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Wang Y, Liu Y, Wang Y, Mai H, Chen Y, Zhang Y, Ji Y, Cong X, Gao Y. Clinical characteristics of outpatients with influenza-B-associated pneumonia and molecular evolution of influenza B virus in Beijing, China, during the 2021-2022 influenza season. Arch Virol 2024; 169:30. [PMID: 38233704 PMCID: PMC10794387 DOI: 10.1007/s00705-023-05957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
We analyzed the clinical characteristics of outpatients with influenza-B-associated pneumonia during the 2021-2022 influenza season and analyzed the molecular epidemiology and evolution of influenza B virus. The presence of influenza B virus was confirmed by reverse transcription polymerase chain reaction (RT-PCR). Electronic medical records were used to collect and analyze data of outpatients. The HA and NA genes were phylogenetically analyzed using ClustalW 2.10 and MEGA 11.0. Out of 1569 outpatients who tested positive for influenza B virus, 11.7% (184/1569) developed pneumonia, and of these, 19.0% (35/184) had underlying diseases. Fever, cough, and sore throat were the most common symptoms. Among the complications, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and shock accounted for 2.7% (5/184), 4.9% (9/184), and 1.6% (3/184), respectively. Of the outpatients, 2.7% (5/184) were admitted to the hospital, and 0.5% (1/184) of them died. All of the strains from Beijing were identified as belonging to the B/Victoria lineage. The HA and NA gene sequences of 41 influenza B viruses showed high similarity to each other, and all of them belonged to clade 1A.3. Compared with the vaccine strain B/Washington/02/2019, all of the isolates contained N150K, G181E, and S194D mutations. S194D, E195K, and K200R mutations were detected in the 190 helix of the receptor binding region of HA. Co-mutations of H122Q, A127T, P144L, N150K, G181E, S194D, and K200R in HA and D53N, N59S, and G233E in NA were detected in 78.0% (32/41) of the isolates, and 56.3% (18/32) of these were from outpatients with influenza-B-associated pneumonia. Influenza outpatients with underlying diseases were more likely to develop pneumonia. No significant differences were observed in clinical symptoms or laboratory results between outpatients with and without pneumonia, so testing for influenza virus seems to be a good choice. The observed amino acid variations suggest that current vaccines might not provide effective protection.
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Affiliation(s)
- Yanxin Wang
- Department of Infectious Diseases, Peking University People's Hospital, Beijing, China
| | - Yafen Liu
- Department of Infectious Diseases, Peking University People's Hospital, Beijing, China
| | - Yue Wang
- Department of Infectious Diseases, Peking University People's Hospital, Beijing, China
| | - Huan Mai
- Department of Infectious Diseases, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Chen
- Department of Infectious Diseases, Peking University People's Hospital, Beijing, China
| | - Yifan Zhang
- Department of Infectious Diseases, Peking University People's Hospital, Beijing, China
| | - Ying Ji
- Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Xu Cong
- Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Yan Gao
- Department of Infectious Diseases, Peking University People's Hospital, Beijing, China.
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Kibar Akilli I, Bilge M, Uslu Guz A, Korkusuz R, Canbolat Unlu E, Kart Yasar K. Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia. J Pers Med 2022; 12:801. [PMID: 35629223 PMCID: PMC9144423 DOI: 10.3390/jpm12050801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
This is a retrospective and observational study on 1511 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 1511 patients, 879 male (58.17%) and 632 female (41.83%) with a mean age of 60.1 ± 14.7 were included in the study. Survivors and non-survivors groups were statistically compared with respect to survival, discharge, ICU admission and in-hospital death. Although gender was not statistically significant different between two groups, 80 (60.15%) of the patients who died were male. Mean age was 72.8 ± 11.8 in non-survivors vs. 59.9 ± 14.7 in survivors (p < 0.001). Overall in-hospital mortality was found to be 8.8% (133/1511 cases), and overall ICU admission was 10.85% (164/1511 cases). The PSI/PORT score of the non-survivors group was higher than that of the survivors group (144.38 ± 28.64 versus 67.17 ± 25.63, p < 0.001). The PSI/PORT yielding the highest performance was the best predictor for in-hospital mortality, since it incorporates the factors as advanced age and comorbidity (AUROC 0.971; % 95 CI 0.961−0.981). The use of A-DROP may also be preferred as an easier alternative to PSI/PORT, which is a time-consuming evaluation although it is more comprehensive.
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Affiliation(s)
- Isil Kibar Akilli
- Department of Pulmonary Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey
| | - Muge Bilge
- Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey;
| | - Arife Uslu Guz
- Department of Pulmonary Disease, Mehmet Akif Ersoy Training and Research Hospital, University of Health Sciences, Turgut Ozal Boulevard, No. 11, Kucukcekmece, Istanbul 34303, Turkey;
| | - Ramazan Korkusuz
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
| | - Esra Canbolat Unlu
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
| | - Kadriye Kart Yasar
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
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3
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Zhan Y, Chen X, Guan W, Guan W, Yang C, Pan S, Wong SS, Chen R, Ye F. Clinical impact of nosocomial infection with pandemic influenza A (H1N1) 2009 in a respiratory ward in Guangzhou. J Thorac Dis 2021; 13:5851-5862. [PMID: 34795934 PMCID: PMC8575854 DOI: 10.21037/jtd-21-897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
Background Nosocomial outbreaks of pandemic influenza A (H1N1) 2009 virus [A(H1N1)pdm09] easily develop due to its high transmissibility. This study aimed to investigate the clinical impacts of a nosocomial outbreak of A(H1N1)pdm09 between 21 January and 17 February 2016. Methods Patients who developed influenza-like illness (ILI) more than 48 hours after hospitalization in the index ward were enrolled as suspected patients, defined as group A and quarantined. Patients in other wards were defined as group B. A phylogenetic tree was constructed to determine the origins of the hemagglutinin and neuraminidase genes. Results After the implementation of an infection control measure bundle, the outbreak was limited to eight patients with ILIs in group A. Nasal swabs from seven patients were positive for A(H1N1)pdm09. All the patients recovered after treatment. Prolonged viral shedding was observed in a patient with bronchiectasis and Penicillium marneffei infection. Compared to the expected duration of hospitalization in patients without fever, those with fever had a median 7-day delay in discharge and a mean excess cost of 3,358 RMB. The four influenza strains identified were genetically identical to the A/California/115/2015 strain. Six of the 54 patients in group B who underwent bronchoscopy developed transient fever. These patients were hospitalized in various wards of the hospital and recovered after a short-term course of empirical antibiotics. Conclusions After the implementation of infection control measures, the nosocomial A(H1N1)pdm09 outbreak was rapidly contained; infected patients had a delay in discharge and excess costs, but no deaths occurred.
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Affiliation(s)
- Yangqing Zhan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaojuan Chen
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Weijie Guan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenda Guan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Chunguang Yang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Sihua Pan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Sook-San Wong
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Rongchang Chen
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, China
| | - Feng Ye
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Multinational evaluation of the BioFire® FilmArray® Pneumonia plus Panel as compared to standard of care testing. Eur J Clin Microbiol Infect Dis 2021; 40:1609-1622. [PMID: 33655440 PMCID: PMC7924818 DOI: 10.1007/s10096-021-04195-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
This study compared standard of care testing (SOC) to BioFire® FilmArray® Pneumonia plus Panel (PNplus). PNplus detects 15 bacteria with semiquantitative log bin values, 7 antibiotic resistance markers, three atypical bacteria (AB), and eight viral classes directly from bronchoalveolar lavage-like specimens (BLS) and sputum-like specimens (SLS). Fifty-two laboratories from 13 European countries and Israel tested 1234 BLS and 1242 SLS with PNplus and SOC. Detection rates and number of pathogens/samples were compared for PNplus pathogens. PNplus bin values and SOC quantities were compared. Three thousand two hundred sixty-two bacteria in PNplus were detected by PNplus and/or SOC. SOC detected 57.1% compared to 95.8% for PNplus (p ≤ 0.0001). PNplus semiquantitative bin values were less than SOC, equal to SOC, or greater than SOC in 5.1%, 25.4%, and 69.6% of results, respectively. PNplus bin values were on average ≥ 1 log than SOC values (58.5% 1–2 logs; 11.0% 3–4 logs). PNplus identified 98.2% of MRSA and SOC 55.6%. SOC detected 73/103 AB (70.9%) and 134/631 viruses (21.2%). PNplus detected 93/103 AB (90.3%) and 618/631 viruses (97.9%) (p ≤ 0.0001). PNplus and SOC mean number of pathogens/samples were 1.99 and 1.44, respectively. All gram-negative resistance markers were detected. PNplus and SOC results were fully or partially concordant for 49.1% and 26.4% of specimens, respectively. PNplus was highly sensitive and detected more potential pneumonia pathogens than SOC. Semiquantification may assist in understanding pathogen significance. As PNplus generates results in approximately 1 h, PNplus has potential to direct antimicrobial therapy in near real time and improve antimicrobial stewardship and patient outcomes.
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5
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Viral pneumonia in China: from surveillance to response. Lancet Public Health 2020; 5:e633-e634. [PMID: 33271074 PMCID: PMC7834624 DOI: 10.1016/s2468-2667(20)30264-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 11/23/2022]
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6
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Shi T, Arnott A, Semogas I, Falsey AR, Openshaw P, Wedzicha JA, Campbell H, Nair H. The Etiological Role of Common Respiratory Viruses in Acute Respiratory Infections in Older Adults: A Systematic Review and Meta-analysis. J Infect Dis 2020; 222:S563-S569. [PMID: 30849176 PMCID: PMC7107439 DOI: 10.1093/infdis/jiy662] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/06/2018] [Indexed: 12/16/2022] Open
Abstract
Acute respiratory tract infections (ARI) constitute a substantial disease burden in adults and elderly individuals. We aimed to identify all case-control studies investigating the potential role of respiratory viruses in the etiology of ARI in older adults aged ≥65 years. We conducted a systematic literature review (across 7 databases) of case-control studies published from 1996 to 2017 that investigated the viral profile of older adults with and those without ARI. We then computed a pooled odds ratio (OR) with a 95% confidence interval and virus-specific attributable fraction among the exposed (AFE) for 8 common viruses: respiratory syncytial virus (RSV), influenza virus (Flu), parainfluenza virus (PIV), human metapneumovirus (HMPV), adenovirus (AdV), rhinovirus (RV), bocavirus (BoV), and coronavirus (CoV). From the 16 studies included, there was strong evidence of possible causal attribution for RSV (OR, 8.5 [95% CI, 3.9-18.5]; AFE, 88%), Flu (OR, 8.3 [95% CI, 4.4-15.9]; AFE, 88%), PIV (OR, not available; AFE, approximately 100%), HMPV (OR, 9.8 [95% CI, 2.3-41.0]; AFE, 90%), AdV (OR, not available; AFE, approximately 100%), RV (OR, 7.1 [95% CI, 3.7-13.6]; AFE, 86%) and CoV (OR, 2.8 [95% CI, 2.0-4.1]; AFE, 65%) in older adults presenting with ARI, compared with those without respiratory symptoms (ie, asymptomatic individuals) or healthy older adults. However, there was no significant difference in the detection of BoV in cases and controls. This review supports RSV, Flu, PIV, HMPV, AdV, RV, and CoV as important causes of ARI in older adults and provides quantitative estimates of the absolute proportion of virus-associated ARI cases to which a viral cause can be attributed. Disease burden estimates should take into account the appropriate AFE estimates (for older adults) that we report.
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Affiliation(s)
- Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh
| | - Andrew Arnott
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh
| | - Indre Semogas
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh
| | - Ann R Falsey
- University of Rochester School of Medicine, New York.,ReSViNET Foundation, Zeist, The Netherlands
| | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh.,ReSViNET Foundation, Zeist, The Netherlands
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Moon SM, Choe J, Na SJ, Chung CR, Suh GY, Jeon K. Comparative Study on the Effect of Cidofovir Treatment for Severe Adenovirus Pneumonia. J Intensive Care Med 2020; 36:1436-1442. [PMID: 32954945 DOI: 10.1177/0885066620960687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adenovirus infection can cause severe pneumonia even in immunocompetent adults. However, there is limited data on the benefits of cidofovir treatment in severe adenovirus pneumonia. The objective of this study was to evaluate the association of cidofovir treatment with clinical improvement in immunocompetent adult patients with severe adenovirus pneumonia. METHODS We evaluated 22 male patients who admitted to intensive care unit (ICU) with severe adenovirus pneumonia between January 2014 and December 2019. The patients were divided into 2 groups, patients treated with cidofovir or not. Clinical outcomes including time to defervescence and stopping of oxygen supplement, length of stay in ICU and hospital, and the need for mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) were compared between the 2 groups. RESULTS Among 22 patients, 13 patients (59%) were treated with cidofovir and 9 (41%) were not. The difference in mean time (95% confidence interval [CI]) to defervescence and stopping of oxygen supplement between cidofovir group and no cidofovir group was 2.1 (-5.7 to 10.0) and 1.0 (-14.9 to 16.8) days, respectively. The difference in mean length of stay (95% CI) in ICU and hospital between the 2 groups was 0.2 (-7.1 to 7.5) and -0.4 (-18.3 to 17.5) days, respectively. The differences in proportion of patients requiring MV and ECMO between the 2 groups was 28.2 (-17.4 to 73.8) % and -10.3 (-52.2 to 31.7) %, respectively. CONCLUSIONS The treatment with cidofovir for severe adenovirus pneumonia in immunocompetent patients did not improve clinical outcomes. Further studies with larger samples with prospective design are warranted.
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Affiliation(s)
- Seong Mi Moon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Jiang R, Han B, Dou C, Zhou F, Cao B, Li X. Analysis of antibiotic usage for viral community-acquired pneumonia in adults. Front Med 2020; 15:139-143. [PMID: 32535730 PMCID: PMC7292937 DOI: 10.1007/s11684-019-0736-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/02/2019] [Indexed: 12/28/2022]
Abstract
The rationale for the antibiotic treatment of viral community-acquired pneumonia (CAP) in adults was analyzed to develop a clinical reference standard for this condition. Clinical data from 166 patients diagnosed with viral pneumonia across 14 hospitals in Beijing from November 2010 to December 2017 were collected. The indications for medications were evaluated, and the rationale for the use of antibiotics was analyzed. A total of 163 (98.3%) patients with viral pneumonia were treated with antibiotics. A combination of C-reactive protein (CRP) and procalcitonin (PCT) was used as markers to analyze the possible indications for antibiotic use. With threshold levels set at 0.25 µg/L for PCT and 20 mg/L for CRP, the rate of unreasonable use of antibiotics was 55.2%. By contrast, at a CRP level threshold of 60 mg/L, the rate of antibiotic misuse was 77.3%. A total of 39 of the 163 (23.9%) patients did not meet the guidelines for drug selection for viral CAP in adults. The unreasonable use of antibacterial drugs for the treatment of viral CAP in adults is a serious concern. Clinicians must reduce the unnecessary use of antibiotics.
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Affiliation(s)
- Rongmeng Jiang
- Department of Infectious Diseases, Beijing Ditan Hospital, Beijing, 100015, China
| | - Bing Han
- Department of Infectious Diseases, Beijing Ditan Hospital, Beijing, 100015, China
| | - Chang Dou
- Department of Internal Medicine, Beijing Capital International Airport Hospital, Beijing, 100621, China
| | - Fei Zhou
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Xingwang Li
- Department of Infectious Diseases, Beijing Ditan Hospital, Beijing, 100015, China.
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Jeong S, Park MJ, Song W, Kim HS. Advances in laboratory assays for detecting human metapneumovirus. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:608. [PMID: 32566634 PMCID: PMC7290561 DOI: 10.21037/atm.2019.12.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Human metapneumovirus (HMPV) is one of the major causes of acute respiratory tract infection (ARI) and shows high morbidity and mortality, particularly in children and immunocompromised patients. Various methods for detecting HMPV have been developed and applied in clinical laboratories. When reviewing the literature, we found that polymerase chain reaction (PCR)-based assays have been most frequently and consistently used to detect HMPV. The most commonly used method was multiplex reverse transcriptase-PCR (RT-PCR; 57.4%), followed by real-time RT-PCR (38.3%). Multiplex RT-PCR became the more popular method in 2011-2019 (69.7%), in contrast to 2001-2009 (28.6%). The advent of multiplex PCR in detecting broader viral pathogens in one run and coinfected viruses influenced the change in user preference. Further, newly developed microarray technologies and ionization mass spectrometry were introduced in 2011-2019. Viral culture (including shell vial assays) and fluorescent immunoassays (with or without culture) were once the mainstays. However, the percentage of studies employing culture and fluorescent immunoassays decreased from 21.4% in 2001-2010 to 15.2% in 2011-2019. Meanwhile, the use of PCR-based methods of HMPV detection increased from 78.6% in 2001-2010 to 84.8% in 2011-2019. The increase in PCR-based methods might have occurred because PCR methods demonstrated better diagnostic performance, shorter hands-on and run times, less hazards to laboratory personnel, and more reliable results than traditional methods. When using these assays, it is important to acquire a comprehensive understanding of the principles, advantages, disadvantages, and precautions for data interpretation. In the future, the combination of nanotechnology and advanced genetic platforms such as next-generation sequencing will benefit patients with HMPV infection by facilitating efficient therapeutic intervention. Analytical and clinical validation are required before using new techniques in clinical laboratories.
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Affiliation(s)
- Seri Jeong
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyon-Suk Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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10
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Russell E, Yang A, Tardrew S, Ison MG. Parainfluenza Virus in Hospitalized Adults: A 7-Year Retrospective Study. Clin Infect Dis 2020; 68:298-305. [PMID: 29961826 DOI: 10.1093/cid/ciy451] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/25/2018] [Indexed: 12/30/2022] Open
Abstract
Background Parainfluenza virus (PIV) is a cause of respiratory tract infection in children and the immunocompromised population, but its clinical manifestations, impact, and outcomes in hospitalized adults are not well studied. Methods This retrospective study included adults (≥18 years old) admitted to Northwestern Memorial Hospital or Prentice Women's Hospital (both in Chicago, Illinois) between 1 August 2009 and 31 July 2016 with a positive molecular test result for PIV. Epidemiologic, clinical, and outcomes data were collected from the enterprise data warehouse and patient electronic health records after institutional review board approval. Descriptive statistics were used to summarize the data. Results A total of 550 adults with a positive molecular test for PIV were identified. Differences in seasonality, clinical presentation, and prevalence between the different PIV serotypes (PIV-1, PIV-2, and PIV-3) were identified. The most common signs/symptoms were cough (88%), productive sputum (55%), fever (63%), and dyspnea (49%). Of the patients administered antibiotics, 349 (79.6%) had no confirmed bacterial infection throughout their hospitalization. The average length of hospitalization was 7.7 days. Presence of bacterial coinfection (P = .01), fungal coinfection (P < .01), decreased body mass index (P = .03), and increased respiratory rate (P < .01) were associated with significant differences in mortality rates. Conclusions PIV infection is associated with substantial morbidity in hospitalized adults. Such data will be useful in understanding the impact on epidemiology and outcomes if a PIV-specific vaccine becomes available. Furthermore, this highlights the need for novel preventive and therapeutic approaches to PIV infection.
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Affiliation(s)
- Elliott Russell
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy Yang
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sydney Tardrew
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Zhou F, Wang Y, Liu Y, Liu X, Gu L, Zhang X, Pu Z, Yang G, Liu B, Nie Q, Xue B, Feng J, Guo Q, Liu J, Fan H, Chen J, Zhang Y, Xu Z, Pang M, Chen Y, Nie X, Cai Z, Xu J, Peng K, Li X, Xiang P, Zhang Z, Jiang S, Su X, Zhang J, Li Y, Jin X, Jiang R, Dong J, Song Y, Zhou H, Wang C, Cao B. Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network. Eur Respir J 2019; 54:13993003.02406-2018. [PMID: 31164430 DOI: 10.1183/13993003.02406-2018] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/02/2019] [Indexed: 02/05/2023]
Abstract
Although broad knowledge of influenza viral pneumonia has been established, the significance of non-influenza respiratory viruses in community-acquired pneumonia (CAP) and their impact on clinical outcomes remains unclear, especially in the non-immunocompromised adult population.Hospitalised immunocompetent patients with CAP were prospectively recruited from 34 hospitals in mainland China. Respiratory viruses were detected by molecular methods. Comparisons were conducted between influenza and non-influenza viral infection groups.In total, 915 out of 2336 adult patients with viral infection were enrolled in the analysis, with influenza virus (28.4%) the most frequently detected virus, followed by respiratory syncytial virus (3.6%), adenovirus (3.3%), human coronavirus (3.0%), parainfluenza virus (2.2%), human rhinovirus (1.8%) and human metapneumovirus (1.5%). Non-influenza viral infections accounted for 27.4% of viral pneumonia. Consolidation was more frequently observed in patients with adenovirus infection. The occurrence of complications such as sepsis (40.1% versus 39.6%; p=0.890) and hypoxaemia (40.1% versus 37.2%; p=0.449) during hospitalisation in the influenza viral infection group did not differ from that of the non-influenza viral infection group. Compared with influenza virus infection, the multivariable adjusted odds ratios of CURB-65 (confusion, urea >7 mmol·L-1, respiratory rate ≥30 breaths·min-1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years) ≥3, arterial oxygen tension/inspiratory oxygen fraction <200 mmHg, and occurrence of sepsis and hypoxaemia for non-influenza respiratory virus infection were 0.87 (95% CI 0.26-2.84), 0.72 (95% CI 0.26-1.98), 1.00 (95% CI 0.63-1.58) and 1.05 (95% CI 0.66-1.65), respectively. The hazard ratio of 90-day mortality was 0.51 (95% CI 0.13-1.91).The high incidence of complications in non-influenza viral pneumonia and similar impact of non-influenza respiratory viruses relative to influenza virus on disease severity and outcomes suggest more attention should be given to CAP caused by non-influenza respiratory viruses.
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Affiliation(s)
- Fei Zhou
- Dept of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Institute of Respiratory Medicine Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.,These authors contributed equally to this work
| | - Yimin Wang
- Dept of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Institute of Respiratory Medicine Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.,These authors contributed equally to this work
| | - Yingmei Liu
- Dept of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Institute of Respiratory Medicine Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.,These authors contributed equally to this work
| | - Xuedong Liu
- Dept of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China.,These authors contributed equally to this work
| | - Li Gu
- Dept of Infectious Diseases, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,These authors contributed equally to this work
| | - Xiaoju Zhang
- Dept of Respiratory Medicine, Henan Provincial People's Hospital, Zhengzhou, China.,These authors contributed equally to this work
| | - Zenghui Pu
- Dept of Infectious Diseases, Yantai Yu Huang-Ding Hospital, Yantai, China.,These authors contributed equally to this work
| | - Guoru Yang
- Dept of Pulmonary and Critical Care Medicine, Weifang No. 2 People's Hospital, Weifang, China.,These authors contributed equally to this work
| | - Bo Liu
- Dept of Respiratory and Critical Care Medicine, Linzi District People's Hospital, Zibo, China.,These authors contributed equally to this work
| | - Qingrong Nie
- Dept of Respiratory and Critical Care Medicine, Liangxiang Hospital, Beijing, China
| | - Bing Xue
- Dept of Respiratory Medicine, Chuiyangliu Hospital Affiliated to Tshinghua University, Beijing, China
| | - Jing Feng
- Dept of Respiratory Medicine, General Hospital of Tianjin Medical University, Tianjin, China
| | - Qiang Guo
- Dept of Respiratory, Emergency and Critical Care Medicine, First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Jianhua Liu
- Dept of Respiratory Medicine, Beijing Huairou Hospital of University of Chinese Academy of Science, Beijing, China
| | - Hong Fan
- Dept of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Chen
- Dept of Respiratory Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Zhang
- Dept of Respiratory Medicine, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Zhenyang Xu
- Dept of Pulmonary and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Min Pang
- Dept of Respiratory Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yu Chen
- Dept of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Beijing China
| | - Xiuhong Nie
- Dept of Respiratory Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhigang Cai
- Dept of Pulmonary and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinfu Xu
- Dept of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China
| | - Kun Peng
- Dept of Respiratory Medicine, Beijing No. 6 Hospital, Beijing, China
| | - Xiangxin Li
- Dept of Pulmonary and Critical Care Medicine, Beijing Changping Hospital, Beijing, China
| | - Pingchao Xiang
- Dept of Pulmonary and Critical Care Medicine, Peking University Shougang Hospital, Beijing, China
| | - Zuoqing Zhang
- Dept of Respiratory Medicine, Beijing Shijingshan Hospital, Beijing, China
| | - Shujuan Jiang
- Dept of Pulmonary and Critical Care Medicine, Shandong Province Hospital, Jinan, China
| | - Xin Su
- Dept of Respiratory Medicine, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing, China
| | - Jie Zhang
- Dept of Respiratory Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanming Li
- Dept of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China
| | - Xiuhong Jin
- Dept of Respiratory Medicine, Beijing Pinggu Hospital, Beijing, China
| | - Rongmeng Jiang
- Infectious Disease Diagnosis and Treatment Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianping Dong
- Dept of Infectious Diseases, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing, China
| | - Yuanlin Song
- Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Zhou
- Dept of Respiratory Medicine, Beijing Electric Power Hospital, Beijing, China
| | - Chen Wang
- Dept of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Institute of Respiratory Medicine Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.,These authors contributed equally to this work
| | - Bin Cao
- Dept of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Institute of Respiratory Medicine Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China .,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.,These authors contributed equally to this work
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12
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Chen J, Li X, Wang W, Jia Y, Lin F, Xu J. The prevalence of respiratory pathogens in adults with community-acquired pneumonia in an outpatient cohort. Infect Drug Resist 2019; 12:2335-2341. [PMID: 31440068 PMCID: PMC6679678 DOI: 10.2147/idr.s213296] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/17/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose Community-acquired pneumonia is a common illness worldwide. In adults, community-acquired bacterial pneumonia has been well studied, but viral pneumonia is less well understood. We designed this study to identify respiratory pathogens, including common pneumonia-causing bacteria, viruses and atypical pneumonia pathogens, using reverse transcription-polymerase chain reaction. Patients and methods We conducted a retrospective study of outpatients with community-acquired pneumonia at the Fever Clinic of Peking University Third Hospital. We collected sputum or throat swabs from patients diagnosed with community-acquired pneumonia. Multiplex real-time reverse transcription-polymerase chain reaction was performed for 20 pathogens, including 9 viruses, 3 atypical pathogens and 8 bacteria. Results There were 232 outpatients enrolled in our study, and 153 patients (65.9%) had positive test results, of which 26.7% were viruses, 19.4% were atypical pathogens and 19.8% were bacteria. Mycoplasma pneumoniae infection was detected at the highest frequency (19.0%), exceeding Streptococcus pneumoniae infection. The most commonly identified viral pathogens were IFVs (15.1%), PIVs (3.4%) and RhV (2.6%). The most commonly identified bacteria were Streptococcus pneumoniae (9.1%), Haemophilus influenza (6.5%) and Klebsiella pneumoniae (2.6%). Conclusion Our study suggests that viruses were commonly detected in outpatients with CAP, and IFVs were the most common viruses, especially during flu season. Patients with viral infection were prone to viral-bacterial coinfection. Mycoplasma pneumoniae was the leading pathogen in the outpatients with CAP. Viral infection occurs in a large number of outpatients with CAP, and it should receive greater attention in clinical work.
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Affiliation(s)
- Jing Chen
- Department of Infectious Disease, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xiaoguang Li
- Department of Infectious Disease, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Wang
- Department of Infectious Disease, Peking University Third Hospital, Beijing, People's Republic of China
| | - Ying Jia
- Department of Infectious Disease, Peking University Third Hospital, Beijing, People's Republic of China
| | - Fei Lin
- Department of Infectious Disease, Peking University Third Hospital, Beijing, People's Republic of China
| | - Jie Xu
- Department of Infectious Disease, Peking University Third Hospital, Beijing, People's Republic of China
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13
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Kim HJ, Choi SM, Lee J, Park YS, Lee CH, Yim JJ, Yoo CG, Kim YW, Han SK, Lee SM. Respiratory virus of severe pneumonia in South Korea: Prevalence and clinical implications. PLoS One 2018; 13:e0198902. [PMID: 29912989 PMCID: PMC6005478 DOI: 10.1371/journal.pone.0198902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/28/2018] [Indexed: 01/30/2023] Open
Abstract
Background Severe viral pneumonia is associated with a high mortality rate. However, due to the vulnerability of critically ill patients, invasive diagnostic methods should be performed with caution in the intensive care unit (ICU). It would be helpful if the prevalence, risk factors, and clinical impact of virus detection are elucidated. Methods We evaluated patients with severe pneumonia between January 1st 2008 and December 31st 2015. Reverse transcription-polymerase chain reaction (RT-PCR) analysis was performed for 8 respiratory viruses when viral pathogen could not be excluded as the origin of severe pneumonia. The baseline characteristics, laboratory results, microbiological findings, and clinical outcomes of the patients were analyzed. Results Of the 2,347 patients admitted to the medical ICU, 515 underwent RT-PCR for respiratory viruses, 69 of whom had positive results. The detection rate was higher during the winter, with a community onset, in patients with history of recent chemotherapy, and low platelet count. Additional bronchoscopic sampling along with upper respiratory specimen increased the yield of viral detection. Respiratory syncytial virus was the most common pathogen detected, while influenza A was the most common virus with bacterial coinfection. Respiratory virus detection led to changes in clinical management in one-third of the patients. Conclusions The detection of viral pathogens in patients with severe pneumonia is not rare, and can be more common in certain group of patients. Invasive sampling for RT-PCR can be helpful, and such detection can lead to positive changes in clinical management.
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Affiliation(s)
- Hyung-Jun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Mi Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinwoo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul-Gyu Yoo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Whan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Koo Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Min Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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14
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Dadashi M, Goudarzi H, Owlia P, Faghihloo E. Prevalence of human respiratory syncytial virus in Iran: a systematic review and meta-analysis. Future Virol 2018. [DOI: 10.2217/fvl-2017-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: We sought to determine the prevalence of human respiratory syncytial virus (HRSV) in people in Iran between the year 1996 and 2016. Methods: Prevalence of HRSV in Iran was determined from 1996 to 2016 using data from PubMed, Web of Science, EMBASE, Cochrane Library, Google Scholar and Iranian databases. Analysis was performed by Comprehensive Meta-Analysis software. Result: The prevalence of HRSV infections was 18.0% (95% CI: 14.6–22.0) in people in different regions of Iran. Additionally, the incidence of HRSV in north, center, west and south of Iran were 16.4% (95% CI: 11.8–22.4), 20.0% (95% CI: 15.5–25.5), 16.8% (95% CI: 10.0–27.0) and 10.6% (95% CI: 2.4–36.9), respectively. Conclusion: According to the high prevalence of HRSV infection among people with respiratory infections in Iran, HRSV screening and evaluating of co-circulate HRSV genotypes can be helpful for vaccination design in the future.
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Affiliation(s)
- Masoud Dadashi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parviz Owlia
- Molecular Microbiology Research Center, Shahed University, Tehran, Iran
| | - Ebrahim Faghihloo
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Cao B, Huang Y, She DY, Cheng QJ, Fan H, Tian XL, Xu JF, Zhang J, Chen Y, Shen N, Wang H, Jiang M, Zhang XY, Shi Y, He B, He LX, Liu YN, Qu JM. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. CLINICAL RESPIRATORY JOURNAL 2017; 12:1320-1360. [PMID: 28756639 PMCID: PMC7162259 DOI: 10.1111/crj.12674] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023]
Abstract
Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.
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Affiliation(s)
- Bin Cao
- National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Capital Medical University, Beijing 100029, China
| | - Yi Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Dan-Yang She
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Jian Cheng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan 610041, China
| | - Xin-Lun Tian
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiang-Yan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing 210002, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Li-Xian He
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - You-Ning Liu
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
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16
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Abstract
Lower respiratory tract infection is a leading cause of death in the United States. Advances in diagnostic testing have improved our ability to detect pathogens. Viral pathogens are important causal pathogens in immunocompetent patients. As the number of elderly adults and those with chronic medical conditions increases, the burden of viral respiratory infections will increase. Clinicians must be familiar with the characteristics of rhinovirus, human adenoviruses, respiratory syncytial virus, and human metapneumovirus. Major challenges include distinguishing true infection from asymptomatic carriage and characterizing patients admitted with severe lower respiratory tract infection who do not have a causative pathogen identified.
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17
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Affiliation(s)
- Raj D Shah
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes 14-045, Chicago, IL 60611, USA
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes 14-045, Chicago, IL 60611, USA.
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18
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Abstract
Human rhinovirus (HRV) and coronavirus (HCoV) infections are associated with both upper respiratory tract illness (“the common cold”) and lower respiratory tract illness (pneumonia). New species of HRVs and HCoVs have been diagnosed in the past decade. More sensitive diagnostic tests such as reverse transcription-polymerase chain reaction have expanded our understanding of the role these viruses play in both immunocompetent and immunosuppressed hosts. Recent identification of severe acute respiratory syndrome and Middle East respiratory syndrome viruses causing serious respiratory illnesses has led to renewed efforts for vaccine development. The role these viruses play in patients with chronic lung disease such as asthma makes the search for antiviral agents of increased importance.
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Affiliation(s)
- Stephen B Greenberg
- Department of Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, Texas
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19
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Shih HI, Wang HC, Su IJ, Hsu HC, Wang JR, Sun HFS, Chou CH, Ko WC, Hsieh MI, Wu CJ. Viral Respiratory Tract Infections in Adult Patients Attending Outpatient and Emergency Departments, Taiwan, 2012-2013: A PCR/Electrospray Ionization Mass Spectrometry Study. Medicine (Baltimore) 2015; 94:e1545. [PMID: 26402811 PMCID: PMC4635751 DOI: 10.1097/md.0000000000001545] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Viral etiologies of respiratory tract infections (RTIs) have been less studied in adult than in pediatric populations. Furthermore, the ability of PCR/electrospray ionization mass spectrometry (PCR/ESI-MS) to detect enteroviruses and rhinoviruses in respiratory samples has not been well evaluated. We sought to use PCR/ESI-MS to comprehensively investigate the viral epidemiology of adult RTIs, including testing for rhinoviruses and enteroviruses. Nasopharyngeal or throat swabs from 267 adults with acute RTIs (212 upper RTIs and 55 lower RTIs) who visited a local clinic or the outpatient or emergency departments of a medical center in Taiwan between October 2012 and June 2013 were tested for respiratory viruses by both virus isolation and PCR/ESI-MS. Throat swabs from 15 patients with bacterial infections and 27 individuals without active infections were included as control samples. Respiratory viruses were found in 23.6%, 47.2%, and 47.9% of the 267 cases by virus isolation, PCR/ESI-MS, and both methods, respectively. When both methods were used, the influenza A virus (24.3%) and rhinoviruses (9.4%) were the most frequently identified viruses, whereas human coronaviruses, human metapneumovirus (hMPV), enteroviruses, adenoviruses, respiratory syncytial virus, and parainfluenza viruses were identified in small proportions of cases (<5% of cases for each type of virus). Coinfection was observed in 4.1% of cases. In the control group, only 1 (2.4%) sample tested positive for a respiratory virus by PCR/ESI-MS. Patients who were undergoing steroid treatment, had an active malignancy, or suffered from chronic obstructive pulmonary disease (COPD) were at risk for rhinovirus, hMPV, or parainfluenza infections, respectively. Overall, immunocompromised patients, patients with COPD, and patients receiving dialysis were at risk for noninfluenza respiratory virus infection. Rhinoviruses (12.7%), influenza A virus (10.9%), and parainfluenza viruses (7.3%) were the most common viruses involved in the 55 cases of lower RTIs. The factors of parainfluenza infection, old age, and immunosuppression were independently associated with lower RTIs. In conclusion, PCR/ESI-MS improved the diagnostic yield for viral RTIs. Non-influenza respiratory virus infections were associated with patients with comorbidities and with lower RTIs. Additional studies that delineate the clinical need for including non-influenza respiratory viruses in the diagnostic work-up in these populations are warranted.
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Affiliation(s)
- Hsin-I Shih
- From the Departments of Emergency Medicine (H-IS, H-CH); Public Health (H-IS); Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University (C-HC, W-CK, C-JW); National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes (H-CW, I-JS, J-RW, M-IH, C-JW); Department of Medical Laboratory Science and Biotechnology (J-RW); and Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (HSS)
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