Acute Respiratory Distress Syndrome Caused by Human Adenovirus in Adults: A Prospective Observational Study in Guangdong, 2019–2020

Abstract Background: Viral causes of acute respiratory distress syndrome (ARDS) are mostly limited to influenza. However, adenovirus has been emerging as a cause of ARDS with a high mortality rate and described in adults are rare.Methods: We conducted a prospective, single-center observational study of viral pneumonia with ARDS and confirmed adenovirus-associated ARDS in adults at our quaternary referral institution between March 2019 and June 2020. We prospectively analyzed clinical characteristics, laboratory test results, radiological characteristics, viral load from nasopharyngeal swabs and endotracheal aspirates, treatments, and outcomes for the study participants.Results: The study enrolled 143 ARDS patients, including 47 patients with viral pneumonia-related ARDS, among which there were 14 adenovirus-associated ARDS patients, which accounted for 29.79% of the viral pneumonia-related ARDS cases. Among the adenovirus-associated ARDS patients, 78.57% were men with a mean age of 54.93 ± 19.04 years. Adenovirus-associated ARDS patients had no specific clinical characteristics, but they presented with shortness of breath and fever, and their initial chest radiographic findings were multifocal or showed diffuse opacity. The viral load and the positivity rate in the lower respiratory tract were higher than that of the upper respiratory tract in the patients with adenovirus-associated ARDS, and 85.71% of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. All patients required invasive mechanical ventilation treatment. The average time from shortness of breath to the application of invasive ventilation was 24 hours. The median duration of invasive mechanical ventilation was 22 days (14–75 days). Six patients (42.86%) required renal replacement therapy, and three patients (21.43%) required extracorporeal membrane oxygenation support. Additionally, 85.71% of the 14 adenovirus-associated ARDS patients survived.Conclusion: Adenovirus infection is an important cause of virus-related ARDS. The positivity rate of adenovirus infection in lower respiratory tract secretions was higher than that in upper respiratory tract secretions in these patients. Most of the patients had a significant decrease in the number of CD3+CD4+ T cells during the early stage. Early identification and intervention to prevent disease progression are essential for reducing the mortality rate in these patients.

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Acute Respiratory Distress Syndrome Caused By Human Adenovirus In Adults: A Prospective Observational Study In Guangdong, 2019–2020

10.21203/rs.3.rs-641948/v2 ◽

2021 ◽

Author(s):

Zhan Wu ◽

Rong Zhang ◽

Dongdong Liu ◽

Xuesong Liu ◽

Jierong Zhang ◽

...

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Clinical Characteristics ◽

Distress Syndrome ◽

Early Stage ◽

Invasive Mechanical Ventilation ◽

Viral Pneumonia ◽

Upper Respiratory Tract ◽

Shortness Of Breath ◽

Upper Respiratory

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STUDIES ON EXPERIMENTAL PNEUMONIA

Journal of Experimental Medicine ◽

10.1084/jem.32.6.719 ◽

1920 ◽

Vol 32 (6) ◽

pp. 719-744 ◽

Cited By ~ 9

Author(s):

Russell L. Cecil ◽

Francis G. Blake

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Acute Inflammation ◽

Early Stage ◽

Acute Stage ◽

Cebus Capucinus ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Lymphoid Structures ◽

Nose And Throat

1. Virulent influenza bacilli, when injected into the nose and throat of monkeys (Cebus capucinus and Macacus syrichtus), excite an acute inflammation of the upper respiratory tract, characterized by swelling and hyperemia of the mucous membrane, infiltration of the mucosa and subrnucosa with leucocytes, desquamation of epithelial cells, and the production of a mucopurulent exudate. The accessory sinuses are often implicated in the infection. 2. Experimental Bacillus influenzæ infections of the upper respiratory tract are frequently accompanied or followed by bronchiolitis, peribronchial infiltration, and bronchopneumonia with hemorrhage and edema in the early stage, emphysema and bronchiectasis in the later stages. In general, the process closely resembles uncomplicated Bacillus influenzæ pneumonia in man. 3. The injection of virulent influenza bacilli directly into the trachea of monkeys induces in them an experimental bronchiolitis and hemorrhagic bronchopneumonia, similar in all respects to spontaneous Bacillus influenzæ pneumonia. 4. In experimental Bacillus influenzæinfections of either the upper or lower respiratory tract the influenza bacillus can usually be recovered during .the acute stage by culture, either pure or in association with other bacteria. 5. In experimental Bacillus influenzæ infections in monkeys characteristic changes occur in the thymus gland—hyperplasia of the follicles, distention of the lymphatic channels, and infiltration of the parenchyma with leucocytes. This enlargement appears to be merely part of a general hyperplasia of the lymphoid structures in the cervical and thoracic regions.

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Viral etiology and epidemiology of pediatric patients hospitalized for acute respiratory tract infections in Macao: a retrospective study from 2014 to 2017

BMC Infectious Diseases ◽

10.1186/s12879-021-05996-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cheng Lei ◽

Lisong Yang ◽

Cheong Tat Lou ◽

Fan Yang ◽

Kin Ian SiTou ◽

...

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Pediatric Patients ◽

Respiratory Infections ◽

Upper Respiratory Tract ◽

Viral Etiology ◽

Upper Respiratory ◽

Syncytial Virus ◽

Tract Infections

Abstract Background Acute respiratory infections (ARIs) are among the leading causes of hospitalization in children. Understanding the local dominant viral etiologies is important to inform infection control practices and clinical management. This study aimed to investigate the viral etiology and epidemiology of respiratory infections among pediatric inpatients in Macao. Methods A retrospective study using electronic health records between 2014 and 2017 at Kiang Wu Hospital was performed. Nasopharyngeal swab specimens were obtained from hospitalized children aged 13 years or younger with respiratory tract diseases. xMAP multiplex assays were employed to detect respiratory agents including 10 respiratory viruses. Data were analyzed to describe the frequency and seasonality. Results Of the 4880 children enrolled in the study, 3767 (77.1%) were positive for at least one of the 13 viral pathogens tested, of which 2707 (55.5%) being male and 2635 (70.0%) under 2 years old. Among the positive results, there were 3091 (82.0%) single infections and 676 (18.0%) multiple infections. The predominant viruses included human rhinovirus/enterovirus (HRV/EV 27.4%), adenovirus (ADV, 15.8%), respiratory syncytial virus B (RSVB, 7.8%) and respiratory syncytial virus A (RSVA, 7.8%). The detection of viral infection was the most prevalent in autumn (960/1176, 81.6%), followed by spring (1095/1406, 77.9%), winter (768/992, 77.4%), and summer (944/1306, 72.3%), with HRV/EV and ADV being most commonly detected throughout the 4 years of study period. The detection rate of viral infection was highest among ARI patients presented with croup (123/141, 87.2%), followed by lower respiratory tract infection (1924/2356, 81.7%) and upper respiratory tract infection (1720/2383, 72.2%). FluA, FluB and ADV were positive factors for upper respiratory tract infections. On the other hand, infection with RSVA, RSVB, PIV3, PIV4, HMPV, and EV/RHV were positively associated with lower respiratory tract infections; and PIV1, PIV2, and PIV3 were positively associated with croup. Conclusions This is the first study in Macao to determine the viral etiology and epidemiology of pediatric patients hospitalized for ARIs. The study findings can contribute to the awareness of pathogen, appropriate preventative measure, accurate diagnosis, and proper clinical management of respiratory viral infections among children in Macao.

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MIST THERAPY RECONSIDERED; AN EVALUATION OF THE RESPIRATORY DEPOSITION OF LABELLED WATER AEROSOLS PRODUCED BY JET AND ULTRASONIC NEBULIZERS

PEDIATRICS ◽

10.1542/peds.43.5.799 ◽

1969 ◽

Vol 43 (5) ◽

pp. 799-808

Author(s):

Jack Wolfsdorf ◽

David L. Swift ◽

Mary Ellen Avery

Keyword(s):

Standard Deviation ◽

Respiratory Tract ◽

Propylene Glycol ◽

Lower Respiratory Tract ◽

Aerosol Deposition ◽

Geometric Standard Deviation ◽

Upper Respiratory Tract ◽

Nasal Breathing ◽

Upper Respiratory ◽

Mass Median

Aerosol deposition in the upper and lower respiratory tract using technetium-labelled water aerosol, produced by jet and ultrasonic nebulizers, with and without 10% propylene glycol, was examined under conditions of nasal, normal mouth, and tube breathing in 15 normal adults. With nasal breathing, 91.5% (± 5.5) and 83.2% (± 6.3) of the mass of the aerosol produced by the jet and ultrasonic nebulizers, respectively, was deposited in the upper respiratory tract. Similar fractional depositions were observed with the addition of 10% propylene glycol. When breathing was carried out via a mouth tube, 43% to 59% of the mass of the aerosol produced by the nebulizers was deposited in the upper respiratory tract. The mass median diameters of the available aerosols produced by the jet and ultrasonic nebulizers were 6.0 µ (geometric standard deviation = 2.5) and 2.8 µ (geometric standard deviation = 2.1), respectively; the densities of the aerosols produced were 8 and 34 µl/liter air. With nasal or normal mouth breathing, the volume of water, in aerosol form, that could be deposited per 24 hours in the lower respiratory tract of an adult was calculated to be about 6 ml and 49 ml for the jet and ultrasonic nebulizer, respectively.

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Otorhinolaryngological manifestations of COVID-19

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0014.8514 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Jarosław Wysocki

Keyword(s):

Respiratory Tract ◽

Distress Syndrome ◽

Clinical Symptoms ◽

Wide Spectrum ◽

Multiple Organ ◽

Upper Respiratory Tract ◽

Equilibrium System ◽

Similar Frequency ◽

Upper Respiratory ◽

Loss Of Strength

COVID-19 manifests itself in a wide spectrum of clinical symptoms, both in terms of their variety and severity. It can be asymptomatic or abortive, mild, moderate, severe and lightning, as septic with multiple organ failure and shock Typical leading symptoms of COVID-19 are: high fever poorly responding to drugs, severe loss of strength, chest pain, dyspnoea, pain headaches, bone and joint pain and muscle pain, until the onset of acute respiratory distress syndrome (ARDS). However, many publications mention among the possible symptoms also others, not related to the involvement of the lower respiratory tract. These are gastrointestinal disorders, damage to the central and peripheral nervous system, catarrh of the upper respiratory tract and dysfunctions of the sensory organs. The aim of this literature review was to determine the frequency of various head and neck dysfunctions that are part of COVID-19. Symptoms of conjunctivitis, nasal mucosa, pharynx and larynx are reported by about of patients, but they do not always occur at the same time, as in infections caused, for example, by rhinoviruses. Anosmi / hyposmia or ageusia / hypogeusia occur with a similar frequency. Symptoms of damage to the equilibrium system, such as dizziness, are reported by approx. 1/3, vertigo and hearing loss approx. 5-6%, tinnitus approx. 10% of patients. Reports of coexistence with COVID-19 of peripheral paresis of the facial nerve are so far relatively few and often included in the neurological disorders, the frequency of which is also about 1/3 of COVID-19 cases. Importantly, both catarrhal symptoms and the others listed here may precede, co-occur or follow the appearance of the leading symptoms of COVID-19. They can also be the only symptoms of this disease. This should prompt otorhinolaryngologists to be particularly vigilant in this regard

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Challenges in the delivery of critical care in India during the COVID-19 pandemic

Journal of the Intensive Care Society ◽

10.1177/1751143720952590 ◽

2020 ◽

pp. 175114372095259

Author(s):

Bharath Kumar Tirupakuzhi Vijayaraghavan ◽

Sheila Nainan Myatra ◽

Meghena Mathew ◽

Nirmalyo Lodh ◽

Jigeeshu Vasishtha Divatia ◽

...

Keyword(s):

Critical Care ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Tract ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Upper Respiratory Tract ◽

Care Services ◽

Life Threatening ◽

Upper Respiratory

Coronavirus disease 2019 cases in India continue to increase and are expected to peak over the next few weeks. Based on some projection models, India is expected to have more than 10 million cases by September 2020. The spectrum of disease can vary from mild upper respiratory tract symptoms to life-threatening acute respiratory distress syndrome and multi-organ failure requiring intensive care. Even if less than 5% of patients require critical care services, this will still rapidly overwhelm the healthcare system in a country, where intensive care services and resources are scarce and unevenly distributed. In this perspective article, we highlight the critical care preparedness of India for the pandemic and the associated challenges.

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Optimal induction of upper respiratory tract immunity to reovirus 1/L by combined upper and lower respiratory tract inoculation

Vaccine ◽

10.1016/s0264-410x(98)00382-x ◽

1999 ◽

Vol 17 (11-12) ◽

pp. 1404-1415 ◽

Cited By ~ 10

Author(s):

A HODSONTHOMPSON

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Upper Respiratory Tract ◽

Upper Respiratory

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Diagnosis of influenza from lower respiratory tract sampling after negative upper respiratory tract sampling

Virulence ◽

10.4161/viru.22466 ◽

2013 ◽

Vol 4 (1) ◽

pp. 82-84 ◽

Cited By ~ 9

Author(s):

Isaac I. Bogoch ◽

Jason R. Andrews ◽

Kimon C. Zachary ◽

Elizabeth L. Hohmann

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Upper Respiratory Tract ◽

Upper Respiratory

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Paired nasopharyngeal and deep lung testing for SARS-CoV2 reveals a viral gradient in critically ill patients: a multi-centre study

10.1101/2020.07.19.20156869 ◽

2020 ◽

Author(s):

Islam Hamed ◽

Nesreen Shaban ◽

Marwan Nassar ◽

Sam Love ◽

Martin D Curran ◽

...

Keyword(s):

Viral Load ◽

Respiratory Tract ◽

Critically Ill ◽

Critically Ill Patients ◽

Lower Respiratory Tract ◽

Limit Of Detection ◽

Upper Respiratory Tract ◽

Rt Pcr ◽

Multi Centre Study ◽

Upper Respiratory

Introduction Samples for diagnostic tests for SARS-CoV-2 can be obtained from the upper (nasopharyngeal/oropharyngeal swabs) or lower respiratory tract (sputum or tracheal aspirate or broncho-alveolar lavage - BAL). Data from different testing sites indicates different rates of positivity. Reverse-transcriptase polymerase chain reaction (RT-PCR) allows for semi-quantitative estimates of viral load as time to crossing threshold (Ct) is inversely related to viral load. Objectives The objective of our study was to evaluate SARS-CoV2 RNA loads between paired nasopharyngeal (NP) and deep lung (endotracheal aspirate or BAL) samples from critically ill patients. Methods SARS-CoV-2 RT-PCR results were retrospectively reviewed for 51 critically ill patients from 5 intensive care units in 3 hospitals ; Addenbrookes Hospital Cambridge (3 units), Royal Papworth Cambridge (1 unit), and Royal Sunderland Hospital (1 unit). At the times when paired NP and deep lung samples were obtained, one patient had been on oxygen only, 6 patients on non-invasive ventilation, 18 patients on ECMO, and 26 patients mechanically ventilated. Results Results collected showed significant gradient between NP and deep lung viral loads. Median Ct value was 29 for NP samples and 24 for deep lung samples. Of 51 paired samples, 16 were negative (below limit of detection) on NP swabs but positive (above limit of detection) on deep lung sample, whilst 2 were negative on deep sample but positive on NP (both patients were on ECMO). Conclusions It has been suggested that whilst SARS-CoV1 tends to replicate in the lower respiratory tract, SARS-CoV2 replicates more vigorously in the upper respiratory tract. These data challenge that assumption. These data suggest that viral migration to, and proliferation in, the lower respiratory tract may be a key factor in the progression to critical illness and the development of severe acute respiratory syndrome (SARS). Factors which promote this migration should be examined for association with severe COVID-19. From a practical point of view, patients with suspected severe COVID-19 should have virological samples obtained from the lower respiratory tract where-ever possible, as upper respiratory samples have a significant negative rate.

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