audiograms, imaging studies, surgical records, discharge letters, histological records, and follow-up records, were reviewed. RESULTS: One thousand eight hundred meningiomas were operated on between 1978 and 2002 at the Neurosurgical Department of Nordstadt Hospital. Among them, there were 421 cerebellopontine angle meningiomas; 7 of these (1.7% of cerebellopontine angle meningiomas) were limited to the IAC. One additional patient underwent surgery at the Neurosurgical Department of the International Neuroscience Institute, where a total of 21 cerebellopontine angle meningiomas were treated surgically from 2001 to 2003. As a comparison, the incidence of intrameatal vestibular schwannomas during the same period, 1978 to 2002, was 168 of 2400 (7%). There were five women and three men, and the mean age was 49.3 years (range, 27–59 yr). Most patients had signs and symptoms of vestibulocochlear nerve disturbance at presentation. One patient had sought treatment previously for total hearing loss before surgery. No patient had a facial paresis at presentation. The neuroradiological workup revealed a homogeneously contrast-enhancing tumor on magnetic resonance imaging in all patients with hypointense or isointense signal intensity on T1- and T2-weighted images. Some intrameatal meningiomas showed broad attachment, and some showed a dural tail at the porus. In all patients, the tumor was removed through the lateral suboccipital retrosigmoid approach with drilling of the posterior wall of the IAC. Total removal was achieved in all cases. Severe infiltration of the facial and vestibulocochlear nerve was encountered in two patients. There was no operative mortality. Hearing was preserved in five of seven patients; one patient was deaf before surgery. Postoperative facial weakness was encountered temporarily in one patient. CONCLUSION: Although intrameatal meningiomas are quite rare, they must be considered in the differential diagnosis of intrameatal mass lesions. The clinical symptoms are very similar to those of vestibular schwannomas. A radiological differentiation from vestibular schwannomas is not always possible. Surgical removal of intrameatal meningiomas should aim at wide excision, including involved dura and bone, to prevent recurrences. The variation in the anatomy of the faciocochlear nerve bundle in relation to the tumor has to be kept in mind, and preservation of these structures should be the goal in every case.

Children With Influenza A Infection: Treatment With Rimantadine

PEDIATRICS ◽  
1987 ◽  
Vol 80 (2) ◽  
pp. 275-282
Author(s):  
Caroline Breese Hall ◽  
Raphael Dolin ◽  
Christine L. Gala ◽  
David M. Markovitz ◽  
Yu Qin Zhang ◽  
...  
Keyword(s):  
Influenza A ◽  
Clinical Signs ◽  
Severity Of Illness ◽  
Signs And Symptoms ◽  
Clinical Isolates ◽  
Double Blind Study ◽  
Double Blind ◽  
Viral Shedding ◽  
Development Of Resistance ◽  
Clinical Signs And Symptoms

Treatment with rimantadine of influenza in children and the potential development of resistance in clinical isolates associated with therapy have not been previously studied. We compared rimantadine to acetaminophen therapy in a controlled, double-blind study of 91 children with influenza-like illness. Of 69 children with proven influenza A/H3N2 infection, 37 received rimantadine and 32 received acetaminophen for five days. Children receiving rimantadine showed significantly greater reduction in fever and improvement in daily scores for symptoms and severity of illness during the first three days. Viral shedding also diminished significantly during the first two days but subsequently increased such that by days 6 and 7 the proportion of children shedding virus, as well as the quantity of virus shed, was significantly greater in the rimantadine group. During the seven-day study, of the 22 children in the rimantadine group with serial isolates tested, ten (45.5%) had resistant isolates compared with two (12.5%) of those with serial isolates in the acetaminophen group (P &lt; .03). Thus, of the total 37 children in the rimantadine group, 27% were found to have resistant isolated compared with 6% in the total group receiving acetaminophen (P &lt; .04). Furthermore, the mean inhibitory concentration of rimantadine increased with time in the rimantadine group (r = .4, P = .002) but not in the acetaminophen group. Rimantadine therapy, thus, appears to be significantly more effective than acetaminophen in ameliorating the clinical signs and symptoms of influenza in children. Treatment with rimantadine was also associated with increased viral shedding after the medication was discontinued and with the development of resistance in the clinical isolates, the significance of which is unknown.

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