Outbreak of severe acute respiratory infection in Southern Province, Sri Lanka in 2018: a cross-sectional study.

OBJECTIVES: To determine aetiology of illness among children and adults presenting during outbreak of severe respiratory illness in Southern Province, Sri Lanka, in 2018. DESIGN: Prospective, cross-sectional study. SETTING: 1600-bed, public, tertiary care hospital in Southern Province, Sri Lanka. PARTICIPANTS: 410 consecutive patients, including 371 children and 39 adults, who were admitted with suspected viral pneumonia (passive surveillance) or who met case definition for acute respiratory illness (active surveillance) in May to June 2018. RESULTS: We found that cocirculation of influenza A (22.6% of cases), respiratory syncytial virus (27.8%) and adenovirus (AdV) (30.7%; type B3) was responsible for the outbreak. Mortality was noted in 4.5% of paediatric cases identified during active surveillance. Virus type and viral coinfection were not significantly associated with mortality. CONCLUSIONS: This is the first report of intense cocirculation of multiple respiratory viruses as a cause of an outbreak of severe acute respiratory illness in Sri Lanka, and the first time that AdV has been documented as a cause of a respiratory outbreak in the country. Our results emphasise the need for continued vigilance in surveying for known and emerging respiratory viruses in the tropics.

Successful use of extracorporeal membrane oxygenation in acute respiratory distress syndrome following accidental chlorine gas inhalation at a swimming pool.

While there is evidence to support the use of extracorporeal membrane oxygenation in acute respiratory distress syndrome due to a variety of causes, its use in chlorine gas-induced acute respiratory distress syndrome has not been described in the English medical literature. We present a young girl who had severe acute respiratory distress syndrome following exposure to chlorine gas during the disinfection process at a swimming pool. She failed conventional management and underwent venovenous extracorporeal membrane oxygenation. Despite multiple infections and a pneumothorax, she eventually recovered. Chlorine gas was the first agent of chemical warfare which caused a massive death toll during the First World War. Even today, the chemical is produced in large quantities and the threat of a large-scale leak is ever-present from industrial accidents or terrorist attacks. The criteria to assess and manage chlorine gas-induced acute respiratory distress syndrome are likely to be the same as for other causes of acute respiratory distress syndrome and extracorporeal membrane oxygenation can be used successfully.