scholarly journals 725. Clinical Outcomes of Elderly Individuals Presenting with Acute Respiratory Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S260-S260
Author(s):  
Allison Bloom ◽  
Sunil Suchindran ◽  
Micah T Mcclain
Keyword(s):  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Respiratory Infections ◽  
Point Of Care ◽  
Predictive Ability ◽  
Elderly Subjects ◽  
Acute Respiratory Infections ◽  
Elderly Individuals ◽  
Increased Risk ◽  
Scoring Tool

Abstract Background Elderly individuals experience increased morbidity and mortality from acute respiratory infections (ARI), which are complicated by difficulties defining etiologies of ARI and risk-stratifying patients in order to guide care. A number of scoring tools have been developed to predict illness severity and patient outcome for proven pneumonia, however less is known about the use of such metrics for all causes of ARIs. Methods We analyzed risk factors, clinical course and major outcomes of individuals ≥60 years of age presenting to the emergency department with a clinical diagnosis of ARI over a 5-year period. Results Of the enrolled individuals 40 had proven viral infection and 52 proven bacterial infections, but 184 patients with clinically adjudicated ARI (67%) remained without a proven microbial etiology despite extensive workup. Age (71.5 vs. 65.9 years, P < 0.001) and presence of cancer and heart failure were strongly predictive of illness severe enough to require hospital admission as compared with treatment in the outpatient setting. Of those with proven etiology, individuals with bacterial infection were more likely to require hospital and ICU admission (P < 0.001). When applied to this study, a modified PORT score was found to correlate more closely with clinical outcome measures than a modified CURB-65 (r, 0.54 vs. 0.39). Jackson symptom scores, historically used for viral illness, were found to inversely correlate with outcomes (r, −0.34) and show potential for differentiating viral and bacterial etiologies (P = 0.02). Interestingly, a multivariate analysis showed that a novel scoring tool utilizing sex, heart rate, respiratory rate, blood pressure, BUN, glucose and presence of chronic lung disease and cancer was highly predictive of poor outcome in elderly subjects with all-cause ARI. Conclusion Elderly subjects are at increased risk for poor clinical outcomes from ARI and their clinical management remains challenging. However, modified PORT, CURB-65, Jackson symptom score, and a novel scoring tool presented herein all offer some predictive ability for all-cause ARI in elderly subjects. Such broadly applicable scoring metrics have the potential to assist in treatment and triage decisions at the point of care. Disclosures All authors: No reported disclosures.

scholarly journals FRI0458 EFFICACY AND SAFETY OF PCV13 VACCINATION IN JIA PATIENTS WITH SYSTEMIC MANIFESTATIONS ON TOCILIZUMAB AND CANAKINUMAB TREATMENT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 826.1-827
Author(s):  
D. Vankova ◽  
E. Alexeeva ◽  
T. Dvoryakovskaya ◽  
K. Isaeva ◽  
A. Chomakhidze ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Clinical Effectiveness ◽  
Immunosuppressive Drugs ◽  
Acute Stage ◽  
Acute Respiratory Infections ◽  
Efficacy And Safety ◽  
Vaccine Response ◽  
Protection Level ◽  
Acute Group ◽  
Increased Risk

Background:The need for continuous use of immunosuppressive drugs leads to increased risk of developing infectious diseases in children with juvenile idiopathic arthritis with systemic manifestation (sJIA). Questions about choosing the optimal vaccination time and the effect of different classes of therapy on vaccination effectiveness are still open.Objectives:To study clinical and laboratory effectiveness of PCV13-vaccination in children with sJIA on tocilizumab (TOC) and canakinumab (CAN) treatment depending on disease activity stage.Methods:Prospective cohort study included 2 groups of sJIA patients: in stable remission (Remission group, n=53) receiving CAN (n=10) or TOC (n=43) treatment, and in acute stage of disease (Acute group, n=25) which started to received CAN (n=7) or TOC (n=18) either before vaccination (Acute Treated Before subgroup, n=17) or after vaccination (Acute Treated After subgroup, n=8). 0.5 ml of the 13-valent PCV was administered once subcutaneously. Efficacy was evaluated by achieving of protection level of anti-pneumococcal antibodies after 4 weeks and by clinical indicators after 6 month follow-up: frequency of acute respiratory infections, frequency of antibiotics treatment courses, frequency of temporary withdrawal of biologics treatment due to severe infections. Frequency of events were counted per patients-years.Results:Four weeks after vaccination, protection level of anti-pneumococcal antibodies was achieved by for 36 (67.9%) patients in Remission group, 16 (64%) patients in Acute group (intergroup p=0.932), and in 8 (47.06%) patients in Acute Treated Before subgroup and in 8 (100%) patients in Acute Treated After subgroup (intersubgroup p=0.022). PCV13 have shown high clinical effectiveness in both Remission group and Acute group. Reducing of acute respiratory infections frequency was as follows: from 4.57 to 2.15 episodes per patient-year in Remission group (p<0.001) and from 4.32 to 1.28 per patient-year in Acute group (p<0.001).Duration of antibiotics treatment reduced from 2.31 to 0.81 weeks per 1 patient-year in Remission group (p<0.001) from 1.97 to 0.74 in Acute group (p<0.001). Among patients who were previously treated with biologics, frequency of therapy withdrawal reduced from 4.34 to 2.42 per patient-year in Remission group (p<0.001) and from 3.53 to 1.18 in Acute Treated Before subgroup (p=0.002). The incidence of reactions to vaccination of PCV13 (local hyperemia, pain, subfebrile temperature) was similar in groups (22 (41.5%) for Remission group and 7 (28%) for Acute group, p= 0.319).Conclusion:Vaccination with the 13-valent PCV has demonstrated high clinical efficacy and safety in children with sJIA both in the acute stage of the disease and during remission. Vaccination of patients in acute stage of sJIA before treatment has advantages over vaccination during remission or after prolonged immunosuppressive therapy in terms of achieving an adequate vaccine response.Disclosure of Interests:Dariya Vankova: None declared, Ekaterina Alexeeva Grant/research support from: Roche, Pfizer, Centocor, Novartis, Speakers bureau: Roche, Novartis, Pfizer., Tatyana Dvoryakovskaya: None declared, Ksenia Isaeva: None declared, Aleksandra Chomakhidze: None declared, Rina Denisova: None declared, Anna Mamutova: None declared, Anna Fetisova: None declared, Marina Gautier: None declared, Elizaveta Krekhova: None declared, Meyri Shingarova: None declared, Ivan Kriulin: None declared, Anastasiya Kontorovich: None declared, Olga Galkina: None declared, Tatyana Radygina: None declared, Irina Zubkova: None declared, Natalia Tkachenko: None declared, Yanina Orlova: None declared, Mariya Kurdup: None declared, Anna Ismailova: None declared, Alina Alshevskaya: None declared, Andrey Moskalev: None declared, Olga Lomakina: None declared

Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care

2012 ◽  
Author(s):  
Rune Aabenhus ◽  
Jens-Ulrik S Jensen ◽  
Karsten Juhl Jørgensen ◽  
Asbjørn Hróbjartsson ◽  
Lars Bjerrum
Keyword(s):  
Primary Care ◽  
Respiratory Infections ◽  
Point Of Care ◽  
Acute Respiratory Infections ◽  
Point Of Care Tests

scholarly journals The aging lung mucosa: A proteomics study

2021 ◽  
Author(s):  
Andreu Garcia-Vilanova ◽  
Angelica M. Olmo-Fontanez ◽  
Juan I. Moliva ◽  
Anna Allue Guardia ◽  
Harjinder Singh ◽  
...  
Keyword(s):  
Regulatory Networks ◽  
Elderly Population ◽  
Respiratory Infections ◽  
The Elderly ◽  
Pulmonary Diseases ◽  
Lung Cells ◽  
Molecular Fingerprints ◽  
Elderly Individuals ◽  
Increased Risk ◽  
Insight Into

The elderly population is at increased risk of acute and chronic respiratory infections and other pulmonary diseases, and it is estimated that this population will double in the next 30 years. Biochemical changes in the lung alveolar mucosa and lung cells alter local immune response as we age, creating opportunities for invading pathogens to establish successful infections. Indeed, the lungs of the elderly are a pro-inflammatory, pro-oxidative, dysregulated environment but this environment has remained understudied. We performed a comprehensive, quantitative proteomic profile of the lung mucosa in the elderly, developing insight into the molecular fingerprints, pathways, and regulatory networks that characterize the lung in old age. We identified neutrophils in the lungs of elderly individuals as possible contributors to dysregulated lung tissue environment. This study establishes a baseline for future investigations to develop strategies to mitigate susceptibility to respiratory infections in the elderly.

IS ASTHMA AND USE OF INHALED CORTICOSTEROIDS A RISK FACTOR FOR COVID-19 INFECTION?A CLINICAL REVIEW

2021 ◽  
pp. 1-3
Author(s):  
Ajeet Subramaniam ◽  
Aktham Ghazal
Keyword(s):  
Risk Factor ◽  
Lung Disease ◽  
Clinical Review ◽  
Inhaled Corticosteroids ◽  
Respiratory Infections ◽  
Acute Respiratory Infections ◽  
Increased Risk ◽  
Lower Airways

Asthma is the most common chronic inammatory lung disease worldwide and SARS-CoV-2 primarily affects the upper and lower airways leading to marked inammation, the question arises about the possible clinical and pathophysiological association between asthma and SARS-CoV-2/COVID-19. Other questions include whether use of Inhaled Corticosteroids (ICS) affects the outcomes of acute respiratory infections due to coronavirus, whether patients with asthma are at increased risk of developing COVID-19? This clinical review aims to answer some of these questions based on latest research on asthma and COVID-19.

scholarly journals Association of Acute Respiratory Infections with Indoor Air Pollution from Biomass Fuel Exposure among Under-Five Children in Jimma Town, Southwestern Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Abebaw Addisu ◽  
Tesfalem Getahun ◽  
Mulunesh Deti ◽  
Yilkal Negesse ◽  
Besufekad Mekonnen
Keyword(s):  
Particulate Matter ◽  
Respiratory Infection ◽  
Acute Respiratory Infection ◽  
Indoor Air Pollution ◽  
Respiratory Infections ◽  
Biomass Fuel ◽  
Acute Respiratory Infections ◽  
Under Five ◽  
Under Five Children ◽  
Increased Risk

Background. Most of the households in developing countries burn biomass fuel in traditional stoves with incomplete combustion that leads to high indoor air pollution and acute respiratory infections. Acute respiratory infection is the most common cause of under-five morbidity and mortality accounting for 2 million deaths worldwide and responsible for 18% of deaths among under-five children in Ethiopia. Although studies were done on acute respiratory infections, the majority of studies neither clinically diagnose respiratory infections nor use instant measurement of particulate matter. Methods. The community-based cross-sectional study design was employed among under-five children in Jimma town from May 21 to June 7, 2020. A total of 265 children through systematic random sampling were included in the study. The data were collected using a pretested semistructured questionnaire and laser pm 2.5 meter for indoor particulate matter concentration. Associations among factors were assessed through correlation analysis, and binary logistic regression was done to predict childhood acute respiratory infections. Variables with p -value less than 0.25 in bivariate regression were the candidate for the final multivariate logistic regression. Two independent sample t-tests were done to compare significant mean difference between concentrations of particulate matter. Results. Among 265 under-five children who were involved in the study, 179 (67.5%) were living in households that predominantly use biomass fuel. Prevalence of acute respiratory infections in the study area was 16%. Children living in households that use biomass fuel were four times more likely to develop acute respiratory infections than their counterparts (AOR: 4.348; 95% CI: 1.632, 11.580). The size of household was significantly associated with the prevalence of acute respiratory infections. Under-five children living in households that have a family size of six and greater had odds of 1.7 increased risk of developing acute respiratory infections than their counterparts (AOR: 1.7; 95% CI: 1.299, 2.212). The other factor associated with acute respiratory infection was separate kitchen; children living in households in which there were no separate kitchen were four times at increased risk of developing acute respiratory infection than children living in households which have separate kitchen (AOR: 4.591; 95% CI: 1.849, 11.402). The concentration of indoor particulate matter was higher in households using biomass fuel than clean fuel. There was statistically higher particulate matter concentration in the kitchen than living rooms (t = 4.509, p ≤ 0.001 ). Particulate matter 2.5 concentrations (μg/m3) of the households that had parental smoking were significantly higher than their counterparts (AOR: 20.224; 95% CI: 1.72, 12.58). Conclusion. There is an association between acute respiratory infections and biomass fuel usage among under-five children. Focusing on improved energy sources is essential to reduce the burden and assure the safety of children.

scholarly journals Epidemiological and clinical features of acute respiratory infections occurring in St. Petersburg during the 2017–2018 and 2018–2019 epidemic seasons

2021 ◽  
Vol 13 (2) ◽  
pp. 53-60
Author(s):  
D. A. Guzhov ◽  
E. A. Elpaeva ◽  
M. A. Egorova ◽  
V. A. Eder ◽  
I. L. Baranovskya ◽  
...  
Keyword(s):  
Clinical Features ◽  
Respiratory Infection ◽  
Acute Respiratory Infection ◽  
Influenza A ◽  
Bacterial Infections ◽  
Respiratory Infections ◽  
Influenza B Virus ◽  
Influenza B ◽  
Acute Respiratory Infections ◽  
Pharyngeal Wall

Objective: to analyze the epidemiological and clinical features of acute respiratory infections occurring during the St. Petersburg 2017-2018 and 2018-2019 epidemic seasons.Materials and methods: the study included 457 patients, treated in St. Petersburg clinics from 2017-2019, displaying symptoms of acute respiratory infection (ARI), including evaluation of their clinical histories. Pathogen types were determined by polymerase chain reaction (PCR). Data analysis was carried out using mathematical statistics methods using the Statistica 10 software package (StatSoft Inc.).Results: in this study, we examined the epidemiological and clinical features of acute respiratory infections in St. Petersburg occurring during two epidemic seasons, 2017-2018 and 2018-2019. The 2017-2018 season was characterized by a prevalence of infections caused by influenza B viruses and influenza A subtype H3N2 viruses. In the 2018-2019 season, there was a greater number of acute respiratory viral infections (ARVIs) and infections caused by influenza A subtype H1N1pdm; influenza B virus was detected only in isolated cases. In the 2017-2018 sore throats and muscle aches were a characteristic symptom of influenza A H1N1pdm infections, of bacterial infections – only sore throats. It was shown that throat pain and vasodilation of the scleral and soft palate vessels were significantly more frequent in the 2017-2018 season, compared to the 2018-2019 season. Cough and redness of the posterior pharyngeal wall were hallmark signs of ARVIs in the 2018-2019 season.Conclusion: according to the data, each epidemic season is characterized not only by its own type-specific acute respiratory infection frequencies, but also by different clinical manifestation frequencies. For global monitoring, treatment effectiveness evaluation, and refined study of acute respiratory infection clinical features, it is advisable to use approaches which incorporate accurate, specific, and rapid molecular biological methods capable of identifying a broad range of pathogens.

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