Severe Infections Due to Respiratory Viruses

Trends of respiratory viruses and factors associated with severe acute respiratory infection in patients presenting at a university hospital: a 6-year retrospective study across the COVID-19 pandemic

Background

The COVID-19 pandemic significantly disrupted the epidemiology of respiratory viruses, altering seasonal patterns and reducing circulation. While recovery trends have been observed, factors associated with severe acute respiratory infections (SARIs) during pre- and post-pandemic periods remain underexplored in middle-income countries.

Objective

This study aimed to analyze the trends in respiratory virus circulation and identify factors associated with SARI in patients attending a tertiary care university hospital in western Mexico over a six-year period spanning the pre-pandemic, pandemic, and post-pandemic phases.

Methods

A retrospective study was conducted using data from 19,088 symptomatic patients tested for respiratory viruses between 2018 and 2024. Viral trends were analyzed through interrupted time series (ITS) modeling, incorporating locally estimated scatterplot smoothing (LOESS) and raw positivity rates. Additionally, ITS analysis was performed to evaluate temporal changes in SARI proportions across different phases of the pandemic. Multivariate logistic regression models were applied to determine independent risk factors for SARI across different time periods.

Results

During the pandemic (2020-2021), respiratory virus positivity rates significantly declined, particularly for influenza, which experienced a sharp reduction but rebounded post-2022. Respiratory syncytial virus (RSV) demonstrated a delayed resurgence, whereas other respiratory viruses exhibited heterogeneous rebound patterns. ITS modeling of SARI proportions revealed a significant pre-pandemic increasing trend, followed by a slower rise during the pandemic, and a sharp post-pandemic drop in early 2022, before resuming an upward trajectory. Among older adults (>65 years), a marked increase in SARI was observed at the beginning of the pandemic, while younger groups showed more stable patterns. Logistic regression identified advanced age, male sex, cardiovascular disease, obesity, and immunosuppression as major risk factors for SARI, while vaccination consistently showed a protective effect across all periods and subgroups.

Conclusion

The COVID-19 pandemic induced persistent shifts in respiratory virus circulation, disrupting seasonal dynamics and modifying the burden of SARI. The findings underscore the importance of continuous surveillance, targeted vaccination programs, and early diagnostics to mitigate severe outcomes. These results highlight the need for adaptive public health strategies in middle-income countries to address evolving respiratory disease threats.

Severe adenovirus pneumonia complicated by acute respiratory distress syndrome in immunocompetent patients: a case report and literature review

Background

Human adenovirus (HAdV) is one of the most important pathogens detected in acute respiratory illness in pediatric and immunocompromised patients, but it is relatively rare to develop severe pneumonia in immunocompetent patients. We analyzed the clinical features, as well as the diagnosis and treatment processes, to provide a reference for clinical practice.

Case presentation

We report a case of severe pneumonia caused by HAdV, complicated by acute respiratory distress syndrome (ARDS), in an immunocompetent patient with no underlying conditions. Chest computed tomography (CT) revealed consolidation in the right lower lung. Conventional microbial tests were negative, but metagenomic next-generation sequencing (mNGS) identified a large number of HAdV sequences in blood and sputum. Together with the clinical symptoms, this confirmed the diagnosis of severe pneumonia caused by HAdV. The patient was discharged after timely treatment with cidofovir.

Conclusion

In our study, we described a rare case of severe pneumonia caused by HAdV, complicated by ARDS, in an immunocompetent patient. mNGS proves to be an effective diagnostic tool for guiding treatment decisions.

Role of CCL2/CCR2 axis in pulmonary fibrosis induced by respiratory viruses

Respiratory virus infection is an important cause of both community acquired pneumonia and hospital-acquired pneumonia. Various respiratory viruses, including influenza virus, avian influenza virus, respiratory syncytial virus (RSV), SARS-CoV, MERS-CoV, and SARS-CoV-2, result in severe fibrosis sequelae after the acute phase. Since the COVID-19 pandemic, respiratory virus infection, as an important cause of pulmonary fibrosis, has attracted increasing attention around the world. Respiratory virus infection usually triggers robust inflammation responses, leading to large amounts of proinflammatory mediator production, such as chemokine (C-C motif) ligand 2 (CCL2), a critical chemokine involved in the recruitment of various inflammatory cells. Moreover, CCL2 plays a pivotal role in the pathogenesis of fibrosis progression, through regulating recruitment of bone marrow-derived monocytes and increasing the expression of extracellular matrix proteins. This review provided a concise overview of the common fibrosis sequelae after virus infection. Then we discussed the elevated levels of CCL2 in various respiratory virus infection, underscoring its potent profibrotic role. Targeting the CCL2/CCR2 axis holds promise for alleviating fibrosis sequelae post-acute virus infection and warrants further investigation.

NRF2 Antioxidant Response and Interferon-Stimulated Genes Are Differentially Expressed in SARS-CoV-2-Positive Young Subjects

BACKGROUND

Several respiratory viruses, including Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), suppress nuclear factor-E2-related factor-2 (NRF2) antioxidant response, generating oxidative stress conditions to its advantage. NRF2 has also been reported to regulate the innate immune response through the inhibition of the interferon (IFN) pathway. However, its modulation in younger individuals and its correlation with the IFN response remain to be elucidated.

METHODS

The NRF2 and redox-related genes expression was examined in nasopharyngeal swabs from children attending the pediatric hospital for SARS-CoV-2 molecular testing. Expression levels were analyzed by stratifying the population according to the SARS-CoV-2 positivity, age, or the presence of symptoms. The results were correlated with Types I and III IFN genes and IFN-stimulated genes (ISGs).

RESULTS

We found that NRF2 expression was markedly diminished in positive patients compared to negative. Moreover, it correlated with higher expression of IFNα2 and IFNλ3, as well as ISG15 and ISG56. Interestingly, symptomatic patients with anosmia/ageusia showed pronounced expression of apurinic/apyrimidinic endonuclease1/redox factor 1 (APE1), together with Type I IFNs, ISG56, and the inflammasome component NLRP3.

CONCLUSION

The results indicate an interdependence between NRF2 antioxidant pathway and IFN-mediated response during SARS-CoV-2 infection in young subjects.

Levodropropizine for children and adolescents with acute post-viral cough: an evidence-based choice

Acute post-viral cough is a common symptom, usually mild-moderate and self-resolving. However, acute cough may be particularly annoying, affecting sleep, and quality of life, also of the family. Thus, treatment is deemed necessary. Antitussive remedies may be pharmacological or non-pharmacological. Antitussive drugs are either central or peripheral. Central drugs are burdened with significant side effects and can cause abuse, especially in adolescents. Levodropropyzine, on the other hand, is an effective peripheral drug, as demonstrated by two meta-analyses, and has an optimal safety profile. Non-pharmacological remedies tend to be safe, but few substances have a documented degree of efficacy. Therefore, when managing children and adolescents with a post-viral cough, the practical approach may be based on levodropropizine use, which is preferable when the cough is particularly persistent and disturbs sleep.

Epidemiology of respiratory pathogens in patients with acute respiratory infections during the COVID-19 pandemic and after easing of COVID-19 restrictions

We aimed to investigate the epidemiological characteristics of non-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) respiratory pathogens among patients with acute respiratory infections (ARIs) in Shijiazhuang, China, during the coronavirus disease 2019 (COVID-19) pandemic (January 2021--December 2022) and after the relaxation of COVID-19 restrictive measures (January 2022--December 2023). This retrospective study enrolled 6,633 ARIs patients who visited the Hebei General Hospital between 2021- and 2023. Nasopharyngeal swabs samples were collected for multiplex PCR detection of 13 common respiratory pathogens. Respiratory pathogens were detected in 31.58% of individuals diagnosed with ARIs, whileereas a co-infection with multiple pathogens was observed in 8.5% of the ARI patients. In the years 2021 and 2022, 326 (27.63%) and 283 (24.38%) respiratory pathogens were found to be positive, respectively, during the COVID-19 pandemic. However, in 2023, subsequent to the easing of COVID-19 restrictions, the positivity rate significantly rose to 34.62%, with 4,292 cases identified. The majority of positive cases over the last three3 years were concentrated in patients under 14 years old. The predominant pathogens identified were human rhinovirus (HRVs) (15.08%) in 2021, mycoplasma pneumonia (MP) (6.46%) in 2022, and influenza A virus (FluA) (11.35%) in 2023. Seasonal prevalence patterns of most pathogens were affected, except for parainfluenza virus (PIV). There was a simultaneous increase in the positive cases and positivity rates of FluA and adenovirus (ADV) Iin 2023, compared to 2021 and 2022. Additionally, the infection rates of respiratory syncytial virus (RSV), MP, and coronavirus (CoV) in 2023 either exceeded or were comparable to those in 2021 and 2022. Conversely, the positivity rates of PIV, RVs, metapneumovirus (MPV), and influenza B virus (FluB) were lower in 2023 compared to 2021 or 2022.

IMPORTANCE

The implementation of strict non-pharmaceutical interventions (NPIs) during the coronavirus disease 2019 (COVID-19) pandemic may lead to changes in the epidemiological features of respiratory pathogens, as well as the occurrence of immune debt, potentially causing a resurgence in respiratory pathogen activity following the easing of strict NPIs measures. There are limited reports on the epidemiological characteristics of respiratory pathogens among patients of all ages with acute respiratory infections (ARIs) during the COVID-19 pandemic and after the easing of COVID-19 restrictions. Our study investigated the epidemiology of 13 respiratory pathogens in Shijiazhuang, China, from January 2021 to December 2023. Thisese data isare crucial for the ongoing surveillance of epidemiological shifts in respiratory pathogens during and post the -COVID-19 pandemic, and serves as a scientific foundation for the prevention and management of ARIs.

Respiratory virus infections in symptomatic and asymptomatic children upon hospital admission: new insights

Objective

Describe and compare the prevalence of symptomatic and asymptomatic or recently resolved respiratory infections in hospitalized children.

Design

Cross-sectional study.

Setting

Three hospital primary-to-quaternary care pediatric healthcare system.

Patients

People less than 22 years old who underwent admission screening for respiratory viruses using a multitarget polymerase chain reaction (PCR) panel from August 2020 through April 2022.

Methods

The symptom status of each patient was recorded by the ordering provider. The prevalence of each virus was described comparing symptomatic and asymptomatic patients. Results for each virus were stratified by age group and trends were examined over time.

Results

Of the 32,812 eligible PCR panels collected, 12,965 (39.5%), 18,651 (56.8%), and 1,196 (3.6%) were obtained from patients who were symptomatic, asymptomatic, or had missing or unknown symptom status, respectively. Symptomatic patients were much more likely to test positive for a respiratory virus (67.3% vs 27.0%). The most common viruses detected in asymptomatic patients were rhinovirus/enterovirus (18.0%), SARS-CoV-2 (3.6%), and parainfluenza viruses (2.3%). The odds ratio of testing positive when symptomatic was significantly greater than unity for all viruses but varied by virus and age group. The proportion of positive tests for each virus was dynamic and changed with intermittent epidemics, or viral "waves."

Conclusions

More than one-quarter of children without respiratory symptoms admitted to a pediatric healthcare system had PCR-detectable respiratory viruses. Children with symptoms of a respiratory infection are nevertheless much more likely to have a respiratory virus detected by PCR.

Supporting vaccine (co)-administration decisions: Development and validation of a tool for assessing the risk of severe outcomes due to lower respiratory tract infections

OBJECTIVE

To develop and validate a score to predict the 90-day risk of hospitalization/death in patients with low respiratory tract infections (LRTIs) with the aim to support clinical decision making on vaccine (co)-administration.

METHODS

We formed a cohort of patients aged 18 years or older being diagnosed with LRTIs in the period between January 1, 2012 and December 31, 2022. Each patient was followed until occurrence of respiratory-related hospitalization/death up to the end of the study period (December 31, 2022). Along with age and sex, forty determinants were adopted to assemble the respiratory tract infection (RTI)-Health Search (HS) core using the development sub-cohort. The prediction accuracy of the score was therefore assessed in the validation sub-cohort.

RESULTS

We identified 252,319 patients being diagnosed with LRTIs (females: 54.7 %; mean age: 60 (SD:18.1)). When the risk of LRTIs-related hospitalizations/deaths was estimated via RTI-HScore, its predicted value was equal to 1.4 % over a 90-day event horizon. The score showed explained variation and discrimination accuracy were equal to 45 % (95 % CI: 44-47 %) and 81 % (95 % CI: 79-84 %), respectively. The calibration slope did not significantly differ from the unit (p = 0.8314).

CONCLUSIONS

The RTI-HScore was featured by good accuracy for prediction of LRTIs-related complications over a 90-day follow-up. Such a tool might therefore support general practitioners to enhance patients' care by facilitating approaches for (co)-administration of vaccines for respiratory infections through a score-based decision support system.

RSV and rhinovirus increase pneumococcal carriage acquisition and density, whereas nasal inflammation is associated with bacterial shedding

Epidemiological studies report the impact of co-infection with pneumococcus and respiratory viruses upon disease rates and outcomes, but their effect on pneumococcal carriage acquisition and bacterial load is scarcely described. Here, we assess this by combining natural viral infection with controlled human pneumococcal infection in 581 healthy adults screened for upper respiratory tract viral infection before intranasal pneumococcal challenge. Across all adults, respiratory syncytial virus (RSV) and rhinovirus asymptomatic infection confer a substantial increase in secondary infection with pneumococcus. RSV also has a major impact on pneumococcal density up to 9 days post challenge. We also study rates and kinetics of bacterial shedding through the nose and oral route in a subset. High levels of pneumococcal colonization density and nasal inflammation are strongly correlated with increased odds of nasal shedding as opposed to cough shedding. Protection against respiratory viral infections and control of pneumococcal density may contribute to preventing pneumococcal disease and reducing bacterial spread.

Circulation and Seasonality of Respiratory Viruses in Hospitalized Patients during Five Consecutive Years (2019-2023) in Perugia, Italy

The emergence of SARS-CoV-2 and the non-pharmacological interventions adopted to counter its spread appear to have led to changes in the normal circulation and seasonality of respiratory viruses. Our study aims to investigate changes related to the circulation of respiratory viruses, not SARS-CoV-2, among hospitalized patients in Perugia, Central Italy, between 2019 and 2023. The samples were collected from individuals who went to the emergency room (ER) or were hospitalized and analyzed using a molecular multiplex test. The results underline that non-pharmaceutical interventions altered the typical seasonal circulation patterns of different respiratory viruses. Those mostly affected were enveloped viruses like influenza viruses that disappeared in 2021; the least impact was recorded for Rhinovirus, which was detected during the pandemic period, maintaining the same seasonality observed in the pre-pandemic period although with a reduction in the number of positive samples. Our data underline the importance of the continuous monitoring of these viruses, especially to understand the timing with which prevention measures, not only non-pharmacological interventions but also the equipment of vaccine doses and monoclonal antibodies, should be adopted to reduce their circulation, particularly in the population at risk of developing severe forms of lower respiratory tract infection.

Analysis of the epidemic characteristics of common respiratory pathogens infection in children in a 3A special hospital

OBJECTIVE

To analyze the epidemic characteristics of common respiratory tract infection pathogens in children with respiratory tract infection, and provide scientific basis for the prevention and control of respiratory tract infection.

METHODS

A retrospective collection of clinical data was conducted on 11,538 children with respiratory tract infections at Luoyang Maternal and Child Health Hospital from December 2022 to November 2023. The types of respiratory tract infections, including upper and lower respiratory tract infections, as well as five respiratory pathogens: influenza A virus (influenza A), influenza B virus (influenza B virus, adenovirus (ADV), respiratory syncytial virus (RSV), and Mycoplasma pneumoniae (MP) infections, were analyzed and compared for different genders, ages, temperatures, and air quality in different months; And the changes of five pathogens in children with respiratory tract infections of different disease severity.

RESULTS

From December 2022 to November 2023, a total of 11,538 children with respiratory infections were included in the analysis, including 6436 males and 5102 females, with an age of 4.92 ± 2.03 years. The proportion of upper respiratory tract infections is as high as 72.17%, and lower respiratory tract infections account for 27.83%. Among them, 2387 were positive for Flu A antigen, with a positive rate of 20.69%, 51 cases were positive for Flu B antigen, and the positive rate was 0.4%, 1296 cases were positive for adv antigen, with a positive rate of 11.23%, 868 cases were positive for RSV antigen, with a positive rate of 7.52%, 2481 cases were positive for MP IgM antibody or MP antigen, and the positive rate was 21.50%. Flu B in male children The infection rate of ADV and MP was higher than that of female children (p < 0.05); Among children in different age groups, the older the age, the older the Flu A The higher the infection rate of MP (p < 0.05), the higher the positive rate of RSV in children with younger age (p < 0.05). The positive rate of ADV in children aged 3-6 years and > 6 years was higher than that in children aged 0-3 years (p < 0.05); Flu A and MP are popular throughout the year, and the positive rate peaks during the period of temperature rise and air quality decline from February to March, and during the period of temperature drop and air quality index rise from August to November, The positive rate of RSV peaked after the turning point of temperature rise from March to April. The infection rate was higher during the period of sharp decline in air quality from March to May and sharp decline in temperature in November, The positive rate of ADV was higher at the turning point of temperature rise from February to March, and then the infection rate decreased. During the period of sharp temperature drop from August to November, the positive rate increased sharply, and the peak of infection occurred; As the disease worsens, The positive rates of Flu A, Flu B, RSV, MP and combined infection with more than two pathogens were all increased (p < 0.05).

CONCLUSION

After the new coronavirus epidemic in 2022, Flu A and MP have the highest infection rate of respiratory pathogens in children, showing a peak growth in general, with epidemic characteristics changing with environmental temperature, air quality and seasons. The main disease type is upper respiratory tract infection, MP and adv infections were mainly in male children, Flu A, MP and ADV infections are more common in older children, RSV infection was more common in younger children; Flu A, Flu B, RSV and MP infection and the co infection of more than two pathogens may more easily lead to the occurrence of severe pneumonia.

The Novel A-Type Proanthocyanidin-Rich Phytocomplex SP4™ Acts as a Broad-Spectrum Antiviral Agent against Human Respiratory Viruses

The appearance of new respiratory virus infections in humans with epidemic or pandemic potential has underscored the urgent need for effective broad-spectrum antivirals (BSAs). Bioactive compounds derived from plants may provide a natural source of new BSA candidates. Here, we investigated the novel phytocomplex formulation SP4™ as a candidate direct-acting BSA against major current human respiratory viruses, including coronaviruses and influenza viruses. SP4™ inhibited the in vitro replication of SARS-CoV-2, hCoV-OC43, hCoV-229E, Influenza A and B viruses, and respiratory syncytial virus in the low-microgram range. Using hCoV-OC43 as a representative respiratory virus, most of the antiviral activity of SP4™ was observed to stem primarily from its dimeric A-type proanthocyanidin (PAC-A) component. Further investigations of the mechanistic mode of action showed SP4™ and its PAC-A-rich fraction to prevent hCoV-OC43 from attaching to target cells and exert virucidal activity. This occurred through their interaction with the spike protein of hCoV-OC43 and SARS-CoV-2, thereby interfering with spike functions and leading to the loss of virion infectivity. Overall, these findings support the further development of SP4™ as a candidate BSA of a natural origin for the prevention of human respiratory virus infections.

Intracellular Streptococcus pneumoniae develops enhanced fluoroquinolone persistence during influenza A coinfection

Streptococcus pneumoniae is a major pathogen responsible for severe complications in patients with prior influenza A virus (IAV) infection. We have previously demonstrated that S. pneumoniae exhibits increased intracellular survival within IAV-infected cells. Fluoroquinolones (FQs) are widely used to treat pneumococcal infections. However, our prior work has shown that S. pneumoniae can develop intracellular FQ persistence, a phenomenon triggered by oxidative stress within host cells. This persistence allows the bacteria to withstand high FQ concentrations. In this study, we show that IAV infection enhances pneumococcal FQ persistence during intracellular survival within pneumocytes, macrophages, and neutrophils. This enhancement is partly due to increased oxidative stress induced by the viral infection. We find that this phenotype is particularly pronounced in autophagy-proficient host cells, potentially resulting from IAV-induced blockage of autophagosome-lysosome fusion. Moreover, we identified several S. pneumoniae genes involved in oxidative stress response that contribute to FQ persistence, including sodA (superoxide dismutase), clpL (chaperone), nrdH (glutaredoxin), and psaB (Mn+2 transporter component). Our findings reveal a novel mechanism of antibiotic persistence promoted by viral infection within host cells. This underscores the importance of considering this phenomenon when using FQs to treat pneumococcal infections, especially in patients with concurrent influenza A infection.

Repurposing Anticancer Drugs Targeting the MAPK/ERK Signaling Pathway for the Treatment of Respiratory Virus Infections

Respiratory virus infections remain a significant challenge to human health and the social economy. The symptoms range from mild rhinitis and nasal congestion to severe lower respiratory tract dysfunction and even mortality. The efficacy of therapeutic drugs targeting respiratory viruses varies, depending upon infection time and the drug resistance engendered by a high frequency of viral genome mutations, necessitating the development of new strategies. The MAPK/ERK pathway that was well delineated in the 1980s represents a classical signaling cascade, essential for cell proliferation, survival, and differentiation. Since this pathway is constitutively activated in many cancers by oncogenes, several drugs inhibiting Raf/MEK/ERK have been developed and currently used in anticancer treatment. Two decades ago, it was reported that viruses such as HIV and influenza viruses could exploit the host cellular MAPK/ERK pathway for their replication. Thus, it would be feasible to repurpose this category of the pathway inhibitors for the treatment of respiratory viral infections. The advantage is that the host genes are not easy to mutate such that the drug resistance rarely occurs during short-period treatment of viruses. Therefore, in this review we will summarize the research progress on the role of the MAPK/ERK pathway in respiratory virus amplification and discuss the potential of the pathway inhibitors (MEK inhibitors) in the treatment of respiratory viral infections.

Viral Pneumonia: From Influenza to COVID-19

Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.

Prevalence of Respiratory Viral Infections in Deceased Persons during the COVID-19 Pandemic Season 2021-2022: A Population-Based Observational Study

Although the omicron variant of SARS-CoV-2 circulated intensely during the 2021-2022 season, many patients with severe acute respiratory disease tested negative for COVID-19. The aim of this study was to assess the presence of different respiratory viruses in deceased persons. The proportion of deceased persons with respiratory viral infections in the 2021-2022 season in Navarre, Spain, was estimated considering all deaths caused by confirmed COVID-19 according to the epidemiological surveillance and the results of multiplex PCR tests for respiratory viruses performed in a sample of deceased persons with a cause of death other than COVID-19. Of 3578 deaths, 324 (9.1%) were initially reported as caused by pre-mortem confirmed COVID-19. A sample of 242 persons who died by causes other than COVID-19 were tested post-mortem; 64 (26.4%) of them were positive for any respiratory virus: 11.2% for SARS-CoV-2, 5.8% for rhinovirus, 3.7% for human coronavirus, 2.5% for metapneumovirus, 1.7% for respiratory syncytial virus, 1.7% for parainfluenza, 1.2% for influenza, and less than 1% each for adenovirus and bocavirus. Combining both approaches, we estimated that 34.4% of all deceased persons during the study period had a respiratory viral infection and 19.2% had SARS-CoV-2. Only 33.3% (9/27) of SARS-CoV-2 and 5.0% (2/40) of other viruses detected post-mortem had previously been confirmed pre-mortem. In a period with very intense circulation of SARS-CoV-2 during the pandemic, other respiratory viruses were also frequently present in deceased persons. Some SARS-CoV-2 infections and most other viral infections were not diagnosed pre-mortem. Several respiratory viruses may contribute to excess mortality in winter.

Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed.

Epidemiological Study of Respiratory Virus Infections among Hospitalized Children Aged 14 Years and Younger during COVID-19 Pandemic in Wuhan, China, 2018-2022

Introduction

The viral etiological characteristics and prevalence of hospitalized children with acute respiratory tract infection were preliminary studied in Wuhan City during the COVID-19 pandemic, to provide a reliable scientific basis for better understanding of the role of various pathogens in cases and for the prevention and clinical treatment of acute respiratory tract infection.

Methods

A total of 69,086 children with acute respiratory infections hospitalized and treated in our department from January 2018 to December 2022 were enrolled as our research subjects. Sociodemographic and clinical data as well as nasopharyngeal samples were collected from patients. Respiratory syncytial virus (RSV), adenovirus (ADV), infuenza virus A (FluA), infuenza virus B (FluB), and parainfluenza virus (PIV) were detected by direct immunofluorescence (DFA) to understand and analyze the epidemic characteristics of respiratory pathogens in children during the COVID-19 pandemic.

Results

The total detection rate of respiratory pathogens was 24.52% of the 69,086 hospitalized children. The frequency of respiratory viruses in those ADV, RSV, FluA, FluB, and PIV was 14.67%, 46.40%, 7.76%, 5.23%, and 25.95%. There were significant differences between the various pathogens (P < 0.001). There were the fewest pathogen-positive patients and positive detection rate in 2020 during the COVID-19 pandemic. There were significant differences in the pathogen detection rate among different years (P < 0.001). In addition, the results showed that the total detection rate of respiratory virus tested in different age groups was significantly different (P < 0.001). The positive detection rate was highest in the 1-3-year-old age group, which is prone to acute respiratory infections. We also found that different pathogens showed obvious seasonal fluctuation and epidemic. RSV reached its peak in winter. ADV is mainly prevalent in spring and summer. FluA has a high detection rate in winter. Winter and spring are the peak seasons for FluB infection, whereas PIV is detected in all seasons, with a higher incidence rate in the spring and summer.

Conclusion

The epidemiological distribution of pathogens of acute respiratory tract infection in hospitalized children in Wuhan from 2018 to 2022 varies with gender, age, and season. Nonpharmaceutical interventions (NPIs) were implemented as control measures worldwide and reduced the transmission of respiratory pathogens. NPIs are likely to be the primary driver of the dramatic reduction in respiratory virus infection activity in the early stages of the COVID-19 pandemic, to dissolving NPIs can lead to a recurrence of viral infection pathogens, especially in children.

Interventions to improve outcomes in community-acquired pneumonia

INTRODUCTION

Community-acquired pneumonia (CAP) is a common infection associated with high morbimortality and a highly deleterious impact on patients' quality of life and functionality. We comprehensively review the factors related to the host, the causative microorganism, the therapeutic approach and the organization of health systems (e.g. setting for care and systems for allocation) that might have an impact on CAP-associated outcomes. Our main aims are to discuss the most controversial points and to provide some recommendations that may guide further research and the management of patients with CAP, in order to improve their outcomes, beyond mortality.

AREA COVERED

In this review, we aim to provide a critical account of potential measures to improve outcomes of CAP and the supporting evidence from observational studies and clinical trials.

EXPERT OPINION

CAP is associated with high mortality and a highly deleterious impact on patients' quality of life. To improve CAP-associated outcomes, it is important to understand the factors related to the patient, etiology, therapeutics, and the organization of health systems.

Qiangli Wuhu mixture alleviates LPS-induced pneumonia by inhibiting the TLR4/NF-κB/NLRP3 pathway: a study based on network pharmacology

CONTEXT

Qiangli Wuhu (QLWH) mixture is a concoction approved and registered by Ningxia Medical Products Administration. It has therapeutic effects on various types of pneumonia.

OBJECTIVE

To clarify the mechanisms of QLWH in treating pneumonia.

MATERIALS AND METHODS

The potential targets of QLWH in the treatment of pneumonia were predicted by network pharmacology. Male, Institute of Cancer Research (ICR) mice were randomly divided into five groups of 12 mice, control, vehicle, QLWH (10 and 20 mg/kg) and dexamethasone (DXM), and orally treated twice daily with normal saline, QLWH or DXM. The pneumonia model was established by tracheal instillation of lipopolysaccharide (LPS). After treatment five days, ELISA, H&E staining and Western blot were used to investigate protective effects of QLWH.

RESULTS

Nine hundred and ninety-four active ingredients were found through network pharmacology, corresponding to 135 targets for the treatment of pneumonia; compared to the vehicle group, QLWH (10 and 20 mg/kg) significantly decreased the levels of TNF-α (14.3% and 28.8%), IL-1β (23.9% and 42.8%) and IL-6 (13.2% and 16.1%), increased the levels of IL-10 (134.3% and 172.9%); in terms of mechanism, QLWH down-regulated TLR4/NF-κB/NLRP3 axis related proteins in lung tissue of pneumonia model mice (p < 0.05).

DISCUSSION AND CONCLUSIONS

This study combined network pharmacology and animal experiments, providing effective evidence for the clinical promotion of QLWH. Meanwhile, it is of significance for further development.