Severe short-lasting left ventricular dysfunction associated with a respiratory infection

Introduction. Since clinical and electrocardiographic features of various cardiac disorders may overlap, the differential diagnosis of left ventricular (LV) dysfunction may be difficult even for the most experienced physicians. Recent advances in cardiac imaging may help clinicians to establish an accurate diagnosis and initiate adequate treatment. The aim of this case report is to raise awareness of a very short-lasting LV dysfunction during respiratory infections and to underline the importance of multimodality imaging in this clinical setting. Case outline. A previously healthy 37-year-old male presented with atypical chest pain and ST-segment elevation in the inferolateral leads during severe mental stress and acute respiratory infection. Acute myocardial infarction, myocarditis, coronary vasospasm and stress cardiomyopathy were all considered as a differential diagnosis. A rapid onset of severe LV dysfunction and a complete recovery within 4 days was detected by echocardiography and further evaluated by multimodality imaging, including multislice computed tomography and cardiac magnetic resonance imaging. Conclusion. Severe, but very short-lasting LV dysfunction may be triggered by various causes, including upper respiratory tract infections. Since the symptoms of respiratory infections may obscure those of LV dysfunction, myocardial dysfunction in these patients may go undetected with possible serious consequences.

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Ambient air pollution and risk of respiratory infection among adults: evidence from the multiethnic study of atherosclerosis (MESA)

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2020-000866 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000866

Author(s):

Kipruto Kirwa ◽

Carly M Eckert ◽

Sverre Vedal ◽

Anjum Hajat ◽

Joel D Kaufman

Keyword(s):

Air Pollution ◽

Respiratory Infection ◽

Respiratory Infections ◽

Ambient Air ◽

Acute Respiratory Infections ◽

Upper Respiratory Tract ◽

Short Term ◽

Study Region ◽

Short Term Exposure ◽

Tract Infections

BackgroundAir pollution may affect the risk of respiratory infection, though research has focused on uncommon infections or infections in children. Whether ambient air pollutants increase the risk of common acute respiratory infections among adults is uncertain, yet this may help understand whether pollutants influence spread of pandemic respiratory infections like COVID-19.ObjectiveTo estimate the association between ambient air pollutant exposures and respiratory infections in adults.MethodsDuring five study examinations over 12 years, 6536 participants in the multiethnic study of atherosclerosis (MESA) reported upper respiratory tract infections, bronchitis, pneumonia or febrile illness in the preceding 2 weeks. Using a validated spatiotemporal model, we estimated residential concentrations of ambient PM2.5, NOx and NO2 for the 2–6 weeks (short-term) and year (long-term) prior to each examination.ResultsIn this population aged 44–84 years at baseline, 10%–32% of participants reported a recent respiratory infection, depending on month of examination and study region. PM2.5, NOx and NO2 concentrations over the prior 2–6 weeks were associated with increased reporting of recent respiratory infection, with risk ratios (95% CIs) of 1.04 (1.00 to 1.09), 1.15 (1.10 to 1.20) and 1.21 (1.10 to 1.33), respectively, per increase from 25th to 75th percentile in residential pollutant concentration.ConclusionHigher short-term exposure to PM2.5 and traffic-related pollutants are associated with increased risk of symptomatic acute respiratory infections among adults. These findings may provide an insight into the epidemiology of COVID-19.

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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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Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections

PEDIATRICS ◽

10.1542/peds.101.s1.163 ◽

1998 ◽

Vol 101 (Supplement_1) ◽

pp. 163-165 ◽

Cited By ~ 11

Author(s):

Scott F. Dowell ◽

S. Michael Marcy ◽

William R. Phillips ◽

Michael A. Gerber ◽

Benjamin Schwartz

Keyword(s):

Respiratory Tract ◽

Antimicrobial Agents ◽

Respiratory Infections ◽

The United States ◽

Antimicrobial Treatment ◽

Antimicrobial Use ◽

Upper Respiratory Tract ◽

Oral Agents ◽

Upper Respiratory ◽

Tract Infections

This article introduces a set of principles to define judicious antimicrobial use for five conditions that account for the majority of outpatient antimicrobial use in the United States. Data from the National Center for Health Statistics indicate that in recent years, approximately three fourths of all outpatient antibiotics have been prescribed for otitis media, sinusitis, bronchitis, pharyngitis, or nonspecific upper respiratory tract infection.1Antimicrobial drug use rates are highest for children1; therefore, the pediatric age group represents the focus for the present guidelines. The evidence-based principles presented here are focused on situations in which antimicrobial therapy could be curtailed without compromising patient care. They are not formulated as comprehensive management strategies. For most upper respiratory infections that require antimicrobial treatment, there are several appropriate oral agents from which to choose. Although the general principles of selecting narrow-spectrum agents with the fewest side effects and lowest cost are important, the principles that follow include few specific antibiotic selection recommendations.

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Prescription Surveillance and Polymerase Chain Reaction Testing to Identify Pathogens during Outbreaks of Infection

BioMed Research International ◽

10.1155/2013/746053 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Hiroaki Sugiura ◽

Tsuguto Fujimoto ◽

Tamie Sugawara ◽

Nozomu Hanaoka ◽

Masami Konagaya ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Syndromic Surveillance ◽

Respiratory Infections ◽

Emerging Infectious Diseases ◽

Upper Respiratory Tract ◽

Chain Reaction ◽

Specific Pathogen ◽

Polymerase Chain ◽

Syncytial Virus ◽

Tract Infections

Syndromic surveillance, including prescription surveillance, offers a rapid method for the early detection of agents of bioterrorism and emerging infectious diseases. However, it has the disadvantage of not considering definitive diagnoses. Here, we attempted to definitively diagnose pathogens using polymerase chain reaction (PCR) immediately after the prescription surveillance system detected an outbreak. Specimens were collected from 50 patients with respiratory infections. PCR was used to identify the pathogens, which included 14 types of common respiratory viruses andMycoplasma pneumoniae. Infectious agents includingM. pneumoniae, respiratory syncytial virus (RSV), rhinovirus, enterovirus, and parainfluenza virus were detected in 54% of patients. For the rapid RSV diagnosis kit, sensitivity was 80% and specificity was 85%. For the rapid adenovirus diagnosis kit, no positive results were obtained; therefore, sensitivity could not be calculated and specificity was 100%. Many patients were found to be treated for upper respiratory tract infections without the diagnosis of a specific pathogen. In Japan, an outbreak ofM. pneumoniaeinfection began in 2011, and our results suggested that this outbreak may have included false-positive cases. By combining syndromic surveillance and PCR, we were able to rapidly and accurately identify causative pathogens during a recent respiratory infection outbreak.

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Medical Consultations After Typhoon Haiyan in a Field Hospital in the Philippines

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2019.99 ◽

2019 ◽

Vol 14 (1) ◽

pp. 34-38

Author(s):

Julita Gil Cuesta ◽

Joris Adriaan Frank van Loenhout ◽

Maria Lourdes de Lara Banquesio ◽

Masniza Mustaffa ◽

Debarati Guha-Sapir

Keyword(s):

Respiratory Tract Infections ◽

Respiratory Infections ◽

District Hospital ◽

The Philippines ◽

Upper Respiratory Tract ◽

Field Hospital ◽

Adult Men ◽

Medical Consultations ◽

Upper Respiratory ◽

Tract Infections

ABSTRACTIntroduction and Objectives:Typhoon Haiyan partially destroyed the Ormoc District Hospital in the Philippines. A field hospital was established to replace its outpatient department for 5 weeks. We investigated the reasons for medical consultation in the field hospital.Methods:We described the consultations by sex, age, week, and diagnosis according to the Surveillance in Post-Extreme Emergencies and Disasters system. We compared the number and proportion of upper respiratory tract infections (URTIs) with a control season in 2014.Results:We included 6785 consultations, 55.9% from women. The majority of consultations were communicable diseases (88.2%) followed by noncommunicable (7.1%) and injuries (5.6%). Males suffered more often from injuries than women (66.0% vs 34.0%). Consultations due to injuries decreased from 10.0% in the first to 2.9% in the last week. The most frequent diagnosis over the study period was acute respiratory infections (ARIs) (73.1%), of which 83.0% were children. The number of daily URTIs was higher than in a similar 2014 period.Conclusions:ARI was the most prevalent diagnosis. We recommend ARI treatments being fully accessible after such a disaster. During the first week, injury prevention should focus on adult men. Studies after natural disasters should include control periods to better understand disease distribution, ultimately improving the prioritization in disasters.

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Usefulness of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections in children

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01756-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yang Li ◽

Lanfang Min ◽

Xin Zhang

Keyword(s):

Differential Diagnosis ◽

Respiratory Tract ◽

Bacterial Infection ◽

Bacterial Infections ◽

Respiratory Tract Infections ◽

Respiratory Infections ◽

Diagnostic Value ◽

Significant Difference ◽

Group A ◽

Tract Infections

Abstract Background There is a lack of studies comparing PCT, CRP and WBC levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections. It is necessary to explore the correlation between above markers and different types of ARTI. Methods 108 children with confirmed bacterial infection were regarded as group A, 116 children with virus infection were regarded as group B, and 122 children with mycoplasmal infection were regarded as group C. The levels of PCT, CRP and WBC of the three groups were detected and compared. Results The levels of PCT, CRP and WBC in group A were significantly higher than those in groups B and C (p < 0.05). The positive rate of combined detection of PCT, CRP and WBC was significant higher than that of single detection. There was no significant difference in PCT, CRP and WBC levels between the group of G+ bacterial infection and G− bacterial infection (p > 0.05). ROC curve results showed that the AUC of PCT, CRP and WBC for the diagnosis of bacterial respiratory infections were 0.65, 0.55, and 0.58, respectively. Conclusions PCT, CRP and WBC can be combined as effective indicators for the identification of acute bacterial or no-bacterial infections in children. The levels of PCT and CRP have higher differential diagnostic value than that of WBC in infection, and the combined examination of the three is more valuable in clinic.

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Bacterial Infections of the Adult Upper Respiratory Tract

10.2310/fm.1237 ◽

2019 ◽

Author(s):

Laura K Certain ◽

Miriam B Barshak

Keyword(s):

Respiratory Tract ◽

Bacterial Infections ◽

Respiratory Tract Infections ◽

Respiratory Infections ◽

Group A Streptococcus ◽

The United States ◽

Controlled Study ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections

Upper respiratory tract infections are the most common maladies experienced by humankind.1 The majority are caused by respiratory viruses. A Dutch case-controlled study of primary care patients with acute respiratory tract infections found that viruses accounted for 58% of cases; rhinovirus was the most common (24%), followed by influenza virus type A (11%) and coronaviruses (7%). Group A streptococcus (GAS) was responsible for 11%, and 3% of patients had mixed infections. Potential pathogens were detected in 30% of control patients who were free of acute respiratory symptoms; rhinovirus was the most common.2 Given the increasing problem of antibiotic resistance and the increasing awareness of the importance of a healthy microbiome, antibiotic use for upper respiratory infections should be reserved for those patients with clear indications for treatment. A recent study of adult outpatient visits in the United States found that respiratory complaints accounted for 150 antibiotic prescriptions per 1,000 population annually, yet the expected “appropriate” rate would be 45.3 In other words, most antibiotic prescriptions for these complaints are unnecessary. Similarly, a study in the United Kingdom found that general practitioners prescribed antibiotics to about half of all patients presenting with an upper respiratory infection, even though most of these infections are viral.4 This review contains 5 figures, 16 tables, and 82 references. Keywords: infection, airway, sinusitis, otitis media, otitis externa, pharyngitis, epiglottitis, abscess

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P1333 The importance of multimodality imaging in the characterization of a congenital myocardial diverticulum

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.771 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

G Ramirez-Escudero Ugalde ◽

A M R Arantza Manzanal Rey ◽

N G I Nora Garcia Ibarrondo ◽

M C P Mireia Codina Prat ◽

L R G Lara Ruiz Gomez ◽

...

Keyword(s):

Differential Diagnosis ◽

Tissue Characterization ◽

Multimodality Imaging ◽

Interventricular Septum ◽

Fibrous Tissue ◽

Scar Tissue ◽

Left Ventricular ◽

Ventricular Diverticulum ◽

Asymptomatic Patients

Abstract Congenital ventricular diverticulum is a rare cardiac malformation, usually detected on echocardiographic examinations in asymptomatic patients. However, they can also cause embolisms, arrhythmias and sudden death due to ventricular rupture. Multimodality imaging can help in the characterization of its morphology and in the differential diagnosis. We report a case of an 83-year-old woman, pacemaker carrier due to complete atrioventricular block, who consulted for paroxysmal episodes of palpitations, being diagnosed of atrial fibrillation. A transthoracic echocardiogram was performed, observing an appendix at basal septal level with contractility of its wall and with doppler-colour inside, suggestive of myocardial diverticulum. Echocardiographic contrast was injected for better delimitation and characterization of the cavity. MRI was after performed for better characterization of this structure, confirming the presence of an accessory chamber with muscular wall and normal contractility at the level of the basal interventricular septum, without pathological enhancements. We reviewed an angioCT performed for other reasons some years ago, confirming the presence of the same structure, which went unnoticed in that study. The patient followed controls and remained asymptomatic, without evolutionary echocardiographic changes, so that a conservative attitude was maintained. Congenital ventricular diverticulum is formed by an appendix of the entire left ventricular (LV) wall. It can be differentiated into two types: muscular (more frequent, not prone to rupture and associated with other congenital malformations) or fibrous (frequently localized at the base of the heart or in subvalvular areas). Differential diagnosis may include true LV aneurysms (abnormal LV contour with systolic dyskinesia and involving thinned fibrous tissue) and LV pseudoaneurysms (acute contained rupture of the ventricle wall, often after myocardial infarction, also akinetic or dyskinetic). Congenital cardiac diverticulum is characterized by a rapid contrast filling and a narrow neck. MRI provide tissue characterization and is an important tool that helps in the differential diagnosis. In cardiac diverticulums, a thinned but contractile wall is present, without pathological delayed enhancements. In true aneurysms, the wall shows delayed enhancement (scar tissue). Pseudoaneurysms are only composed by pericardium, and the border of the aneurysms show enhancement indicating peri-aneurysmal infarcted area. Left ventricular catheterization can also be useful assessing the morphology and dynamics of the left ventricular chamber. In small, muscular and asymptomatic diverticulums, conservative treatment with follow-up is often recommended. When symptoms appear, medical or surgical treatment should be proposed. Abstract P1333 Figure. Congenital myocardial diverticulum

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Prevention of Acute Upper Respiratory Infections by Consumption of Catechins in Healthcare Workers: A Randomized, Placebo-Controlled Trial

Nutrients ◽

10.3390/nu12010004 ◽

2019 ◽

Vol 12 (1) ◽

pp. 4 ◽

Cited By ~ 3

Author(s):

Daisuke Furushima ◽

Takuma Nishimura ◽

Norikata Takuma ◽

Ryo Iketani ◽

Tomohito Mizuno ◽

...

Keyword(s):

Placebo Group ◽

Healthcare Workers ◽

Xanthan Gum ◽

Respiratory Infections ◽

Controlled Trial ◽

Rank Test ◽

Event Analysis ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Tract Infections

Catechins, phytochemicals contained mainly in green tea, exhibit antiviral activity against various acute infectious diseases experimentally. Clinical evidence supporting these effects, however, is not conclusive. We performed a placebo-controlled, single-blind, randomized control trial to evaluate the clinical effectiveness of consumption of catechins-containing beverage for preventing acute upper respiratory tract infections (URTIs). Two hundred and seventy healthcare workers were randomly allocated to high-catechin (three daily doses of 57 mg catechins and 100 mg xanthan gum), low-catechin (one daily dose of 57 mg catechins and 100 mg xanthan gum), or placebo (0 mg catechins and 100 mg xanthan gum) group. Subjects consumed a beverage with or without catechins for 12 weeks from December 2017 through February 2018. The primary endpoint was incidence of URTIs compared among groups using a time-to-event analysis. A total of 255 subjects were analyzed (placebo group n = 86, low-catechin group n = 85, high catechin group n = 84). The URTI incidence rate was 26.7% in the placebo group, 28.2% in the low-catechin group, and 13.1% in the high-catechin group (log rank test, p = 0.042). The hazard ratio (95% confidence interval (CI)) with reference to the placebo group was 1.09 (0.61–1.92) in the low-catechin group and 0.46 (0.23–0.95) in the high-catechin group. These findings suggest that catechins combined with xanthan gum protect against URTIs.

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Cardioprotection of dapagliflozin and vildagliptin in rats with cardiac ischemia-reperfusion injury

Journal of Endocrinology ◽

10.1530/joe-17-0457 ◽

2018 ◽

Vol 236 (2) ◽

pp. 69-84 ◽

Cited By ~ 30

Author(s):

Pongpan Tanajak ◽

Piangkwan Sa-nguanmoo ◽

Sivaporn Sivasinprasasn ◽

Savitree Thummasorn ◽

Natthaphat Siri-Angkul ◽

...

Keyword(s):

Infarct Size ◽

Myocardial Dysfunction ◽

Ischemia Reperfusion ◽

Combined Therapy ◽

Left Ventricular ◽

Cardiac Ischemia ◽

Lv Function ◽

Insulin Resistant ◽

Lv Dysfunction ◽

Dipeptidyl Peptidase 4 Inhibitors

Sodium-glucose cotransporter 2 inhibitor (SGLT2-i) effects on cardiac ischemia/reperfusion (I/R) injury are unclear. Unlike SGLT2-i, dipeptidyl peptidase 4 inhibitors (DPP4-i) have shown effective cardioprotection in cardiac I/R injury. We aimed to investigate whether SGLT2-i reduces myocardial dysfunction and myocardial injury to a greater extent than DPP4-i in obese insulin-resistant rats with/without cardiac I/R injury. The high-fat (HF) diet-induced obese insulin-resistant rats were divided into 4 groups and received the following treatments for 28 days: vehicle (HFV); vildagliptin at a dosage of 3 mg/kg/day (HFVil); dapagliflozin at a dosage of 1 mg/kg/day (HFDa) and combination drugs (HFDaVil). At the end, I/R injury was induced by a 30-min left anterior descending coronary occlusion and 120-min reperfusion. Dapagliflozin showed a greater efficacy than vildagliptin in improving the metabolic impairments, low frequency/high frequency (LF/HF) ratio, systolic blood pressure and left ventricular (LV) function in comparison to HFV rats. In cardiac I/R injury, dapagliflozin had a greater efficacy than vildagiptin in decreasing mitochondrial DRP1, cleaved caspase 3, LV dysfunction and infarct size in comparison to HFV rats. However, the combined therapy showed the greatest efficacy in attenuating LV dysfunction, mitochondrial DRP1 and infarct size in comparison to HFV rats. In conclusion, dapagliflozin has a more pronounced effect than vildagliptin in obese insulin-resistant rats for the improvement of LV function. In rats with cardiac I/R injury, although dapagliflozin had a greater efficacy on cardioprotection than vildagliptin, the combined therapy exerted the highest cardioprotective effects potentially by reducing mitochondrial fission.

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