scholarly journals High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
M. M. van der Zalm ◽  
E. Walters ◽  
M. Claassen ◽  
M. Palmer ◽  
J. A. Seddon ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Respiratory Viruses ◽  
Respiratory Illnesses ◽  
Viral Aetiology ◽  
High Prevalence ◽  
Observational Cohort ◽  
Future Work ◽  
Viral Respiratory

Abstract Background The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up. Methods In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8. Results Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0–48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8. Conclusions We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.

scholarly journals 1129. Targeted Voriconazole Prophylaxis in Heart Transplantation Recipients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S338-S338
Author(s):  
Michael Lin ◽  
Ignacio Echenique ◽  
Michael Angarone ◽  
Allen Anderson ◽  
Valentina Stosor
Keyword(s):  
Heart Transplantation ◽  
Fungal Infections ◽  
Single Case ◽  
Statistical Significance ◽  
Antifungal Prophylaxis ◽  
Observational Cohort Study ◽  
Observational Cohort ◽  
Univariate Analyses

Abstract Background The use of antifungal prophylaxis, targeted or universal, remains controversial and unstudied. The goal of this study is to determine the role of targeted voriconazole prophylaxis (VORI) in prevention of invasive fungal infections (IFI) after heart transplantation (HT). Methods We conducted a single-center, prospective, observational cohort study of 276 HT recipients from June 2005 to April 2017 to characterize the incidence and outcome of IFI following targeted VORI. Starting in June 2013, HT recipients with thymoglobulin (ATG) treatment received VORI for 3 months. Probable/proven IFI were defined by EORTC/MSG criteria. Descriptive frequencies and univariate analyses were performed. Results Mean duration of follow-up post-HT was 1,165 days (0–3,152 days). 149 (54%) and 70 (25%) received basiliximab and thymoglobulin induction, respectively. Thirty-one (11%) received VORI, following use of ATG in the setting of induction (68%) or rejection (32%). VORI was started at median of 6 days (0–1,008 days) post-HT for a mean duration of 97 days (5–251 days). Overall, 23 IFIs occurred in 23 recipients (8%) at mean 283 days post-HT (range 2–1,579 days), including seven Aspergillus (one occurring after VORI completion), seven invasive Candida (five with candidemia), two Rhizopus, one Cunninghamella, two histoplasma, two blastomyces, one Cryptococcus, and one multifocal cutaneous Alternaria. Conclusion Targeted VORI resulted in reduced incidences of both early and overall IFI after HT although this did not reach statistical significance. Since instituting this strategy, we have observed a single case of aspergillosis following VORI discontinuation. Overall and 1-year mortality were not impacted. The use of antifungal prophylaxis following HT requires continued investigation both to determine efficacy and toxicity in this patient population. Disclosures All authors: No reported disclosures.

scholarly journals Temperature Dependent Viral Tropism (TDVT): Understanding Viral Seasonality and Pathogenicity as Applied to the Avoidance and Treatment of Endemic Viral Respiratory Illnesses

2021 ◽  
Author(s):  
Patrick D. Shaw Stewart ◽  
Julia Bach
Keyword(s):  
Thermal Sensitivity ◽  
Respiratory Illness ◽  
Respiratory Viruses ◽  
Upper Respiratory Tract ◽  
Temperature Dependent ◽  
Viral Tropism ◽  
Local Climate ◽  
Respiratory Illnesses ◽  
The Tropics ◽  
Viral Respiratory

This review seeks to explain four features of viral respiratory illnesses that have perplexed generations of virologists: (1) the seasonal timing of respiratory illness; (2) the common viruses causing respiratory illness worldwide, including year-round disease in the Tropics; (3) the rapid response of outbreaks to weather, specifically temperature; (4) the rapid arrival and termination of epidemics caused by influenza and other viruses. The inadequacy of the popular explanations of seasonality is discussed, and a simple hypothesis is proposed, called Temperature Dependent Viral Tropism (TDVT), that is compatible with the above features of respiratory illness. TDVT notes that viruses can transmit themselves more effectively if they moderate their pathogenicity (thereby maintaining host mobility) and suggests that endemic respiratory viruses accomplish this by developing thermal sensitivity within a range that supports organ-specific viral tropism within the human body, whereby they replicate most rapidly at temperatures below body temperature. This allows them to confine themselves to the upper respiratory tract and to avoid infecting the lungs, heart, gut etc. Biochemical and tissue-culture studies show that &ldquo;wild&rdquo; respiratory viruses show such natural thermal sensitivity. The typical early autumn surge of colds and the existence of respiratory illness in the Tropics year-round at intermediate levels are explained by the tendency for strains to adapt their thermal sensitivity to their local climate and season. The TDVT hypothesis has important practical implications for preventing and treating respiratory illness including Covid-19. TVDT is testable with many options for experiments to increase our understanding of viral seasonality and pathogenicity.

scholarly journals The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

2017 ◽  
Vol 11 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Irwin Webster ◽  
Pierre Goussard ◽  
Robert Gie ◽  
Jacques Janson ◽  
Gawie Rossouw
Keyword(s):  
Pulmonary Tuberculosis ◽  
Developing Country ◽  
High Prevalence

scholarly journals Cohort profile: The Australian Parkinson's Genetics Study (APGS)

2021 ◽  
Author(s):  
Svetlana Bivol ◽  
George D. Mellick ◽  
Jacob Gratten ◽  
Richard Parker ◽  
Aiobhe Mulcahy ◽  
...  
Keyword(s):  
Neurodegenerative Disorder ◽  
Study Patient ◽  
Individual Risk ◽  
Younger Age ◽  
Patient Reported ◽  
Genetic And Environmental Factors ◽  
Reported Data ◽  
Future Work

Purpose: Parkinson's disease (PD) is a neurodegenerative disorder associated with progressive disability. While the precise aetiology is unknown, there is evidence of significant genetic and environmental influences on individual risk. The Australian Parkinson's Genetics Study (APGS) seeks to study patient-reported data from a large cohort of individuals with PD in Australia to understand the sociodemographic, genetic, and environmental basis of PD susceptibility, symptoms and progression. Participants: In the pilot phase reported here, 1,819 participants were recruited through assisted mailouts facilitated by Services Australia (formerly known as the Australian Government Department of Human Services), based on having three or more prescriptions for anti-PD medications in their Pharmaceutical Benefits Scheme (PBS) records. The average age at the time of the questionnaire was 64 +/- 6 years. We collected patient-reported PD information and socio-demographic variables via an online (93% of the cohort) or paper-based (7%) questionnaire. 1,532 participants (84.2%) had a current PD diagnosis and consented to provide a DNA sample via a saliva sampling kit sent by traditional post. Of these, 1435 (94%) returned the saliva samples for genotyping. Findings to date: 65% of participants were male, and 92% identified as being of European descent. A previous traumatic brain injury was reported by 16% of participants and was associated with a younger age of symptom onset. At the time of the questionnaire, constipation (36% of participants), depression (34%), anxiety (17%), melanoma (16%) and diabetes (10%) were the most commonly reported comorbid conditions. Future plans: We are actively seeking funding to expand the project's scope and reach, including recruiting unaffected controls, and a follow-up questionnaire focused on non-motor symptoms and cognitive function assessment. Future work will explore the role of genetic and environmental factors in the aetiology of PD susceptibility, onset, symptoms and progression, including as part of international PD research consortia.

scholarly journals Sentinel Node Biopsy for Conjunctival Melanoma; Single Centre Experience and Review of Current Literature

2021 ◽  
Vol 28 ◽  
pp. 107327482110421
Author(s):  
Barbara Peric ◽  
Spela Leiler ◽  
Gregor Hawlina ◽  
Boris Jancar ◽  
Marko Snoj ◽  
...  
Keyword(s):  
Overall Survival ◽  
Single Centre ◽  
Node Biopsy ◽  
Single Centre Experience ◽  
Observational Cohort ◽  
The Mean ◽  
The Moment ◽  
Retrospective Observational Cohort Study

Purpose To evaluate the role of sentinel lymph node (SLN) biopsy in patients with conjuctival melanoma (CjM). Study design Retrospective observational cohort study and literature review. Subjects Slovenian patients with CjM are included in the study. Methods Prospectively collected data of CjM patients treated from June 2005 to December 2016 were retrospectively analyzed. Main outcome measures The numbers of SLN biopsy procedures, positive and false positive SLN, and local and regional relapses have been described together with overall survival. Results From June 2005 until December 2016, 24 patients with CjM were treated. The median follow-up time was 65.3 months. The mean Breslow thickness was 1.5 mm (sd = 1.8 mm), and ulceration was present in 29% of cases. Altogether, 14/24 (58%) SLN biopsy procedures were performed. SLN was positive in 2/14 (14%) cases. The estimated 5-year overall survival (OS) of the group was 72.5%, with a median survival of 151 months (95% CI 77–224). From January 2013 to January 2020, five (5/140, 3%) authors reported results comparable to our study. Conclusion Our results confirm that CjM is a rare disease with approximately 14% of positive SLN. At the moment, there are no firm conclusions regarding who would benefit most from SLN biopsy or whether or not CLND should be offered. Data from literature emphasize the need for consistent and uniform staging and future multicentric studies.

scholarly journals Understanding Rhinovirus Circulation and Impact on Illness

Viruses ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 141
Author(s):  
Camille Esneau ◽  
Alexandra Cate Duff ◽  
Nathan W. Bartlett
Keyword(s):  
Clinical Outcomes ◽  
Resource Utilization ◽  
Clinical Studies ◽  
Economic Cost ◽  
Respiratory Viruses ◽  
Therapeutic Strategies ◽  
Research Community ◽  
Respiratory Illnesses ◽  
Specific Focus

Rhinoviruses (RVs) have been reported as one of the main viral causes for severe respiratory illnesses that may require hospitalization, competing with the burden of other respiratory viruses such as influenza and RSV in terms of severity, economic cost, and resource utilization. With three species and 169 subtypes, RV presents the greatest diversity within the Enterovirus genus, and despite the efforts of the research community to identify clinically relevant subtypes to target therapeutic strategies, the role of species and subtype in the clinical outcomes of RV infection remains unclear. This review aims to collect and organize data relevant to RV illness in order to find patterns and links with species and/or subtype, with a specific focus on species and subtype diversity in clinical studies typing of respiratory samples.

scholarly journals Temperature Dependent Viral Tropism: An Explanation of the Seasonality and Pathogenicity of the Endemic Respiratory Viruses

2021 ◽  
Author(s):  
Patrick Shaw Stewart
Keyword(s):  
Thermal Sensitivity ◽  
Respiratory Illness ◽  
Respiratory Viruses ◽  
Upper Respiratory Tract ◽  
Temperature Dependent ◽  
Viral Tropism ◽  
Local Climate ◽  
Respiratory Illnesses ◽  
Organ Specific ◽  
Viral Respiratory

This review seeks to explain four features of viral respiratory illnesses that have perplexed many generations of microbiologists: (1) the seasonal occurrence of viral respiratory illness; (2) the occurrence of respiratory illness year-round in the Tropics; (3) the rapid response of illness to temperature drops in temperate regions; (4) the explosive arrival and rapid termination of epidemics caused by influenza and other respiratory viruses. I discuss the inadequacy of the popular explanations of seasonality, and propose a simple hypothesis, called Temperature Dependent Viral Tropism (TD-VT), that is compatible with the above and other features of respiratory illness. TD-VT notes that viruses can often transmit themselves more effectively if they moderate their pathogenicity (thereby maintaining the mobility of their hosts) and suggests that most endemic respiratory viruses accomplish this by developing thermal sensitivity, in the sense that they normally replicate rapidly only at temperatures below normal body temperature. This allows them to confine themselves to the upper respiratory tract and to avoid infecting the lungs, heart, gut etc. I review biochemical and tissue-culture studies that found that &ldquo;wild&rdquo; respiratory viruses often show natural thermal sensitivity within a range that supports organ-specific tropism within the human body, and I discuss the evident tendency for viral strains to adapt their thermal sensitivity to their local climate and season. I also explore the possible misinterpretation of early experiments where volunteers were inoculated nasally with viral samples and then chilled. Next, I discuss the practical implications of the TD-VT hypothesis for preventing and treating respiratory illness. Finally, I note that the hypothesis is very testable and make suggestions for the most important experiments to increase our understanding of the seasonality and pathogenicity of viral respiratory illness.

Otologic Care in a School for the Deaf

1981 ◽  
Vol 89 (4) ◽  
pp. 651-657 ◽  
Author(s):  
Sylvan E. Stool ◽  
F. Owen Black ◽  
Helen Craig ◽  
Margaret Laird
Keyword(s):  
Deaf Child ◽  
Maintenance Program ◽  
High Prevalence ◽  
High Incidence ◽  
Inner Ear Disease ◽  
Supervision And Training ◽  
School For The Deaf ◽  
And Training

Recent studies at the Western Pennsylvania School for the Deaf revealed both a high prevalence and a high incidence of external, middle, and inner ear disease among the students enrolled. This paper illustrates the role of the otolaryngologist in the otologic evaluation, diagnosis, treatment, and follow-up in this special population and in the supervision and training of relevant health care personnel. Included in this discussion are (1) the implementation and results of an otologic surveillance and maintenance program at the school for the deaf, (2) the methods and results of vestibular evaluation in this population, and (3) an example of the procedures possible to prepare for and facilitate the hospitalization of a deaf child.

scholarly journals Evaluation of Potential Factors Contributing to Microbiological Treatment Failure inStreptococcus PyogenesPharyngitis

2001 ◽  
Vol 12 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Susan M Kuhn ◽  
Jutta Preiksaitis ◽  
Gregory J Tyrrell ◽  
Taj Jadavji ◽  
Deirdre Church ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Patient Characteristics ◽  
Respiratory Viruses ◽  
Host Factors ◽  
Beta Hemolytic Streptococcus ◽  
Group A ◽  
Potential Factors ◽  
Microbiological Treatment

BACKGROUND:A cohort study of children with pharyngitis aged two to 16 years was conducted to assess the role of microbial and host factors in group A beta-hemolytic streptococcus (GABHS) microbiological treatment failure.METHODS:GABHS-infected children had pharyngeal swabs repeated two to five days after completing a 10-day course of penicillin V. M and T typing, and pulsed field gel electrophoresis were performed on the isolates, and the isolates were evaluated for tolerance. Patient characteristics and clinical features were noted and nasopharyngeal swabs for respiratory viruses were taken at enrolment.RESULTS AND CONCLUSIONS:Of 286 patients enrolled, 248 (87%) could be evaluated. GABHS was cultured from 104 patients (41.9%), of whom 33 (33.7%) had microbiological treatment failures on follow-up. Although there was a trend toward failure for younger children (mean 6.5±2.4 years versus 7.3±2.4 years, P=0.07) and M type 12 (24% versus 10%, P=0.08), no factors were associated with treatment failure.

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