Viral Infections of the Upper Airway in the Setting of COVID-19: A Primer for Rhinologists

Background Viral respiratory tract infections are associated with a significant burden of disease and represent one of the leading causes of mortality worldwide. The current Coronavirus Disease 2019 (COVID-19) pandemic highlights the devastating toll that respiratory viruses have on humanity and the desperate need to understand the biological characteristics that define them in order to develop efficacious treatments and vaccines. To date, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected nearly 600 times more people and resulted in 200 times more deaths relative to Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) combined. Objective Through this review, we aim to summarize the key characteristics of respiratory viruses that hold global significance, with a focus on SARS-CoV-2. Our goal is to disseminate our current knowledge of these infectious agents to otolaryngologists, in particular rhinologists, practicing in the COVID-19 era. Methods The general and clinical characteristics of selected respiratory viruses along with available viral treatments and vaccines are reviewed. Results There has been significant progress in our understanding of the epidemiology and pathogenesis of various respiratory viruses. However, despite the advancement in knowledge, efficacious vaccines and antiviral treatments remain elusive for most respiratory viruses. The dire need for these scientific discoveries is highlighted by the recent COVID-19 pandemic, which has prompted investigators worldwide to conduct clinical trials at an accelerated timeline in an effort to reduce the morbidity and mortality associated with SARS-CoV-2 infection. Rhinologists will continue to remain on the front-lines of pandemics associated with respiratory viruses. Conclusion In light of these unprecedented times, the need to understand the nuances of these viral respiratory pathogens, especially SARS-CoV-2, cannot be overemphasized. This knowledge base is of particular importance to otolaryngologists, whose expertise in the upper airway coincides with the anatomic tropism of these infectious agents.

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Respiratory viral infections in the elderly

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466621995050 ◽

2021 ◽

Vol 15 ◽

pp. 175346662199505

Author(s):

Alastair Watson ◽

Tom M. A. Wilkinson

Keyword(s):

Immune System ◽

Viral Infections ◽

Point Of Care ◽

The Elderly ◽

Respiratory Viruses ◽

Morbidity And Mortality ◽

Detection Methods ◽

Respiratory Viral Infections ◽

Tract Infections ◽

Prolonged Hospital

With the global over 60-year-old population predicted to more than double over the next 35 years, caring for this aging population has become a major global healthcare challenge. In 2016 there were over 1 million deaths in >70 year olds due to lower respiratory tract infections; 13–31% of these have been reported to be caused by viruses. Since then, there has been a global COVID-19 pandemic, which has caused over 2.3 million deaths so far; increased age has been shown to be the biggest risk factor for morbidity and mortality. Thus, the burden of respiratory viral infections in the elderly is becoming an increasing unmet clinical need. Particular challenges are faced due to the interplay of a variety of factors including complex multimorbidities, decreased physiological reserve and an aging immune system. Moreover, their atypical presentation of symptoms may lead to delayed necessary care, prescription of additional drugs and prolonged hospital stay. This leads to morbidity and mortality and further nosocomial spread. Clinicians currently have limited access to sensitive detection methods. Furthermore, a lack of effective antiviral treatments means there is little incentive to diagnose and record specific non-COVID-19 viral infections. To meet this unmet clinical need, it is first essential to fully understand the burden of respiratory viruses in the elderly. Doing this through prospective screening research studies for all respiratory viruses will help guide preventative policies and clinical trials for emerging therapeutics. The implementation of multiplex point-of-care diagnostics as a mainstay in all healthcare settings will be essential to understand the burden of respiratory viruses, diagnose patients and monitor outbreaks. The further development of novel targeted vaccinations as well as anti-viral therapeutics and new ways to augment the aging immune system is now also essential. The reviews of this paper are available via the supplemental material section.

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Clinical-epidemiological peculiarities of acute respiratory infections in children from 3 to 12 years and evaluation of effectiveness of antivirus therapy

Journal Infectology ◽

10.22625/2072-6732-2019-11-3-38-45 ◽

2019 ◽

Vol 11 (3) ◽

pp. 38-45

Author(s):

S. A. Khmilevskaya ◽

N. I. Zryachkin ◽

V. E. Mikhailova

Keyword(s):

Viral Infections ◽

Respiratory Infections ◽

Molecular Genetic ◽

Respiratory Viruses ◽

Acute Respiratory Infections ◽

Age Group ◽

Leading Role ◽

Respiratory Viral Infections ◽

Acute Respiratory Viral Infection ◽

Tract Infections

The aim: to study the etiological structure of acute respiratory infections in children aged 3 to 12 hospitalized in the early stages of the disease in the department of respiratory infections of the children’s hospital, and to reveal the features of their clinical course and the timing of DNA / RNA elimination of respiratory viruses from nasal secretions, depending on the method of therapy. Materials and methods: 100 children with acute respiratory infections aged 3 to 12 years were monitored. The nasal secrets on the DNA / RNA of respiratory viruses were studied by PCR. Depending on the method of therapy, patients were divided into 2 groups: patients of group 1 (comparison) received basic treatment (without the use of antiviral drugs), in patients of the 2nd group (main), along with basal therapy, the drug was used umifenovir in a 5-day course at the ageappropriate dosage. Results: In the etiologic structure of ARVI in children from 3 to 12 years, the leading place was taken by rhinovirus, influenza and metapneumovirus infections (isolated – 18%, 19% and 20% respectively, in the form of a mixed infection – 11%). The main syndromic diagnosis at the height of the disease was rhinopharyngitis. Complications were observed in 42% of cases, as often as possible with flu – 53% of cases. Features of metapneumovirus infection in children of this age group were: predominance of non-severe forms of the disease in the form of acute fever with symptoms of rhinopharyngitis, as well as a small incidence of lower respiratory tract infections. The use of the drug umiphenovir in children with acute respiratory viral infections of various etiologies contributed to significantly faster elimination of viral DNA / RNA from the nasal secretion, which was accompanied by a ecrease in the duration of the main clinical and hematological symptoms of the disease, a decrease in the incidence of complications, and reduced the duration of stay in hospital. Conclusion: application of modern molecular genetic methods of diagnostics made it possible to identify the leading role of influenza, metapneumovirus and rhinovirus infections in the etiology of acute respiratory viral infection in patients aged 3 to 12 years, and to determine a number of clinical features characteristic of this age group. The results of the study testify to the effectiveness of umiphenovir in the treatment of children with acute respiratory viral infections of various etiologies and allow us to recommend this drug as an effective and safe etiotropic agent.

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Infection, inflammation and thrombosis: a review of potential mechanisms mediating arterial thrombosis associated with influenza and severe acute respiratory syndrome coronavirus 2

Biological Chemistry ◽

10.1515/hsz-2021-0348 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Stefan Veizades ◽

Alexandria Tso ◽

Patricia K. Nguyen

Keyword(s):

Myocardial Infarction ◽

Severe Acute Respiratory Syndrome ◽

Arterial Thrombosis ◽

Viral Infections ◽

Respiratory Viruses ◽

Causal Connection ◽

Immune Systems ◽

Clinical Observations ◽

Increased Risk ◽

Time Of Infection

Abstract Thrombosis has long been reported as a potentially deadly complication of respiratory viral infections and has recently received much attention during the global coronavirus disease 2019 pandemic. Increased risk of myocardial infarction has been reported during active infections with respiratory viruses, including influenza and severe acute respiratory syndrome coronavirus 2, which persists even after the virus has cleared. These clinical observations suggest an ongoing interaction between these respiratory viruses with the host’s coagulation and immune systems that is initiated at the time of infection but may continue long after the virus has been cleared. In this review, we discuss the epidemiology of viral-associated myocardial infarction, highlight recent clinical studies supporting a causal connection, and detail how the virus’ interaction with the host’s coagulation and immune systems can potentially mediate arterial thrombosis.

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Etiology of Respiratory Tract Infections in Children in Cali, Colombia

PEDIATRICS ◽

10.1542/peds.57.1.123 ◽

1976 ◽

Vol 57 (1) ◽

pp. 123-130

Author(s):

Jorge A. Escobar ◽

Arthur S. Dover ◽

Alvaro Dueñas ◽

Ermilson Leal ◽

Pablo Medina ◽

...

Keyword(s):

Diagnostic Category ◽

Final Diagnosis ◽

Respiratory Pathogens ◽

Laboratory Procedure ◽

Etiologic Agents ◽

Serologic Evidence ◽

Degree Of Confidence ◽

Tract Infections ◽

Viral Respiratory ◽

Etiologic Diagnosis

One hundred eighty children hospitalized for acute respiratory disease were studied in Cali, Colombia. In the majority of patients, pneumonia was the reason for hospitalization and remained the final diagnosis. Fifty-one cases of pneumonia of indeterminate etiology comprised the largest single diagnostic category, followed by 38 cases of pneumonia associated with measles, and 22 cases associated with serologic evidence of infection with other viral agents or Mycoplasma pneumoniae. Etiologic diagnosis could be assigned with a reasonable degree of confidence in 116 of the 180 patients (64%). The laboratory procedure found most likely to provide the etiologic diagnosis in this series was paired sera specimens for demonstration of rise in antibody titer against the common viral respiratory pathogens. Those most frequently implicated serologically as etiologic agents in the cases studied were, in order of decreasing frequency, measles, influenza, parainfluenza, and adenoviruses.

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Hospital-Acquired Viral Respiratory Tract Infections in the Neonatal Unit: A Comparison with Other Inpatient Groups

Neonatology ◽

10.1159/000506427 ◽

2020 ◽

Vol 117 (4) ◽

pp. 513-516

Author(s):

Chiara Taylor ◽

Shin Tan ◽

Rebecca McClaughry ◽

Don Sharkey

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Viral Infections ◽

Age Groups ◽

Length Of Hospital Stay ◽

Fold Increase ◽

Hospital Inpatient ◽

Tract Infections ◽

Hospital Acquired ◽

Viral Respiratory

Background: Hospital-acquired viral respiratory tract infections (VRTIs) cause significant morbidity and mortality in neonatal patients. This includes escalation of respiratory support, increased length of hospital stay, and need for home oxygen, as well as higher healthcare costs. To date, no studies have compared population rates of VRTIs across age groups. Aim: Quantify the rates of hospital-acquired VRTIs in our neonatal population compared with other inpatient age groups in Nottinghamshire, UK. Methods: We compared all hospital inpatient PCR-positive viral respiratory samples between 2007 and 2013 and calculated age-stratified rates based on population estimates. Results: From a population of 4,707,217, we identified a previously unrecognised burden of VRTI in neonatal patients, only second to the 0–1-year-old group. Although only accounting for 1.3% of the population, half of the infections were in infants <1 year old and neonatal intensive care unit (NICU) patients. Human rhinovirus was the most dominant virus across the inpatient group, particularly in neonatal patients. Despite a two- to three-fold increase in the rate of positive samples in all groups during the colder months (1.1/1,000 October–March vs. 0.4/1,000 April–September), rates in the NICU did not change throughout the year at 4.3/1,000. Pandemic H1N1 influenza rates were 20 times higher in neonatal patients and infants <1 year old. Conclusion: Good epidemiological and interventional data are needed to help inform visiting and infection control policies to reduce transmission of hospital-acquired viral infections to this vulnerable population, particularly during pandemic seasons.

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Role of Probiotics in Stimulating the Immune System in Viral Respiratory Tract Infections: A Narrative Review

Nutrients ◽

10.3390/nu12103163 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3163

Author(s):

Liisa Lehtoranta ◽

Sinikka Latvala ◽

Markus J. Lehtinen

Keyword(s):

Immune System ◽

Respiratory Tract ◽

Clinical Studies ◽

Viral Infections ◽

Narrative Review ◽

Virus Infections ◽

Respiratory Illnesses ◽

Upper Respiratory ◽

Tract Infections ◽

Viral Respiratory

Viral respiratory tract infection (RTI) is the most frequent cause of infectious illnesses including the common cold. Pharmacological solutions for treating or preventing viral RTIs are so far limited and thus several self-care products are available in the market. Some dietary supplements such as probiotics have been shown to modulate immune system function and their role in reducing the risk and the course of RTIs has been investigated extensively within the past decade. However, the mechanism of action and the efficacy of probiotics against viral RTIs remains unclear. We searched PubMed, Google Scholar, and Web of Knowledge for pre-clinical and clinical studies investigating the effect of probiotics on respiratory virus infections, immune response, and the course of upper and lower respiratory tract illness. The literature summarized in this narrative review points out that specific probiotic strains seem effective in pre-clinical models, through stimulating the immune system and inhibiting viral replication. Clinical studies indicate variable efficacy on upper respiratory illnesses and lack proof of diagnosed viral infections. However, meta-analyses of clinical studies indicate that probiotics could be beneficial in upper respiratory illnesses without specific etiology. Further studies aiming at discovering the mechanisms of action of probiotics and clinical efficacy are warranted.

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The prevalence of enteroviruses that cause respiratory infections in patients with influenzavirus A/H1N1 hospitalized in the Lublin province

Current Issues in Pharmacy and Medical Sciences ◽

10.1515/cipms-2015-0015 ◽

2014 ◽

Vol 27 (3) ◽

pp. 199-201

Author(s):

Adrian Jarzynski ◽

Agata Dubas ◽

Malgorzata Polz-Dacewicz

Keyword(s):

Respiratory Tract ◽

Influenza A ◽

Respiratory Tract Infections ◽

Clinical Symptoms ◽

Respiratory Infections ◽

Genetic Material ◽

Respiratory Viruses ◽

Influenza A H1n1 ◽

Tract Infections ◽

Viral Respiratory

ABSTRACT Viruses that cause respiratory tract infections are the most common agents of infectious diseases in humans throughout the world. A virus that infects the respiratory system, may induce various clinical symptoms. What is more, the same symptoms may be caused by different viruses. The aim of the study was to analyze the prevalence of enteroviruses that cause respiratory infections in patients with influenzavirus A/H1N1 hospitalized in the Lublin province. The experimental material was throat and nose swabs taken from patients hospitalized in Lublin and Tomaszow Lubelski. In the group of 44 patients (20 women and 24 men) infected with influenza A/H1N1, the genetic material of enteroviruses was detected in 13 patients (29.5%). Respiratory viruses co-infections are very common in hospitalized patients. Studies show that co-infection with influenza virus and enterovirus are more common in children than in adults. Moreover, viral respiratory tract infections are independent from the patients’ gender.

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Evaluation of viral respiratory pathogens in children aged under five hospitalized with lower respiratory tract infections

Northern Clinics of Istanbul ◽

10.14744/nci.2021.69923 ◽

2021 ◽

Author(s):

Gulsen Akkoc

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Respiratory Pathogens ◽

Lower Respiratory Tract Infections ◽

Under Five ◽

Tract Infections ◽

Viral Respiratory

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Seasonal Coronaviruses and Other Neglected Respiratory Viruses: A Global Perspective and a Local Snapshot

Frontiers in Public Health ◽

10.3389/fpubh.2021.691163 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sunčanica Ljubin-Sternak ◽

Tomislav Meštrović ◽

Ivana Lukšić ◽

Maja Mijač ◽

Jasmina Vraneš

Keyword(s):

Respiratory Tract ◽

Disease Burden ◽

Viral Infections ◽

Respiratory Infections ◽

Cost Effective ◽

Respiratory Viruses ◽

Global Perspective ◽

Local Context ◽

Virological Diagnosis ◽

Tract Infections

Respiratory viral infections are the leading cause of morbidity and mortality in the world; however, there are several groups of viruses that are insufficiently routinely sought for, and can thus be considered neglected from a diagnostic and clinical standpoint. Timely detection of seasonality of certain respiratory viruses (e.g., enveloped viruses such as seasonal coronaviruses) in the local context can aid substantially in targeted and cost-effective utilization of viral diagnostic approaches. For the other, non-enveloped and year-round viruses (i.e., rhinovirus, adenovirus, and bocavirus), a continuous virological diagnosis needs to be implemented in clinical laboratories to more effectively address the aetiology of respiratory infections, and assess the overall impact of these viruses on disease burden. While the coronavirus disease 2019 (COVID-19) pandemic is still actively unfolding, we aimed to emphasize the persistent role of seasonal coronaviruses, rhinoviruses, adenoviruses and bocaviruses in the aetiology of respiratory infections. Consequently, this paper concentrates on the burden and epidemiological trends of aforementioned viral groups on a global level, but also provides a snapshot of their prevalence patterns in Croatia in order to underscore the potential implications of viral seasonality. An overall global prevalence in respiratory tract infections was found to be between 0.5 and 18.4% for seasonal coronaviruses, between 13 and 59% for rhinoviruses, between 1 and 36% for human adenoviruses, and between 1 and 56.8% for human bocaviruses. A Croatian dataset on patients with respiratory tract infection and younger than 18 years of age has revealed a fairly high prevalence of rhinoviruses (33.4%), with much lower prevalence of adenoviruses (15.6%), seasonal coronaviruses (7.1%), and bocaviruses (5.3%). These insights represent a relevant discussion point in the context of the COVID-19 pandemic where the testing of non-SARS-CoV-2 viruses has been limited in many settings, making the monitoring of disease burden associated with other respiratory viruses rather difficult.

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Respiratory Viruses Dynamics and Interactions: Ten Years of Surveillance in Central Europe

10.21203/rs.3.rs-957569/v1 ◽

2021 ◽

Author(s):

Gibran Horemheb-Rubio ◽

Ralf Eggeling ◽

Norbert Schmeisser ◽

Nico Pfeifer ◽

Thomas Lengauer ◽

...

Keyword(s):

Dual Infection ◽

Respiratory Viruses ◽

Influenza Viruses ◽

Respiratory Pathogens ◽

Agglomerative Clustering ◽

University Hospitals ◽

Information Theoretic Measures ◽

Pathogen Testing ◽

Tract Infections ◽

Other Regarding

Abstract Background: Lower respiratory tract infections are among the main causes of death. Although there are many respiratory viruses, diagnostic efforts are focused mainly on influenza. The Respiratory Viruses Network (RespVir) collects infection data, primarily from German university hospitals, for a high diversity of infections by respiratory pathogens. In this study, we computationally analysed a subset of the RespVir database, covering 217,150 samples tested for 17 different viral pathogens in the time span from 2010 to 2019. Methods: We calculated the prevalence of 17 respiratory viruses, analysed their seasonality patterns using information-theoretic measures and agglomerative clustering, and analysed their propensity for dual infection using a new metric dubbed average coinfection exclusion score (ACES). Results: After initial data pre-processing, we retained 206,814 samples, corresponding to 1,408,657 performed tests. We found that Influenza viruses were reported for less than half of all infections and that they exhibited the highest degree of seasonality Coinfections of viruses are frequent, the most prevalent coinfection was rhinovirus/bocavirus and most of the virus pairs had a positive ACES indicating a tendency to exclude each other regarding infection. Conclusions: The analysis of respiratory viruses dynamics in monoinfection and coinfection contributes to the prevention, diagnostic, treatment, and development of new therapeutics. Data obtained from multiplex testing is fundamental for this analysis and should be prioritized over single pathogen testing.

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