Sex differences in the immune response to acute COVID-19 respiratory tract infection

Abstract Background Sex differences in COVID-19 are increasingly recognized globally. Although infection rates are similar between the sexes, men have more severe illness. The mechanism underlying these sex differences is unknown, but a differential immune response to COVID-19 has been implicated in several recent studies. However, how sex differences shape the immune response to COVID-19 remains understudied. Methods We collected demographics and blood samples from over 600 hospitalized patients diagnosed with COVID-19 from May 24th 2020 to April 28th, 2021. These patients were divided into two cohorts: Cohort 1 was further classified into three groups based on the severity of the disease (mild, moderate and severe); Cohort 2 patients were longitudinally followed at three time points from hospital admission (1 day, 7 days, and 14 days). MultiPlex and conventional ELISA were used to examine inflammatory mediator levels in the plasma in both cohorts. Flow cytometry was conducted to examine leukocyte responses in Cohort 2. Results There were more COVID+ males in the total cohort, and the mortality rate was higher in males vs. females. More male patients were seen in most age groups (in 10-year increments), and in most ethnic groups. Males with severe disease had significantly higher levels of pro-inflammatory cytokines (IL-6, IL-8, MCP-1) than females; levels of IL-8, GRO, sCD40L, MIP-1β, MCP-1 were also significantly higher in severe vs. mild or control patients in males but not in females. Females had significantly higher anti-inflammatory cytokine IL-10 levels at 14 days compared to males, and the level of IL-10 significantly increased in moderate vs. the control group in females but not in males. At 7 days and 14 days, males had significantly more circulating neutrophils and monocytes than females; however, B cell numbers were significantly higher in females vs. males. Conclusion Sex differences exist in hospitalized patients with acute COVID-19 respiratory tract infection. Exacerbated inflammatory responses were seen in male vs. female patients, even when matched for disease severity. Males appear to have a more robust innate immune response, and females mount a stronger adaptive immune response to COVID-19 respiratory tract infection.

Download Full-text

A study on association between respiratory tract infection and serum 25 (OH) vitamin D level in children

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20204545 ◽

2020 ◽

Vol 7 (11) ◽

pp. 2198

Author(s):

Rajesh Kumar Sah ◽

Hemant Kumar

Keyword(s):

Vitamin D ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Serum Vitamin ◽

Acute Respiratory Tract Infection ◽

Control Group ◽

Medical College ◽

Serum Vitamin D ◽

25 Oh Vitamin D

Background: Acute respiratory tract infection are a major cause of global morbidity and mortality. Observational studies report consistent independent association between low serum concentration of 25-hydroxy-vitamin D and susceptibility to acute respiratory tract infection. This study was done to assess serum vitamin D level in children and correlation with respiratory tract infection.Methods: The present study was undertaken in department of paediatrics medicine, Patna Medical College and Hospital in patients attending out-patients department (OPD) as well as admitted in in-patients department (IPD). Assessment of serum 25(OH) Vitamin D was done by the enzyme immunoassay kit at Patna Medical College and Hospital.Results: The mean serum vitamin D level in cases was (20.52±5.64 ng/ml) where as in control group was (26.46±4.52 ng/ml) with a statically significant p value of <0.0001, hence cases are associated with vitamin D deficiency.Conclusions: The finding in this study showed significantly decreased mean serum vitamin D level in cases than that of control which implies that vitamin D deficiency predisposes to respiratory tract infection in children.

Download Full-text

Exercise and resistance to infection

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y98-053 ◽

1998 ◽

Vol 76 (5) ◽

pp. 573-580 ◽

Cited By ~ 36

Author(s):

David C Nieman

Keyword(s):

Immune Response ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Killer Cell ◽

Cell Activity ◽

Upper Respiratory Tract Infection ◽

Upper Respiratory Tract ◽

Increased Risk ◽

Upper Respiratory

Epidemiological data suggest that endurance athletes are at increased risk for upper respiratory tract infection (URTI) during periods of heavy training and the 1- to 2-week period following race events. Moderate exercise training has been associated with a reduction in incidence of URTI. There is growing evidence that for several hours subsequent to heavy exertion, several components of both the innate (e.g., natural killer cell activity and neutrophil oxidative burst activity) and adaptive (e.g., T and B cell function) immune system exhibit suppressed function. The immune response to heavy exertion is transient, and further research on the mechanisms underlying the immune response to prolonged and intensive endurance exercise is necessary before meaningful clinical applications can be drawn. Some attempts have been made through chemical or nutritional means (e.g., indomethacin, glutamine, vitamin C, and carbohydrate supplementation) to attenuate immune changes following intensive exercise to lower the risk of infection.Key words: upper respiratory tract infection, immunity, running, lymphocyte, neutrophil.

Download Full-text

Effect of Maternal Fever on Fetal Behavior Assessed by KANET Test

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1238 ◽

2012 ◽

Vol 6 (2) ◽

pp. 160-165

Author(s):

Ulrich Honemeyer ◽

Amira Talic

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Control Group ◽

Significant Difference ◽

Prospective Longitudinal ◽

Primary Localization

ABSTRACT Objective of the study was to assess the possible effect of maternal fever without clinical chorioamnionitis on fetal behavior. In a period of 18 months, in a prospective longitudinal cohort study, Kurjak antenatal neurological test (KANET) was applied to assess fetal behavior in both normal pregnancies and pregnancies complicated by maternal fever. According to the primary localization of the infection, maternal fever group was divided into four groups: Respiratory tract infection, urinary tract infection, malaria and gastrointestinal tract infection. According to KANET test, fetuses with scores >14 were considered normal, 6 to 13 borderline and abnormal, if KANET scores were <5. Differences between groups were examined by Mann-Whitney U-test, differences between subgroups by Steel test. KANET scores differed statistically significant between two main groups. The largest proportion of abnormal KANET scores was found in pregnancies complicated by malaria, while the largest proportion of borderline scores showed fetuses from pregnancies complicated by urinary tract infection. There was no statistical significant difference in KANET scores between the control group and fetuses from pregnancies complicated by respiratory tract infection. KANET test has been shown to be a reliable means to distinguish normal and abnormal fetal behavior. Postnatal follow-up should confirm the data from prenatal assessment of fetal behavior. How to cite this article Talic A, Kurjak A, Honemeyer U. Effect of Maternal Fever on Fetal Behavior Assessed by KANET Test. Donald School J Ultrasound Obstet Gynecol 2012;6(2):160-165.

Download Full-text

EFFECTIVENESS OF MASSAGE THERAPY ON RESPIRATORY STATUS AMONG TODDLERS WITH LOWER RESPIRATORY TRACT INFECTION

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703889 ◽

2015 ◽

Vol 05 (02) ◽

pp. 049-054

Author(s):

Helen Martina M. A ◽

Hepzibah Beulah ◽

Anita David

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Massage Therapy ◽

Routine Care ◽

Control Group ◽

Respiratory Illnesses ◽

Respiratory Status

AbstractLower respiratory tract infection is one of the major prevailing respiratory illnesses in children. The aim of the study is to assess the effectiveness of massage therapy on respiratory status among toddlers with lower respiratory tract infection. A sample of 60 toddlers were conveniently assigned to study and control group, in study group routine care and massage therapy was performed for three days in morning and evening then posttest was conducted end of each day whereas control group receives routine care. The result shows that massage therapy was significantly effective in improving lung functions.

Download Full-text

The risk of hospitalization for respiratory tract infection (RTI) in children who are treated with high-dose IVIG in Kawasaki Disease: a nationwide population-based matched cohort study

PeerJ ◽

10.7717/peerj.4539 ◽

2018 ◽

Vol 6 ◽

pp. e4539 ◽

Cited By ~ 1

Author(s):

Wei-Te Lei ◽

Chien-Yu Lin ◽

Yu-Hsuan Kao ◽

Cheng-Hung Lee ◽

Chao-Hsu Lin ◽

...

Keyword(s):

Kawasaki Disease ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Cox Regression ◽

Systemic Vasculitis ◽

Control Group ◽

High Dose ◽

Research Database ◽

Protective Effects

Background Kawasaki disease (KD) is an immune-mediated systemic vasculitis, and infection plays an important role in the pathophysiology of KD. The susceptibility to infectious disease in patients with KD remains largely unclear. This study aimed to investigate the risk of respiratory tract infection (RTI)-related hospitalizations in children with KD. Methods Data from the Taiwanese National Health Insurance Research Database was analyzed. We excluded patients with history of congenital abnormality, allergic diseases, or hospitalization history. Children with KD were selected as KD group and age- and sex-matched non-KD patients were selected as control group with 1:4 ratio. Both cohorts were tracked for one year to investigate the incidences of RTI-related hospitalizations. Cox regression hazard model was used to adjust for confounding factors and calculate the adjusted hazard ratio (aHR). Results Between January 1996 and December 2012, 4,973 patients with KD were identified as the KD group and 19,683 patients were enrolled as the control group. An obviously reduced risk of RTI-related hospitalizations was observed in KD patients (aHR: 0.75, 95% CI [0.66–0.85]). The decreased risk persisted through the first six-months follow-up period with a peak protection in 3–6 months (aHR: 0.49, 95% CI [0.37–0.64]). Conclusions KD patients had approximately half reduction of risk for RTI-related hospitalizations. The protective effects persisted for at least six months. Further studies are warranted to elucidate the entire mechanism and investigate the influences of intravenous immunoglobulin.

Download Full-text

Effectiveness of oseltamivir treatment on clinical failure in hospitalized patients with lower respiratory tract infection

BMC Infectious Diseases ◽

10.1186/s12879-021-06812-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Timothy L. Wiemken ◽

Stephen P. Furmanek ◽

Ruth M. Carrico ◽

Paula Peyrani ◽

Daniel Hoft ◽

...

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Influenza Infection ◽

Standard Of Care ◽

Hospitalized Patients ◽

Clinical Failure ◽

Tract Infections

Abstract Background Influenza is associated with excess morbidity and mortality of individuals each year. Few therapies exist for treatment of influenza infection, and each require initiation as early as possible in the course of infection, making efficacy difficult to estimate in the hospitalized patient with lower respiratory tract infection. Using causal machine learning methods, we re-analyze data from a randomized trial of oseltamivir versus standard of care aimed at reducing clinical failure in hospitalized patients with lower respiratory tract infection during the influenza season. Methods This was a secondary analysis of the Rapid Empiric Treatment with Oseltamivir Study (RETOS). Conditional average treatment effects (CATE) and 95% confidence intervals were computed from causal forest including 85 clinical and demographic variables. RETOS was a multicenter, randomized, unblinded, trial of adult patients hospitalized with lower respiratory tract infections in Kentucky from 2009 through 2012. Adult hospitalized patients with lower respiratory tract infection were randomized to standard of care or standard of care plus oseltamivir as early as possible after hospital admission but within 24 h of enrollment. After randomization, oseltamivir was initiated in the treatment arm per package insert. The primary outcome was clinical failure, a composite measure including failure to reach clinical improvement within 7 days, transfer to intensive care 24 h after admission, or rehospitalization or death within 30 days. Results A total of 691 hospitalized patients with lower respiratory tract infections were included in the study. The only subgroup of patients with a statistically significant CATE was those with laboratory-confirmed influenza infection with a 26% lower risk of clinical failure when treated with oseltamivir (95% CI 3.2–48.0%). Conclusions This study suggests that addition of oseltamivir to standard of care may decrease clinical failure in hospitalized patients with influenza-associated lower respiratory tract infection versus standard of care alone. These results are supportive of current recommendations to initiate antiviral treatment in hospitalized patients with confirmed or suspected influenza as soon as possible after admission. Trial registration Original trial: Clinical Trials.Gov; Rapid Empiric Treatment With Oseltamivir Study (RETOS) (RETOS); ClinicalTrials.gov Identifier: NCT01248715 https://clinicaltrials.gov/ct2/show/NCT01248715

Download Full-text

Pidotimod in the treatment of pediatric recurrent respiratory tract infection

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.82 ◽

2019 ◽

Vol 35 (4) ◽

Author(s):

Xia Li ◽

Qingfang Li ◽

Xudong Wang ◽

Man Lu ◽

Jingjing Shen ◽

...

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Clinical Efficacy ◽

Conventional Treatment ◽

Control Group ◽

Observation Group ◽

Recurrent Respiratory Tract Infection ◽

Significant Difference ◽

Ifn Γ

Objective: To observe the clinical efficacy of pidotimod in the treatment of recurrent respiratory tract infection in children. Methods: One hundred thirty-two patients with recurrent respiratory tract infection who received treatment in Tianan City Central Hospital were selected and divided into an observation group and a control group using random number table, 66 in each group. Patients in the control group were given conventional treatment, while patients in the observation group were given conventional treatment and pidotimod treatment; the clinical efficacy of the two therapies was compared. The levels of IgG and IgM were measured after treatment. Results: The vital signs and the content of inflammatory mediator and Th1/Th2 in serum before and after treatment were compared, and the clinical efficacy of the two groups was evaluated. The fever, pulmonary rale, cough and antiadoncus of patients in the observation group disappeared earlier than those in the control group (P<0.05). The onset duration of respiratory tract infection and days of antibiotic application of the observation group were shorter than those of the control group after treatment (P<0.05). The times of infection of the observation group were less than that of the control group (P<0.05). Before treatment, the two groups had no significant difference in the content of inflammatory mediators and Th1/Th2 in the serum (P>0.05). The serum content of tumor necrosis factor (TNF)-α and interleukin (IL)-4 of the two groups one week after treatment was lower than that before treatment, and the content of interferon (IFN)-γ and IFN-γ/IL-4 were higher than that before treatment; moreover the observation group had lower serum content of TFN-α and IL-4 and lower content of IFN-γ and IFN-γ/IL-4 compared to the control group (P<0.05). The overall response rate of the observation group was 92.4%, much higher than 81.8% in the control group (P<0.05). Conclusion: Pidotimod has a remarkable efficacy in the treatment of pediatric recurrent respiratory tract infection because it can effectively inhibit the infection and optimize Th1/Th2 immune function. doi: https://doi.org/10.12669/pjms.35.4.82 How to cite this:Li X, Li Q, Wang X, Lu M, Shen J, Meng Q. Pidotimod in the treatment of pediatric recurrent respiratory tract infection. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.82 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Factors related to interrupted inpatient stroke rehabilitation due to acute care transfer or death

Neurorehabilitation ◽

10.3233/nre-203187 ◽

2020 ◽

Vol 47 (2) ◽

pp. 171-179

Author(s):

Rinlada Pongratanakul ◽

Poungkaew Thitisakulchai ◽

Vilai Kuptniratsaikul

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Acute Care ◽

Stroke Rehabilitation ◽

Feeding Tube ◽

Control Group ◽

Case Group ◽

Acute Care Facilities ◽

Care Transfer

OBJECTIVES: To identify factors that are independently related to interrupted stroke rehabilitation due to acute care transfer or death. METHODS: Medical records of stroke inpatients admitted from 2012 to 2017 were reviewed. Stroke inpatients with interrupted stroke rehabilitation due to acute care transfer or death were enrolled into the case group. Those without interruption admitted in the same month were randomly selected into the control group (case to control ratio of 1 : 5). Ten clinical factors were studied. RESULTS: Among stroke inpatients, 3.2% were transferred to acute care facilities and 0.2% died. The most common causes of acute care transfer were respiratory tract infection, intracranial hemorrhage, recurrent ischemic stroke, ischemic heart disease, and seizure. Three factors were found to be significantly associated with interrupted stroke rehabilitation, i.e. presence of feeding tube, presence of anemia and age. Our results also revealed significant association between presence of feeding tube and respiratory tract infection (p = 0.005). CONCLUSION: Feeding tube, anemia and old age were identified as independent predictors of interrupted stroke rehabilitation due to acute care transfer or death. Interventions to reduce severe complications should be implemented in order to prevent interruption of rehabilitation process and to reduce the patient transfer rate.

Download Full-text