scholarly journals A 2018/2019. évi légúti szezonban influenzaszerű betegséggel kórházban ellátott felnőtt betegek klinikai és mikrobiológiai jellemzése

2020 ◽  
Vol 161 (52) ◽  
pp. 2179-2187
Author(s):  
Boglárka Laky ◽  
Bálint Gergely Szabó
Keyword(s):  
Influenza A ◽  
Primary Outcome ◽  
Influenza Season ◽  
Respiratory Viruses ◽  
Complication Rates ◽  
Icu Admission ◽  
B Virus ◽  
All Cause Mortality ◽  
Significant Burden ◽  
Observational Cohort

Összefoglaló. Bevezetés, célkitűzés: Az influenzaszezonban fellépő, elsősorban virális megbetegedések jelentős morbiditási és mortalitási teherrel rendelkeznek. Célunk volt az influenzaszerű betegséggel (ILI) és akut légúti betegséggel (ARI) kórházba felvett felnőtt betegek mikrobiológiai és klinikai karakterisztikájának leírása. Módszerek: Egycentrumos, obszervációs kohorszvizsgálatunk során a 2018/2019. évi légúti szezonban a Dél-pesti Centrumkórház – Országos Hematológiai és Infektológiai Intézet Infektológiai Osztályára ILI/ARI diagnózissal felvett betegek eseteit dolgoztuk fel a kórház elektronikus adatbázisának segítségével. Bevonásra azon betegek kerültek, akiknél légúti PCR-vizsgálat történt. A bevont betegeket alcsoportokra osztottuk: klinikai ILI/ARI, PCR-pozitív ILI/ARI influezavírussal, PCR-pozitív ILI/ARI más vírussal. Elsődleges kimenetelnek a komplikált betegséglefolyást, másodlagos kimenetelnek a kórházi összhalálozást, az intenzív osztályos (ICU-) felvételt, az osztályos ápolás hosszát (LOS) és az ICU LOS-t választottuk. Statisztikai összehasonlításra a Mann–Whitney-féle U-próbát, a Fisher-féle egzakt tesztet használtuk. Eredmények: A bevont 112 eset 42,8%-ában igazolódott influenza A- vagy B-vírus, 7,1%-ban egyéb légúti vírus, második leggyakrabban az RSV etiológiai szerepe. Megelőző kórházi ellátás szignifikánsan gyakrabban fordult elő PCR-pozitív ILI/ARI esetekben (23,2% vs. 42,8%; p = 0,04); ugyanezen betegek körében a panaszok kezdetétől a diagnózisig eltelt idő kb. 1 nappal rövidebb volt (3,0 ± 4,0 vs. 4,0 ± 5,0 nap; p = 0,02). A komplikációk gyakoriságát hasonló nagyságúnak találtuk (46,4% vs. 51,8%; p = 0,72), a leggyakoribb szövődmény a tüdőgyulladás volt (45,5%). ICU-felvételre az esetek 5,4%-ában volt szükség, a kórházi összhalálozás 3,6%-nak adódott. A medián LOS 8,5 ± 8,0 nap, a medián ICU LOS ideje 20,5 ± 30,5 nap volt. Következtetés: A vizsgált légúti szezonban ILI/ARI diagnózissal felvett betegek jelentős részében influenza-, kisebb hányadban egyéb légúti vírusok voltak felelősek a klinikumért. A leggyakoribb szövődmény a pneumonia volt. A légúti PCR-vizsgálat lehetőséget nyújthat az etiológia tisztázására. Orv Hetil. 2020; 161(52): 2179–2187. Summary. Introduction, objectives: A significant burden of morbidity and mortality is caused by seasonal outbreaks of respiratory viruses. Our aim was to identify clinical and microbiological differences among adult patients hospitalized with acute respiratory infection (ARI) or influenza-like illness (ILI). Methods: A single-center observational cohort study was conducted at South Pest Central Hospital, National Institute of Hematology and Infectious Diseases during the 2018/2019 influenza season. Patients were identified using the hospital database, and included in the study if respiratory PCR sampling was done during hospital stay. Subgroups were created according to the identified etiology: clinical ILI/ARI (no PCR positivity), PCR positive ILI/ARI with influenza, PCR positive ILI/ARI with other virus(es). Primary outcome was the occurrence of any complication, secondary outcomes were in-hospital all-cause mortality, intensive care unit (ICU) admission, length of stay (LOS) and ICU LOS. For statistical analysis, Mann–Whitney and Fisher’s tests were used. Results: From 112 identified cases, 42.8% were caused by influenza A or B, 7.1% by other viruses, notably RSV. PCR positivity frequently associated with prior hospitalization (23.2% vs. 42.8%; p = 0.04), and shorter time from symptom onset to diagnosis (3.0 ± 4.0 vs. 4.0 ±5.0 days, p = 0.02). Complication rates were similar among subgroups (46.4% vs. 51.8%; p = 0.72), with pneumonia as a leading complication (45.5%). ICU admission was necessary in 5.4%, in-hospital all-cause mortality was 3.6%. Median LOS and ICU LOS were 8.5 ± 8.0 and 20.5 ± 30.5 days, respectively. Conclusion: During the 2018/2019 season, most ILI/ARI cases were caused by influenza, but other respiratory viruses could also be detected in lower rates. Pneumonia was the most common complication. Respiratory PCR sampling might provide a feasible way of etiology identification. Orv Hetil. 2020; 161(52): 2179–2187.

scholarly journals Based on Transcriptome Sequencing: Clinicians Need to Pay Attention to Fever Caused by Common Respiratory Pathogens During the Global Outbreak of COVID-19

2021 ◽  
Author(s):  
Sheng Yin ◽  
Zeyou Wang ◽  
Min Wang ◽  
Wenlong Wang
Keyword(s):  
Public Health ◽  
Nucleic Acid ◽  
Influenza A ◽  
De Novo ◽  
Respiratory Pathogens ◽  
Public Health Decision ◽  
Significant Difference ◽  
B Virus ◽  
Health Decision ◽  
Observational Cohort

Abstract Objectives:During the COVID-19 pandemic, clinicians and public health decision-makers especially focus on fever patients. Other common pathogens that may cause fever are easily overlooked. We aimed to describe the pathogen infection and epidemic trend of non-SARS-CoV-2 occurring in hospitalized patients.Methods:An observational cohort study of 733 consecutive patients admitted to Hospital Clinic of the Second Xiangya Hospital for COVID-19. All samples of a pharyngeal swab from patients with fever have been tested for nucleic acid and immune antigens of SARS-CoV-2 and Influenza A/B virus. 649 fever patients have been tested for nucleic acid in ten respiratory pathogens. Macrotranscriptome sequencing was performed on 26 samples.Results:Of a total of 733 patients with fever, 2.05% patients had confirmed SARS-CoV-2 infections. Fever patients with common respiratory pathogens in fever patients was 8.78%. There is no integration phenomenon between SARS-Cov-2 and the human genome. SARS-CoV-2 positive samples will also be infected with other viruses, especially adenovirus. Macrotranscript analysis showed that there was no significant difference in the species and genus levels of pathogens between Covid-19 patients and other fever patients. The main pathways that affect human metabolism after SARS-Cov-2 infection are the Calvin-Benson-Bassham cycle, pyrimidine deoxyribonucleotides de novo biosynthesis I and D-galactose degradation V.Conclusions:Most patients have a fever caused by common respiratory pathogens. Clinicians still need to pay more attention to infections of common respiratory pathogens in addition to SARS-CoV-2. China's public health measures to stop the spread of the epidemic have proven effective.

scholarly journals Incidence of medically attended acute respiratory illnesses due to respiratory viruses across the life course during the 2018/19 influenza season

2021 ◽  
Author(s):  
Michael L Jackson ◽  
Lea Starita ◽  
Erika Kiniry ◽  
C Hallie Phillips ◽  
Stacie Wellwood ◽  
...  
Keyword(s):  
Life Course ◽  
Influenza A ◽  
Influenza Season ◽  
Respiratory Illness ◽  
Respiratory Viruses ◽  
Acute Respiratory Illness ◽  
Common Cause ◽  
Influenza A H1n1 ◽  
Syncytial Virus ◽  
The Life Course

Abstract Background While multiple respiratory viruses circulate in humans, few studies have compared the incidence of different viruses across the life course. We estimated the incidence of outpatient illness due to 12 different viruses during November 2018 through April 2019 in a fully enumerated population. Methods We conducted active surveillance for ambulatory care visits for acute respiratory illness (ARI) among members of Kaiser Permanente Washington (KPWA). Enrolled patients provided respiratory swab specimens which were tested for 12 respiratory viruses using RT-PCR. We estimated the cumulative incidence of infection due to each virus overall and by age group. Results The KPWA population under surveillance included 202,562 individuals, of whom 2,767 (1.4%) were enrolled in the study. Influenza A(H3N2) was the most commonly detected virus, with an overall incidence 21 medically attended illnesses per 1,000 population; the next most common viruses were influenza A(H1N1) (18 per 1,000), coronaviruses (13 per 1,000), respiratory syncytial virus (RSV, 13 per 1,000), and rhinovirus (9 per 1,000). RSV was the most common cause of medically attended ARI among children aged 1-4 years; coronaviruses were the most common among adults aged ≥65 years. Conclusions Consistent with other studies focused on single viruses, we found that influenza and RSV were major causes of acute respiratory illness in persons of all ages. In comparison, coronaviruses and rhinovirus were also important pathogens. Prior to the emergence of SARS-CoV-2, coronaviruses were the second-most common cause of medically attended ARI during the 2018/19 influenza season.

scholarly journals Co-circulation of Influenza A and B During the 2016–2017 Influenza Season at Rush University Medical Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S314-S315 ◽  
Author(s):  
Andrew Simms ◽  
Hemil Gonzalez ◽  
Nicholas M Moore ◽  
Leslie A Chapman ◽  
Karen Lolans ◽  
...  
Keyword(s):  
Influenza A ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Quadrivalent Vaccine ◽  
Influenza B Virus ◽  
Influenza B ◽  
Icu Admission ◽  
B Virus ◽  
Pregnancy Status ◽  
Trivalent Vaccine

Abstract Background Two strains of influenza B virus, B/Yamagata and B/Victoria, co-circulate in the USA, typically appearing in late March. This year, influenza B virus (FluB) co-circulated consistently with influenza A virus (FluA). We hypothesized that this could be explained by an increased use of influenza trivalent vaccine, which lacks the B/Yamagata strain, over the quadrivalent vaccine. Methods We performed a retrospective, observational cohort study of patients with laboratory-diagnosed influenza from October 2016 through April 2017. Age, comorbidity categories, pregnancy status, symptoms, The presence of opacity on chest film, ICU admission, death, and receipt of oseltamivir were reviewed for 256 patients. A subset of FluB specimens were subtyped for lineage using RT–PCR. Results Influenza was detected in 495 (10.4%) of 4,754 samples collected, including 305 FluA and 190 FluB. The H3 strain represented 97% of FluA cases. FluB subtypes were: 70, B/Victoria; 21, B/Yamagata; and 41, not subtyped. Chart review was conducted for 124 randomly selected FluA and 132 sequential FluB patients. Median age of patients with FluA was 44 compared with 27 with FluB (P < 0.001). Forty-three (34.7%) FluA patients had heart disease compared with 21 (15.9%) FluB patients (P < 0.001). Otherwise, there were no differences in comorbidities, pregnancy status, clinical symptoms, or infectious complications between FluA vs. FluB patients. Ninety-three (75%) FluA patients and 78 (59.1%) FluB patients received oseltamivir. ICU admission occurred in 15 (12.1%) FluA and 9 (6.8%) FluB patients (OR 1.414; 95% CI 0.83-2.4). Seventy-seven (30%) patients received flu vaccine, 39 with FluA, and 38 with FluB; 97 (37.9%) were not vaccinated and 82 (32%) were missing data. Of those vaccinated, 6 patients received trivalent vaccine, and 71 received quadrivalent. Only 24 patients with B/Victoria and 7 patients with B/Yamagata were vaccinated. Conclusion The proportion of infected patients who had received vaccination was low, limiting our ability to detect the effect of the trivalent vaccine on the incidence of infection with B/Yamagata. In contrast to conventional thought, when compared with influenza B, influenza A (predominantly H3N2) did not appear to disproportionally affect those with most medical comorbidities, and was not disproportionately associated with our identified clinical complications. Disclosures All authors: No reported disclosures.

scholarly journals Post-pandemic influenza A/H1N1pdm09 is associated with more severe outcomes than A/H3N2 and other respiratory viruses in adult hospitalisations

2019 ◽  
Vol 147 ◽  
Author(s):  
C. A. Minney-Smith ◽  
L. A. Selvey ◽  
A. Levy ◽  
D. W. Smith
Keyword(s):  
Clinical Outcomes ◽  
Influenza A ◽  
Respiratory Virus ◽  
Respiratory Illness ◽  
Respiratory Viruses ◽  
Influenza B ◽  
Virus Infections ◽  
Icu Admission ◽  
Hospitalised Patients ◽  
Syncytial Virus

Abstract This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2–5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6–5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47–0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.

scholarly journals Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively

2018 ◽  
Vol 23 (13) ◽  
Author(s):  
Cornelia Adlhoch ◽  
René Snacken ◽  
Angeliki Melidou ◽  
Silviu Ionescu ◽  
Pasi Penttinen ◽  
...  
Keyword(s):  
Eastern Europe ◽  
Influenza A ◽  
Surveillance Data ◽  
H3n2 Virus ◽  
Geographical Spread ◽  
B Virus ◽  
All Cause Mortality ◽  
Influenza Activity ◽  
A Current

We use surveillance data to describe influenza A and B virus circulation over two consecutive seasons with excess all-cause mortality in Europe, especially in people aged 60 years and older. Influenza A(H3N2) virus dominated in 2016/17 and B/Yamagata in 2017/18. The latter season was prolonged with positivity rates above 50% among sentinel detections for at least 12 weeks. With a current west–east geographical spread, high influenza activity might still be expected in eastern Europe.

scholarly journals Outcome of Critically Ill COVID-19 Patients According to the Setting of Corticosteroid Initiation—A Retrospective Observational Cohort Study

2021 ◽  
Vol 11 (12) ◽  
pp. 1359
Author(s):  
Sebastian Voicu ◽  
Thomas Lacoste-Palasset ◽  
Isabelle Malissin ◽  
Shana Bekhit ◽  
Eléonore Cauchois ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Icu Admission ◽  
Failure Assessment ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
Group Survival ◽  
Retrospective Observational Cohort Study

(1) Background: Corticosteroids lower 28-day all-cause mortality in critically ill COVID-19 patients. However, the outcome of COVID-19 patients referred to the intensive care unit (ICU) for respiratory deterioration despite corticosteroids initiated during hospitalization before ICU admission has been poorly investigated. Our objective was to determine survival according to corticosteroid initiation setting. (2) Methods: We conducted a cohort study including all successive critically ill COVID-19 patients treated with corticosteroids and managed in our ICU. We compared survival, whether corticosteroids were initiated before (Cb-group) or after ICU admission (Ca-group), using a propensity score matching. (3) Results: Overall, 228 patients (67 years (56–74); 168M/60F; invasive mechanical ventilation on admission, 17%) were included with 63 patients in the Cb-group and 165 patients in the Ca-group. Survival to hospital discharge was 43% versus 69%, respectively (p = 0.001). In a multivariable analysis, factors associated with death were age (odds ratio, 1.07; 95%-confidence interval, (1.04–1.11); p < 0.0001), the sequential organ failure assessment (SOFA) score on ICU admission (1.30 (1.14–1.50); p = 0.0001) and corticosteroid initiation before ICU admission (2.64 (1.30–5.43); p = 0.007). No significant differences in outcome related to corticosteroid regimen were found. (4) Conclusions: Critically ill COVID-19 patients transferred to the ICU with deterioration despite corticosteroids initiated before admission have a less favorable outcome than patients receiving corticosteroids initiated after ICU admission.

scholarly journals Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017

2017 ◽  
Vol 22 (14) ◽  
Author(s):  
Lasse S Vestergaard ◽  
Jens Nielsen ◽  
Tyra G Krause ◽  
Laura Espenhain ◽  
Katrien Tersago ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Influenza A ◽  
Excess Mortality ◽  
Influenza Season ◽  
European Countries ◽  
Cold Weather ◽  
Attributable Mortality ◽  
Influenza Virus A ◽  
All Cause Mortality

Since December 2016, excess all-cause mortality was observed in many European countries, especially among people aged ≥ 65 years. We estimated all-cause and influenza-attributable mortality in 19 European countries/regions. Excess mortality was primarily explained by circulation of influenza virus A(H3N2). Cold weather snaps contributed in some countries. The pattern was similar to the last major influenza A(H3N2) season in 2014/15 in Europe, although starting earlier in line with the early influenza season start.

scholarly journals Epidemiology and Clinical Outcomes of Respiratory Viral Infections at a Single Tertiary Centre in Alberta, Canada

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S318-S318
Author(s):  
Alastair Teale ◽  
Lori Zapernick ◽  
Geoffrey Taylor ◽  
Stephanie Smith
Keyword(s):  
Clinical Outcomes ◽  
Respiratory Infection ◽  
Influenza A ◽  
Viral Infections ◽  
Antiviral Treatment ◽  
Respiratory Viruses ◽  
Icu Admission ◽  
Respiratory Viral Infections ◽  
Hospital Acquired ◽  
Related Mortality

Abstract Background Respiratory viral infections (RVI) are commonly seen in hospitalized patients. While many studies have examined outcomes with influenza, fewer studies have examined outcomes of community and hospital acquired infections of other respiratory viruses. Methods Data were prospectively collected from adult (age&gt;17 years) inpatients with a positive result from respiratory viral multiplex panel testing during consecutive viral respiratory seasons from November 2014 to April 2017 at our facility. Ambulatory patients were excluded. Clinical outcomes including ICU admission requiring intubation, overall mortality and respiratory virus infection-related mortality was assessed at 30 days post infection. Results A total of 731 inpatients with positive results were identified. Influenza A was the most commonly detected virus (44%) followed by respiratory syncytial virus (RSV)(14%) and rhinovirus/enterovirus (13%). Rates of RSV and human metapneumovirus infections displayed significant yearly variability. There were no significant differences in rates of ICU admission requiring intubation (16.8% vs. 14.3% P = 0.35) between infections caused by influenza A and B and other respiratory viruses. In addition, mortality related to respiratory infections between these groups was also similar (5.7% Influenza vs. 4.5% non-Influenza P = 0.46). Ninety-five (15%) of identified patients had hospital acquired respiratory viral infections. Influenza A was the most commonly isolated hospital acquired infection (39%). Rates of ICU admission requiring intubation (22.6% vs. 14.6%, P = 0.06) and respiratory infection-related mortality (7.4% vs. 4.8%, P = 0.14) were higher in hospital acquired RVI but did not meet statistical significance. Less than half (45%) of all patients testing positive for influenza received antiviral treatment (oseltamivir). Respiratory infection-related mortality was not significantly different between those who were treated and those who were not treated (5.5% vs. 4.4%, P = 0.64). Conclusion While influenza remains the most common community and hospital acquired respiratory viral infection in inpatients at our facility, half of infections were attributed to other respiratory viruses and these resulted in similar rates of serious outcomes including ICU admission and mortality. Disclosures All authors: No reported disclosures.

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