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Foo IJH, Chua BY, Clemens EB, Chang SY, Jia X, McQuilten HA, Yap AHY, Cabug AF, Ashayeripanah M, McWilliam HEG, Villadangos JA, Evrard M, Mackay LK, Wakim LM, Fazakerley JK, Kedzierska K, Kedzierski L. Prior infection with unrelated neurotropic virus exacerbates influenza disease and impairs lung T cell responses. Nat Commun 2024; 15:2619. [PMID: 38521764 PMCID: PMC10960853 DOI: 10.1038/s41467-024-46822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
Immunity to infectious diseases is predominantly studied by measuring immune responses towards a single pathogen, although co-infections are common. In-depth mechanisms on how co-infections impact anti-viral immunity are lacking, but are highly relevant to treatment and prevention. We established a mouse model of co-infection with unrelated viruses, influenza A (IAV) and Semliki Forest virus (SFV), causing disease in different organ systems. SFV infection eight days before IAV infection results in prolonged IAV replication, elevated cytokine/chemokine levels and exacerbated lung pathology. This is associated with impaired lung IAV-specific CD8+ T cell responses, stemming from suboptimal CD8+ T cell activation and proliferation in draining lymph nodes, and dendritic cell paralysis. Prior SFV infection leads to increased blood brain barrier permeability and presence of IAV RNA in brain, associated with increased trafficking of IAV-specific CD8+ T cells and establishment of long-term tissue-resident memory. Relative to lung IAV-specific CD8+ T cells, brain memory IAV-specific CD8+ T cells have increased TCR repertoire diversity within immunodominant DbNP366+CD8+ and DbPA224+CD8+ responses, featuring suboptimal TCR clonotypes. Overall, our study demonstrates that infection with an unrelated neurotropic virus perturbs IAV-specific immune responses and exacerbates IAV disease. Our work provides key insights into therapy and vaccine regimens directed against unrelated pathogens.
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Affiliation(s)
- Isabelle Jia-Hui Foo
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
- Department of Veterinary Biosciences, Faculty of Science, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Brendon Y Chua
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - E Bridie Clemens
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - So Young Chang
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Xiaoxiao Jia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Hayley A McQuilten
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Ashley Huey Yiing Yap
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Aira F Cabug
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Mitra Ashayeripanah
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Hamish E G McWilliam
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Jose A Villadangos
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
- Department of Biochemistry and Pharmacology; Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Maximilien Evrard
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Laura K Mackay
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Linda M Wakim
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - John K Fazakerley
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
- Department of Veterinary Biosciences, Faculty of Science, The University of Melbourne, Melbourne, VIC 3000, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia.
| | - Lukasz Kedzierski
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia.
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2
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The Endless Challenges of Arboviral Diseases in Brazil. Trop Med Infect Dis 2020; 5:tropicalmed5020075. [PMID: 32397512 PMCID: PMC7345859 DOI: 10.3390/tropicalmed5020075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
In this Editorial, we list and discuss some of the main challenges faced by the population and public health authorities in Brazil concerning arbovirus infections, including the occurrence of concurrent epidemics like the ongoing SARS-CoV-2/COVID-19 pandemic.
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3
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Sharp TM, Ryff KR, Alvarado L, Shieh WJ, Zaki SR, Margolis HS, Rivera-Garcia B. Surveillance for Chikungunya and Dengue During the First Year of Chikungunya Virus Circulation in Puerto Rico. J Infect Dis 2017; 214:S475-S481. [PMID: 27920177 DOI: 10.1093/infdis/jiw245] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
After chikungunya virus (CHIKV) transmission was detected in Puerto Rico in May 2014, multiple surveillance systems were used to describe epidemiologic trends and CHIKV-associated disease. Of 28 327 cases reported via passive surveillance, 6472 were tested for evidence of CHIKV infection, and results for 4399 (68%) were positive. Of 250 participants in household cluster investigations, 70 (28%) had evidence of recent CHIKV infection. Enhanced surveillance for chikungunya at 2 hospitals identified 1566 patients who tested positive for CHIKV, of whom 10.9% were hospitalized. Enhanced surveillance for fatal cases enabled identification of 31 cases in which CHIKV was detected in blood or tissue specimens. All surveillance systems detected a peak incidence of chikungunya in September 2014 and continued circulation in 2015. Concomitant surveillance for dengue demonstrated low incidence, which had decreased before CHIKV was introduced. Multifaceted chikungunya surveillance in Puerto Rico resolved gaps in traditional passive surveillance and enabled a holistic description of the spectrum of disease associated with CHIKV infection.
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Affiliation(s)
- Tyler M Sharp
- Dengue Branch, Centers for Disease Control and Prevention (CDC)
| | | | - Luisa Alvarado
- Ponce Health Sciences University.,San Lucas Episcopal Hospital, Ponce, Puerto Rico
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch, CDC, Atlanta, Georgia
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, CDC, Atlanta, Georgia
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4
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Schmid MA, González KN, Shah S, Peña J, Mack M, Talarico LB, Polack FP, Harris E. Influenza and dengue virus co-infection impairs monocyte recruitment to the lung, increases dengue virus titers, and exacerbates pneumonia. Eur J Immunol 2017; 47:527-539. [PMID: 27995614 DOI: 10.1002/eji.201646675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/19/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
Co-infections of influenza virus and bacteria are known to cause severe disease, but little information exists on co-infections with other acute viruses. Seasonal influenza and dengue viruses (DENV) regularly co-circulate in tropical regions. The pandemic spread of influenza virus H1N1 (hereafter H1N1) in 2009 led to additional severe disease cases that were co-infected with DENV. Here, we investigated the impact of co-infection on immune responses and pathogenesis in a new mouse model. Co-infection of otherwise sublethal doses of a Nicaraguan clinical H1N1 isolate and two days later with a virulent DENV2 strain increased systemic DENV titers and caused 90% lethality. Lungs of co-infected mice carried both viruses, developed severe pneumonia, and expressed a unique pattern of host mRNAs, resembling only partial responses against infection with either virus alone. A large number of monocytes were recruited to DENV-infected but not to co-infected lungs, and depletion and adoptive transfer experiments revealed a beneficial role of monocytes. Our study shows that co-infection with influenza and DENV impairs host responses, which fail to control DENV titers and instead, induce severe lung damage. Further, our findings identify key inflammatory pathways and monocyte function as targets for future therapies that may limit immunopathology in co-infected patients.
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Affiliation(s)
- Michael A Schmid
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Karla N González
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA.,Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua
| | - Sanjana Shah
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - José Peña
- Lawrence Livermore National Laboratory, Livermore, CA, USA
| | - Matthias Mack
- Department of Internal Medicine, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
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5
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Fernández E, Smieja M, Walter SD, Loeb M. A predictive model to differentiate dengue from other febrile illness. BMC Infect Dis 2016; 16:694. [PMID: 27876005 PMCID: PMC5120437 DOI: 10.1186/s12879-016-2024-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/14/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Dengue is a major public health problem in tropical and subtropical countries and has a presentation similar to other febrile illnesses. Since laboratory confirmation is frequently delayed, the majority of dengue cases are diagnosed based on symptoms. The objective of this study was to identify clinical, hematological and demographical parameters that could be used as predictors of dengue fever among patients with febrile illness. METHODS We conducted a retrospective cohort study of 548 patients presenting with febrile syndrome to the largest public hospitals in Honduras. Patients' clinical, laboratory, and demographic data as well as dengue laboratory detection by either serology or viral isolation were used to build a predictive statistical model to identify dengue cases. RESULTS Of 548 patients, 390 were confirmed with dengue infection while 158 had negative results. Univariable analysis revealed seven variables associated with dengue: male sex, petechiae, skin rash, myalgia, retro-ocular pain, positive tourniquet test, and gingival bleeding. In multivariable logistic regression analysis, retro-ocular pain petechiae and gingival bleeding were associated with increased risk, while epistaxis and paleness of skin were associated with reduced risk of dengue. Using a value of 0.6 (i.e., 60% probability for a case to be positive based on the equation values), our model had a sensitivity of 86.2%, a specificity of 27.2%, and an overall accuracy of 69.2%; allowing for the diagnosis of dengue to be ruled out and for other febrile conditions to be investigated. CONCLUSIONS Among Honduran patients presenting with febrile illness, our analysis identified key symptoms associated with dengue fever, however the overall accuracy of our model was still low and specificity remains a concern. Our model requires validation in other populations with a similar pattern of dengue transmission.
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Affiliation(s)
- Eduardo Fernández
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada
| | - Stephen D Walter
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
- Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada.
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6
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Perdigão ACB, Ramalho ILC, Guedes MIF, Braga DNM, Cavalcanti LPG, Melo MELD, Araújo RMDC, Lima EG, Silva LABD, Araújo LDC, Araújo FMDC. Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases. Mem Inst Oswaldo Cruz 2016; 111:588-91. [PMID: 27598244 PMCID: PMC5027863 DOI: 10.1590/0074-02760160140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/29/2016] [Indexed: 11/21/2022] Open
Abstract
We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses' epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.
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Affiliation(s)
- Anne Carolinne Bezerra Perdigão
- Laboratório Central de Saúde Pública, Setor de Virologia, Fortaleza, CE, Brasil.,Universidade Estadual do Ceará, Rede Nordeste de Biotecnologia, Fortaleza, CE, Brasil.,Centro Universitário Christus, Fortaleza, CE, Brasil
| | - Izabel Letícia Cavalcante Ramalho
- Laboratório Central de Saúde Pública, Setor de Virologia, Fortaleza, CE, Brasil.,Universidade Estadual do Ceará, Rede Nordeste de Biotecnologia, Fortaleza, CE, Brasil
| | | | - Deborah Nunes Melo Braga
- Universidade Federal do Ceará, Fortaleza, CE, Brasil.,Instituto de Prevenção de Câncer, Fortaleza, CE, Brasil
| | | | | | | | - Elza Gadelha Lima
- Laboratório Central de Saúde Pública, Setor de Virologia, Fortaleza, CE, Brasil.,Universidade Estadual do Ceará, Rede Nordeste de Biotecnologia, Fortaleza, CE, Brasil
| | | | | | - Fernanda Montenegro de Carvalho Araújo
- Laboratório Central de Saúde Pública, Setor de Virologia, Fortaleza, CE, Brasil.,Universidade Estadual do Ceará, Rede Nordeste de Biotecnologia, Fortaleza, CE, Brasil
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7
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Chacon R, Clara AW, Jara J, Armero J, Lozano C, El Omeiri N, Widdowson MA, Azziz-Baumgartner E. Influenza Illness among Case-Patients Hospitalized for Suspected Dengue, El Salvador, 2012. PLoS One 2015; 10:e0140890. [PMID: 26485296 PMCID: PMC4618691 DOI: 10.1371/journal.pone.0140890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
We estimate the proportion of patients hospitalized for suspected dengue that tested positive for influenza virus in El Salvador during the 2012 influenza season. We tested specimens from 321 hospitalized patients: 198 patients with SARI and 123 patients with suspected dengue. Among 121 hospitalized suspected dengue (two co-infected excluded) patients, 28% tested positive for dengue and 19% positive for influenza; among 35 with suspected dengue and respiratory symptoms, 14% were positive for dengue and 39% positive for influenza. One percent presented co-infection between influenza and dengue. Clinicians should consider the diagnosis of influenza among patients with suspected dengue during the influenza season.
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Affiliation(s)
- Rafael Chacon
- Influenza Unit, University of the Valley of Guatemala, Guatemala City, Guatemala
- * E-mail:
| | - Alexey Wilfrido Clara
- Influenza Program, Centers for Disease Control and Prevention for Central American Region, Guatemala City, Guatemala
| | - Jorge Jara
- Influenza Unit, University of the Valley of Guatemala, Guatemala City, Guatemala
| | - Julio Armero
- Health Surveillance Directorate, Ministry of Health of El Salvador, San Salvador, El Salvador
| | - Celina Lozano
- National Influenza Center, Ministry of Health of El Salvador, San Salvador, El Salvador
| | - Nathalie El Omeiri
- Influenza Unit, Training Programs in Epidemiology and Public Health Interventions Network, Guatemala City, Guatemala
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Cohen AL, McMorrow M, Walaza S, Cohen C, Tempia S, Alexander-Scott M, Widdowson MA. Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review. PLoS One 2015; 10:e0128580. [PMID: 26068416 PMCID: PMC4466242 DOI: 10.1371/journal.pone.0128580] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/28/2015] [Indexed: 12/14/2022] Open
Abstract
Infectious diseases and underlying medical conditions common to Africa may affect influenza frequency and severity. We conducted a systematic review of published studies on influenza and the following co-infections or co-morbidities that are prevalent in Africa: dengue, malaria, measles, meningococcus, Pneumocystis jirovecii pneumonia (PCP), hemoglobinopathies, and malnutrition. Articles were identified except for influenza and PCP. Very few studies were from Africa. Sickle cell disease, dengue, and measles co-infection were found to increase the severity of influenza disease, though this is based on few studies of dengue and measles and the measles study was of low quality. The frequency of influenza was increased among patients with sickle cell disease. Influenza infection increased the frequency of meningococcal disease. Studies on malaria and malnutrition found mixed results. Age-adjusted morbidity and mortality from influenza may be more common in Africa because infections and diseases common in the region lead to more severe outcomes and increase the influenza burden. However, gaps exist in our knowledge about these interactions.
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Affiliation(s)
- Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
- United States Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa
- School of Public Health and Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa
- School of Public Health and Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa
| | - Marissa Alexander-Scott
- Division of Applied Research and Technology (DART), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Cincinnati, Ohio, United States of America
- University of Illinois, Springfield, Illinois, United States of America
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Use of simple clinical and laboratory predictors to differentiate influenza from dengue and other febrile illnesses in the emergency room. BMC Infect Dis 2014; 14:623. [PMID: 25421019 PMCID: PMC4245735 DOI: 10.1186/s12879-014-0623-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
Background Clinical differentiation of influenza from dengue and other febrile illnesses (OFI) is difficult, and available rapid diagnostic tests have limited sensitivity. Methods We conducted a retrospective study to compare clinical and laboratory findings between (i) influenza and dengue and (ii) influenza and OFI. Results Of 849 enrolled patients, the mean time between illness onset and hospital presentation was 1.7, 3.7, and 3 days for influenza, dengue, and OFI, respectively. Among pediatric patients (≤18 years) (445 influenza, 24 dengue, and 130 OFI), we identified absence of rashes, no leukopenia, and no marked thrombocytopenia (platelet counts <100 × 109 cells/L) as predictors to distinguish influenza from dengue, whereas rhinorrhea, malaise, sore throat, and mild thrombocytopenia (platelet counts 100-149 × 109/L) were predictors that differentiated influenza from OFI. Among adults (>18 years) (81 influenza, 124 dengue, and 45 OFI), no leukopenia and no marked thrombocytopenia distinguished influenza from dengue, while rhinorrhea and malaise differentiated influenza from OFI. A diagnostic algorithm developed to distinguish influenza from dengue using rash, leukopenia, and marked thrombocytopenia showed >90% sensitivity to identify influenza in pediatric patients. Conclusions This study identified simple clinical and laboratory parameters that can assist clinicians to distinguish influenza from dengue and OFI. These findings may help clinicians diagnose influenza and facilitate appropriate management of affected patients, particularly in resource-poor settings. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0623-z) contains supplementary material, which is available to authorized users.
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10
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Joseph C, Togawa Y, Shindo N. Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses 2014; 7 Suppl 2:105-113. [PMID: 24034494 PMCID: PMC5909385 DOI: 10.1111/irv.12089] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Influenza‐associated bacterial and viral infections are responsible for high levels of morbidity and death during pandemic and seasonal influenza episodes. A review was undertaken to assess and evaluate the incidence, epidemiology, aetiology, clinical importance and impact of bacterial and viral co‐infection and secondary infection associated with influenza. A review was carried out of published articles covering bacterial and viral infections associated with pandemic and seasonal influenza between 1918 and 2009 (and published through December 2011) to include both pulmonary and extra‐pulmonary infections. While pneumococcal infection remains the predominant cause of bacterial pneumonia, the review highlights the importance of other co‐ and secondary bacterial and viral infections associated with influenza, and the emergence of newly identified dual infections associated with the 2009 H1N1 pandemic strain. Severe influenza‐associated pneumonia is often bacterial and will necessitate antibiotic treatment. In addition to the well‐known bacterial causes, less common bacteria such as Legionella pneumophila may also be associated with influenza when new influenza strains emerge. This review should provide clinicians with an overview of the range of bacterial and viral co‐ or secondary infections that could present with influenza illness.
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Affiliation(s)
- Carol Joseph
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
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11
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Lorenzi OD, Gregory CJ, Santiago LM, Acosta H, Galarza IE, Hunsperger E, Muñoz J, Bui DM, Oberste MS, Peñaranda S, García-Gubern C, Tomashek KM. Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections. Am J Trop Med Hyg 2013; 88:472-80. [PMID: 23382160 DOI: 10.4269/ajtmh.12-0373] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2-7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs.
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Affiliation(s)
- Olga D Lorenzi
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
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12
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Predictors of mortality in hospitalized children with pandemic H1N1 influenza 2009 in Pune, India. Indian J Pediatr 2012; 79:459-66. [PMID: 22012138 PMCID: PMC7101687 DOI: 10.1007/s12098-011-0578-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 09/28/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To analyse the factors associated with increased mortality among Indian Children with H1N1. METHODS Data were abstracted from available hospital records of children less than 12 y of age, who were admitted to Sassoon General Hospital in Pune, India, with confirmed pandemic 2009 H1N1 influenza infection from August 2009 through January 2010. Logistic regression analysis was used to identify clinical characteristics associated with mortality. RESULTS Of 775 pediatric cases admitted with Influenza Like Illness (ILI), 92 (11.8%) had confirmed H1N1 influenza infection. The median age of HIN1 cases was 2.5 y; 13 (14%) had an associated co-morbid condition. Median duration of symptoms was 4 d (interquartile range (IQR), 3-7 d). All 92 H1N1 cases received oseltamivir and empiric antimicrobials on admission. Intensive care unit (ICU) admission was required for 88 (96%) children, and 20 (23%) required mechanical ventilation.Fifteen children (16%) died; mortality was associated with presence of diffuse alveolar infiltrate on admission chest radiography (odds ratio (OR) 45, 95%CI :5.4-370; p < 0.001), use of corticosteroids in ARDS in children who required mechanical ventilation (OR 8.12, 95%CI: 2.44-27.05; p = 0.001), SpO(2) <80% on admission (OR 32.8, 95% CI: 5.8-185.5; p < 0.001) and presence of ARDS (OR 345.3, 95% CI :33.5-3564.1; p < 0.001). Necropsy from all children who died showed 9 (60%) had ARDS pattern and necrotizing pneumonitis, diffuse hemorrhage and interstitial pneumonia (n = 4 each, 27%) with gram positive organisms consistent with severe viral and bacterial co-infection. CONCLUSIONS Hypoxia, ARDS and use of corticosteroids in children with ARDS who were mechanically ventilated were the factors associated with increased odds of mortality. Necropsy also suggested bacterial co-infection as a risk factor.
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Kasper MR, Blair PJ, Touch S, Sokhal B, Yasuda CY, Williams M, Richards AL, Burgess TH, Wierzba TF, Putnam SD. Infectious etiologies of acute febrile illness among patients seeking health care in south-central Cambodia. Am J Trop Med Hyg 2012; 86:246-253. [PMID: 22302857 PMCID: PMC3269275 DOI: 10.4269/ajtmh.2012.11-0409] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The agents of human febrile illness can vary by region and country suggesting that diagnosis, treatment, and control programs need to be based on a methodical evaluation of area-specific etiologies. From December 2006 to December 2009, 9,997 individuals presenting with acute febrile illness at nine health care clinics in south-central Cambodia were enrolled in a study to elucidate the etiologies. Upon enrollment, respiratory specimens, whole blood, and serum were collected. Testing was performed for viral, bacterial, and parasitic pathogens. Etiologies were identified in 38.0% of patients. Influenza was the most frequent pathogen, followed by dengue, malaria, and bacterial pathogens isolated from blood culture. In addition, 3.5% of enrolled patients were infected with more than one pathogen. Our data provide the first systematic assessment of the etiologies of acute febrile illness in south-central Cambodia. Data from syndromic-based surveillance studies can help guide public health responses in developing nations.
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Affiliation(s)
- Matthew R. Kasper
- *Address correspondence to Matthew R. Kasper, Department of Bacteriology, U.S. Naval Medical Research Unit 6, Lima, Peru, Unit 3230, DPO, AA 34031. E-mail:
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Hussain R, Al-Omar I, Memish ZA. The diagnostic challenge of pandemic H1N1 2009 virus in a dengue-endemic region: a case report of combined infection in Jeddah, Kingdom of Saudi Arabia. J Infect Public Health 2012; 5:199-202. [PMID: 22541269 DOI: 10.1016/j.jiph.2011.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 12/20/2011] [Accepted: 12/21/2011] [Indexed: 11/28/2022] Open
Abstract
It is difficult to distinguish dengue fever from other febrile illnesses in a dengue-endemic area. This issue was compounded during the H1N1 2009 pandemic of influenza, which also presents as a febrile illness. This first laboratory-confirmed case of co-infection with dengue and influenza A H1N1 2009 strain in Jeddah, Saudi Arabia, highlights the importance of considering co-infections because not only is influenza an ongoing concern in Jeddah, but several viral hemorrhagic fever viruses circulate in this region.
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Affiliation(s)
- Raheela Hussain
- Head of Virology Unit, Regional Laboratory, Ministry of Health, Jeddah, Saudi Arabia.
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Affiliation(s)
- J C Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, New Delhi, India. E-mail:
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