scholarly journals Syncope and Influenza B: A Case of an Arresting Association

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Alan Lucerna ◽  
James Lee ◽  
James Espinosa
Keyword(s):  
Influenza A ◽  
The United States ◽  
Permanent Pacemaker ◽  
Cardiac Complications ◽  
Influenza B ◽  
Sinus Arrest ◽  
Cardiac Events ◽  
Severe Bradycardia ◽  
Pacemaker Placement ◽  
Multiple Episodes

Influenza is a contagious viral illness that usually presents with upper respiratory and pulmonary symptoms. While generally self-limited, pulmonary, renal, metabolic, neurologic, and cardiac complications have all been described in the literature. Here we describe a case of a 46-year-old male with multiple episodes of syncope, found to have severe bradycardia, sinus arrest, and positive influenza B, requiring permanent pacemaker placement. The viruses responsible for the flu can be differentiated into four types: A, B, C, and D. The two primary viruses responsible for the seasonal winter epidemic influenza in the United States are Human Influenza A and B viruses. It has been postulated that the influenza virus may be responsible for activating acute inflammatory cytokines, which then alter electrical conduction properties of endothelial cells. Although there have been cases of sinus arrest in association with influenza, some requiring pacemaker placement, our patient’s presentation with multiple episodes of syncope with severe bradycardia and sinus arrest requiring permanent pacemaker placement, in association with influenza B, is very unusual and possibly unique. Since emergency physicians are at the forefront in the diagnosis, treatment, and disposition of these patients, awareness of influenza triggered cardiac events is essential and lifesaving, especially in unvaccinated patients.

Sexually Transmitted, Urinary Tract, and Gastrointestinal Tract Infections

2016 ◽  
pp. 521-538
Author(s):  
M. Rizwan Sohail
Keyword(s):  
Influenza A ◽  
The United States ◽  
Antigenic Drift ◽  
Influenza B ◽  
Sexually Transmitted ◽  
Influenza Pandemics ◽  
Population Immunity ◽  
Large Numbers ◽  
Seasonal Epidemics ◽  
Tract Infections

Influenza causes annual, seasonal epidemics that lead to tens of thousands of deaths each year in the United States. Two influenza A strains (H3N2 and H1N1) and 1 or 2 influenza B strains typically circulate during winter months and undergo minor antigenic mutations (antigenic drift) resulting in annual seasonal epidemics. Influenza pandemics occur more rarely (every 20-30 years) and are the result of major antigenic changes (antigenic shift) leading to large numbers of infections due to low levels of population immunity. In seasonal epidemics, 80% to 90% of deaths due to influenza occur in persons older than 65 years.

scholarly journals Improving Identification of Patients at Low Risk for Major Cardiac Events After Noncardiac Surgery Using Intraoperative Data

2020 ◽  
Vol 15 (10) ◽  
pp. 581-587
Author(s):  
Amol S Navathe ◽  
Victor J Lei ◽  
Lee A Fleisher ◽  
ThaiBinh Luong ◽  
Xinwei Chen ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Characteristic Curve ◽  
Risk Index ◽  
Model Performance ◽  
The United States ◽  
Noncardiac Surgery ◽  
Low Risk ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Complications ◽  
Cardiac Events

BACKGROUND/OBJECTIVE: Risk-stratification tools for cardiac complications after noncardiac surgery based on preoperative risk factors are used to inform postoperative management. However, there is limited evidence on whether risk stratification can be improved by incorporating data collected intraoperatively, particularly for low-risk patients. METHODS: We conducted a retrospective cohort study of adults who underwent noncardiac surgery between 2014 and 2018 at four hospitals in the United States. Logistic regression with elastic net selection was used to classify in-hospital major adverse cardiovascular events (MACE) using preoperative and intraoperative data (“perioperative model”). We compared model performance to standard risk stratification tools and professional society guidelines that do not use intraoperative data. RESULTS: Of 72,909 patients, 558 (0.77%) experienced MACE. Those with MACE were older and less likely to be female. The perioperative model demonstrated an area under the receiver operating characteristic curve (AUC) of 0.88 (95% CI, 0.85-0.92). This was higher than the Lee Revised Cardiac Risk Index (RCRI) AUC of 0.79 (95% CI, 0.74-0.84; P < .001 for AUC comparison). There were more MACE complications in the top decile (n = 1,465) of the perioperative model’s predicted risk compared with that of the RCRI model (n = 58 vs 43). Additionally, the perioperative model identified 2,341 of 7,597 (31%) patients as low risk who did not experience MACE but were recommended to receive postoperative biomarker testing by a risk factor–based guideline algorithm. CONCLUSIONS: Addition of intraoperative data to preoperative data improved prediction of cardiovascular complication outcomes after noncardiac surgery and could potentially help reduce unnecessary postoperative testing.

scholarly journals Anomalous influenza seasonality in the United States and the emergence of novel influenza B viruses

2021 ◽  
Vol 118 (5) ◽  
pp. e2012327118
Author(s):  
Rebecca K. Borchering ◽  
Christian E. Gunning ◽  
Deven V. Gokhale ◽  
K. Bodie Weedop ◽  
Arash Saeidpour ◽  
...  
Keyword(s):  
United States ◽  
Influenza A ◽  
Reproduction Number ◽  
Influenza Season ◽  
The United States ◽  
Influenza B ◽  
Relative Dynamics ◽  
2009 H1n1 ◽  
Kinetics Of ◽  
Early Activity

The 2019/2020 influenza season in the United States began earlier than any season since the 2009 H1N1 pandemic, with an increase in influenza-like illnesses observed as early as August. Also noteworthy was the numerical domination of influenza B cases early in this influenza season, in contrast to their typically later peak in the past. Here, we dissect the 2019/2020 influenza season not only with regard to its unusually early activity, but also with regard to the relative dynamics of type A and type B cases. We propose that the recent expansion of a novel influenza B/Victoria clade may be associated with this shift in the composition and kinetics of the influenza season in the United States. We use epidemiological transmission models to explore whether changes in the effective reproduction number or short-term cross-immunity between these viruses can explain the dynamics of influenza A and B seasonality. We find support for an increase in the effective reproduction number of influenza B, rather than support for cross-type immunity-driven dynamics. Our findings have clear implications for optimal vaccination strategies.

scholarly journals 2553. Individual Patient-Level Data Meta-Analysis of Live Attenuated and Inactivated Influenza Vaccine Effectiveness Among US Children, 2013–2014 Through 2015–2016

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S68-S68
Author(s):  
Jessie Chung ◽  
Brendan Flannery ◽  
Rodolfo Begue ◽  
Herve Caspard ◽  
Laurie Demarcus ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Influenza A ◽  
The United States ◽  
Vaccine Effectiveness ◽  
Vaccination Status ◽  
Influenza B ◽  
Rt Pcr ◽  
Current Season ◽  
Influenza A H1n1 ◽  
Vaccine Type

Abstract Background Quadrivalent live attenuated influenza vaccine (LAIV4) was not recommended for use in the United States for the 2016–2017 and 2017–2018 influenza seasons based on US observational studies of vaccine effectiveness (VE) from 2013–2014 to 2015–2016. We pooled individual patient data on children aged 2–17 years enrolled in 5 US studies during these 3 influenza seasons to further investigate VE by vaccine type. Methods Analyses included 17,173 children enrolled in the US Department of Defense Global Laboratory-based Influenza Surveillance Program, US Influenza Vaccine Effectiveness Network, Influenza Incidence Surveillance Project, Influenza Clinical Investigation for Children, and a Louisiana State University study. Participants’ specimens were tested for influenza by reverse transcription-polymerase chain reaction (RT-PCR), culture, or a combination of rapid antigen testing and RT-PCR. VE was calculated by comparing odds of vaccination with either inactivated influenza vaccine (IIV) or LAIV4 among influenza-positive cases to test-negative controls and calculated as 100 × (1 − odds ratio) in logistic regression models with age, calendar time, influenza season, and study site (random effect). Patients were stratified by prior season vaccination status in a subanalysis. Results Overall, 38% of patients (N = 6,558) were vaccinated in the current season, of whom 30% (N = 1,979) received LAIV4. Pooled VE of IIV against any influenza virus was 51% (95% CI: 47, 54) versus 26% (95% CI: 15, 36) for LAIV4. Point estimates for pooled VE against any influenza by age group ranged from 45% to 58% for IIV and 19% to 34% for LAIV4 during the 3 seasons (Figures 1 and 2). Pooled VE against influenza A(H1N1)pdm09 was 67% (95% CI: 62, 72) for IIV versus 20% (95% CI: −6, 39) for LAIV4. Pooled VE against influenza A(H3N2) was 29% (95% CI: 14, 42) for IIV versus 7% (95% CI: −11, 23) for LAIV4, and VE against influenza B was 52% (95% CI: 42, 60) for IIV and 66% (95% CI: 47, 77) for LAIV4. VE against influenza A(H1N1)pdm09 was lower for LAIV4 versus IIV across all strata of prior season vaccination (Figure 3). Conclusion Consistent with individual studies, our pooled analyses found that LAIV4 effectiveness was reduced for all age groups against influenza A(H1N1)pdm09 compared with IIV. This result did not vary based on prior vaccination status. Disclosures H. Caspard, AstraZeneca: Employee, Salary.

scholarly journals Surveillance for Neuraminidase Inhibitor Resistance among Human Influenza A and B Viruses Circulating Worldwide from 2004 to 2008

2008 ◽  
Vol 52 (9) ◽  
pp. 3284-3292 ◽  
Author(s):  
Tiffany G. Sheu ◽  
Varough M. Deyde ◽  
Margaret Okomo-Adhiambo ◽  
Rebecca J. Garten ◽  
Xiyan Xu ◽  
...  
Keyword(s):  
United States ◽  
Influenza A ◽  
Neuraminidase Inhibitor ◽  
The United States ◽  
H3n2 Virus ◽  
Influenza B ◽  
Close Monitoring ◽  
Oseltamivir Resistance ◽  
H3n2 Influenza ◽  
Inhibitor Resistance

ABSTRACT The surveillance of seasonal influenza virus susceptibility to neuraminidase (NA) inhibitors was conducted using an NA inhibition assay. The 50% inhibitory concentration values (IC50s) of 4,570 viruses collected globally from October 2004 to March 2008 were determined. Based on mean IC50s, A(H3N2) viruses (0.44 nM) were more sensitive to oseltamivir than A(H1N1) viruses (0.91 nM). The opposite trend was observed with zanamivir: 1.06 nM for A(H1N1) and 2.54 nM for A(H3N2). Influenza B viruses exhibited the least susceptibility to oseltamivir (3.42 nM) and to zanamivir (3.87 nM). To identify potentially resistant viruses (outliers), a threshold of a mean IC50 value + 3 standard deviations was defined for type/subtype and drug. Sequence analysis of outliers was performed to identify NA changes that might be associated with reduced susceptibility. Molecular markers of oseltamivir resistance were found in six A(H1N1) viruses (H274Y) and one A(H3N2) virus (E119V) collected between 2004 and 2007. Some outliers contained previously reported mutations (e.g., I222T in the B viruses), while other mutations [e.g., R371K and H274Y in B viruses and H274N in A(H3N2) viruses) were novel. The R371K B virus outlier exhibited high levels of resistance to both inhibitors (>100 nM). A substantial variance at residue D151 was observed among A(H3N2) zanamivir-resistant outliers. The clinical relevance of newly identified NA mutations is unknown. A rise in the incidence of oseltamivir resistance in A(H1N1) viruses carrying the H274Y mutation was detected in the United States and in other countries in the ongoing 2007 to 2008 season. As of March 2008, the frequency of resistance among A(H1N1) viruses in the United States was 8.6% (50/579 isolates). The recent increase in oseltamivir resistance among A(H1N1) viruses isolated from untreated patients raises public health concerns and necessitates close monitoring of resistance to NA inhibitors.

scholarly journals 1521. Risk factors associated with complications of influenza A or B infection, southern Puerto Rico, 2016-2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S762-S763
Author(s):  
Angel L Perez-Caro ◽  
Frances Quiñones-Del Toro ◽  
Marilyn García-Burgos ◽  
Vanessa Rivera-Amill ◽  
Luisa I Alvarado-Domenech
Keyword(s):  
Puerto Rico ◽  
Influenza A ◽  
Tertiary Care ◽  
Febrile Illness ◽  
The United States ◽  
Influenza B Virus ◽  
Influenza B ◽  
Care Hospital ◽  
X Ray ◽  
Chest X Ray

Abstract Background Influenza is one of the most common viral respiratory diseases in the United States with 9–45 million cases per year. In Puerto Rico, more than 18,000 cases of influenza were reported during the 2019/20 season. The Sentinel Enhanced Dengue Surveillance System (SEDSS) conducts acute febrile illness surveillance for inpatient and outpatients at a southern Puerto Rico tertiary care hospital. Methods We performed a retrospective analysis of disease severity among laboratory-confirmed influenza cases enrolled in SEDSS. Cases with complications such as pneumonia or bronchitis evidenced by chest x-ray or clinical diagnosis were classified as severe. Results Between January 2016 and December 2019, there were 2,835 laboratory-confirmed influenza cases. More than half (1,662, 59%) were aged 0–20 years, 51% (n=1,447)were female, and 4% (n=124)required hospital admission. Among all influenza cases, influenza A virus was most common (n = 1,963, 69%) followed by influenza B virus (n = 872, 31%). Odds of having influenza A were higher among adults (OR=1.62; 95% CI:1.38-1.92). Chronic disease history among influenza cases included: asthma (n= 507, 18%), hypertension (n = 337, 12%), hypercholesterolemia (n = 157, 6%), coronary heart disease (n = 79, 3%), immunodeficiency (n = 11, 1%), and kidney disease (n = 10, 1%). Overall, 61(2%) influenza cases developed complications, 21 developed pneumonia of which 85% had chest x-ray performed. One-third of influenza cases with pneumonia or bronchitis had preexisting conditions like asthma (33%) and hypertension (34%). Seventy five percent of Influenza A cases with asthma developed bronchitis or pneumonia. The odds of having severe Influenza were higher among patients with underlying hypertension compared to those without hypertension (OR= 3.8; 95% CI:2.0–7.1). Moreover, influenza cases with asthma had a higher odd of developing pneumonia or bronchitis as compared to those without asthma (OR=2.3; 95% CI: 1.3–4.0). While asthma is a recognized risk factor for influenza complications, isolated hypertension is not. Conclusion Identifying people at risk for influenza complications provides a guide for clinicians and public health officials to implement preventive measures and improve clinical outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Development of an Alternative Modified Live Influenza B Virus Vaccine

2017 ◽  
Vol 91 (12) ◽  
Author(s):  
Jefferson J. S. Santos ◽  
Courtney Finch ◽  
Troy Sutton ◽  
Adebimpe Obadan ◽  
Isabel Aguirre ◽  
...  
Keyword(s):  
Influenza A ◽  
The United States ◽  
Influenza B Virus ◽  
Influenza B ◽  
Temperature Sensitive ◽  
Complete Protection ◽  
C Terminus ◽  
B Virus

ABSTRACT Influenza B virus (IBV) is considered a major human pathogen, responsible for seasonal epidemics of acute respiratory illness. Two antigenically distinct IBV hemagglutinin (HA) lineages cocirculate worldwide with little cross-reactivity. Live attenuated influenza virus (LAIV) vaccines have been shown to provide better cross-protective immune responses than inactivated vaccines by eliciting local mucosal immunity and systemic B cell- and T cell-mediated memory responses. We have shown previously that incorporation of temperature-sensitive (ts) mutations into the PB1 and PB2 subunits along with a modified HA epitope tag in the C terminus of PB1 resulted in influenza A viruses (IAV) that are safe and effective as modified live attenuated (att) virus vaccines (IAV att). We explored whether analogous mutations in the IBV polymerase subunits would result in a stable virus with an att phenotype. The PB1 subunit of the influenza B/Brisbane/60/2008 strain was used to incorporate ts mutations and a C-terminal HA tag. Such modifications resulted in a B/Bris att strain with ts characteristics in vitro and an att phenotype in vivo. Vaccination studies in mice showed that a single dose of the B/Bris att candidate stimulated sterilizing immunity against lethal homologous challenge and complete protection against heterologous challenge. These studies show the potential of an alternative LAIV platform for the development of IBV vaccines. IMPORTANCE A number of issues with regard to the effectiveness of the LAIV vaccine licensed in the United States (FluMist) have arisen over the past three seasons (2013–2014, 2014–2015, and 2015–2016). While the reasons for the limited robustness of the vaccine-elicited immune response remain controversial, this problem highlights the critical importance of continued investment in LAIV development and creates an opportunity to improve current strategies so as to develop more efficacious vaccines. Our laboratory has developed an alternative strategy, the incorporation of 2 amino acid mutations and a modified HA tag at the C terminus of PB1, which is sufficient to attenuate the IBV. As a LAIV, this novel vaccine provides complete protection against IBV strains. The availability of attenuated IAV and IBV backbones based on contemporary strains offers alternative platforms for the development of LAIVs that may overcome current limitations.

scholarly journals Pacemaker Placement in Patients with Stroke-Mediated Autonomic Dysregulation

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Ali A. Alsaad ◽  
Christopher O. Austin ◽  
Maisha T. Robinson ◽  
Michael B. Phillips
Keyword(s):  
Medulla Oblongata ◽  
Posterior Inferior Cerebellar Artery ◽  
Clinical Manifestations ◽  
Permanent Pacemaker ◽  
Sinus Arrest ◽  
Autonomic Dysregulation ◽  
Ischemic Disease ◽  
Lateral Medullary Syndrome ◽  
Pacemaker Placement ◽  
Symptomatic Bradycardia

Lateral medullary syndrome (LMS) is an ischemic disease of the medulla oblongata, which involves the territory of the posterior inferior cerebellar artery. Lateral medullary syndrome is often missed as the cause of autonomic dysregulation in patients with recent brain stem stroke. Due to the location of the baroreceptor regulatory center in the lateral medulla oblongata, patients with LMS occasionally have autonomic dysregulation-associated clinical manifestations. We report a case of LMS-associated autonomic dysregulation. The case presented as sinus arrest and syncope, requiring permanent pacemaker placement. A dual-chamber pacemaker was placed, after failure of conservative measures to alleviate the patient’s symptoms. Our case shows the importance of recognizing LMS as a potential cause for life-threatening arrhythmias, heart block, and symptomatic bradycardia. Placement of permanent pacemaker may be necessary in some patients with LMS presenting with syncope, secondary to sinus arrest.

scholarly journals Takotsubo syndrome with severe bradycardia initiated by seizure: Is the implantation of a permanent pacemaker necessary?

2018 ◽  
pp. bcr-2018-226480 ◽  
Author(s):  
Yoichi Imori ◽  
Yu-Ki Iwasaki ◽  
Hitoshi Takano ◽  
Wataru Shimizu
Keyword(s):  
Cardiogenic Shock ◽  
Sick Sinus Syndrome ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Takotsubo Syndrome ◽  
Sinus Arrest ◽  
Subacute Phase ◽  
Severe Bradycardia ◽  
Cardiovascular Care

Although arrhythmias are frequent in patients with Takotsubo syndrome (TTS), data on sick sinus syndrome remain elusive. Here, we report a case of TTS initiated by a seizure as a physical trigger that led to sinus arrest. The patient presented with cardiogenic shock and bradycardia which required intensive cardiovascular care. However, in the subacute phase of TTS, the sinus function recovered significantly, and pacemaker implantation was deferred.

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