Pneumocystis carinii Pneumonitis in Young Immunocompetent Infants

PEDIATRICS ◽  
1980 ◽  
Vol 66 (1) ◽  
pp. 56-62
Author(s):  
Sergio Stagno ◽  
Linda L. Pifer ◽  
Walter T. Hughes ◽  
Dana M. Brasfield ◽  
Ralph E. Tiller
Keyword(s):  
Influenza A ◽  
Pneumocystis Carinii ◽  
Open Lung Biopsy ◽  
Influenza B ◽  
Severe Respiratory Distress ◽  
Number Of Patients ◽  
Circulating Antigens ◽  
Cytomegalovirus Pneumonia ◽  
Syncytial Virus ◽  
A Prospective Study

Of 67 infants enrolled in a prospective study of infant pneumonia ten (14%) had evidence of Pneumocystis carinii infection. Diagnosis was achieved by demonstrating circulating P carinii antigens by counterimmunoelectrophoresis in all ten cases and by histopathology in the only infant who underwent an open lung biopsy. Antigenemia did not occur in 64 control infants (P = .003), nor in 57 patients of similar age who were hospitalized with pneumonitis due to Chlamydia trachomatis, respiratory syncytial virus, cytomegalovirus, adenovirus, and influenza A and influenza B viruses. None of the ten infants with P carinii pneumonitis had evidence of a primary immunodeficiency nor had any received immunosuppressive medication. These patients were hospitalized at a mean age of 6 weeks (range 2 to 12) and their illness was characterized by its afebrile course, presentation in crisis with severe respiratory distress, apnea, tachypnea, cough, increased IgM, and bilateral pulmonary infiltrates with hyperaeration. The clinical features of P carinii pneumonitis were indistinguishable from those of C trachomatis and cytomegalovirus pneumonia. Treatment with trimethoprim-sulfamethoxazole was associated with rapid disappearance of circulating antigens; however, the small number of patients studied did not permit an analysis of its clinical efficacy. These results indicate that P carinii singly or in combination with other infectious agents may be an important cause of pneumonitis in young, immunocompetent infants with no underlying illnesses.

scholarly journals Influenza and RSV incidence during COVID-19 pandemic—an observational study from in-hospital point-of-care testing

2021 ◽  
Author(s):  
Paul Stamm ◽  
Ingo Sagoschen ◽  
Kerstin Weise ◽  
Bodo Plachter ◽  
Thomas Münzel ◽  
...  
Keyword(s):  
Emergency Room ◽  
Influenza A ◽  
Point Of Care ◽  
Respiratory Viruses ◽  
Pediatric Emergency ◽  
Influenza B ◽  
Complete Suppression ◽  
Emergency Room Patients ◽  
Syncytial Virus ◽  
Point Of Care Tests

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has forced the implementation of unprecedented public health measures strategies which might also have a significant impact on the spreading of other viral pathogens such as influenza and Respiratory Syncytial Virus (RSV) . The present study compares the incidences of the most relevant respiratory viruses before and during the SARS-CoV-2 pandemic in emergency room patients. We analyzed the results of in total 14,946 polymerase chain reaction point-of-care tests (POCT-PCR) for Influenza A, Influenza B, RSV and SARS-CoV-2 in an adult and a pediatric emergency room between December 1, 2018 and March 31, 2021. Despite a fivefold increase in the number of tests performed, the positivity rate for Influenza A dropped from 19.32% (165 positives of 854 tests in 2018/19), 14.57% (149 positives of 1023 in 2019–20) to 0% (0 positives of 4915 tests) in 2020/21. In analogy, the positivity rate for Influenza B and RSV dropped from 0.35 to 1.47%, respectively, 10.65–21.08% to 0% for both in 2020/21. The positivity rate for SARS-CoV2 reached 9.74% (110 of 1129 tests performed) during the so-called second wave in December 2020. Compared to the two previous years, seasonal influenza and RSV incidence was eliminated during the COVID-19 pandemic. Corona-related measures and human behavior patterns could lead to a significant decline or even complete suppression of other respiratory viruses such as influenza and RSV.

scholarly journals The Panther Fusion System with Open Access Functionality for Laboratory-Developed Tests for Influenza A Virus Subtyping

2020 ◽  
Vol 58 (6) ◽  
Author(s):  
Kathleen A. Stellrecht ◽  
Jesse L. Cimino ◽  
Vincente P. Maceira
Keyword(s):  
Open Access ◽  
Influenza A ◽  
Limit Of Detection ◽  
Turnaround Time ◽  
Nucleic Acid Amplification ◽  
Influenza B ◽  
Fusion System ◽  
Valuable Complement ◽  
Syncytial Virus

ABSTRACT Nucleic acid amplification tests, such as PCR, are the method of choice for respiratory virus testing, due to their superior diagnostic accuracy and fast turnaround time. The Panther Fusion (Fusion; Hologic) system has an array of highly sensitive in vitro diagnostic (IVD) real-time PCR assays for respiratory viruses, including an assay for influenza A (FluA) virus, influenza B (FluB) virus, and respiratory syncytial virus (RSV) (FFABR assay). The Fusion system has Open Access functionality to perform laboratory-developed tests (LDTs) alongside IVD assays. We developed two LDTs for FluA virus strain typing on the Panther Fusion instrument, enabling side-by-side testing with the FFABR assay. The LDT-FAST assay uses proprietary primers and probes designed by Hologic for the Prodesse ProFAST+ (PFAST) assay. The exWHO-FAST assay is an expanded redesign of the WHO-recommended reverse transcriptase PCRs (RT-PCRs). To evaluate the performance of these two LDTs, 110 FluA virus-positive samples were tested. Of these, 104 had been subtyped previously; 54 were H3, 46 were 09H1, and 4 were fsH1. All were appropriately subtyped by both LDTs. Of the untyped FluA virus samples, three were subtyped as H3 by both LDTs and two were subtyped as H3 by the LDT-FAST assay only. The sample not subtyped by either LDT was retested with the FFABR assay and was now negative. Limit-of-detection (LOD) analyses were performed with five FluA virus strains. The LDT-FAST LODs were similar to the FFABR assay LODs, while the exWHO-FAST LODs were higher for two H3N2 strains, findings that were explained by analysis of primer/probe homology. In conclusion, either FluA virus typing assay would be a valuable complement to the Panther Fusion respiratory menu given the performance of these LDTs, the system’s full automation, and the ability to split eluates for both IVD and LDT testing.

A randomized trial of open lung biopsy versus empiric antimicrobial therapy in cancer patients with diffuse pulmonary infiltrates.

1990 ◽  
Vol 8 (2) ◽  
pp. 222-229 ◽  
Author(s):  
M J Browne ◽  
D Potter ◽  
J Gress ◽  
D Cotton ◽  
J Hiemenz ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Antimicrobial Therapy ◽  
Primary Care Physicians ◽  
Lung Biopsy ◽  
Pneumocystis Carinii ◽  
Open Lung Biopsy ◽  
Open Lung ◽  
Empiric Antimicrobial Therapy ◽  
Number Of Patients ◽  
The Difference

Twenty-four cancer patients with diffuse interstitial pneumonitis (DIP) were randomized to undergo an open lung biopsy (OLB) within 8 hours of presentation (12 patients) or to receive empiric antimicrobial therapy (ET) with trimethoprim-sulfamethoxazole (TMP-SMX) erythromycin for a minimum of 4 days (12 patients). Patients whose condition deteriorated underwent an OLB on day 4. Eight of 12 patients (67%) having OLB survived versus 10 of 12 (83%) receiving ET (P = .64). Morbidity occurred in nine of 12 (75%) having OLB versus eight of 12 (67%) receiving ET (P = 1.0). Concurrently, there were 14 additional cancer patients with DIP who were not randomized (nine refused, three had a coagulopathy contraindicating surgery, two were excluded by primary care physicians) and who were comparable demographically to the randomized group. Two received OLB and 12 ET. Combining the randomized and nonrandomized groups, eight of 14 (57%) having an initial OLB survived versus 18 of 24 (75%) of ET-treated patients (P2 = .19). Results of the OLB were seven Pneumocystis carinii pneumonia (PCP), five nonspecific pneumonitis (NSP), one cytomegalovirus, and one lymphoma. Results of OLB led to discontinuation of antibiotics in three patients. Of the 24 ET patients, eight failed to improve by day 4 and had an OLB. Results were two NSP, two PCP, two cancer, one blastomycosis, and one Candida pneumonia. Complications were seen in 10 of 14 (72%) initial OLB patients versus 14 of 24 (58%) patients on the ET arm (P = .65). When the complication rate between patients receiving only empiric antibiotics was compared with all patients having an OLB (initially or on day 4), the difference was greater in patients undergoing OLB (37% v 72%, respectively) (P2 = .14). ET with TMP-SMX plus erythromycin and broad spectrum antibiotics in granulocytopenic patients appeared to be as successful and potentially less toxic than an OLB in this study. Although the number of patients in this study was small, these data suggest that a trial of empiric antibiotic management may be reasonable in cancer patients presenting with DIP, especially if they are nonneutropenic.

scholarly journals A comparison of influenza and respiratory syncytial virus infections among infants admitted to hospital with acute respiratory infections

1976 ◽  
Vol 77 (3) ◽  
pp. 383-392 ◽  
Author(s):  
E. O. Caul ◽  
D. K. Waller ◽  
S. K. R. Clarke ◽  
B. D. Corner
Keyword(s):  
Influenza Virus ◽  
Respiratory Syncytial Virus ◽  
Rural Areas ◽  
Influenza A ◽  
Respiratory Infections ◽  
Influenza B Virus ◽  
Influenza B ◽  
Virus Infections ◽  
Syncytial Virus ◽  
One Year

SUMMARYAmong 741 children under 5 years admitted to hospital with respiratory infections during two winters, infection with influenza A virus was diagnosed in 70 (9%), with influenza B virus in 8 (1%), and with respiratory syncytial virus (RSV) in 259 (35 %). Both influenza virus and RSV infections were diagnosed most frequently in children under the age of one year, and diagnosed more frequently in males than females. Influenza illnesses were more severe in boys than girls. Both infections occurred more often, but were not more severe, in children from a conurbation than in those from ‘rural’ areas. Convulsions were the cause of 36% of admissions with influenza A infections, but were rare in RSV infections. Bronchiolitis was the reason for 39% of admissions with RSV infections, but was rare in influenza infections. It is suggested that infants admitted to hospital are a good source of influenza virus strains for monitoring arttigenic variation.

scholarly journals Performance of a Novel Point-of-Care Molecular Assay for Detection of Influenza A and B Viruses and Respiratory Syncytial Virus (Enigma MiniLab) in Children with Acute Respiratory Infection

2015 ◽  
Vol 54 (1) ◽  
pp. 212-215 ◽  
Author(s):  
Sam T. Douthwaite ◽  
Charlotte Walker ◽  
Elisabeth J. Adams ◽  
Catherine Mak ◽  
Andres Vecino Ortiz ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Influenza A ◽  
Respiratory Virus ◽  
Point Of Care ◽  
Influenza B Virus ◽  
Influenza B ◽  
Molecular Assay ◽  
B Virus ◽  
Syncytial Virus ◽  
Virus Influenza

The performance of the Enigma MiniLab assay for influenza A and B viruses and respiratory syncytial virus (RSV) was compared to a centralized laboratory respiratory virus panel. The positive and negative percent agreement for influenza A virus, influenza B virus, and RSV were 79.2% (95% confidence interval [95% CI], 57.8 to 92.9%) and 99.4% (95% CI, 98.4 to 99.9), 100% (95% CI, 47.8 to 100%) and 100% (95% CI, 99.3 to 100%), 98.5% (95% CI, 94.6 to 99.8%) and 94.5% (95% CI, 91.9 to 96.4%), respectively.

scholarly journals Transmission of Acute Respiratory Infections in a City: Agent-Based Approach

2020 ◽  
Vol 15 (2) ◽  
pp. 338-356
Author(s):  
A.I. Vlad ◽  
T.E. Sannikova ◽  
A.A. Romanyukha
Keyword(s):  
Incidence Rate ◽  
Influenza A ◽  
Respiratory Infections ◽  
Reproductive Rate ◽  
Immune Memory ◽  
Influenza B Virus ◽  
Influenza B ◽  
Acute Respiratory Infections ◽  
Agent Based ◽  
Syncytial Virus

An incidence curve of acute respiratory infections in Moscow has three picks between September and April and reaches its maximum in January- February. The emergence of new strains of influenza A could account for only one pick a year. The most cases of common cold are caused by ubiquitous low pathogenic viruses. In order to simulate weekly fluctuation of incidence rate of acute respiratory illnesses we developed an agent-based model. It contains 10 millions agents with such attributes as sex, age, social status, levels of specific immune memory and lists of contacts. Each agent can contact with members of its household, colleagues or classmates. Through such contacts susceptible agent can be infected with one of seven circulating respiratory viruses. Viruses differ in their immunologic properties and assume to present influenza A virus, influenza B virus, parainfluenza, adenovirus, coronavirus, rhinovirus and respiratory syncytial virus. The rate of transmission depends on duration of contact, vulnerability of susceptible agent, infectivity of infected agent and air temperature. Proposed network of social interactions proved to be sufficiently detailed as it provided good fitting for observed incidence rate including periods of school holidays and winter public holidays. Additionally, the estimates of basic reproductive rate for the viruses confirm that all these viruses except new strains of influenza A are relatively harmless and unable to cause significant growth of acute respiratory infections morbidity.

scholarly journals Seroprevalence of IgM Antibody in Atypical Pneumonia Causing Pathogens by Pneumoslide, IFA

2020 ◽  
pp. 1-10
Author(s):  
Puneeta Singh ◽  
Shalabh Malik ◽  
Vandana Lal
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Legionella Pneumophila ◽  
Influenza A ◽  
Age Groups ◽  
Influenza B ◽  
Atypical Pneumonia ◽  
Serum Samples ◽  
Viral Pathogens ◽  
Atypical Pathogens ◽  
Syncytial Virus

Background: Atypical bacterial and viral pathogens play an important role in atypical pneumonia are responsible for one of the leading causes of morbidity and mortality, particularly in developing countries. Objective: The purpose of this study to determine the prevalence of bacterial and viral pathogens causing acute atypical pneumonia in different age groups and seasonality patterns of prevalence in India. Methods: This retrospective study was conducted on 680 samples tested during December 2018 to August 2019, performed at Microbiology department of Dr. Lal Path Labs. Serum samples were used for Pneumoslide IgM test diagnose 9 Atypical bacterial & viral pathogens: Legionella pneumophila (LP), Mycoplasma pneumoniae (MP), Coxiella burnetti (COX), Chlamydophila pneumonia (CP) Adenovirus (ADV), Respiratory syncytial virus (RSV) Influenza A (INFA), Influenza B (INFB), Parainfluenza serotypes 1,2 &3(PIVs). Results: Of a total 477(70.1%) samples were positive for atypical pneumonia pathogens. Atypical pneumonia was seen in extremes of age ie: <=5 years and >60 elderly adults without much of a gender bias. Co infections was seen in 62.1%. Legionella pneumophila (42.5%) was the dominant pathogen followed by Influenza B (41.7%) Mycoplasma pneumoniae (33.4%), Parainfluenza serotypes 1,2 &3 (29.4%) respectively. Atypical pneumonia has a spring predominance that is peaking in March. Conclusion: Among six predominant atypical pathogens, Legionella pneumophila and Influenza B was most predominant pathogens, as a causative agent of atypical pneumonia followed by Mycoplasma pneumoniae seen mostly in young (0-5 years) comparison to all age groups. Hence, Pneumoslide IgM as a multi panel test needed to ensure initiation of targeted therapy. Pneumoslide IgM, by IFA is a rapid, cost effective easy to identify & classify atypical pneumonia causing pathogens.

scholarly journals Evaluation of Performance Characteristics of Panther Fusion Assays for Detection of Respiratory Viruses from Nasopharyngeal and Lower Respiratory Tract Specimens

2018 ◽  
Vol 56 (8) ◽  
Author(s):  
Soya S. Sam ◽  
Angela M. Caliendo ◽  
Jessica Ingersoll ◽  
Deborah Abdul-Ali ◽  
Charles E. Hill ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Positive Result ◽  
Lower Respiratory Tract ◽  
Influenza A ◽  
Performance Characteristics ◽  
Influenza B Virus ◽  
Influenza B ◽  
Respiratory Pathogens ◽  
Percent Agreement ◽  
Syncytial Virus

ABSTRACT Accurate and rapid diagnosis is needed for timely intervention and clinical management of acute respiratory infections. This study evaluated performance characteristics of the Panther Fusion assay for the detection of influenza A virus (Flu A), influenza B virus (Flu B), respiratory syncytial virus (RSV), parainfluenza viruses 1 to 3 (Para 1 to 3), human metapneumovirus (hMPV), rhinovirus (RV), and adenovirus (Adeno) targets in comparison to those of the eSensor and Lyra assays using 395 nasopharyngeal (NP) and 104 lower respiratory tract (LRT) specimens. Based on the consensus positive result established (positive result in 2 of the 3 assays), the NP specimens for the Fusion and eSensor assays had 100% positive percent agreement (PPA) for all the analytes and the Lyra assays had 100% PPA for Flu A and Adeno analytes. A 100% negative percent agreement (NPA) was observed for all the Lyra analytes, whereas those for the Fusion targets ranged from 98.4 to 100% and those for the eSensor ranged from 99.4 to 100% for all the analytes except RV. For the LRT specimens, Fusion had 100% PPA and 100% NPA for all the targets except hMPV. There was a 100% PPA for eSensor analytes; the NPA ranged from 98 to 100%, except for RV. For the Lyra assays, the PPA ranged between 50 and 100%, while the NPA was 100% for all the targets except Adeno. The Fusion assay performed similarly to the eSensor assay for majority of the targets tested and provides laboratories with a fully automated random-access system to test for a broad array of viral respiratory pathogens.

scholarly journals Utility and Challenges of a Multi-pathogen Diagnostic Platform for Characterizing Public Health Threats of Severe Acute Respiratory Infections in Six Countries

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S17-S18
Author(s):  
Jennifer Milucky ◽  
Keyword(s):  
Public Health ◽  
Influenza A ◽  
Age Distribution ◽  
Simultaneous Detection ◽  
Case Fatality ◽  
Influenza B ◽  
Upper Respiratory Tract ◽  
Severe Acute Respiratory Infection ◽  
Syncytial Virus ◽  
Multiple Pathogens

Abstract Background Pneumonia causes significant morbidity and mortality worldwide. Comprehensive etiology studies of pneumonia in adults are limited; however, new diagnostics enable simultaneous detection of multiple pathogens in respiratory specimens. Characterizing the public health threat of severe acute respiratory infection (SARI) may enhance global health security. We studied potential etiologies of SARI among adults in six countries over a 12-month period using multi-pathogen diagnostics. Methods We enrolled SARI cases (acute onset of fever and cough, requiring hospitalization, in an adult) from Global Disease Detection sites in Bangladesh, China, Egypt, Guatemala, Kenya, and Thailand and healthy frequency-matched controls (2 controls: 5 cases) by time (onset), age group (18–49, 50–64, 65+ years), and catchment area. Demographics, clinical data, and nasopharyngeal and oropharyngeal specimens were collected from cases and controls. Specimens were tested for 16 viruses and 14 bacteria using Taqman® Array Card, which uses real-time reverse transcriptase polymerase chain reaction. Results We enrolled 2,388 cases and 1,135 controls from Oct 2013 through Oct 2015. Age distribution (Figure) and seasonality varied by site: enrollment peaked in summer months in Bangladesh, Thailand, and China, and in winter months in Egypt, but was stable throughout the year in Guatemala and Kenya. Case fatality rate across all study locations was 2.3% (range 0–7.0%). One or more pathogens was detected in 76% of cases and in 67% of controls; ≥2 pathogens were detected in 42% of cases and 37% of controls. Pathogens more commonly detected among cases than controls included influenza A (OR 13.3, CI 7.0–25.2; 12.8% of cases vs. 1.1% of controls), influenza B (OR: 27.0, CI 8.6–84.8; 8.1% vs. 0.3%), and respiratory syncytial virus (RSV) (OR: 9.4, CI 3.4–25.8; 4.0% vs. 0.4%). Conclusion In this SARI study, frequent detection of multiple pathogens in the oro- and nasopharynx of both cases and controls made etiology attribution difficult. Influenza and RSV, however, were likely to be causes of SARI. Because upper respiratory tract specimens may not accurately reflect disease in the lung, better specimens are needed to determine pneumonia etiology, particularly for bacteria. Disclosures All authors: No reported disclosures.

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