RESUMO
BACKGROUND: Seasonal influenza can cause severe illness leading to intensive care unit (ICU) admission and death. OBJECTIVE: To define the clinical and epidemiological features of severe seasonal influenza infection and factors associated with mortality. STUDY DESIGN: A retrospective review was conducted on all patients with laboratory-confirmed influenza infection who were either admitted into the ICU or died in the two largest tertiary hospitals in Singapore from 2011-2015. RESULTS: Of 520 patients included in our study, 423 (81.3%) had influenza A infection and the rest with influenza B. Of patients with influenza A infection, 70.0% (296/423) were subtyped, of whom 24.0% (71/296) had A/H1N1pdm2009 and 76.0% (225/296) had A/H3N2. The median age of patients was 72 years (IQR 61-82). Males constituted 53.1% (276/520). Median Charlson comorbidity index score was 1 (IQR 0-3). About 70% had physical or radiological evidence of pneumonia upon admission. In-hospital mortality was 58.1% (302/520). On multiple logistic regression analysis, factors positively associated with mortality were age ≥65 years (adjusted odds ratio, aORâ¯=â¯3.64, 95%CI 2.21-5.99, pâ¯<â¯0.001), malignancy (aORâ¯=â¯2.53, 95%CI 1.12-5.73; pâ¯=â¯0.026), and hypoalbuminemia (aORâ¯=â¯2.16, 95%CI 1.26-3.73; pâ¯=â¯0.005), while antiviral therapy (aORâ¯=â¯0.33, 95%CI 0.17-0.63; pâ¯<â¯0.001) and ventilation (aORâ¯=â¯0.23, 95% CI 0.13-0.39; pâ¯<â¯0.001) were negatively associated. CONCLUSIONS: Patients with severe seasonal influenza infection were characterized by advanced age, hypoalbuminemia and presence of pneumonia on admission. Age ≥65 years, malignancy, and hypoalbuminemia were associated with increased mortality, and antiviral therapy and ventilation with decreased mortality.
Assuntos
Hospitalização/estatística & dados numéricos , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vírus da Influenza A/classificação , Influenza Humana/mortalidade , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Retrospectivos , Estações do Ano , Singapura , Centros de Atenção TerciáriaRESUMO
Singapore experienced its first documented Zika virus outbreak in 2016. We identified clinical and laboratory parameters that increase the probability for Zika or dengue virus infection. Early during the illness, combinations of key parameters obtained through clinical assessment and hematologic tests can help distinguish between these infections.
Assuntos
Vírus da Dengue/genética , Dengue/epidemiologia , Surtos de Doenças , Infecção por Zika virus/epidemiologia , Zika virus/genética , Adulto , Animais , Antígenos Virais/sangue , Dengue/diagnóstico , Dengue/imunologia , Dengue/fisiopatologia , Vírus da Dengue/imunologia , Vírus da Dengue/isolamento & purificação , Diagnóstico Diferencial , Exantema/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Viral/sangue , Singapura/epidemiologia , Zika virus/imunologia , Zika virus/isolamento & purificação , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/imunologia , Infecção por Zika virus/fisiopatologiaRESUMO
An outbreak of invasive group B Streptococcus (GBS) disease occurred in Singapore in mid-2015. We conducted a case-control study of 22 adults with invasive GBS infections during June 21-November 21, 2015. Consumption of raw fish was strongly associated with invasive sequence type 283 infections, but not with non-sequence type 283 infections.